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Running head: THEORY DEVELOPMENT

Theory Development for the study: Infection control practices and Quality Healthcare Delivery

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THEORY DEVELOPMENT 2

Theory Development for the study: Infection control practices and Quality Healthcare Delivery

Introduction

The professionalization of nursing has been facilitated through the establishment and the

application of a diversity of nursing theories. These theories have provided the conceptual

framework for examining different contexts in a clinical setting. Furthermore, these frameworks

provide the approach for analysis, organization as well as decision making in core nursing

practices. Consequently, the theories offer the structure for co-operating with other health care

workers in the delivery of health services. Nursing theories provide fundamental approaches to

infection control practices and healthcare delivery. This essay discusses the application of theory

in infection control practices and quality healthcare delivery. Mainly, the paper analyzes on how

the diffusion of innovation theory can be applied to enhance infection control practices in

healthcare. The fundamentals of this theory will then be used in developing a novel theory that

would better meet the needs of this research.

A Discussion of the “Diffusion of Innovation Theory”

The theory of diffusion of innovation considers diffusion as the process as to which an

innovation is conveyed through particular channels over a given period among the members of a

social system. The framework for this diffusion of innovation has been adapted for utilization in

the infection control and prevention (Radford, 2011). This framework can be applied just like the

other models from implementation science in the infection control and prevention research.

Krein, Saint & Damschroder (2015) observe that diffusion of innovation theory is

significant for infection control in health care. This theory has been based on an extensive tradition

of research in various disciplines which in turn offers a considerable framework for understanding

and solving the discrepancy between the ideal and practical use of evidence-based practices in the

clinical settings Increased concerns about having efficient and safer health care imply that more

emphasis has been made on ensuring the infection prevention and control innovations are

appropriate for clinical use. Apparently, clinical epidemiologists play a vital role in the

implementation process. McCullen (2013) further observes that the concepts of diffusion of

innovation theory as well as the new field of implementation science would be effective in

continuing to ensure that there is the future success in the effort to minimize health-care related

infection.

According to Rodgers (1962), diffusion is simply a decision-making process that takes

place in five stages. These processes consist of a series of communication channels over a specific

period for members of a similar social system. The processes include interest, awareness,

assessment, test, and implementation. It is possible for any person to reject a given innovation at

any time in the course of the adoption process. Figure 1.1 below presents Rodgers five stages of

the decision innovation process.

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Figure 1: 1 Five stages of the adoption process

Source: Rodgers, (1962)

Rodger’s Diffusion of Innovation Theory is based on the idea that over time, a given

concept or idea acquires momentum and spreads (diffuses) through a specific social system or

population. Consequently, people end up embracing a novel idea, product or behavior. Adoption

implies that an individual can do something differently than he or she used to do previously. This

includes changing behavior, purchasing a product/service or acquiring new behavior. Before

adoption, an individual must, first of all, perceive the knowledge, idea, behavior or product as a

new innovative. Through this, diffusion is them made possible. After knowledge, then people

must be persuaded to see the need of embracing the innovation. The individual then decides on

whether and how to make use of the idea. The next stage is the implementation phase where

individuals are now expected to apply the idea to the actual work contexts (Peres, 2010). The

applicability of this idea and its effectiveness is then confirmed by the management.

In this perspective, nurses must, therefore, understand novel infection control practices

and know how they can be applied for an effective health outcome. After this knowledge is

imparted to them, they are then persuaded on the need to use the new practice or idea in the

implementing the stipulated infection control practices other than the existing ones. They will

then be required to decide on the implementation of this practice/idea. After making a decision,

they will then apply the idea in their work setting. An evaluation should then be done on whether

or not the idea is effective. From this assessment, modifications can then be done accordingly.

The Behavioral Theory and Its Mechanism

The Behavioral Theory is about behavioral control mechanisms that can be used to

change the attitudes and behavior of health care practitioners into embracing change and new

practices to enhance healthcare delivery. This theory intends to explain the people’s ability in

exerting self-control when working under specific principles. Similar to the goals of Rodger's

Diffusion of Innovation Theory, the goal of the theory of behavioral control is to make change

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their attitude and behavior towards new practices/idea. In normal occasions, behavioral

intentions of individuals are largely influenced by attitudes concerning the probability that the

behavior will exert towards the anticipated outcome alongside the subjective assessment of the

benefits and risks associated with the expected outcome.

