Association of Hospitals' Experience with Bundled Payment for Care Improvement Model with the Diffusion of Acute Hospital Care at Home.

OBJECTIVE: To examine whether hospitals' experience in a prior payment model incentivizing care coordination is associated with their decision to adopt a new payment program for a care delivery innovation. DATA SOURCES: Data were sourced from Medicare fee-for-service claims in 2017, the list of participants in Bundled Payment for Care Improvement initiatives (BPCI and BPCI-Advanced), the list of hospitals approved for Acute Hospital Care at Home (AHCaH) between November 2020 and August 2022, and the American Hospital Association Survey. STUDY DESIGN: Retrospective cohort study. Hospitals' adoption of AHCaH was measured as a function of hospitals' BPCI experiences. Hospitals' BPCI experiences were categorized into five mutually exclusive groups: (1) direct BPCI participation, (2) indirect participation through physician group practices (PGPs) after dropout, (3) indirect participation through PGPs only, (4) dropout only, and (5) no BPCI exposure. DATA COLLECTION/EXTRACTION METHODS: All data are derived from pre-existing sources. General acute hospitals eligible for both BPCI initiatives and AHCaH are included. PRINCIPAL FINDINGS: Of 3248 hospitals included in the sample, 7% adopted AHCaH as of August 2022. Hospitals with direct BPCI experience had the highest adoption rate (17.7%), followed by those with indirect participation through BPCI physicians after dropout (11.8%), while those with no exposure to BPCI were least likely to participate (3.2%). Hospitals that adopted AHCaH were more likely to be located in communities where more peer hospitals participated in the program (median 10.8% vs. 0%). After controlling for covariates, the association of the adoption of AHCaH with indirect participation through physicians after dropout was as strong as with early BPCI adopter hospitals (average marginal effect: 5.9 vs. 6.2 pp, p < 0.05), but the other categories were not. CONCLUSIONS: Hospitals that participated in the bundled payment model either directly or indirectly PGPs were more likely to adopt a care delivery innovation requiring similar competence in the next period.

Determinants of Plasma Alzheimer's Disease Biomarker Use by Primary Care Providers and Dementia Specialists.

BACKGROUND: The efficiencies of plasma Alzheimer's disease (AD) biomarkers could facilitate early AD diagnosis. Unfortunately, limited knowledge exists about whether and how they would be used by clinicians. OBJECTIVE: To identify and compare determinants of plasma AD biomarker use reported by primary care providers and dementia specialists. DESIGN: Semi-structured interviews with clinicians organized using Rogers' Diffusion of Innovations theory and analyzed using an iterative coding approach. PARTICIPANTS: The subjects were internal and family medicine, neurology, and geriatrics providers with varying degrees of expertise in dementia diagnosis and care. MAIN MEASURES: Factors influencing a clinician's decision to use or not use plasma AD biomarkers in clinical practice. KEY RESULTS: We interviewed 30 clinicians (16 family or internal medicine providers, 8 geriatricians, and 6 neurologists). Fifteen were dementia specialists. Hesitance to use plasma AD biomarkers was due to perceived lack of effective treatments for AD, limited access to supports, and stigma. Plasma AD biomarkers would be more readily adopted by clinicians with dementia expertise. CONCLUSIONS: Several factors will influence clinical use of plasma AD biomarkers. Some of them may inform the design of interventions to promote the effective and appropriate clinical translation of these tests.

Implementing a Standardized Phase-of-Care Craniotomy Education Program.

Leaders at a community hospital in the southeastern United States sought to add a craniotomy program to meet the needs of the local patient population. Perioperative and critical-care nurses required specific knowledge and skills to care for patients undergoing craniotomy procedures. The facility's education team applied adult learning theories and an innovation diffusion framework when developing an evidence-based craniotomy education program. A clinical nurse specialist conducted a gap analysis and readiness assessment to determine the nurses' knowledge, skills, and competence to care for patients; attitudes and behaviors toward implementation of the new program; and preferred learning methods. The three-tiered phase-of-care education program included didactic learning sessions, shadowing experiences, hands-on experience with equipment, and simulation sessions. The program focused on effective collaboration and care transitions. Nurses were satisfied with the program, and they continue to participate in ongoing quarterly simulation sessions with case study scenarios to enhance their skills.

