Factors that influence the adoption of a school-based eHealth alcohol prevention program: a mixed methods study

Abstract

Abstract Background Drinking alcohol among adolescents is a public health problem worldwide. Evidence-based research has shown that using eHealth interventions effectively reduces risk behaviors such as alcohol consumption. However, despite its benefits, there has been a poor intention to adopt such innovations, and limited resources exist to understand factors influencing the uptake decision to use school-based eHealth alcohol prevention programs. This study aims to identify factors influencing the adoption of a computer-tailored eHealth alcohol prevention program among Spanish school personnel to increase voluntary adoption likelihood. Rogers' Diffusion of Innovations theory and the Integrated Change Model frameworks were used as theoretical bases for understanding the adoption process. Methods A cross-sectional study employing an exploratory sequential mixed methods research design following a development mixing purpose was carried out. First, interviews were conducted with ten Spanish school counselors to assess factors influencing the adoption of the school-based eHealth program by exploring participants' awareness and salient beliefs concerning attitudes, social influences, and self-efficacy. Second, an online quantitative questionnaire was developed based on the qualitative research findings. Third, the new questionnaire was applied to Spanish school personnel (N = 100), including the school management team, school counselors, and teachers. Results School personnel with a strong intention to adopt the program (intenders) perceived significantly more advantages and positive innovation attributes than those participants with a weaker intention to adopt (non-intenders). Intenders perceived a higher personal relevance towards using the program, more self-efficacy and positive social influences from their colleagues, and a greater agreement in preparing action plans than the non-intenders group. Advantages and social support were found to explain a significant portion of the variance in the adoption intention. Conclusions This study suggests that health intervention researchers should develop strategies to enhance educators' pro-innovation attitudes, perceived personal relevance and responsibility, and perceived ease of use towards adopting an eHealth program. Furthermore, our results indicate that fostering an environment which supports the acceptance of the intervention among the school personnel and planning specific actions with the goal intention of using the program are crucial elements in optimizing adoption promotion and, therefore, fostering dissemination of eHealth programs in school settings.