There is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new order of things . . . . Whenever his enemies have the ability to attack the innovator, they do so with the passion of partisans, while the others defend him sluggishly, so that the innovator and his party alike are vulnerable.
Getting a new idea adopted, even when it has obvious advantages, is difficult. Many innovations require a lengthy period of many years from the time when they become available to the time when they are widely adopted. Therefore, a common problem for many individuals and organizations is how to speed up the rate of diffusion of an innovation. The following case illustration provides insight into some common difficulties facing diffusion campaigns.
The public health service in Peru attempts to introduce innovations to villagers to improve their health and lengthen their lives. This change agency encourages people to install latrines, burn garbage daily, control house flies, report cases of infectious diseases, and boil drinking water. These innovations involve major changes in thinking and behavior for Peruvian villagers, who do not understand the relationship of sanitation to illness. Water boiling is an especially important health practice for Peruvian villagers. Unless they boil their drinking water, patients who are cured of an infectious disease in a medical clinic often return within a short time to be treated again for the same disease.
A two-year water-boiling campaign conducted in Los Molinas, a peasant village of two hundred families in the coastal region of Peru, persuaded only eleven housewives to boil water. From the viewpoint of the public health agency, the local health worker, Nelida, had a simple task: to persuade the housewives of Los Molinas to add water boiling to their pattern of daily behavior. Even with the aid of a medical doctor, who gave public talks on water boiling, and fifteen village housewives who were already boiling water, Nelidaâs diffusion campaign failed. To understand why, we need to take a closer look at the culture, the local environment, and the individuals in Los Molinas.
Most residents of Los Molinas are peasants who work as field hands on local plantations. Water is carried by can, pail, gourd, or cask. The three sources of water in Los Molinas include a seasonal irrigation ditch close to the village, a spring more than a mile away from the village, and a public well whose water most villagers dislike. All three sources are subject to pollution at all times and show contamination whenever tested. Of the three sources, the irrigation ditch is the most commonly used. It is closer to most homes, and the villagers like the taste of its water.
Although it is not feasible for the village to install a sanitary water system, the incidence of typhoid and other waterborne diseases could be greatly reduced by boiling water before it is consumed. During her two-year campaign in Los Molinas, Nelida made several visits to every home in the village and devoted especially intensive efforts to twenty-one families. She visited each of the selected families between fifteen and twenty-five times; eleven of these families now boil their water regularly.
What kinds of people do these numbers represent? We describe three village housewives: one who boils water to obey custom, one who was persuaded to boil water by the health worker, and one of the many who rejected the innovation.
Mrs. A: Custom-Oriented Adopter
Mrs. A is about forty and suffers from a sinus infection. The Los Molinas villagers call her the âsickly one.â Each morning, Mrs. A boils a potful of water, which she uses throughout the day. She has no understanding of germ theory, as explained by Nelida. Her motivation for boiling water is a complex local custom of âhotâ and âcoldâ distinctions. The basic principle of this belief system is that all foods, liquids, medicines, and other objects are inherently hot or cold, quite apart from their actual temperature. In essence, the hot-cold distinction serves as a series of avoidances and approaches in such behavior as pregnancy, child rearing, and the health-illness system.
Boiled water and illness are closely linked in the norms of Los Molinas. By custom, only the ill use cooked, or âhotâ water. If an individual becomes ill, it is unthinkable to eat pork (very cold) or drink brandy (very hot). Extremes of hot and cold must be avoided by the sick; therefore, raw water, which is perceived to be very cold, must be boiled to make it appropriate.
Villagers learn from early childhood to dislike boiled water. Most can tolerate cooked water only if a flavoring, such as sugar, lemon, or herbs, is added. Mrs. A likes a dash of cinnamon in her drinking water. The village belief system does not involve the notion of bacteriological contamination of water. By tradition, boiling is aimed at eliminating the âcoldâ quality of unboiled water, not the harmful bacteria. Mrs. A drinks boiled water in obedience to local norms, because she perceives herself as ill. She adopted the innovation, but for the wrong reason.
