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Community-level influences of behavior change

How can you resolve to change in 2013? With a community. The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online, and to highlight some of the great resources, we’ve excerpted Prathibha Varkey, MD, MPH, MHPE’s Mayo Clinic Preventive Medicine and Public Health Board Review below.

Community and population health can be enhanced by recognizing the different levels of influence, namely intrapersonal, interpersonal, and organizational influences. More recently, attention is being paid to the importance of interpersonal influences through the study of social networks. Smoking cessation rates of individuals increase as more contacts in their social network quit smoking, and individuals gain weight as more contacts in their social network gain weight. Another example of social influence is an after-school program for teenagers that may not change attitudes but may reduce the opportunity to engage in risky behaviors. Organizational support for behavior change can be in the form of higher taxes on tobacco or alcohol, building recreational centers to enhance physical activity, cleaning up the environment (in one study, neighborhood deterioration was a better predictor of sexually transmitted disease than low education attainment), and using or regulating message delivery by the media.

Bringing about change at the population level may follow the principles of diffusion of innovation, as described by Everett Rogers. In this model, the social system comprises five adopter categories: (1) innovators, (2) early adopters, (3) early majority, (4) late majority, and (5) laggards. Innovators are important for change because they get the process started, but they are not very influential because too much uncertainty about the changed behavior still exists when they adopt the change. The early adopters are key to diffusing an innovation; this group tends to include the opinion leaders, and others usually solicit their advice about new innovations. This model of diffusion of innovation predicts whether innovations and change will be successful on a large scale.

How rapidly an innovation will be diffused depends on the characteristics of the innovation, how it is communicated, and the social system. The characteristics of innovation that determine its speed of adoption include its perceived relative advantage over current practice, compatibility with current practices and needs of the adopters, ease of use (simple vs complex), “trialability” (testable on a small scale), and observability (visibility of results).

The principles of this model can be useful for predicting behavior change or diffusion of best practices at the community or population level. For example, screening mammography has been widely adopted by physicians because it is perceived to detect early stage breast cancer, the test is easy for physicians to order, patient compliance is not burdensome, and results are visible in a short time. In contrast, smoking cessation counseling has been slower to diffuse because the results are not as visible (most people will not quit when advised to do so), the intervention is more complex than just ordering a test, and physician practices are not geared toward counseling.

  • Intrapersonal, interpersonal, and organizational influences affect community and population health.
  • Health changes at the population level may propagate in a manner predicted by the principles of diffusion of innovation.


A comprehensive and concise review of relevant preventive medicine and public health topics, the Mayo Clinic Preventive Medicine and Public Health Board Review is an ideal study guide for residents preparing to take the examination of the American Board of Preventive Medicine for the first time, as well as for physicians preparing for recertification. Its emphasis on evidence-based information and recommendations makes Mayo Clinic Preventive Medicine and Public Health Board Review a credible, practical resource that can be used in clinical, public health, and academic settings

The Mayo Clinic Scientific Press suite of publications is now available on Oxford Medicine Online. With full-text titles from Mayo Clinic clinicians and a bank of 3,000 multiple-choice questions, Mayo Clinic Toolkit provides a single location for residents, fellows, and practicing clinicians to undertake the self-testing necessary to prepare for, and pass, the Boards and remain up-to-date. Oxford Medicine Online is an interconnected collection of over 250 online medical resources which cover every stage in a medical career, for medical students and junior doctors, to resources for senior doctors and consultants. Oxford Medicine Online has relaunched with a brand new look and feel and enhanced functionality. Our aim is to ensure that the site continues to deliver the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.

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Recent Comments

  1. […] at the Oxford University Press blog, a great piece highlighting research being done on the impacts and influences of networks and […]

  2. Anthony McLean

    The impact of social proof and social norms on influencing behaviour is something that has long been understood and utilized in marketing, but less so elsewhere. One of the challenges with social proof however has been identified in research, that under self assessment we drastically underestimate the impact that the behaviour of other people has on us. These publications are a worthy investment of time to ensure that medical professionals and others understand the impact that the science of influence and behaviour change can have on community behaviour, health and perceptions. For those new to the field I would strongly recommend Dr. Robert B Cialdini’s book Influence as a great place to start your exploration of influence and behavioural change.

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