title: 'They hear "Africa" and they think that there can't be any good services'--perceived context in cross-national learning: a qualitative study of the barriers to Reverse Innovation.
abstract: BACKGROUND
  Country-of-origin of a product can negatively influence its rating, particularly if the product is from a low-income country. It follows that how non-traditional sources of innovation, such as low-income countries, are perceived is likely to be an important part of a diffusion process, particularly given the strong social and cognitive boundaries associated with the healthcare professions.
  
  
  METHODS
  Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in Reverse Innovation in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also to understand whether, in their experience translating or attempting to translate innovations from low-income contexts into the US, the source of the innovation matters in the adopter context. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison.
  
  
  RESULTS
  Our findings show that innovations from low-income countries tend to be discounted early on because of prior assumptions about the potential for these contexts to offer solutions to healthcare problems in the US. Judgments are made about the similarity of low-income contexts with the US, even though this is based oftentimes on flimsy perceptions only. Mixing levels of analysis, local and national, leads to country-level stereotyping and missed opportunities to learn from low-income countries.
  
  
  CONCLUSIONS
  Our research highlights that prior expectations, invoked by the Low-income country cue, are interfering with a transparent and objective learning process. There may be merit in adopting some techniques from the cognitive psychology and marketing literatures to understand better the relative importance of source in healthcare research and innovation diffusion. Counter-stereotyping techniques and decision-making tools may be useful to help decision-makers evaluate the generalizability of research findings objectively and transparently. We suggest that those interested in Reverse Innovation should reflect carefully on the value of disclosing the source of the innovation that is being proposed, if doing so is likely to invoke negative stereotypes.
authors.affiliation: Institute of Global Health Innovation, Department of Surgery and Cancer, Division of Surgery, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK. m.harris@imperial.ac.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Harris
authors.affiliation: Commonwealth Fund, 1 East 75th Street, New York, 10021, USA. EW@CMWF.org.
authors.forename: Emily
authors.initials: E
authors.lastname: Weisberger
authors.affiliation: Department of Nutrition, Food Studies and Public Health, New York University, 411 Lafayette Street, New York, 10003, USA. drs1@nyu.edu.
authors.forename: Diana
authors.initials: D
authors.lastname: Silver
authors.affiliation: UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Room 31-235B, Center for Health Sciences, Los Angeles, CA, 90095-1772, USA. jmacinko@g.ucla.edu.
authors.forename: James
authors.initials: J
authors.lastname: Macinko
mesh_terms: D000349:Africa; D015982:Bias; D003695:Delivery of Health Care / Q000379:methods*; D006801:Humans; D007858:Learning; D009936:Organizational Innovation; D011287:Prejudice; D036301:Qualitative Research