Health Related Behavior &

Theories & Model in HEP

By: Methy (Mph)

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 Health Related Behavior
In this chapter we will see:
Definition of behavior and related terms
Factors affecting behavior
Role of human behavior in disease
prevention & health promotion.
Application of health education theories
& models in behavior change

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 Introduction
Much behaviour is related to health
either directly or indirectly.

Health behavior: contribute to the overall

health of individual & community

Unhealthy behaviors affect health of

individuals, communities & quality of life
at different levels.
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Cont’d…

The health promotion & diseases

prevention usually involves some
changes in life styles or human
behaviour.

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 Definition of terms
Behaviour is an action that has
a specific frequency,
duration and
purpose whether conscious or unconscious. Or
It is what we “do” and how we “act”.
E.g., of how people’s actions can affect their health:
Using mosquito nets and insect sprays helps to

keep mosquito away.

Bottle Feeding put children at risk of diarrhoea.

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Def…
Life style: collection of behaviours that makes
up a person’s way of life - including diet,
clothing, family life, housing and work.

Customs: are behaviors that many people

share.
It is the pattern of action shared by some or
all members of the society.

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Def…
Traditions: are behaviours that have been
carried out for a long time & handed down
from parents to children.

Customs & traditions are behaviors that have

been carried out for a long time and have been
handed down from parents to children.

They will be more difficult to change than

behavior s that have been recently acquired
and held only by individuals
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Cont’d…
Culture: is whole complex of knowledge,
attitude, norms, beliefs, values, habits,
customs, traditions & any other capabilities &
skills acquired by man as a member of
society.
Examples of cultural practices:
 Eatingwith fingers is normal for Ethiopian
community.
 FGM is practiced in many parts of Ethiopia.

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Factors Affecting Human Behaviour

1. Predisposing,
2. Enabling and
3. Reinforcing factors.

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1. PREDISPOSING FACTORS
 Provide rationale or motivation for behavior to occur.
Some of these are:
Knowledge
Belief
Education
Attitudes
Values
 E.g. For an individual to use condom, he has to have
knowledge about condom and develop positive attitude
towards utilization of condom.

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Predisposing...
Knowledge is knowing things, objects, events,
persons, situations and everything in the universe.
e.g., knowledge about methods of prevention of
HIV

Belief is a conviction/ confidence that a phenomenon

or object is true or real.
beliefs deals with a people’s understanding of
themselves and their environment
derived from our parents, grandparents, …
 E.g., Cold Temp. causes respiratory problems.
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Cont’d..’
How beliefs are formed
A belief might have been formed an individual
or community personal experiences

e.g. seen a child receive immunization and then get

measles (e.g. through poorly-kept vaccines),

in such way it is difficult to change those belief

that have arisen through a person’s direct
experience unless you can provide a practical
demonstration
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Cont’d…
A person also develops beliefs from what
he/she reads or hears from other persons.

E.g. many beliefs acquired during

childhood from our parents and others in our
family or community through primary
socialization.
At each stage of human life cycle from pre-
school, school, to young adult upwards
beliefs can be formed.
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Cont’d…

It can be difficult to change those

beliefs that have been held for a long
time since childhood or have been
acquired from trusted persons in the
community.

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Predisposing... Attitudes

Attitudes and beliefs are frequently confused

The term attitude should be used for a person

judgment of a behavior as good or bad and
worth carrying out.

Thus judgment will depend on the beliefs

held about the consequences of performing
the behavior.

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Cont’d …
Attitudes are relatively constant feelings,
predispositions or set of beliefs directed towards
an object, person or situation.

They are evaluative feelings and reflect our

likes and dislikes

Come from our experiences or from those of

people close to us
E.g., attitudes of patients toward physician
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Predisposing...
Values - are general, abstract guidelines for
our lives, decisions, goals, choices, & actions.
They are shared ideas of a groups or a
society as to what is right or wrong, correct or
incorrect, desirable or undesirable, acceptable
or unacceptable, ethical or unethical, etc.,
They can be positive or negative.
E.g. honesty, theft,
being married and having many children

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Predisposing...
Norms are social rules that specify
appropriate & inappropriate behavior in a
given situations.