Recognizing the preventive quality in the adoption of innovations: The case of third-party ownership photovoltaic systems in Finland.

This study explores the role of the preventive quality of innovations on their adoption intention. The preventive quality of innovations is a distinctive feature of innovations that is directed towards avoiding a future, possibly harmful event. Empirically grounded in third-party ownership of photovoltaic systems in Finland, this study examines data collected from an online survey measuring respondent intention to adopt. A series of hypotheses theoretically grounded in the Diffusion of Innovations theory and the preventive quality of innovations were tested through Partial Least Squares Structural Equation Modeling with SmartPLS4. Findings for the overall sample reveal that the preventive quality and the relative advantage of innovations influenced adoption intention positively. Findings highlight the preventive quality of innovations as a construct that acts as the greatest contributor to the dependent variable.

Mechanism substitution in preventive innovations: Dissecting the reproduction of health inequalities in the United States.

In the last three decades, numerous studies in different countries have corroborated the main postulates of the Fundamental Cause Theory (FCT), providing evidence showing how health inequalities are reproduced as society increases its capacity to control disease and/or avoid its consequences through preventive innovations. However, documenting the reproductive logic proposed by the theory requires the development of a dynamic analytical approach to consider socioeconomic disparities in the incorporation of multiple preventive innovations over time, which could act as mediating mechanisms of the durable relationship between socioeconomic status and health/mortality. This study draws on data from different waves of the National Health Interview Survey and the National Health and Nutrition Examination Survey to analyze the diffusion processes of various innovations in the U.S. The results of the study show that educational inequalities emerge, are amplified, and are reduced by the continuous diffusion of preventive innovations, supporting the meta-hypothesis of substitution of mediating mechanisms according to the interconnections of FCT and Diffusion of Innovation Theory.

How can residents protect and promote pollinators? The diffusion of residential pollinator-friendly gardening.

Urbanization and land use change are leading causes of declines in pollinator abundance and diversity. However, researchers in different regions of the world have found that some pollinators can thrive in urban landscapes, depending on land use practices, environmental conditions, and species traits. Residential landscapes constitute a significant portion of urban green space and thus, residents' adoption of landscape practices to promote pollinators can play a central role in addressing the global pollinator challenge. Yet, although residents' willingness and intention appear strong, adoption of pollinator-friendly gardening remains low. The present study - guided by the Diffusion of Innovations theory - aimed to build empirical understanding by surveying 1598 [State] residents on their experiences and perceptions related to pollinator-friendly gardening to determine the most salient barriers and opportunities to engagement. Key findings suggest making the practice more widely observable and reducing perceived complexity in learning to do the practice are critical to promoting adoption. This demonstrates, in practical terms, that: (1) targeted efforts to build residents' actionable knowledge about pollinator-friendly gardening may significantly reduce uncertainty and boost the likelihood of adoption; and (2) examples of active pollinator gardens need to be more widely showcased and popularized (e.g., through experiential or virtual demonstrations). We also found most residents living in homeowner associations (HOAs) believed HOA policies on pollinator-friendly gardening were restrictive or the residents were unsure whether they are allowed to practice pollinator-friendly gardening. Given these perceptions strongly associated with residents' low intent to engage in pollinator-friendly gardening, a major opportunity exists to diffuse the practice and increase adoption by working with HOAs and community leaders to become promoters of - rather than barriers to - pollinator-friendly gardening.

Adoption of community-based strategies for sustainable vector control and prevention.

