Diffusion of Health Care Policy Innovation across States: A Case Study of Dense Breast Notification Legislation and the Influence of Patient Advocacy

The diffusion of health policy is a well-studied topic. The recent increased availability of information through the Internet and social media has enabled the formation of virtual patient advocacy groups . These policy entrepreneurs may be changing the dynamics of the diffusion of health policy. The purpose of this study is to use a specific case, the diffusion of dense breast legislation, to explore the manner in which the patient advocacy, and in particular virtual advocacy group have altered the manner in which policy diffuses among the states. In this case, the diffusion of the legislation occurred without any funding for expert resources, such as lobbyists, and was challenged by well-funded groups, e.g., state medical and radiology associations. Rather a virtual network of advocates drove legislative policy changes. A general inductive qualitative analysis of semi-structured interviews with key stakeholders in three states (early, middle and later adopter), identified the following key themes: 1. The Internet and Web 2. 0 allowed grass root groups with limited resources to drive state-level health policy diffusion. 2. The proposed legislation reached the top of the policy agenda in each state because of the convergence of personal stories, research and relationships. 3. Gender and the prevalence of breast cancer among women facilitated the policy process. 4. Policy change typically was driven by local state factors, with the experience of other states as a secondary contributor to the policy diffusion. 5. The success of these grass root organizations is highly dependent on the effectiveness of the policy entrepreneur