E.g., greeting as a social norm to be

conformed among members who know each
other.

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Cont’d…

Action needed for predisposing

factors:
Health education to modify beliefs and
values of individuals or whole community

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2. ENABLING FACTORS
Chxcs of Environment that facilitates healthy
behavior & any skill or resource required to attain the
behavior.

Required for a motivation to be realized.

E.g.,
 Availabilityand/or accessibility, affordability of health
resources -Time, money and materials,
 Government laws, priority and commitment to health
 Presence of health related skills

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ENABLING...

E.g.,
For a mother to give ORS to her child with
diarrhea Enabling factors would be:
Time, container, salt, sugar
Knowledge of how to prepare & administer
it.

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Action to be done for enabling factors

Service improvement to promote accessibility,

effectiveness and quality

Advocacy to
raise profile of issues,
influence policy and
promote Intersectoral collaboration ;
 Skills training

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3. REINFORCING FACTORS:
come subsequent to the behavior.
important for persistence or repetition of the
behavior.
The most important reinforcing factors for a
behaviour to occur or avoid include:
Family
Peers, teachers
Employers, health providers
Community leaders
Decision makers
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Action to be done for reinforcing factors:

Health education targeted at influential persons in

family and community

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 ROLE OF HUMAN BEHAVIOR
IN PREVENTION OF DISEASE

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What is prevention?
Prevention is planning for & measures taken to
forestall the onset of a disease or other health problem
before the occurrence of undesirable health events.

Levels of prevention of disease

1. Primary prevention
2. Secondary prevention
3. Tertiary prevention

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Primary prevention
The purpose of primary prevention is to keep healthy
people healthy and prevent them getting disease
E.g.
Immunization
Improved water supply
Family planning
Promotion of health behaviors and the
discouraging of health damaging behaviors

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Secondary prevention
Is the name given to interventions at early stage of a
problem before it becomes serious.
E.g.
Illness behavior
Screening

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Tertiary prevention
An important part of tertiary prevention is to
ensure patients follow treatment procedure

Tertiary prevention overlaps with secondary

prevention and includes behaviors that
involved in treatment and rehabilitation.

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ROLE OF HUMAN BEHAVIOR IN PREVENTION OF DISEASE

Health behaviours: - actions that healthy people

undertake to keep themselves or others & prevent disease.
Exercise, Good nutrition, breast feeding,
reduction of health damaging behaviours like smoking are
examples of healthy behaviours

Utilization behaviour: - utilization of health services

such as ANC, child health, immunization, family
planning…etc

Illness behaviour: - recognition of early symptoms and

prompt self-referral for treatment.
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ROLE…
Compliance behaviours: - following a course of
prescribed drugs such as for tuberculosis.

Rehabilitation behaviours: - what people need to do

after a serious illness to prevent further disability.
Community action: - actions by individuals and
groups to change & improve their surroundings to
meet special needs.

Early treatment seeking behaviour: searching

solution or treatment for her/his problem(s) /disease(s)
as early as possible.
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Cont’d…
Hygiene behavior:
Cleaning children
Washing hands have to be done everyday
Behaviors that involve
Spending time or money,
require learning new skills or
conflict with existing practices
will be more difficult to promote than ones
that are simple to carry out and fit in with
existing.
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 Application of health education
theories & models in behavior
change

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 Introduction
In most health interventions, changing behavior is the goal;
however, altering human behavior is extremely difficult
So, how does one go about fostering behavior change?

First, one must understand:

What types of things help to start the behavior;
Why people continue with a behavior, even if they know it is
bad for them; and
How unhealthy behaviors can be stopped or replaced with
healthy ones.
Theories have been developed to answer just such
questions.
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Theory
A theory is a set of interrelated concepts,
definitions, and propositions that present a
systematic view of events or situations by specifying
relations among variables, in order to explain and
predict the events or situations (Kerlinger, 1986, p.
9).

A theory is systematic explanation for the observed

facts and laws that relate to a particular aspect of life
(Babbie, 1989, p. 46).