Community engagement strategies provide tools for sustainable vector-borne disease control. A previous cluster randomized control trial engaged nine intervention communities in seven participatory activities to promote management of the domestic and peri-domestic environment to reduce risk factors for vector-borne Chagas disease. This study aims to assess the adoption of this innovative community-based strategy, which included chickens' management, indoor cleaning practices, and domestic rodent infestation control, using concepts from the Diffusion of Innovations Theory. We used questionnaires and semi-structured interviews to understand perceptions of knowledge gained, intervention adoption level, innovation attributes, and limiting or facilitating factors for adoption. The analysis process focused on five innovation attributes proposed by the Diffusion of Innovations Theory: relative advantage, compatibility, complexity, trialability, and observability. Rodent management was highly adopted by participants, as it had a relative advantage regarding the use of poison and was compatible with local practices. The higher complexity was reduced by offering several types of trapping systems and having practical workshops allowed trialability. Observability was limited because the traps were indoors, but information and traps were shared with neighbors. Chicken management was not as widely adopted due to the higher complexity of the method, and lower compatibility with local practices. Using the concepts proposed by the Diffusion of Innovations Theory helped us to identify the enablers and constraints in the implementation of the Chagas vector control strategy. Based on this experience, community engagement and intersectoral collaboration improve the acceptance and adoption of novel and integrated strategies to improve the prevention and control of neglected diseases.

Lessons Learned from a Shared Curriculum on Tobacco Cessation Using a Mixed-Methods Approach.

Although the sharing of curricular content between health professional schools can reduce faculty burden, the literature provides little guidance to support these efforts. The objective of this investigation was to synthesize data from two prior studies to delineate recommendations guiding the future development of shared curricula in health professional education. Applying Rogers' Diffusion of Innovations Theory as a guiding framework, relevant data were extracted from a two-phase mixed-methods study evaluating the long-term impact of the shared Rx for Change: Clinician-Assisted Tobacco Cessation program. Phase 1, a qualitative study, involved telephone interviews with faculty participants of train-the-trainer workshops conducted between 2003 and 2005. These results informed the development of a phase 2 national survey, administered electronically as a long-term follow-up (13 to 15 years later) with train-the-trainer workshop participants. Results from the two studies were synthesized and summarized, producing seven key recommendations to guide development of shared curricula: (1) appeal to attendees, (2) relate content to clinical practice, (3) deliver live, in-person training, (4) develop high-quality materials, delivered by experts, (5) provide support, (6) meet accreditation standards, and (7) demonstrate effectiveness. Future program developers should consider these recommendations to enhance dissemination, adoption, and long-term sustainability of shared curricular content.

Will the implementation process for goal-oriented primary care succeed? A qualitative study investigating five perceived attributes of goal-oriented care.

Throughout the western world, goal oriented care (GOC) is increasingly promoted as a strategy towards more person-centered, integrated care. The implementation of goal-oriented care not only takes place at the micro-level with individual primary care providers (PCPs) changing their approach, but also requires meso- and macro-level investment. In this study, we zoom in on experiences and actions of various meso- and macro-level actors that are actively engaged with implementing GOC, both within their organization or at the policy level. In-depth interviews were conducted with n = 23 actors from a variety of different organizations (governmental institutions, provider organizations, patient organizations, health/social care organizations, primary care zones/care councils, etc.), using a semi- interview guide inspired by realist interviewing. Three main drivers for implementation were identified: recognition, commitment and coordination. On top of that, results were interpreted through Rogers' Diffusion of Innovations (Dol) theory in which five attributes are discussed that contribute to or hinder implementation success. Our findings can help define actions to support and facilitate the implementation process of an innovation such as GOC.

Diffusion of a micronutrient home fortification program for infants and toddlers in a multi-ethnic population in rural western China.

