Use of the Theory of Diffusion of Innovations to Explore Decision-Making Units for Adoption of HIV Prevention Programs in Atlanta Public Schools Open Access

Abstract

Due to the disproportionate burden of HIV among youth ages 13-24, there is a need for age-specific interventions that consistently reach large portions of the youth population. Schools have provided suitable platforms for delivery of health-related interventions in the past, and may also serve to promote HIV prevention programs. The purpose of this qualitative case study was to provide insight into the processes through which schools in the Atlanta Public School (APS) system adopt new HIV prevention programming. Interviews were conducted in person or over the phone with APS administrators, teachers and administrators from an APS charter school, and employees from three organizations that work with APS schools to provide sexual health initiatives. Participants were asked about the decision-making process that precedes adoption of new HIV-related programming at the district and individual school levels, as well as other factors that impact the adoption of new programming. Participants were recruited through referrals and snowball sampling methods. Interviews were transcribed and thematic coding was used to identify emergent themes related to the research questions. Qualitative analysis of the data revealed that though power to approve or reject new programs ultimately lay within school and district leadership structures, successful adoption is reliant on a spectrum of individuals that each play key roles at different points in the adoption process. Additionally, successful adoption of programming is impacted by factors such as the felt need, leadership readiness, availability of resources, ease of program implementation, provision of training, current staff workload, buy-in, and logistics. The Theory of Diffusion of Innovations (DOI) was found to be an appropriate model for the study of HIV program adoption in schools, and should be expanded in the future to include constructs pertaining to external collaborations and circumstance external to the unit of adoption. Based on the findings, this study recommends that teams looking to work with schools to provide HIV prevention initiatives do the following: 1) work to raise community awareness about the benefits of programming, and 2) engage and open communication channels between all program stakeholders throughout the entire adoption process for early identification and resolution of potential obstacles.

Table of Contents

CHAPTER 1: INTRODUCTION................1

Statement of the Problem......................1

Purpose and Research Questions............2

Theoretical Framework..........................3

CHAPTER 2: LITERATURE REVIEW........5

HIV Transmission and Prevention..........5

Behavioral Risk Factors for Adolescents and Young Adults (AYA)...5

Sex and HIV Education in Schools...........6

School-Based HIV Education in Georgia..7

Atlanta Public Schools as Delivery Platforms for HIV Prevention...9

Evolution of Diffusion of Innovations Research...9

CHAPTER 3: METHODS........................12

Research Design...................................12

Site Selection.......................................12

Participants.........................................13

Data Collection....................................14

Data Analysis.......................................14

CHAPTER 4: RESULTS..........................16

Participation.......................................16

Study Findings....................................16

Research Question 1............................16

Research Question 2............................33

CHAPTER 5:DISCUSSION....................42

Research Question 1 and the Theory of Diffusion of Innovations...42

Example 1: District-Level Adoption......43

Example 2: Externally-Developed School-Level Adoption...43

Example 3: Internally-Developed School-Level Adoption....44

Research Question 2 and the Theory of Diffusion of Innovations.....45

Findings Beyond the Theory of Diffusion of Innovations...49

Strengths and Limitations...................49

Recommendations..............................51

Conclusion.........................................54

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral
Keyword	Public Schools Atlanta, Georgia School Leadership Diffusion of Innovations HIV/AIDS Prevention
Committee Chair / Thesis Advisor	Thompson, Nancy J, Emory University
Committee Members	Camacho-Gonzalez, Andres, Emory University Miner, Kathleen R, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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