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 Concepts, Constructs, & Variables
Concepts are the major components of a theory; they are its
building blocks or primary elements.
Concepts can vary in the extent to which they have meaning
or can be understood outside the context of a specific theory.

When concepts are developed or adopted for use in a particular

theory, they are called constructs.
Example: Perceived susceptibility in (HBM).

Constructs and concepts are the same except concepts are

called constructs when used within a theoretical model.

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 Cont’d …
The specific construct has a precise definition in the
context of that theory.

Variables are the empirical counterparts or operational

forms of constructs.

They specify how a construct is to be measured in a

specific situation.

Variables should be matched to constructs when

identifying what should be assessed in the evaluation of a
theory-driven program.
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Cont’d …
Theories are by their nature abstract; that is, they do not
have a specified content or topic area.

It is like an empty coffee cup, they have a shape and

boundaries but nothing concrete inside.

They only come alive in public health and health

behavior when they are filled with practical topics,
goals, and problems.

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 Models
Just as constructs form the foundation for the
development of a theory, theories are used in
the same manner as building blocks of a
model.

Health behavior and the guiding concepts for

influencing it are far too complex to be
explained by a single, unified theory.

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Cont’d…
Models combine theories (often in a
sophisticated manner):
to help understand a specific problem in a
particular setting
to produce an educational framework for the
development of appropriate health education
interventions.

Model - systematic representation of an object or

event in idealized and abstract form.
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 Model

theo ry theory

construct construct constru ct

Figure 1: constructs, theories and model

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The Health Belief Model (HBM)
is a psychological model that attempts to explain
& predict health behaviors by focusing on the
attitudes & beliefs of individuals.

Developed in the 1950s as part of an effort by social

psychologists in the United States Public Health
Service to explain
The lack of public participation in health
screening and prevention programs

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HBM…
Since then it has been used to explore a
variety of long- & short-term health behaviors
key constructs
Perceived Threat:
perceived
susceptibility and
perceived severity of a health condition.

Perceived Benefits
Perceived Barriers
Cues to Action
Self-efficacy
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Implications of HBM for Health Behaviors

Since health motivation is its central focus,

the HBM is a good fit for addressing problem
behaviors that evoke health concerns

Six constructs of the HBM provide a useful

framework for designing both short-term and
long-term behavior change strategies.

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Potential Change Strategies
1. Perceived susceptibility
Define what populations(s) are at risk and
their levels of risk

Tailor/modify risk information based on an

individual’s characteristics or behaviors

Help the individual to develop an accurate

perception of his or her own risk
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HBM…
2. Perceived severity
Specify the consequences of a condition and
recommended action
3. Perceived benefits
what the potential positive results will be
person’s beliefs regarding perceived benefits of the various
available actions for reducing the disease threat
4. Perceived barriers
The potential negative aspects of a particular health
action - perceived barriers - may act as impediments to
undertaking recommended behaviors.
A kind of non-conscious, cost-benefit analysis occurs
wherein individuals weigh the action’s expected benefits
with perceived barriers
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HBM…
5. Cues to action
Provide ”how to” information, promote
awareness, and employ reminder systems
Events (internal or external) which can activate a
person's "readiness to act" and stimulate an
observable behavior. 
6. Self-efficacy
Is the confidence that one can successfully
execute the behavior required to produce the
outcomes
Give verbal reinforcement to demonstrate
desired behaviors
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 Constructs of HBM (Health Belief Model)
Individual Perception Modifying Factors Likelihood of Action

Demographic variables, (Age, sex, ethnicity, etc.)

Socio psychological variables, (Personality, social
class, peer and reference group pressure, etc.)
Structural variables (i.e., knowledge about the Perceived
Perceived Benefits
Benefits
(Minus)
(Minus)
disease, prior contact with the disease, etc).
Perceived
Perceived barriers
barriers
towards
towards the desired
the desired
action/behavior
action/behavior
Perceived
susceptibility to
Likelihood of Taking
disease “X”, Perceived threat of
Perceived severity
of disease “X” disease “X” Recommended
Preventive Health
Action/Behavior
Cues to action
- Mass media campaigns
– Advice from others
– Reminder postcard
– Illness of family member or friend
– News paper or magazine, article, etc.