BACKGROUND: The micronutrient home fortification programs contribute to the prevention of childhood anemia. WHO suggested applying culturally appropriate strategies to implement the micronutrient home fortification programs in various communities. However, there is little knowledge on evidence-based effective diffusion strategies of the micronutrient home fortification programs in multi-ethnic populations. This study aims to examine the diffusion of a micronutrient home fortification program with micronutrient powder (MNP) in a multi-ethnic population by investigating factors associated with being an 'early' or a 'later' adopter of MNP. METHODS: We conducted a cross-sectional study in rural western China. Multistage sampling was used to select children's caregivers in Han, Tibetan, and Yi ethnic communities (N = 570). The diffusion of innovations theory informed the data collection on caregivers' decision process and was applied to classify participants into the MNP adopter categories of 'leaders', 'followers', 'loungers', and 'laggards'. The ordered logistic regression model estimated the factors associated with the MNP adopter categories. RESULTS: Caregivers from the Yi ethnic subgroup were likely to adopt MNP relatively late (AOR = 1.67; 95%CI = 1.09, 2.54) compared with Han and Tibetan ethnic subgroups. Caregivers with more knowledge regarding the MNP feeding method (AOR = 0.71; 95%CI = 0.52, 0.97) and those with stronger self-efficacy in adopting MNP (AOR = 0.85; 95%CI = 0.76, 0.96) were more likely to adopt MNP earlier than others. The following messages and channels also tend to make caregivers adopt MNP earlier: hearing that 'MNP was free' from villagers (AOR = 0.45; 95%CI = 0.20, 0.98), and learning 'MNP feeding method' from township doctors (AOR = 0.16; 95%CI = 0.06, 0.48). CONCLUSIONS: Disparities in adopting MNP existing among different ethnic groups require more effective diffusion strategies in disadvantaged minority ethnic groups. Enhancing self-efficacy in adopting MNP and knowledge on feeding method of MNP have the potential to make caregivers adopt MNP earlier. Peer networks and township doctors can be effective agencies to facilitate the diffusion and adoption of MNP.

Internal and Environmental Predictors of Physician Practice Use of Screening and Medications for Opioid Use Disorders.

Medications for opioid use disorder (MOUD) remain highly inaccessible despite demonstrated effectiveness. We examine the extent of screening for opioid use and availability of MOUD in a national cross-section of multi-physician primary care and multispecialty practices. Drawing on an existing framework to characterize the internal and environmental context, we assess socio-technical, organizational-managerial, market-based, and state-regulation factors associated with the use of opioid screening and offering of MOUD in a practice. A total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Having advanced health information technology functionality was positively associated with both screening for opioid use and offering MOUD in a practice, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models. These results suggest that improving access to information and expertise may enable physician practices to respond more effectively to the nation's ongoing opioid epidemic.

The burden of COVID-19 in French Guiana: Vaccine-averted deaths, hospitalizations and costs.

Objectives: French Guiana, the least-vaccinated French territory, also has the lowest COVID-19 vaccination coverage in Latin America. We aimed to estimate how many deaths, hospitalizations and costs the vaccines had and could have avoided. Methods: We calculated the Number Needed to Vaccinate to prevent one death per year, 1 standard hospitalization, 1 Intensive Care Unit admission given the mean incidence numbers of the past 6 months, and divided the number of persons vaccinated to estimate how many deaths and hospitalizations had been avoided in French Guiana at that time. Results: The crude number needed to vaccinate to prevent one death per year, the crude number needed to vaccinate to prevent one hospitalization per 6 months were computed Based on our observed incidence and ICU admission rate, the crude number needed to vaccinate to prevent one ICU admission per 6 months.After 6 months with an incidence exceeding 400 per million inhabitants, and 148 observed deaths, we estimate that vaccination avoided 46 deaths (IC95%=43.5-48.7). If the number of vaccinated persons had reached the same proportion as mainland France, 141 deaths per year could have been prevented (IC95%=131.9-147.6).With 2085 hospitalization and 370 ICU admissions during the same period, we estimate that the current albeit low vaccination rate avoided 300 hospital (IC95%=280-313) and 77 (IC95%=72-81) ICU admissions. With the same vaccination rates as mainland France, we estimate that 900 hospitalizations and 231 ICU admissions would have been avoided.Similarly, there would have been 139 ICU admission (instead of 370). Conclusions: In sparsely populated French Guiana these numbers are quite substantial and framing the vaccine benefits and wasted opportunities using such concrete numbers may help convincing undecided persons to get vaccinated.

Understanding the Adoption of Dietary Interventions Within a Chinese Autism Online Community: A Diffusion of Innovations Perspective.

