Diffusion Associates

Are you seeking to improve the lives of more individuals and help more communities?

Diffusion Associates can help. 

We design and assess interventions with scale in mind.

Effective practices often fail to spread to those in need. When spread does occur, implementation may not be sustained or local adaptation renders the innovation ineffective. 

We work with program innovators and sponsors to scale out interventions so they can serve more people with comparable benefits. 

We do this by focusing on the characteristics of the innovation, organizational readiness, community structure, and fidelity.  


Scaling Social Innovations

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Innovation characteristics

Innovation characteristics describe how we think about new practices and programs. Is it too costly or complex? Does it reliably work well? Does it fit with our needs and ways of work? Perceived characteristics like these can go a long way in determining how others perceive an innovation. Related questions are important too. Are the innovation’s components well defined and tied to a theory of change? Which components can be adapted to a local context and which should not? We help to answer these and other questions about innovations to increase and accelerate adoption.

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Organizational readiness

Organizational readiness tools can be applied to the organization that developed the innovation to assess its willingness and capacity to support adoption by others and the potential adopting organizations as a way to assess their preparation to implement an innovation that they will then introduce in a community. Does the developer have the infrastructure to support scaling? Which scaling pathway, and which partners, make the most sense? What organizational factors are key to effective and sustained use? We help to determine organizational readiness to scale out or adopt, implement, and sustain an innovation.

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Community structure

Community structure is the informal network of relationships among potential adopting organizations or communities. When you know who influences whom, you have a chance to increase the number of adopters and the pace of adoption. Which organizations are opinion leaders in a county or city? And across counties or cities, which ones do the majority of others look to for advice when confronted with an interesting innovation? We help identify influencers who can move innovations into systems.

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Fidelity is the extent to which a new practice or program is implemented by subsequent adopters in the way that was intended by its developers. Does the innovation need to be changed to heighten its successful implementation? What types of adaptations are appropriate and even advantageous? How will implementation and impact be evaluated? We help clarify fidelity expectations and align them with evaluation designs.

Our Team

A Collaborative Approach

Diffusion Associates takes a collaborative approach to work – you are part of our team. Diffusion Associates draws on the knowledge and expertise of colleagues across the country to ensure we have the right team to work with you. 

R. Sam Larson

PhD, Michigan State University

Diffusion Associates is led by R. Sam Larson (Ph.D., Michigan State University). Larson builds collaborative teams drawing on the strengths of researchers and practitioners from across the country. She has led and collaborated on numerous evaluations of educational and social service programs supported by funders such as the Robert Wood Johnson Foundation, The Wallace Foundation, the W.K. Kellogg Foundation, the State of Michigan, and the U.S. Centers for Disease Control and Prevention. She was on faculty at Ohio University and the University of Denver, an internal evaluator and knowledge management director in Kaiser Permanente, and an administrator at Michigan State University. 


James W. Dearing

PhD, University of Southern California

Brandt Endowed Professor in the Department of Communication at Michigan State University. Dearing studies the strategic use of diffusion of innovation concepts to accelerate the spread of evidence-based practices, programs, and policies as a form of translational science.

Caryn Medved

PhD, University of Kansas

Professor and Graduate Program Director at Baruch College with the City University of New York. Medved has expertise in qualitative methods and offers workshops in qualitative analysis. She has conducted in-depth interview-based research for the last two decades on issues of gender, work, and family. 

Nagesh Rao

PhD, Michigan State University

Professor and Chair of the Department of Social Medicine, Heritage College of Osteopathic Medicine, at Ohio University. Rao’s scholarly work focuses on cultural competence, diversity, inclusion in health care, and the strategic role of intercultural communication in creating healthy individuals and communities. 

Brandon Walling

PhD, Michigan State University

Health Communication Specialist at The MITRE Corporation. Walling’s work explores mental health communication via mixed methodologies using quantitative and qualitative data analysis. 

Tom Backer

PhD, University of California Los Angeles

Senior Research Fellow, Center for Southern California Studies at California State University Northridge, where he also is Executive Director of Valley Nonprofit Resources. Backer studies and works with people, organizations, and communities to help them meet the challenges of innovation and change.

Projects & Clients

A Well-Rounded Portfolio

In addition to the selected projects and clients listed below, Diffusion Associates team members have individually worked on a variety of projects with many clients including the Bill & Melinda Gates Foundation, Robert Wood Johnson Foundation, the National Science Foundation, the National Institutes of Health, and numerous other State and Federal agencies and nonprofits.

Project ECHO: Implementation Study

Robert Wood Johnson Foundation
Working with 25 Implementation Fellows, we studied the adoption, implementation, and planned sustainability of 62 ECHO programs across 34 ECHO hubs. Potential adopters and implementers of ECHO can read a set of FAQs and implementation profiles at Project ECHO Adoption and Implementation Guidance: Lessons from the Field. Data analysis continues and will be updated here.  

Project ECHO: Review and Research Agenda

Robert Wood Johnson Foundation
This paper introduces Project ECHO (Extension for Community Healthcare Outcomes), describes its core components as an intervention, and briefly recount its ascent as a way to bring specialty health care to underserved rural populations. We conclude with suggestions for future evaluation and research to improve its performance in the field as it scales out.