FIG
05/10/2021 1: Becker’s Health Belief Model (1974), where Cues to Action is recently added
49
 Application of HBM
Concept Definition Application
Perceived Belief about the  Define population(s) at risk, risk levels
susceptibility chances of experiencing  Personalize risk based on a person’s
a risk or getting a characteristics or behavior
condition or disease  Make perceived susceptibility more
consistent with individual’s actual risk

Perceived Belief about how  Specify consequences of risks and

severity serious a condition and conditions
its sequelae are
Perceived Belief in efficacy of the  Define action to take: how, where, when;
benefits advised action to  clarify the positive effects to be expected
reduce risk or
seriousness of impact
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 cont’d…
Perceive Belief about the tangible  Identify & reduce perceived barriers
d barriers and psychological costs through reassurance, correction of
of the advised action misinformation, incentives, assistance

Cues to Strategies to activate  Provide how-to information, promote

action “readiness” awareness, use appropriate reminder
systems
Self- Confidence in one’s  Provide training and guidance in
efficacy ability to take action performing recommended action Use
progressive goal setting
 Give verbal reinforcement
Demonstrate desired
 Behaviors Reduce anxiety
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 Limitations
General limitations of the HBM include:
As a psychological model it does not take into
consideration other factors, such as environmental
or economic factors, that may influence health
behaviors; and

The model does not incorporate the influence of

social norms and peer influences on people's
decisions regarding their health behaviors

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THEORY OF REASONED ACTION (BEHAVIOR INTENTION)

Explain & predict a variety of human behaviors under

voluntary control since 1967.
Assumption:
Humans are rational and that the intention to act
is the most immediate determinant of behaviour.

Has four main constructs:

A. Norms
B. Attitudes,
C. Intentions, and
D. Behavior
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TRA…
A. Behavior: A specific behavior defined by a
combination of four components:
Action, Target, Context, and Time
e.g., implementing a sexual HIV risk

reduction strategy by using condoms

(action)
with commercial sex workers (target)

in brothels (context)

every time (time).

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TRA…

B. Intention: The intent to perform a behavior

 is the best predictor that a desired behavior will
actually occur.

Same components used to define behavior is

used
Both attitude and norms, influence one's
intention to perform a behavior.

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TRA…

C. Attitude: A person's positive or negative

feelings toward performing the defined
behavior.
Behavioral Beliefs: are a combination of a
person's beliefs regarding the outcomes of a
defined behavior and the person's evaluation
of potential outcomes.
These beliefs will differ from population to
population.

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TRA…
D. Norms: A person's perception of other
people's opinions regarding the defined
behavior
Normative Beliefs: a combination of a person's
beliefs regarding other people's views of a behavior
and person's willingness to conform to those views.

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TRA…
The behavioral and normative beliefs -
influence individual attitudes and subjective
norms, respectively.

Attitudes & norms shape a person's

intention to perform a behavior.

Person's intention remains the best indicator

that the desired behavior will occur.
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 Behavioral
Behavioral
Beliefs Attitude
Attitude
Beliefs
towards
towardsthe
the
behavior
behavior
Evaluation
Evaluationofof
Behavioral
Behavioral
Outcomes
Outcomes Behavioral Behavior
Behavioral Behavior
Intention
Intention
Normative
Normative
beliefs
beliefs
Subjective
Subjective
Motivation Norms
Motivationtoto Norms
Comply
Comply

Fig: Theory of Reasoned Action

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 Limitations
Some limitations of the TRA include the inability of the
theory, due to its individualistic approach, to consider the
role of environmental and structural issues and the
linearity of the theory components

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SOCIAL LEARNING THEORY
Also called Social Cognitive Theory
Proposes that behavior change is
influenced by
a) The environment,
b) Personal factors, and
c) Aspects of the behavior itself.
SLT believes that behavior is dynamic.
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 For example,
In the absence of legislation about
smoking, if non-smokers are sufficiently
assertive about not smoking it becomes
more likely that a smoker will modify their
behaviour.