Dietary interventions are common but controversial treatments for autistic people. This study aims to understand the adoption of dietary interventions based on diffusion of innovations theory in the autism online community from four aspects: popularity, adoption process, the influence of opinion leaders, and post-adoption feedback. Our data was extracted from a Chinese autism community named Baidu Tieba autism forum. We applied a mixed-method including four analytical approaches: descriptive statistics for popularity analysis; machine learning models for automatic data classification and topic detection; social network analysis for exploring the influence of opinion leaders on the adoption phase; content analysis for revealing the family caregiver-reported feedback after adoption. Dietary interventions have become increasingly popular in the autism online community since 2018. Analysis of the adoption process revealed that family caregivers at different stages of adoption focused on different topics, and the number of interactions with opinion leaders had a significant effect on the highest level (p < .001) and stage span (p < .001) of health information adoption. According to findings from the feedback of family caregivers, the effects of dietary interventions varied from individuals with autism. Our study revealed the diffusion of unproven interventions, which is of great significance in promoting evidence-based practices.

Intervention Characteristics Considered in Health Educators' Adoption Decision-Making Process.

It is well known that perceptions of intervention characteristics (e.g., cost, source, evidence strength and quality) are a critical link from dissemination to implementation. What is less known is the process by which researchers understand the characteristics most valued by key intermediaries (i.e., real-world decision-makers), particularly in the federal system of Cooperative Extension. In Extension, university-based specialists are available to assist county-based agents in program selection, delivery, and evaluation. For this work, a sequential explanatory mixed-methods design was used to conduct surveys and semi-structured interviews, informed by the Diffusion of Innovations theory and Consolidated Framework for Implementation Research. Educators and specialists were recruited across 47 states to identify characteristics of health promotion interventions that facilitate the adoption decision-making process. Analysis of intervention attribute importance survey data was conducted through a one-way ANOVA with Bonferroni post hoc test to determine individual variable differences between responses. Interviews underwent a conventional content analysis. In total, 121 educators and 47 specialists from 33 states completed the survey. Eighteen educators and 10 specialists completed interviews. Educators and specialists valued components such as the community need for the intervention, and potential reach compared with other components including previous delivery settings and external funding of the intervention (p < .05). Qualitative data indicated divergence between educators and specialists; educators valued understanding the intervention cost (time and training) and specialists valued the evidence base and external funding available. Intervention developers should communicate information valued by different stakeholders to improve the adoption of evidence-based interventions.

Caregivers' Perspectives of Pharmacist Intervention in Children's Antibiotic Prescriptions for Upper Respiratory Tract Infections.

Background: Community pharmacists can help fight antimicrobial resistance by intervening in children's antibiotic prescriptions for upper respiratory tract infections (URTIs). However, caregivers' attitudes and perspectives on this are unknown. Objective: To evaluate children's caregivers' acceptability of pharmacists intervening in their antibiotic prescriptions for URTIs with respect to their knowledge of and attitude toward pharmacists and knowledge, beliefs, and behaviors related to antibiotics. Methods: A 69-item survey was created and sent to a panel of caregivers. ANCOVA and path analysis were used to evaluate the relationship between caregiver characteristics and their acceptability of pharmacists intervening in children's antibiotic prescriptions for URTIs. Results: Responses from 246 caregivers who met the inclusion and exclusion criteria were analyzed. Mean caregivers' acceptability of pharmacists intervening in children's antibiotic prescriptions for URTIs was 3.25 out of 5 (±1.01). The ANCOVA model (adjusted R2 = .636) showed positive attitude toward pharmacists and being more accepting of health advice from pharmacists since the start of the COVID-19 pandemic were associated with higher caregiver acceptability of pharmacists intervening in children's antibiotic prescriptions. Caregivers with better relationships with their pharmacist also tend to have better attitudes toward pharmacists. Not wanting antibiotics for symptom relief was associated with decreased acceptability scores. Conclusion: Overall caregiver acceptability of pharmacists intervening in antibiotic prescriptions was slightly above neutral. Building a relationship with caregivers could help change their attitude and increase the acceptability of pharmacists intervening in children's antibiotic prescriptions. Caregivers seeking symptomatic relief may be more open to non-antibiotic alternatives.