Strategies to Scale Up Social Programs

Wallace Foundation
Scaling what works is a crucial component of systems change. How to scale (“pathways”), whom to involve (“partnerships’), and retention of program quality (“fidelity”) are three strategic decisions that are critical to the scaling out of effective social programs. This study explores these strategic decisions, how they are related, and how they can work in concert.

Comprehensive Community Health Models

W.K. Kellogg Foundation
A three-year cluster evaluation of a $28 million effort to affect the redesign of health systems in three Michigan counties. This multi-method theoretically-based evaluation framed from the perspective of diffusion of innovations included longitudinal surveys, interviews, archival data, cost analysis, participant observation, and quantitative modeling.

Building Bridges Initiative Cluster Evaluation

W.K. Kellogg Foundation
This multi-year $13.5 million project focused on developing nonprofit management education programs based on theory and practitioner experience. The corresponding multi-year cluster evaluation included formative evaluation of network development and innovation spread and a summative report of outcomes and impacts.

Designing the Diffusion of PrEP

Centers for Disease Control and Prevention (CDC)
In this American Journal of Preventive Medicine issue, Dearing, Larson, and others apply diffusion concepts to biomedical interventions and specifically pre-exposure prophylaxis (PrEP). We review strategic steps in creating and adapting an evidence-based intervention to increase its chances of being positively perceived, adopted, implemented, and sustained in practice.

Selected Publications

Informing Practitioners, Researchers & Policy Makers

Selecting and Implementing a Telemonitoring Program: Case Studies of Project ECHO

Extension for Community Healthcare Outcomes (Project ECHO) is a telementoring program for health professionals that uses adult learning techniques and interactive video technology to connect distal community providers with specialist and multidisciplinary teams in real-time collaborative sessions. Larson and Medved examine the adoption, implementation, and sustainability of ECHO programs at four academic medical centers in the journal Metropolitan Universities.

Project ECHO: Review and Research Agenda

This paper introduces Project ECHO (Extension for Community Healthcare Outcomes), describes its core components as an intervention, and briefly recount its ascent as a way to bring specialty health care to underserved rural populations. We conclude with suggestions for future evaluation and research to improve its performance in the field as it scales out. 

Strategies to Scale Up Social Programs: Pathways, Partnerships and Fidelity
This study funded by the Wallace Foundation and conducted by Larson, Dearing and Baker, assesses the conditions and circumstances that favor one scaling-up strategy over others. The primary focus is on collaboration and partnerships found in 45 social innovations that scaled up using different strategies.

An Agenda for Research on the Sustainability of Public Health Programs
In this American Journal of Public Health publication, Scheirer and Dearing provide guidance for research and evaluation of health program sustainability, including definitions and types of sustainability, specifications and measurements of dependent variables, definitions of independent variables or factors that influence sustainability, and suggestions for designs for research and data collection.

Design Research and the Diffusion of Innovations
This chapter in The Handbook of Design Research Methods in Education: Innovations in Science, Technology, Engineering and Mathematics Learning and Teaching by Larson and Dearing introduces the diffusion of innovation paradigm and explicates how, in the case of consequential innovations such as design research, diffusion operates. It poses questions that can facilitate a purposive diffusion strategy for accelerating the spread of design research as a new and effective methodology for use by educational researchers.

Designing for Diffusion of a Biomedical Intervention
In this American Journal of Preventive Medicine publication, Dearing, Larson and others apply what is known about diffusion to the general case of biomedical interventions and specifically pre-exposure prophylaxis (PrEP). It defines designing for diffusion as the taking of strategic steps early in the process of creating and refining an evidence-based intervention to increase its chances of being noticed, positively perceived, accessed, and tried and then adopted, implemented, and sustained in practice.

Diffusing STEM Pedagogies: The Role of Opinion Leaders
Larson and Meyer use literature and exploratory data to contrast awareness and persuasion and suggest that opinion leaders in academic departments can play a critical role in the diffusion of STEM pedagogies in this article from Metropolitan Universities.

Disseminating Proven Approaches to Physical Activity Promotion
Approaches from diffusion of innovations and social marketing are used to propose efficient means to promote and enhance the dissemination of evidence-based physical activity programs in this article by Dearing, Maibach and Buller published in the American Journal of Preventive Medicine .

How Centers Work: Building and Sustaining Academic Nonprofit Centers
In this publication from the W. K. Kellogg Foundation, Larson and Barnes share findings about the development and sustainability of academic nonprofit centers. They describe how these centers work – how they were created, who leads them, how they are lead, and how they gain academic credibility and institutional stability.

Local Reinvention of the CDC HIV Prevention Community Planning Initiative
In the Journal of Community Health, Larson, Dearing and others conclude that to fully achieve the potential of HIV prevention community planning a distinction should be drawn so that information-seeking tasks are centrally coordinated and decision-making tasks are decentralized.

Next Steps in Designing for Diffusion of Pre-Exposure Prophylaxis
Dearing, Norton and Larson suggest that pre-exposure prophylaxis, a biomedical intervention with potential to be highly effective if well implemented and used, appears well suited to sequential demonstration, first for experimental purposes with the objective of assessment of feasible delivery methods, and second for exemplary purposes with the objective of promoting its effective implementation in this article in the American Journal of Preventive Medicine.

Contact Us

Let's Be Thought Partners

If you’re seeking to improve the lives of more individuals and help more communities by scaling out an intervention(s), we are ready to talk.

Email: rsamlarson@diffusionassociates.com

Phone: 303.907.3794