The document summarizes a study that used Rogers' Theory of Diffusion of Innovations to examine unintended consequences of a new health intervention in Burkina Faso. The intervention involved performance-based financing and health equity measures for indigents implemented by the World Bank. Through interviews and observation, the study found the intervention triggered unintended consequences related to falsification of performance data and retrospective filling out of medical registries as the intervention interacted with the local context and characteristics of actors. The Theory of Diffusion of Innovations provided a useful lens to guide data collection and understanding of unintended consequences, though it presented challenges in exploring a wide range of consequences versus focusing on a few variables.

1. Using the Theory of Diffusion of Innovations
to Study Unintended Consequences
of Health Interventions
METHODS FOR IMPLEMENTATION SCIENCE
IN GLOBAL HEALTH
April, 20th. 2017
McGill University
Workshop co-organised by REALISME Chair and McGill of Global Health Programs
Anne-Marie Turcotte-Tremblay
in collaboration with Manuela De Allegri & Valéry Ridde

2. Context
New & complex interventions implemented to improve health
Commonality: uncertainty about how they will unfold
Unintended consequences (UC): changes for which there is a
lack of purposeful action or causation that occur to a social
system as a result of an innovation
May be equally important as intended changes
Researchers & evaluators rarely focus on UC:
Difficulty in predicting and measuring

3. Objectives of the Study
Burkina Faso/World Bank tests new intervention
1. Performance-based financing
2. Health equity measures for indigents
World Bank funded an impact evaluation
Little attention to processes and unintended consequences (UC)
Many stakeholders express concerns about potential UC
Research objective: to document the UC of the intervention in
Burkina Faso

4. Theory on Diffusion of Innovations (Rogers, 2003)

5. Method
Design: Multiple case study
Data collection
• Up to 2 weeks of field work in each healthcare center
• Semi-structured interviews and informal discussions
• Non participant observation with systematic note taking
Analysis: content analysis with QDA Miner

6. Results
The nature and use of the intervention
interacted with the context andthe
characteristics of actors to trigger unintended
consequences related to PBF and health equity
measures for indigents
Example: falsification of performance data
and retrospective filling out of medical
registries

7. Lessons learned for
implementation
science in global
health
Strengths
• The theory of diffusion of innovation:
useful lens to guide our focus during data
collection
• Encouraged the use of methods inspired
from anthropology
Challenges
• Cast a wide net to explore unintended
consequences (vs focusing on a few variables
in depth)
• Categorising consequences = make choices
and develop operational definitions

8. To go further
Allen-Scott LK, Hatfield JM, McIntyre L. A Scoping Review of Unintended Harm Associated with Public Health
Interventions: Towards a Typology and an Understanding of Underlying Factors. Int J Public Health. 2014 Feb;59(1):3–
14.
Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The Extent and Importance of Unintended
Consequences Related to Computerized Provider Order Entry. J Am Med Inform Assoc JAMIA. 2007 Aug;14(4):415–23.
Bloomrosen M, Starren J, Lorenzi NM, Ash JS, Patel VL, Shortliffe EH. Anticipating and Addressing the Unintended
Consequences of Health IT and Policy: A Report from the AMIA 2009 Health Policy Meeting. J Am Med Inform Assoc.
2011;18(1):82–90.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of Innovations in Service Organizations:
Systematic Review and Recommendations. Milbank Q. 2004;82(4):581–629.
Merton RK. The Unanticipated Consequences of Purposive Social Action. Am Sociol Rev. 1936;1(6):894–904.
Morell J. Why Are there Unintended Consequences of Program Action and What Are the Implications for Doing
Evaluation? Am J Eval. 2005;26(4):444–63.
Rogers EM. Diffusion of Innovation. 5th ed. New York: Free Press; 2003.
Yin RK. Case Study Research: Design and Methods. Thousand Oaks: SAGE; 2009. 241 p.

9. Let’s discuss together!
Meet the experts
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