Rogers (1995) identified general factors that affect or influence the diffusion of innovations. This early work on program diffusion was based on a synthesis of careful observation from case studies. One major finding is that early adopters share traits that can be readily measured or inferred from behaviors or attitudes. While this earlier work was observational in nature and did not attempt to influence adoption itself, assessments can be used to identify communities, organizations, institutions, families, as well as individuals who are most likely to be early adopters of such programs. Thus identification of those likely to be early adopters and targeting prevention efforts to these groups represent a potential strategy to affect program adoption.
More recently, the same principles underlying research on diffusion of interventions and social influence have been used proactively to increase the adoption of prevention programs and test adoption strategies in group-based randomized trials. One approach used early in HIV prevention is to target opinion leaders in a community who would themselves deliver peer-to-peer messages to promote increased program adoption. Kelly, St. Lawrence, and colleagues (1991), for example, successfully identified and then trained gay opinion leaders in rural communities to encourage safe sexual practices. These leaders were able to modify HIV risk behaviors in their communities. Also, media campaigns for HIV prevention in developing countries are using soap operas in which leading actors talk openly about the use of condoms and getting tested for HIV (Valente, 1996).
A similar approach is now being used in approaches to youth suicide prevention; teenage leaders are trained to deliver messages to both peers and adults in their community aimed at increasing help seeking among suicidal youth. Suicidal youth are often much less likely to talk to adults than are nonsuicidal youth (Wyman, Brown, et al., 2008), yet the vast majority of youth tell a friend before committing suicide. A general strategy for reducing suicide is to increase willingness to talk to a trusted adult by both suicidal youth and their friends. One such program (Sources of Strength) is designed to change peer norms about secrecy and disclosure surrounding distressed youth. A first implementation step is to identify peer leaders from diverse social networks. The program then modifies norms by having each of the peer leaders identify trusted adults in their own lives to whom they would turn at times of stress.