Difusão da Lei Geral da Micro e Pequena Empresa em municípios paulistas / Difusión de la Ley General de las Micro y Pequeñas Empresas en los municipios de São Paulo / Diffusion of the Micro and Small Business Law in municipalities of São Paulo

Resumo Este artigo tem como objeto de análise a implantação da Lei Complementar nº 123, de 2006 (LC nº 123/2006), que instituiu o Estatuto Nacional da Microempresa e da Empresa de Pequeno Porte (MPE), por municípios paulistas. Utilizou-se o referencial teórico de difusão de políticas públicas tendo como objetivo estudar seu processo de adoção, observando os diferentes contextos e momentos de coerção previstos na legislação federal. Com base nas discussões teóricas relacionadas com o mecanismo de difusão chamado de coerção, respondeu-se a seguinte pergunta: qual é a influência do mecanismo de coerção vertical na difusão da Lei Geral da MPE nos municípios paulistas? A técnica "análise de sobrevivência" foi aplicada para identificar fatores explicativos da difusão da política, considerando variáveis de desenho institucional, políticas e partidárias, efeito vizinhança, necessidade da política, organizações/atores sociais e fatores estruturais. Os resultados demonstram que, conforme varia o desenho institucional de coerção, mudam os fatores explicativos da difusão dessa política na ponta, de modo que os aspectos locais, incluindo atores sociais, fatores regionais e questões estruturais, importam para a difusão, variando conforme o contexto coercitivo.

Resumen Este artículo analiza la implementación de la Ley General de las Micro y Pequeñas Empresas por parte de los municipios de São Paulo. Se utilizó la teoría de la difusión de políticas, con el objetivo de estudiar el proceso de adopción de esta política pública, observando los diferentes contextos y momentos de coerción previstos en la legislación federal. A partir de las discusiones teóricas relacionadas con el mecanismo de difusión denominado coerción, se respondió a la siguiente pregunta: ¿cuál es la influencia del mecanismo de coacción vertical en la difusión de la mencionada ley en los municipios de São Paulo? Se aplicó la técnica de análisis de supervivencia para identificar factores explicativos de la difusión de políticas, considerando variables institucionales, políticas y partidarias, efecto barrio, necesidad de políticas, organizaciones/actores sociales y factores estructurales. Los resultados muestran que a medida que varía el diseño institucional de coerción, los factores explicativos de la difusión de esta política al final cambian, de modo que los aspectos locales, incluidos los actores sociales, los factores regionales y los problemas estructurales importan para la difusión, variando de acuerdo con el contexto coercitivo.

Abstract This article analyzes the implementation of the General Law for Micro and Small Business by municipalities in São Paulo. The theory of policy diffusion was used to study the process of adopting this public policy in the different contexts of coercion. The article presents theoretical discussions on the diffusion mechanism "coercion" and answers the question: what is the influence of the vertical coercion mechanism in the diffusion of the General Law in the municipalities of São Paulo? The survival analysis technique was applied to identify explanatory factors of policy diffusion, considering institutional, political, and party design variables, neighborhood effect, internal needs, organizations/social actors, and structural factors. The results show that as the institutional rules of coercion vary, the explanatory factors of the diffusion change so that local aspects, including social actors, regional factors, and structural issues, matter for the diffusion, varying according to the coercive context.

Dissemination in Extension: Health Specialists' Information Sources and Channels for Health Promotion Programming.

In the National Cooperative Extension System (herein: Extension), state-level specialists serve as key intermediaries between research, educators, and the community members they serve. There is a need to understand information seeking and sharing practices (i.e., dissemination) among specialists to increase the adoption of evidence-based health promotion programs. Specialists (N = 94) across 47 states were identified and invited to participate in this mixed methods study. A one-way ANOVA with Bonferroni corrections was used to analyze survey data. Data collected through semi-structured interviews were analyzed using an immersion crystallization approach. Forty-seven health specialists completed the survey representing 31 eligible states (65%) and were predominately female (89%), Caucasian (70%), had a doctorate (62%), and were employed within Extension for 10.2 + 9.7 years. The information sources used most frequently were academic journals and other specialists, and most used email and online meetings to communicate. Qualitative findings support the use of other specialists as a primary source of information and indicate specialists' desire for an on-demand, bi-directional, online national repository of Extension programs. This repository would facilitate the dissemination of evidence-based programming across the system and reduce program duplication as well as information burden on county-based educators.

