What are we actually trying to change?

The tension

Adoption sounds precise. In practice, the word is often used for almost any sign that a microbiome proposition is moving forward.

• A consumer orders a test.
• A clinician uses one with a patient.
• A laboratory agrees to a pilot.
• A pharmaceutical company evaluates a platform.
• A commercial partner signs a contract.

Each matters. None tells us, on its own, whether adoption has occurred. The distinction is important because each describes something different. Low awareness is not the same problem as low trial. Low trial is not the same as weak repeat use. And repeated individual use is not the same as a proposition becoming part of routine organisational practice. Calling all of these adoption can hide where the real problem sits.

The better starting question is simpler: what are we actually trying to change?

What recurs

Across microbiome propositions, three patterns make the distinction particularly important.

Trial gets mistaken for adoption. Novelty still carries weight in the microbiome. Consumers are curious. Scientists explore new datasets. Clinicians participate in studies. Companies evaluate emerging platforms. A first use tells us that someone was interested, motivated or supported enough to try something. It tells us much less about what happens when the novelty and additional support disappear.

The technology becomes the unit of adoption. Companies ask how to drive adoption of a test, platform or product. But people rarely change behaviour because a technology exists. They change when it helps them do something that matters better, faster, with greater confidence or with enough additional value to justify the effort.

The apparent user gets too much attention. The person who benefits from a microbiome proposition may not be the person who uses it, buys it, approves it or can prevent it from entering routine practice. Adoption can depend on several behaviours changing together.

The common problem is not simply insufficient adoption. It is insufficient precision about what adoption means in that particular situation.

Case in point

Consider a microbiome diagnostic intended to influence a clinical decision. The clinician appears to be the user. But routine use may depend on much more than the clinician deciding that the science is interesting. The laboratory has to process the test reliably. The result has to arrive at the right point in the pathway. The clinician has to understand and trust the output. The information has to change a decision that matters. The patient may need to act on it. The organisation may have to fund it. A payer or evidence committee may need enough confidence to support its use.

There is no single adoption decision here. There is a chain of behaviours, and each person faces a different question. The laboratory may care about workflow and reproducibility. The clinician may care about utility and responsibility. The patient may care about what changes as a result. The organisation may care about cost and outcomes. One part of the chain can work while another stops the proposition entirely. This is why strong interest from the apparent customer can be misleading. Someone can want a microbiome proposition without the system around them being able to use it.

Strategic interpretation

Defining adoption around behaviour changes how the problem is approached.

• Name the behaviour. “Drive adoption” is not specific enough. Define who needs to do what differently for the proposition to create value.
• Understand what happens today. A clinician already makes the decision somehow. A laboratory already has a workflow. A consumer already behaves in a particular way. Even doing nothing is an existing behaviour.
• Define what sustained means. A first use, pilot or purchase shows movement. Adoption requires some form of continuation under ordinary conditions.
• Map the behaviours around the user. The buyer, user, beneficiary, gatekeeper and decision-maker may be different people. Each may have a different reason to move or not move.
• Measure the change. The useful metric is the one that shows whether the intended behaviour is actually becoming established.

This moves adoption away from a general commercial objective and makes it something that can be examined directly. Who changes? What changes? Why would they change? What prevents them from changing? What would tell us that the change has lasted? Those questions are more useful than asking whether the market is adopting the technology.

The current way has an advantage

New microbiome propositions do not enter empty space. Something already happens today. A clinician already makes a decision without the new test. A laboratory already has a workflow. A consumer already manages health using other information. A pharmaceutical company already selects patients, biomarkers and development strategies using established approaches. Even doing nothing is an existing behaviour.

The current way has an important advantage: it already works well enough to persist.

A new microbiome capability may generate richer information, reveal previously invisible biology or improve a measurement. But the person expected to use it is making a different comparison. They are comparing what they do today with what they would have to do tomorrow. That comparison includes scientific performance, but also effort, confidence, time, cost, workflow, responsibility and risk. The strategic question is therefore not simply whether the microbiome proposition is better. It is whether it is better enough to change what someone already does.

Who can say no?

Once adoption is viewed as a set of behaviours rather than a product being accepted by a market, another question becomes important. Who has to say yes? And who only has to say no once? A scientist may champion the technology. A clinician may see its potential. A patient may want it. But procurement can block it. A laboratory may lack capacity. An evidence committee may remain unconvinced. A commercial partner may decide integration is too difficult. The person who stops adoption may sit some distance from both the microbiome science and the eventual benefit.

This is why mapping adoption only around the apparent customer can miss the real constraint. Sometimes the most important behaviour to understand belongs to someone who will never use the product at all.

The future

As microbiome technologies move further into healthcare, therapeutics, nutrition, agriculture and other established systems, defining adoption around behaviour will become more important. The science will improve. Measurements will become more reliable. Interpretation will become more sophisticated. Some microbial signals may become genuinely useful in decisions that matter. But the closer microbiome information moves to those decisions, the more it enters systems with existing workflows, professional judgement, incentives, responsibilities and constraints. In some cases, success will mean persuading someone to adopt a new microbiome product. In others, the strongest outcome may be that nobody thinks they are adopting the microbiome at all.

The microbial information simply becomes part of a treatment decision, a diagnostic pathway, a formulation, a development programme or an agricultural intervention. At that point, the microbiome is not the behaviour being adopted. It is what makes a better behaviour possible.

What changes now

• Name the behaviour. Replace “drive adoption” with a precise description of who needs to do what differently.
• Understand the existing behaviour. Ask why the current way persists before assuming that a scientifically better alternative will replace it.
• Separate trial from sustained use. Decide what would demonstrate that the new behaviour continues when novelty, additional support and exceptional attention disappear.
• Map everyone who matters. Identify the user, buyer, beneficiary, decision-maker and gatekeeper, and the behaviour required from each.
• Measure the change itself. Attention, pilots and first purchases matter, but the stronger signal is whether the intended behaviour becomes part of ordinary practice.

Three questions for the executive team

• What, precisely, must someone do differently for our microbiome proposition to create value?
• Why does the current behaviour persist, and is our alternative better enough to change it?
• What would tell us that the new behaviour has become normal rather than simply tried?

The bottom line

Microbiome adoption does not happen when somebody understands the science, tries the product or makes a first purchase. It happens when the science becomes useful enough to change what someone normally does, and that change persists. Before asking how to drive adoption, be clear about what you are actually trying to change.