James W. Dearing

Effectively translating health promotion, disease prevention, and healthcare research results into evidence-based innovations (new practices, programs, policies, and technologies) in public health and healthcare settings is a complex challenge – even when the innovations in question are simple. When those innovations are complex, these challenges are exponentially more pronounced. Complex health innovations often involve multiple components, reliance on repeated enactment by organisational staff, and multifaceted consequences for interest-holders, which means that the task of effective and sustained translation can be daunting. In this chapter, we distinguish two processes – dissemination and diffusion – and show both how they are distinct and how they are related when strategising about complex new interventions in health. We call this designing for diffusion.

Project Extension for Community Healthcare Outcomes (Project ECHO), a telementoring intervention in which medical specialists share knowledge with medical generalists, has spread to many sites during its 22 years, reaching providers in nearly 200 countries. Based on our familiarity with the ECHO Institute, its practices, and our work with ECHO implementers at many sites, we explain the diffusion of this telehealth intervention in which medical specialists and generalist providers mentor each other in delivering specialty care to patients. We find the diffusion of Project ECHO to be well-accounted for by traditional factors including the perceived attributes of the ECHO model, the status of prominent ECHO adopters, and the inter-organizational environment within which the model arose. We also identify aspects of the ECHO model that have not always figured prominently in studies of diffusion but likely stimulated diffusion in this case. These include charismatic leadership, model elasticity, optional evaluation, and bounded elasticity. The Project ECHO experience can inform the decisions by proponents of other health care innovations to accelerate and broaden diffusion.

Global health reciprocal innovations originate in low-income and middle-income countries as well as high-income countries before their developers communicate about them with potential adopters in other countries as a transnational team. While communication technology has enabled a more rapid and broader sharing of information about innovations to prevent disease and improve health, innovations of various types have spread among countries, at all levels of income, for many centuries. In this article, we introduce the idea of reciprocal coproduction as a basis for the international sharing of information about innovations that exhibit potential for improving global health. Reciprocal coproduction occurs through two relational team-based processes: developer-led reinvention of an innovation so that it retains its desirable causal effects and implementer-led adaptation of that innovation so that it is compatible with new contexts into which it is introduced. Drawing on research and our own experiences across a range of health issues, we discuss common barriers to reciprocal coproduction and the diffusion of reciprocal innovations. We conclude with lessons drawn from dissemination and implementation science about the effective translation of reciprocal innovations from country to country so that researchers, policy-makers and social entrepreneurs can best ensure equity, accelerate adoptions and heighten the likelihood that global health reciprocal innovations will make a positive difference in health.

Across the globe, there are successful health innovations that could help improve public health in US communities at lower cost and with higher effectiveness than standard practice. However, which factors should be considered to heighten the likelihood of successful transfer of global health ideas to the US still warrants more empirical investigation. This study aimed to develop a conceptual framework delineating important factors to be considered for successful introduction of global health innovations to US communities, based on diffusion of innovations literature and case studies of global health innovations that have been adopted in US communities. Five global health innovations adopted in US communities were selected based on expert panel recommendations and a review of academic and gray literatures. These innovations had diverse origins (Columbia, Mexico, South Africa, Sweden, and Wales) and exhibited various means of achieving desired health outcomes. We conducted archival research and 27 interviews (42 interviewees) with leaders and stakeholders of the five innovations to identify important factors for the transfer of global health innovations to the US. Six factors were determined to be important for global health innovation adoption in the US: (1) innovation attributes, (2) linking agents, (3) inter-organizational partnerships, (4) scale up strategies, (5) implementation processes and outcomes in US communities, and (6) policy and social context. These factors correspond well to factors emphasized in the diffusion of innovation literature, although the importance of some sub-factors (e.g., stigma regarding the origin of innovations) diverged from the literature. Based on our findings, we developed the Designing for Diffusion Framework for Global Health Innovations. The framework provides a comprehensive picture of factors that can be facilitators or hindrances for moving a global health innovation to the US to help smooth the diffusion process for better adoption and implementation in US communities.

