Using the Diffusion of Innovations framework to assess the adoption of a school health policy: North Carolina's Healthy Youth Act

North Carolina has been an abstinence-only state since 1995. In 2009, North Carolina's General Assembly passed the Healthy Youth Act, requiring all school districts to adopt an abstinence plus reproductive health and safety curriculum. Because each district is allowed to adopt and operationalize the policy differently and evidence shows that some districts were previously teaching more than abstinence-only education, the level of adoption of the Healthy Youth Act was expected to vary throughout the state. Using the Diffusion of Innovations framework, a mixed methods study was conducted to assess the level of adoption statewide to explore program attributes and perceptions which influenced the rate of adoption of the Healthy Youth Act in North Carolina school districts. Individuals in charge of the adoption from each school district were invited to participate in an online survey and upon completion, were given the opportunity to opt into the follow-up interview. The combined results indicate both the perceived relative advantage and compatibility of the program contributed significantly to the adoption of the Healthy Youth Act. Additionally, the perception of community needs influenced both these perceptions and the process of adopting the new curriculum. Discussion and recommendations will include how the perception of the community influences the steps of the adoption process and the utility of the Diffusion of Innovations framework as a guide to understand the adoption of future health policies both in North Carolina and nationwide.