Opinion Leaders

Opinion Leaders have informal influence on the attitudes and behaviors of people involved with implementing or delivering the innovation (Flodgren et al., 2011; Greenhalgh, Robert, et al., 2004; E. Rogers, 2003). Waltz et al. reported on one study that found that informing opinion leaders was the fifth most commonly recommended implementation strategy by participating implementation experts (Waltz et al., 2019).

The original CFIR elaborated on this role further by acknowledging that opinion leaders can exert a strong negative or positive effect (Locock et al., 2001). The role and definition of opinion leaders is varied and complex. Locock et al. highlighted two types of opinion leaders: experts and peers (Locock et al., 2001). Expert opinion leaders exert influence through their authority and status (see Opportunity) (Greenhalgh, Robert, et al., 2004). Peer opinion leaders exert influence through their representativeness and credibility (Greenhalgh, Robert, et al., 2004). Implementation Facilitators or Leads may use Opinion Leaders in a social system as “lieutenants” in diffusion activities (E. Rogers, 2003). Opinion leaders can lose the respect of their peers if they come to be regarded as a professional change agent (E. Rogers, 2003; L. Rogers et al., 2020). The effect of Opinion Leaders on promoting use of innovations is mixed based on a review of randomized control trials ranging from -6% to +25% in improving behaviors of healthcare professionals (Doumit et al., 2007).

Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.

Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Dorsey et al. identified five measures (Dorsey et al., 2021). Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), three (60%) of the measures could not be scored, one had a score of zero and the other a score of two. Results indicate the need for continued development of high-quality measures.

As we become aware of measures, we will post them here. Please contact us with updates.

Dorsey, C. N., Mettert, K. D., Puspitasari, A. J., Damschroder, L. J., & Lewis, C. C. (2021). A systematic review of measures of implementation players and processes: Summarizing the dearth of psychometric evidence. Implementation Research and Practice, 2, 263348952110024. https://doi.org/10.1177/26334895211002474.

Doumit, G., Gattellari, M., Grimshaw, J., & O’Brien, M. A. (2007). Local opinion leaders: Effects on professional practice and health care outcomes. The Cochrane Database of Systematic Reviews, 1, CD000125. https://doi.org/10.1002/14651858.CD000125.pub3.

Flodgren, G., Parmelli, E., Doumit, G., Gattellari, M., O’Brien, M. A., Grimshaw, J., & Eccles, M. P. (2011). Local opinion leaders: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD000125.pub4.

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q, 82(4), 581–629.

Locock, L., Dopson, S., Chambers, D., & Gabbay, J. (2001). Understanding the role of opinion leaders in improving clinical effectiveness. Social Science & Medicine, 53(6), 745–757. https://doi.org/10.1016/S0277-9536(00)00387-7.

Lewis, C. C., Mettert, K. D., Stanick, C. F., Halko, H. M., Nolen, E. A., Powell, B. J., & Weiner, B. J. (2021). The psychometric and pragmatic evidence rating scale (PAPERS) for measure development and evaluation. Implementation Research and Practice, 2, 263348952110373. https://doi.org/10.1177/26334895211037391.

Rogers, E. (2003). Diffusion of innovations: 5th ed. Free Press.

Rogers, L., De Brún, A., & McAuliffe, E. (2020). Defining and assessing context in healthcare implementation studies: A systematic review. BMC Health Services Research, 20(1), 591. https://doi.org/10.1186/s12913-020-05212-7.

Waltz, T. J., Powell, B. J., Fernández, M. E., Abadie, B., & Damschroder, L. J. (2019). Choosing implementation strategies to address contextual barriers: Diversity in recommendations and future directions. Implementation Science, 14(1), 42. https://doi.org/10.1186/s13012-019-0892-4.