This theory, therefore, rests on the assumption that ineffectively embracing a new idea,

practice or concept in infection control endeavors, then those mandated with the responsibility of

implementing them must be made to belief that the idea/practice is better than what is currently

available. This conception is borrowed from the first and second stages in Rodger’s decision

innovation process. It is also related to the third stage of Rodger's model of decision making

since the theory also requires individuals to assess the benefits or drawbacks of embracing the

new concept before accepting/adopting them. Figure 1.2 below presents the key tenets of the

proposed model

The main components of the Behavioral Theory: Source:

The behavioral theory articulates that behavioral achievement is largely depended on

ability (which is behavioral control and motivation (intention). As depicted in the figure above,

the theory consists of six major constructs which represent an individual's control over a given

behavior.

Behavioral beliefs: This is the level at which a person harbors either unfavorable or

favorable assessment of a particular behavior in question. It involves taking into concern the

general outcome in performing the given behavior. For example, in the context of embracing

new infection control practices, the healthcare practitioners are naturally used to conventional

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practices and methodologies in infection medicine. Therefore, for them to accept the new

concepts/approaches in the same, they would require a change of their attitudes towards a

positive trajectory so that they can see the benefit of the new concept and the expected outcome

it is supposed to generate.

Behavioral intention/Attitude towards the behavior: These largely consist of the

motivational factors that influence a certain behavior. When the motivation factors are stronger,

then there is more likely to cause the intention of performing the behavior. In other words, there

is more likelihood that the behavior will be undertaken. In the nursing context, the motivational

factors may include such issues as easiness of the practice, a more effective outcome, lesser

workload, and lesser resources used among others. On the other hand, patients will see the need

of embracing the new practice because it is more effective, has a better outcome, it is easy to use,

it is less costly, or it is friendlier than others.

Supposed Behavioral Control:

This is a perception of an individual regarding the difficulty or easiness of undertaking a

given behavior; in this case, a new practice of infection control. Supposed behavioral control

differs across actions and contexts, leading to people having different attitudes of behavior

control as per the situation demands. Therefore, the proposed theory will be able to harmonize

the diverse perceptions held by different people to achieve a common goal.

Research Questions and Hypothesis

1. What is the attitude of nurses towards implementation of a new practice in infection

control and healthcare delivery?

2. How will the nurse’s perception be changed to accommodate the new ideas and

practices for effective infection control?

3. How viable are the new practices/ideas compared to the existing ones in infection

control?

Hypothesis:

#1: Nurses have a negative attitude in embracing new practices for healthcare delivery

#2: It is possible to change the nurse’s perception positively to make them accept the new

practices

#3: The new practices have a high probability of enhancing the effectiveness of infection control

practices as well as improving the quality of healthcare delivery

Conclusion

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It is hoped that the “behavioral control” theory can be effectively used in changing the

attitude of healthcare practitioners towards embracing change and innovation. In addition, it can

also be used by nurses in predicting and explaining a broad range of health intentions and

behaviors including utilization of health services, embracing the use of vaccines and preventive

medicines, application of new health practices by the nurses and above all help in normative and

behavioral control for both healthcare workers and patients.

References

Peres, R. (2010). Innovation diffusion and new product growth models: A critical review and

research directions. International Journal of Research in Marketing. 27(2): 91–106

Krein, S., Saint, S., & Damschroder, L. (2015). Diffusion of innovation theory in hospital

Epidemiology and infection control. Infectious Disease Advisor. Retrieved from

https://www.infectiousdiseaseadvisor.com/hospital-infection-control/diffusion-of-

innovation-theory-in-hospital-epidemiology-and-infection-control/article/598549/

McCullen, N. J. (2013). Multiparameter Models of Innovation Diffusion on Complex

Networks. SIAM Journal on Applied Dynamical Systems. 12 (1): 515–532.

Rogers, E. (1962). Diffusion of innovations (1st ed.). New York: Free Press of Glencoe

Radford, S. (2011). Linking Innovation to Design: Consumer Responses to Visual Product

Newness. Journal of Product Innovation Management. 28 (1): 208–220.

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