Factors Influencing Implementation of the Innovations Among HIV Health Care Providers: A Study Using Mixed Methodologies

Introduction: In the field of healthcare, numerous valuable new insights become available each year, however, there is a gap between innovations and everyday practice. To develop effective strategies to spread and sustain innovations in health service delivery, it is necessary to identify factors influencing implementation of the innovations. The current study aims to 1) identify the factors influencing individual attitudes toward innovation among health care providers in HIV clinics in China; and 2) recognize the barriers to implementation of innovations in HIV-related clinical setting.

Method: A mixed methodology combing both qualitative and quantitative studies was employed in the current study. A total of 323 health care providers were recruited from 41 HIV clinics across 12 cities/counties in Guangxi, China to participate in a self-administered survey. Multivariate analysis was performed to identify the factors affecting individual attitudes towards innovation. We also conducted in-depth interviews among 37 HIV health care providers from various organizations (CDC, health bureau, hospital, and HIV clinics) and multiple levels (province, city, and county) who were engaged in HIV prevention and treatment in Guangxi, China. All interviews were digitally recorded and transcribed verbatim. All transcripts were uploaded to Atlas.ti v5.0 and analyzed by thematic content analysis methods.

Results: After controlling for demographics and work-related characteristics, depression (aβ=-.526, p=.049) and occupational stress (aβ=-.260, p=.043) were negatively associated with positive attitude toward innovation while higher level of social support from family was associated with more positive attitude toward innovation (aβ=-.101, p=.019). Qualitative data analysis suggested that innovation implementation may be impeded by overwhelming working load, frequent turn overs, limited leaders’ support, and financial problems. A lack of performance evaluation system and social norms valuing innovation may also a structural obstacle for innovation implementation. 

Conclusions: Individual attitude towards innovation were influenced by factors at individual level (depression), organizational level (occupational stress) and family level (social support for work from family). It is crucial to develop a multi-level strategy engaging individual, organizational, and structural level efforts to facilitate innovation implementation in HIV-related health service.