Has Covid-19 accelerated opportunities for digital entrepreneurship? An Indian perspective.

Covid-19 has challenged many businesses to orient themselves towards digital solutions for their survival. Due to the rising digital wave during Covid-19, there has been a plethora of opportunities for aspiring entrepreneurs to enter the market. Hence, this study focuses on understanding emerging areas and technologies for digital entrepreneurship. This study adopted a qualitative approach with semi-structured interviews through the lens of the diffusion of innovations theory. A total of 23 entrepreneurs responded and presented their views on Covid-19-induced opportunities for digital entrepreneurship. A structured process of open, axial, and selective coding was adopted for the thematic analysis. The study presents a framework based on four promising propositions. Results of the thematic analysis indicate the emergence of digital entrepreneurship opportunities in technology (EdTech, FinTech, cybersecurity), healthcare (diagnostics, virtual care, fitness), entertainment (over the top, gaming, social media), and e-commerce (contactless delivery, payment methods, augmented reality). In this study, entrepreneurs presented their views based on their experience with the platform or technology they operated. To this end, the present study offers implications both for scholars and entrepreneurs working in and aspiring to digital entrepreneurship along with future scope of research.

Long-Term Trends in Obesity Prevalence by Socio-Economic Group in Five European Countries and the USA: The Relevance of the Diffusion of Innovations Theory.

INTRODUCTION: Cross-national comparison suggests that the timing of the obesity epidemic differs across socio-economic groups (SEGs). Similar to the smoking epidemic, these differences might be described by the diffusion of innovations theory, which states that health behaviours diffuse from higher to lower SEGs. However, the applicability of the diffusion of innovations theory to long-term time trends in obesity by SEG is unknown. We studied long-term trends in the obesity prevalence by SEG in England, France, Finland, Italy, Norway, and the USA and examined whether trends are described by the diffusion of innovations theory. METHODS: Obesity prevalence from 1978 to 2019 by educational level, sex, and age group (25+ years) from health surveys was harmonized, age-standardized, Loess-smoothed, and visualized. Prevalence rate differences were calculated, and segmented regression was performed to obtain annual percentage changes, which were compared over time and across SEGs. RESULTS: Obesity prevalence among lower educated groups has exceeded that of higher educated groups, except among American men, in all countries throughout the study period. A comparable increase across educational levels was observed until approximately 2000. Recently, obesity prevalence stagnated among higher educated groups in Finland, France, Italy, and Norway and lower educated groups in England and the USA. DISCUSSION: Recent trends in obesity prevalence by SEG are mostly in line with the diffusion of innovations theory; however, no diffusion from higher to lower SEGs at the start of the epidemic was found. The stagnation among higher SEGs but not lower SEGs suggests that the latter will likely experience the greatest future burden.

Behavioral intention to use distance teaching in the pandemic era.

This study aimed at exploring the impact of post-epidemic era on teachers' behavioral intention of distance education. In this study, purposive sampling method was used to enroll 390 teachers in colleges and universities, high schools and vocational schools, and junior high and elementary schools to be the research subjects for the questionnaire survey. A total of 360 questionnaires were collected for statistics, and AMOS 23.0 statistical software was used to analyze the correlation between variables. Meanwhile, a structural equation model was used to analyze and verify the impact of the technology acceptance model, information system success model, and diffusion of innovations theory. According to the results, the system quality of distance teaching platforms certainly affected perceived usefulness, and perceived usefulness affected teachers' attitudes toward using distance teaching systems. In addition, perceived ease of use had an impact on perceived usefulness, and trialability had an impact on teachers' attitudes toward using distance teaching systems. Finally, teachers' attitude toward using a distance teaching system also affected their behavioral intention. According to the results, suggestions were made in this study to teachers and students for distance teaching. Additionally, the main contribution of this study lies in providing specific strategies for further distance teaching through empirical results in combination with on-site teaching.