Physical activity after cancer diagnosis has been consistently associated with improvements in quality of life and prognosis. However, few cancer survivors meet physical activity recommendations, and adherence is even lower among those living in rural settings. The purpose of this quasi-experimental study was to evaluate the implementation of a clinic-based physical activity program for cancer survivors at a rural community oncology setting. We also examined changes in quality-of-life measures among 24 cancer survivors participating in the physical activity program and described challenges and opportunities to optimize future implementation efforts in rural settings. Significant pre- to post-program improvements in fatigue (5.5 to 6.8; p = 0.03), constipation (7.7 to 9.0; p = 0.02), pain (6.7 to 8.0; p = 0.007), and sleep quality (p = 0.008) were observed. Participants also reported improved nausea, stamina, depression, stress, and overall physical health after participation in the physical activity program, although the differences were not statistically significant (all p-values > 0.13). However, the reach of the physical activity program was limited, with only 0.59% of cancer survivors participating. Fidelity to the physical activity program was relatively high, with 72.7% of survivors participating in at least five classes. Our findings suggest that physical activity programs in oncological settings may need tailoring to effectively reach rural cancer survivors.

For billions of people, the threat of the Novel Coronavirus SARS-CoV-2 and its variants has precipitated the adoption of new behaviors. Pandemics are radical events that disrupt the gradual course of societal change, offering the possibility that some rapidly adopted innovations will persist in use past the time period of the event and, thus, diffuse more rapidly than in the absence of such an event. Human-machine communication includes a range of technologies with which many of us have quickly become more familiar due to stay-athome orders, distancing, workplace closures, remote instruction, home-bound entertainment, fear of contracting COVID-19, and boredom. In this commentary I focus on Artificial Intelligence (AI) agents, and specifically chatbots, in considering the factors that may affect chatbot diffusion. I consider anthropomorphism and expectancy violations, the characteristics of chatbots, business imperatives, millennials and younger users, and from the user perspective, uses and gratifications.

Rapid diffusion of solutions to a changing climate is paramount if the US is to mitigate carbon emissions. A timely response depends on how people perceive and understand innovations such as new pr...

Community engagement is a vital aspect of addressing environmental contamination and remediation. In the United States, the Superfund Research Program (SRP) forms groups of academic researchers from the social and physical sciences into Community Engagement Cores (CECs) and Research Translation Cores (RTCs), which focus on various aspects of informing and working with communities during and through the resolution of environmental crises. While this work typically involves engaging directly with members of affected communities, no two situations are the same. In some cases, alternative approaches to community engagement can be more appropriate for community improvement than traditional approaches. In particular, when research teams become involved in contamination crises at a late point in the process, their contributions can be better directed at supporting and reinforcing the work of institutional stakeholders charged with remediating pollution. Relevant factors include issue fatigue among a local population, and contamination that is due to a major employer. Supported by literature and experience, we offer several propositions that we believe lay out conditions that warrant such an approach by academic teams, rather than their direct engagement with unaffiliated individuals in communities.

Loss of property value is a major concern in communities faced with the toxic byproducts of industrial practices. Even after site remediation, stigma may persist and negatively affect market values of residential properties. To study the effects of contamination and of remediation on property values in Midland, Michigan, where dioxins have been released into the environment through the incineration of contaminated waste and the discharge of contaminated water for many years, records of assessed value were obtained for 229 homes within the same neighborhood for the previous 18 years. A multilevel, longitudinal analysis was conducted to determine if there was a relationship between level of dioxin and assessed value after controlling for housing characteristics. Remediated and un-remediated properties saw increases in value at a similar rate over time. However, a property’s level of dioxin was found to have a small, significant, and negative relationship with assessed value, and this negative effect was present regardless if a home had been remediated or not. These results suggest that while environmental remediation may be effective at removing the contamination, its economic effects may persist for a longer period of time.