Mrs. B: Persuaded Adopter
The B family came to Los Molinas a generation ago, but they are still strongly oriented toward their birthplace in the high Andes. Mrs. B worries about lowland diseases that she feels infest the village. It is partly because of this anxiety that the public health worker, Nelida, was able to convince Mrs. B to boil water. To Mrs. B, Nelida is a friendly authority (rather than a âdirt inspector,â as she is seen by other housewives) who imparts useful knowledge and brings protection from uncertain threats. Mrs. B not only boils water but has also installed a latrine and sent her youngest child to the health center for a checkup.
Mrs. B is marked as an outsider in the community by her highland hairdo and stumbling Spanish. She will never achieve more than marginal social acceptance in the village. Because the community is not an important reference group to her, Mrs. B can deviate from the village norms on health innovations. With nothing to lose socially, Mrs. B gains in personal security by heeding Nelidaâs advice. Mrs. Bâs practice of boiling water has no effect in improving or damaging her marginal status. She is grateful to Nelida for teaching her how to neutralize the danger of contaminated water, which she perceives as a lowland peril.
Mrs. C: Rejector
This housewife represents the majority of Los Molinas families who were not persuaded by the efforts of the change agent during the two-year water-boiling campaign. In spite of Nelidaâs repeated explanations, Mrs. C does not understand germ theory. How, she argues, can microbes survive in water that would drown people? Are they fish? If germs are so small that they cannot be seen or felt, how can they hurt a grown person? There are enough real threats in the world to worry aboutâpoverty and hungerâwithout bothering about tiny animals that one cannot see, hear, touch, or smell. Mrs. Câs allegiance to traditional village norms is at odds with the boiling of water. A firm believer in the hot-cold superstition, she feels that only the sick should drink boiled water.
Why Did the Diffusion of Water Boiling Fail?
This intensive two-year campaign by a public health worker in a Peruvian village of two hundred families, aimed at persuading housewives to boil drinking water, was largely unsuccessful. Nelida was able to encourage only about 5 percent of the population, eleven families, to adopt the innovation. The diffusion campaign in Los Molinas failed because the innovation was perceived as culturally inappropriate by the villagers. Local tradition links hot foods with illness. Boiling water makes water less âcoldâ and hence appropriate only for the sick. If a person is not ill, he or she is prohibited by village norms from drinking boiled water. Only individuals who are not integrated into local networks risk defying the community norm on water boiling. An important factor regarding the adoption rate of an innovation is its compatibility with the values, beliefs, and past experiences of individuals in the social system. Nelida and her superiors in the public health agency should have understood the hot-cold belief system, as it is found throughout Peru (and in most nations of Latin America, Africa, and Asia). The indigenous knowledge system caused the failure of the diffusion effort for water boiling in Los Molinas.
Nelidaâs failure demonstrates the importance of interpersonal networks in the adoption or rejection of an innovation. Socially an outsider, Mrs. B was marginal to the Los Molinas community, although she lived there for several years. Nelida was a more important referent for Mrs. B than were her neighbors, who shunned her. Anxious to win reflected social prestige from the higher-status Nelida, Mrs. B adopted water boiling, not because she understood the correct health reasons but because she wanted to obtain Nelidaâs approval. Thus we see that the diffusion of innovations is a social process, even more than a technical matter.
Nelida worked with the wrong housewives if she wanted to launch a self-generating diffusion process in Los Molinas. She concentrated her efforts on village women such as Mrs. A and Mrs. B. Unfortunately, they were perceived as a sickly one and a social outsider, respectively, and were not perceived as social models of water-boiling behavior by the other women. The village opinion leaders, who could have activated local networks to spread the innovation, were ignored by Nelida. As a result, the rate of adoption of the innovation did not reach a critical mass, after which the diffusion process would have become self-sustaining.
