Working alongside program & policy leaders to bring innovations to scale.



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Client Centered and Socially Focused

Effective practices too often fail to spread to those in need. When spread does occur, implementation is often not sustained or local adaptation renders the innovation ineffective. We work with technology and program innovators and their sponsors to design for diffusion by taking additional steps early in the process of creating an innovation, and throughout its lifespan, to increase the likelihood that it is noticed, positively perceived, accessed and tried, adopted and implemented and, thus, successfully crossing the research-to-practice chasm.

Highly Customized Work

Diffusion Associates works closely with clients to determine how to best spread, implement and assess innovations. Our work is theoretically based, practice focused and highly customized. Our work with clients includes:

• Readiness assessment of change agencies, delivery systems, and target populations.
• Critical assessment and selection of innovations for diffusion and target population(s).
• Network identification and partnership formation to increase the spread of innovations.
• Formative evaluation for the purpose of improving the likelihood of adoption by the target population.
• Implementation monitoring to identify opportunities for sustained use.
• Identification of positive reinvention by implementers and users to facilitate rapid improvement cycles in organizations.
• Outcome evaluation of promising practices to assess their effectiveness.

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R. Sam Larson (Ph.D., Michigan State University) is an Assistant Dean of Operations and Finance in the College of Education and an assistant professor in the Department of Educational Administration. Prior to joining MSU, Larson was the Director of Knowledge Management and Implementation Support at Kaiser Permanente Colorado. Her work there focused on identifying member's health needs and addressing them using evidence based treatment and prevention programs. Sam serves as the Director for Diffusion Associates (and prior to that Applied Research). In this role, she has built 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. At present, her primary areas of inquiry include collaboration strategies used to scale-up social innovations and the use of evidence in higher education decision making.

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James W. Dearing (Ph.D., University of Southern California) is Professor and Chairperson of the Department of Communication at Michigan State University. He has been Senior Scientist with Kaiser Permanente and on the faculties of several universities. Dearing has served on the National Academy of Science/Institute of Medicine framework committee for a programmatic review of the National Institute for Occupational Safety and Health, a Centers for Disease Control and Prevention Community Guide health marketing and health communication review committee, and was scientific advisor to the coordinating committee of the NIH Science of Dissemination and Implementation Research National Conference. He 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. At present, a primary interest of his is the role of health, education, and environmental policy entrepreneurs in helping to scale up pro-social innovations.


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.

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Project ECHO

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.

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Collaboration for Scaling Up Social Innovations

Wallace Foundation

This study 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.

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Dissemination & Implementation Planning for PrEP

Centers for Disease Control and Prevention (CDC)

Diffusion Associates worked with the CDC to apply a Designing for Diffusion (D4D) framework to the national introduction and scale-up of a biomedical intervention, preexposure prophylaxis (PrEP) for preventing HIV.

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Advise Seeking Network Identification

Rocky Mountain Health Plans

Working with the client, we helped to conceptualize, design and collect survey responses from among 450 family practice clinics. Once mapped, we identified an influence network that could be activated for the spread of best practices in health care.

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Building Bridges Initiative 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.

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Comprehensive Community Health Models Cluster Evaluation

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.


Informing Practitioners, Researchers & Policy Makers

Project ECHO for 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.

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 and others apply what is known about diffusion to the general case of biomedical interventions and specifıcally pre-exposure prophylaxis (PrEP). It defines designing for diffusion as the taking of strategic steps early in the process of creating and refıning an evidence-based intervention to increase its chances of being noticed, positively perceived, accessed, and tried and then adopted, implemented, and sustained in practice.

Designing for Diffusion: How Can We Increase Uptake of Cancer Communication Innovations?
Dearing and Kreuter conclude that augmenting current dissemination practices with evidence-based concepts from diffusion science, marketing science, and knowledge utilization hold promise for improving results by eliciting greater market pull in this journal article from Patient Education and Counseling.

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, fırst 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.

Why (we think) Facilitation Works: Insights from Organizational Learning Theory
Berta, Cranley, Dearing and others argue that our understanding of facilitation and its effects is limited in part by a lack of clear theoretical grounding and then propose a theoretical home for facilitation in organizational learning theory in this Implementation Science article.


Diffusion Associates

1777 Hitching Post, East Lansing, MI 48823

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Phone: 303.907.3794