Thus the social influence has impacted on

the individual's choice.
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SLT…
Constructs
1. Reinforcement - Reinforcements are either
positive or negative consequences of a behavior.
2. Behavior capability - In order for a change to
take place, one must learn;
 what to do to change and
 how to do it
3. Expectancies - the value one places on the
expected result.
 If the result is important to the person, the behavior
change that will yield the result is more likely to
happen.
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SLT…
4. Self efficacy - Belief in one’s ability to successfully
change one’s behavior.
 Self efficacy is connected with another construct
called “outcome expectations.”
 These are the benefits one expects to receive by
changing one’s behavior.

5. Reciprocal determinism – describes interactions

between behavior, personal factors, and
environment, where each influences the others.

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SLT…
It helps a health educator to understand the
complex relationships between:

The individual and his/her environment,

How actions and conditions reinforce or
discourage change, &
The importance of believing in and
knowing how to change.

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 SOCIAL LEARING THEORY APPLICATION
Concept Definition Application
Reciprocal Behaviour changes result from Involve the individual and
Determinism interaction between person and relevant others; work to change
environment; change is bi- the environment, if warranted.
directional.
Behavioural Capability Knowledge and skills to influence Provide information and
behaviour. training about action.

Expectations Beliefs about likely results of action. Incorporate information about

likely results of action in advice.

Self-Efficacy Confidence in ability to take action Point out strengths; use

and persist in action. persuasion and encouragement;
approach behaviour change in
small steps.

Reinforcement Responses to a person’s behaviour Provide incentives, rewards,

that increase or decrease the chances praise; encourage self-reward;
of recurrence. decrease possibility of negative
responses that deter positive
changes.
STAGES OF CHANGE MODEL
Also called transtheoretical model (TTM)
Initially published in 1979 by Prochaska.  

Is an integrative, bio-psycho-social model to

conceptualize the process of intentional behavior change. 

Behavior change is viewed as a process, not an event,

with individuals at various levels of motivation or
"readiness" to change.

Since people are at different points in this process,

planned interventions should match their stage.
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TTM…cont’d
There are six stages that have been identified in the
model and presented as a linear process of change.:
A. Pre-contemplation - the person is unaware of the
problem or has not thought seriously about
change;
B. Contemplation - the person is seriously thinking
about a change (in the near future);
C. Preparation - the person is planning to take
action and is making final adjustments before
changing behavior;

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TTM…cont’d
d. Action - the person implements some specific action plan
to overtly modify behavior and surroundings;

e. Maintenance - the person continues with desirable actions

(repeating the periodic recommended steps while struggling
to prevent lapses and relapse; and

f. Termination - the person has zero temptation and the

ability to resist relapse.

In relapse, the person reverts back to old behavior which

can occur during either action or maintenance.

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 STAGES OF CHANGE MODEL
Concept Definition Application

Pre-contemplation Unaware of the problem hasn’t Increase awareness of need

though about change. for change, personalize
information on risks and
benefits.

Contemplation Thinking about change, in the Motivate, encourage to make

near future. specific plans.

Commitment Making a plan to change. Assist in developing concrete

action plans, setting gradual
goals.

Action Implementation of specific Assist with feedback,

action plans. problem solving, social
support, reinforcement.

Maintenance Continuation of desirable Assist in coping, reminders,

actions, or repeating periodic finding alternatives, avoiding
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recommended step(s). slips/relapses. 70
 STAGES OF CHANGE MODEL
(Prochaska J & DiClemente C, 1984)

Exit:
Maintaining
‘safer’ lifestyle
Action: Maintenance:
Making Maintaining
changes change

Commitment: Relapse:
Ready to Relapsing
change back
Contemplating:
Thinking
Pre-contemplation about change
Not interested in
changing ‘risky’
lifestyle

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Stages Of Change Model As Applied To HIV/AIDS Programme

Contemplation Decision/
Precontemplation Young man Determination
Young man has heard believes that he Young man is
about AIDS but and his friends ready & plans to
doesn’t think it is are at risk and use condoms
relevant to his life. thinks that he should so goes to a shop
do something. to buy them.

Maintenance Action
Wearing condoms Young man buys
has become a habit and uses condoms.
and young man
regularly buys them.
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Limitations
As a psychological theory, the stages of change
focuses on the individual without assessing the role
that structural and environmental issues may have
on a person's ability to enact behavior change.

