The role of linking agents in the diffusion of health promotion programs.

This article examines the role of state health department dental offices as linking agents in the diffusion of an effective preventive health program, the fluoride mouthrinse program (FMRP) in public schools. The aim of this program is to prevent dental caries by a weekly mouthrinsing by elementary school students. In contrast to the traditional focus of diffusion research on characteristics of the innovation and characteristics of the adopter, this study emphasizes an ecological approach, i.e., the transmittal mechanisms for diffusion. The state dental offices are examined as linking agents, which serve as program advocates or champions for diffusing the FMRP from the national level, where it was developed, to the thousands of local school districts and schools for adoption and continued delivery. Using data from interviews with state dental directors and archival sources, a multivariate model was developed and used to explain the percent of a state's elementary schools using the mouthrinse program. The results support the key role of linking agents in disseminating effective health promotion programs into actual use. Implications are discussed for both research and practice.