Disability, Diversity and Dissemination:
A Review of the Literature on Topics Related to Increasing
the Utilization of Rehabilitation Research Outcomes
among Diverse Consumer Groups

PART 1 - Theoratical Framework

Introduction: Seeing and hearing "from a different position"

Linking disability research outcomes with the people who can use them is a complex task under any circumstance (NCDDR, 1997). The task is further complicated by, on the one hand, the enormous diversity in terms of broad demographic characteristics among people with disabilities and their families, and on the other hand, the relative homogeneity among rehabilitation researchers and service providers (Smart & Smart, 1997; Bradsher, 1995). Circumstance, race, culture, language, experience, and belief can influence people's access to information and services; their roles in and treatment by agencies and by other individuals; their goals for rehabilitation and independent living; and the kinds and sources of information they find to be credible and useful.

Communicating effectively — including both giving and receiving information, so that researchers and service providers clearly understand the needs and circumstances of those they seek to help, and so that consumers understand the uses, requirements, limitations, and benefits of research outcomes and rehabilitation services — is one of the most difficult elements in this equation. As the writer Hannah Arendt (1958, cited in Greene, 1993, p. 13) once observed, each person "sees or hears from a different position," and sometimes what individuals see and hear can diverge strongly.

Another way of considering this concern is to think of information as "culture specific." According to Cochrane and Atherton (1980, cited in Metoyer-Duran, 1991, p. 320) "the proper unit of analysis for considering information services in a culturally pluralistic society should be the 'cultural community,' which is composed of potential users who may have distinct values, beliefs, and attitudes towards external information services." Metoyer-Duran also quotes Menon's (1983) observation that, because information is culture specific it is, consequently, "largely incommunicable unless it has been 'acculturated'" (p. 320). A major element in the dissemination and utilization process, then, is to find ways of "acculturating" information about rehabilitation research outcomes, a task that includes listening as well as speaking.

Such a task, in some ways at least, may sound deceptively simple: Gather information about a specific culture and tailor the resulting materials and media accordingly. However, there are a number of complicating factors, discussions of which will form the bulk of this literature review:

• Concepts of race, ethnicity, and culture are often intertwined and misapplied, and often in ways that result in stereotyped beliefs about groups and individuals.
• It is problematic to assume that minority groups share a common culture or other characteristics. Rather, it is important to look at subpopulations, seeking to identify commonalties and differences. As Bartolome and Macedo (1997) conclude, "We need to avoid the lumping of multiple identities into a monolithic entity such as race or ethnicity" (p. 224).
• The concept of culture refers not only to groups of people who can be distinguished by a common geography, bloodline, language, and/or set of customs. One can also speak of what Mason (1994) describes as "non-ethnic cultural groups," including, for example, "lesbians and gays, elders, women, people with disabilities, religious minorities, and others" (p. 1).
• As Sonia Nieto observes, "culture is often thought of as a characteristic rather than a process" (Kenyatta & Tai, 1997b, p. 176). However, it is in reality fluid, constantly evolving.
• It is often difficult to sort out factors that are related to culture rather than to socio-economic status or other life circumstances.
• The issue of power — of institutionalized patterns of inequity that lead some groups to be subordinated to a dominant, "mainstream" group — is one of the greatest barriers to the development of a rehabilitation research and service system that is responsive to the needs of all people with disabilities. The volatility of this issue makes it extraordinarily difficult to examine and address.

Many reports addressing the topic of diversity consist primarily of lists and descriptions of characteristics that differentiate "minority" cultures from that of mainstream U.S. culture, and discussions of ways that researchers and rehabilitation professionals can become more sensitive to those differences. This review will address some of those descriptions. But a broader conceptual orientation is necessary in order to get to the most persistent barriers and misunderstandings.

As noted above, diversity is a broad concept. However, the rehabilitation-related literature on this topic is limited, particularly literature that is grounded in empirical research. Material that does exist focuses almost entirely on racial and ethnic groups rather than on "non-ethnic" cultural groups. The scope of this literature review, therefore, is largely restricted to discussions related to racial and ethnic diversity. Another limitation is the lack of systematic information about the characteristics and processes of rehabilitation research environments. Where the rehabilitation literature does address diversity issues, the focus is almost exclusively on service delivery, primarily via rehabilitation counseling. There is a small but growing body of material regarding the implications of cultural diversity for research and knowledge utilization in more general contexts, but little or none of this work specifically addresses the rehabilitation field.

Given the restricted research base, it is difficult to draw firm conclusions about many aspects of disability, diversity, and the dissemination process. Where possible, however, this document attempts to incorporate relevant information from other disciplines, particularly the literature on minorities and public health services, and educational and sociological inquiries into relations between minority and majority groups. It also attempts to apply the available information to the process of linking rehabilitation research outcomes with potential users, suggesting implications for the activities of identifying research needs, designing and conducting research, disseminating research outcomes, and promoting the utilization of those outcomes among targeted users.

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