The stages of change presents a descriptive rather

than a causative explanation of behavior,

The relationship between stages is not always clear.

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INNOVATION DIFFUSION THEORY
Outline
1. Introduction Diffusion of innovations
2. Elements of Diffusion of Innovations
3. The adoption process
4. Rates of adoption
5. Characteristics of innovations- Critical Dynamics of
Innovation Diffusion
6. Adopter categories

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 What is Diffusion of Innovations theory?

is a theory that analyzes, as well as helps to

explain, the adaptation of a new innovation.

It addresses how ideas, products, and social

practices that are perceived as “new” spread
throughout a society or from one society to
another.

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…cont’d
Diffusion is the process by which an innovation is
communicated through certain channels over time
among the members of a social system (Everett Rogers-
1962) or

“Ideas & products and messages & behaviors spread

just like viruses do”- (Malcolm Gladwell).

Innovation is an idea, practice, or object that is

perceived as new by an individual or other unit of
adoption.

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Purpose:
For understanding the process of diffusion
and social change.

to study the adoption of a wide range of

health behaviors and programs.
E.g.,
Condom use,
Smoking cessation, and
Use of new tests and technologies by health

practitioners.

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 Concepts/Elements of
Diffusion of Innovations
1. The innovation,
2. Communication channels,
3. Time or rate of adoption, and
4. The social system

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…cont’d
1. Innovation:
An idea, object, or practice that is thought to be new by
an individual, organization, or community.

2. Communication channels:

 Communication is the process by which participants

create and share information with one another in order to
reach a mutual understanding.
 A communication channel is the means by which
messages get from one individual to another.

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…cont’d
3. Time:
 it answers the question, how long it takes to adopt the
innovation?

4. Social system- a set of interrelated units that are engaged

in joint problem-solving to accomplish a common goal.

The members or units of a social system may be:

 Individuals,
Informal groups,
Organizations, and/or subsystems.

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 Five stages of adoption process
1. Knowledge
 Individual is first exposed to an
innovation

 but lacks information about the

innovation.

 has not been inspired to find more

information about the innovation.
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…cont’d
2. Persuasion-
 In this stage individual is interested in the
innovation and

 Actively seeks detail information about

the innovation and

 Forms favorable or unfavorable attitude

toward the innovation.

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…cont’d
3. Decision-
individual takes the concept of innovation
Weighs advantages/disadvantages
Decides whether to adopt or reject.

Due to the individualistic nature of this stage

Rogers notes that it is the most difficult
stage to acquire empirical evidence (Rogers,
1964).

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…cont’d
4. Implementation-
Individual employs (puts into use) the
innovation to a varying degree depending on
the situation &

Determines the usefulness of the

innovation and

May search for further information about

it.
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…cont’d
5. Confirmation-
individual finalizes their decision
to continue using the innovation

may use the innovation to its

fullest potential.

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Model of Stages in Innovation-Decision Process;
source: Rogers (1995)
:Prior condition
,previous practice .1
,perceived needs/problems .2
,Innovativeness .3
Norms of social systems .4
Communication channel

Knowledge Precaution Decision Implementation Confirmation

Social system variable:: Continued adoption

1. Socio-economic Perceived chxcs of the later adoption
Adoption
,characteristics innovation:
Personality .2 1. Relative advantage,
variable 2. Compatibility,
Discontinuance
3.communication 3. Complexity,
Rejection continued
behavior 4. Trialability, rejection
5. observability
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 Rates of adoption
Is the relative speed with which
members of a social system adopt an
innovation.

Measured by the length of time

required for a certain percentage of the
members of a social system to adopt an
innovation.
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…cont’d
Determined by an individual’s
adopter category.

In general individuals who first

adopt an innovation require a shorter
adoption period than late adopters.

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…cont’d
Within the rate of adoption there is a
point at which an innovation reaches
critical mass.