How potential adopters view a change agent affects their willingness to adopt new ideas. In Los Molinas, Nelida was perceived differently by lower-and middle-status housewives. Most poor families saw the health worker as a âsnooperâ sent to Los Molinas to pry for dirt and to press already harassed housewives into keeping cleaner homes. Because the lower-status housewives had less free time, they were unlikely to talk with Nelida about water boiling. Their contacts outside the community were limited, and as a result, they saw the technically proficient Nelida with eyes bound by the traditional beliefs of Los Molinas. They distrusted this outsider, whom they perceived as a social stranger. Nelida, who was middle class by Los Molinas standards, was able to secure more positive results from housewives whose socioeconomic status and cultural background were more similar to hers. This tendency for more effective communication to occur with those who are more similar to a change agent occurs in most diffusion campaigns. Unfortunately, those individuals who most need the help provided by the change agent are least likely to accept it.
Nelida was âinnovation-orientedâ rather than âclient-oriented.â She was unable to put herself in the role of the village housewives, and thus her attempts at persuasion failed to reach her clients because the message did not suit their needs. Nelida talked to villagers about germ theory, which they could not (and did not need to) understand. These factors produced the diffusion failure in Los Molinas. Once the remainder of the book has been read, it will be easier to understand the water-boiling case.
Diffusion is a special type of communication in which the messages are about a new idea. This newness of the idea in the message content gives diffusion its special character. The newness means that some degree of uncertainty is involved in diffusion. Uncertainty is the degree to which a number of alternatives are perceived with respect to the occurrence of an event and the relative probability of these alternatives. Uncertainty implies a lack of predictability, of structure, of information. Information is a means of reducing uncertainty. Information is a difference in matter-energy that affects uncertainty in a situation where a choice exists among a set of alternatives (Rogers and Kincaid, 1981). A technological innovation embodies information and thus reduces uncertainty about cause-effect relationships in problem solving.
Some authors restrict the term âdiffusionâ to the spontaneous, unplanned spread of new ideas and use the concept of âdisseminationâ for diffusion that is directed and managed. In this book we use the word âdiffusionâ to include both the planned and the spontaneous spread of new ideas.
Many technologists believe that advantageous innovations will sell themselves, that the obvious benefits of a new idea will be widely realized by potential adopters, and that the innovation will diffuse rapidly. Seldom is this the case. Most innovations, in fact, diffuse at a disappointingly slow rate, at least in the eyes of the inventors and technologists who create the innovations and promote them to others.
Scurvy control illustrates how slowly an obviously beneficial innovation spreads. In the early days of long sea voyages, scurvy killed more sailors than did warfare, accidents, and other causes. For instance, of Vasco da Gamaâs crew of 160 men who sailed with him around the Cape of Good Hope in 1497, 100 died of scurvy. In 1601, an English sea captain, James Lancaster, conducted an experiment to evaluate the effectiveness of lemon juice in preventing scurvy. Captain Lancaster commanded four ships that sailed from England on a voyage to India. He served three teaspoonfuls of lemon juice every day to the sailors in one of his four ships. These men stayed healthy. The other three ships constituted Lancasterâs âcontrol group,â as their sailors were not given any lemon juice. On the other three ships, by the halfway point in the journey, 110 out of 278 sailors had died from scurvy. So many of these sailors got scurvy that Lancaster had to transfer men from his âtreatmentâ ship in order to staff the three other ships for the remainder of the voyage.
These results were so clear that one would have expected the British Navy to promptly adopt citrus juice for scurvy prevention on all ships. Not until 1747, about 150 years later, did James Lind, a British Navy physician who knew of Lancasterâs results, carry out another experiment on the HMS Salisbury. To each scurvy patient on this ship, Lind prescribed either two oranges and one lemon or one of five other supplements: a half pint of sea water, six spoonfuls of vinegar, a quart of cider, nutmeg, or seventy-five drops of vitriol elixir. The scurvy patients who got the citrus fruits were cured in a few days and were able to help Dr. Lind care for the other patients. Unfortunately, the supply of oranges and lemons was exhausted in six days.
Certainly, with this further solid evidence of the ability of citrus fruits to combat scurvy, one would expect the British Navy to have adopted this innovation for all shipâs crews on long sea voyages. In fact, it did so, but not until 1795, forty-eight years later, when scurvy was immediately wiped out. After only seventy more years, in 1865, the British Board of Trade adopted a similar policy and eradicated scurvy in the merchant marine.
Why were the authorities so slow to adopt the idea of citrus for scurvy prevention? Other, competing remedies for scurvy were als...