This is a point in time within the

adoption curve that enough individuals
have adopted an innovation

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…cont’d
Rogers outlines several strategies in order to help an
innovation reach critical mass this stage.
These strategies are:
have an innovation adopted by a highly respected
individual within a social network,
 creating an instinctive desire for a specific
innovation.
Inject an innovation into a group of individuals
who would readily use an innovation, and
provide positive reactions and benefits for early
adopters of an innovation.

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 Characteristics of innovations-

Intrinsic characteristics of innovations that influence

an individual’s decision to adopt or reject an
innovation
1. Relative advantages: Q: Is the innovation better than what it
will replace?
2. Compatibility: Q: Does the innovation fit with the intended
audience?

3. Complexity: Q: Is the innovation easy to use?

4. Trialability: Q: Can the innovation be tried before making a
decision to adopt?
5. Observability: Q: Are the results of the innovation
observable and easily measurable?
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Adopter categories
Adopter category classification on the basis
of innovativeness
The categories of adopters are:
1. Innovators,
2. Early adopters,
3. Early majority,
4. Late majority, and
5. Laggards

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1. Innovators
Are the first 2.5% of the individuals in a system
to adopt an innovation.
Are willing to take risks,
Youngest in age,
Have the highest social class,
Have great financial lucidity,
Have closest contact to scientific sources and
interaction with other innovators.

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…cont’d
Plays an important role in the diffusion process:
launching the new idea in the system by importing the
innovation from outside of the system's boundaries.
Plays a gate keeping role in the flow of new ideas into a
system.

How to work with innovators:

Invite keen/eager innovators to be partners in designing
your project.
Recruit and train them as peer educators.

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2. Early adopters
Are the next 13.5% of the individuals in a system to
adopt an innovation.

Have the highest degree of opinion leadership

among the other adopter categories.

Are typically younger in age,

Have a higher social status,

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…cont’d
Have more financial lucidity,
Advanced education, and

Are more socially forward than late

adopters

has the greatest degree of opinion

leadership in most systems.
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How to work with early adopters:
Offer strong face-to-face support for a
limited number of early adopters to trial
the new idea.

Study the trials carefully to discover

how to make
the idea more convenient,
low cost and marketable.

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…cont’d
Reward their egos
e.g. with media coverage.

Promote them as fashion leaders (beginning

with the cultish end of the media market).

Maintain relationships with regular

feedback.

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3. Early majority
Is the next 34 % of the individuals in a system to
adopt an innovation after a varying degree of time.

This time of adoption is significantly longer than

the innovators and early adopters.

Have above average social status,

contact with early adopters, and

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…cont’d
show some opinion leadership.

Adopts new ideas just before the

average member of a system

Interacts frequently with their

peers
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How to work with the early majority:
Offer give-away or competitions to stimulate buzz.

Use mainstream advertising and media stories

featuring endorsements from credible, respected,
similar folks.

Lower the entry cost and guarantees performance.

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…cont’d
Redesign to maximize ease and
simplicity.

Cut the red tape: simplify application

forms & instructions.

Provide strong customer service and

support.

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4. Late majority
is the next 34 % of the individuals in a system
to adopt an innovation.

Approach an innovation with a high degree of

skepticism /doubt and

This could be after the majority of society

has adopted the innovation.

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…cont’d
Late Majority are typically:
 Skeptical about an innovation,
 Have below average social status,

Very little financial lucidity,

In contact with others in late majority & early

majority,

Very little opinion leadership.

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How to work with the late majority:
Focus on promoting social norms rather than just
product benefits

Keep refining the product to increase convenience

and reduce costs.

Emphasize the risks of being left behind.

Respond to criticisms from laggards.

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5. Laggards
are the last 16 % of the individuals in a system to
adopt an innovation.

Laggards typically:
 Tend to be focused on “traditions”,
Have lowest social status,
Lowest financial fluidity,
Oldest of all other adopters,
In contact with only family and close friends,
Very little to no opinion leadership.

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 How to work with laggards:
Give them high levels of personal control over
when, where, how they do the new behaviour.

Maximize their familiarity with new products or

behaviors.

Let them see other laggards successfully adopting

the innovation.

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Diffusion of innovation Model

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 Diffusion of innovation Model
Bell shaped curve (Normal distribution)

34% 34%

14% 16%

<3%

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