[Continuation 3 of 3:]
Characteristics of effective systems and relationships

Issues in dissemination and utilization. Although information is limited regarding dissemination and utilization (D&U) strategies targeted specifically to minority populations, there is a considerable literature base describing D&U processes in general. Experts now understand knowledge utilization as a learning process in which the potential user, or consumer, is "an active problem-solver and a constructor of his or her own knowledge," not merely "a passive receptacle of information and expertise," as earlier D&U theories had suggested (Hutchinson & Huberman, 1993, p. 2). Knowledge is no longer thought of as an inert object to be "sent" and "received," but rather as a fluid set of understandings that are shaped by those who use it as well as by those who originate it (NCDDR, 1996).

The relationships between the potential user and the D&U source, content, context, and media used are critical determinants of effectiveness, with attention to particular user groups as the most central concern. Findings related to the D&U process that have appeared to have particular implications for work with minority persons with disabilities and their families are outlined below.

Credibility and trust. Potential users of research outcomes tend to accept assistance, information, and ideas from sources they know and trust (Carrillo, Lumbley, & Westbrook, 1990; Fullan, 1991; Robinault, Weisinger, & Folsom, 1980). Users tend to be more concerned about the source of the information that is disseminated than about the specific content of the information (Hutchinson & Huberman). Some studies suggest that the source's perceived expertise is less important to users than trustworthiness in obtaining user support (Marquart, O'Keefe, & Gunther, 1995). Given the findings regarding cultural mistrust (discussed in Volume 4, Number 1: Inequities and the rehabilitation system), the importance of establishing credibility and trust with minority populations cannot be overemphasized. And cultural responsiveness is essential to establishing such confidence (Schaller, Parker, & García, 1998).

Utility. If research outcomes are to be used, they must be perceived by potential users as relevant to their needs and daily lives. Dentler (1984), among others, stresses that "the property of knowledge that is essential for [use] is its congruence with the real world of practice" (n.p.). Similarly, a study of Tennessee school systems reported by West and Rhoton (1992) concludes that "the strongest barrier to research utilization statewide was the [perceived] non-practical focus of research reports" (p. 13). For effective D&U, then, researchers must know a great deal about the priorities, needs, environments, and circumstances of their intended users, and must tailor their outcomes and information accordingly.

Cultural responsiveness. To be effective, D&U strategies must be appropriate within potential users' cultural contexts (Duarte & Rice, 1992). This includes understanding and addressing users' perceptions about disability, family, and propriety. Information about research outcomes also must be easily understandable by potential users. Leung (1992), for example, reports that "language differences" are a primary cause of negative attitudes about researchers — not only in terms of English vs. other languages, but in terms of dense, technical descriptions that assume a vocabulary and contextual knowledge most nonresearchers do not possess.

It is also critical to know what dissemination channels are available to, and used by, potential user groups (Edwards, 1991). Leung (1992) notes that one of the most elementary — and important — guidelines for selecting a dissemination medium is that "utilization will not occur if persons with disabilities cannot physically gain access" (p. 299).

Personal contact. Perhaps the most consistent finding in the literature on knowledge utilization is the importance of personal contact for the success of dissemination activities. As Fullan (1991) notes, "The primacy of personal contact in the diffusion of innovations has been known for years" (p. 53). This finding has significant implications for D&U activities targeted to minority populations. To provide for personal contact with potential users, most research agencies must rely on intermediaries. However, relying solely or primarily on intermediaries from government agencies and service providers within the rehabilitation system is likely to prove inadequate. Many people who are oriented to traditional minority cultures tend to seek help outside the established rehabilitation and medical systems, and it is important for researchers to broaden their contact to include these community resources, including, among others, community agencies and organizations, informal community leaders, church personnel, and healers (Schensul, 1992). In addition, persons from lower socioeconomic brackets — who are disproportionately from minority populations — often require special outreach efforts due to their lack of access to mainstream services and resources.

D&U research findings targeted specifically to minority populations. As noted earlier, the research literature contains limited information regarding dissemination media and methods that have proven effective with specific minority populations. However, a few studies exist that suggest promising strategies, at least within the limited contexts studied:

• Metoyer-Duran (1991, 1993) has conducted studies suggesting that "ethnolinguistic gatekeepers" within traditional cultural communities serve as "information and referral agents" (1993, p. 365). Her research suggests "that gatekeepers have greater awareness of and use more information resources than other community members, even when controlling for educational level, employment status, income, and longevity in the community" (1991, p. 325). Metoyer-Duran found that these gatekeepers draw on a number of information sources, including mass media, print, and institutional representatives. However, they are most likely to consult interpersonal sources. To access gatekeepers as potential dissemination channels, she recommends "establishing close relationships with other institutional sources used by gatekeepers" (1993, p. 368).
• Schensul (1992) and colleagues conducted research to help identify dissemination strategies that could effectively deliver information about Alzheimer's disease to elderly Latinos in the U.S.. Among the strategies they tried were presentations in churches, pamphlets left in churches, a community conference, an art exhibit of "symptom depiction cards" drawn by "a well-known Puerto Rican artist" (p. 21), contact with informal building leaders, botánicas, Spanish radio, Spanish and English neighborhood newspapers, and community outreach via service providers. They found that, of the public media they tried, Spanish radio proved the most effective dissemination channel. The authors found "that most Latino elderly prefer listening to one or two specific stations, and do so regularly throughout the day." The authors recommend appearances on radio call-in shows over the more commonly used Public Service Announcements (PSAs), noting that PSAs "hold limited attention and come on infrequently. More effective are call-in shows, especially those focused on the general problems of Latino elderly. . . The Spanish language call-in show is an extremely important untapped venue for dissemination of health-related information because it is interactive" (p. 23). Regarding the effectiveness of Spanish language newspapers, the study found that they were "widely read, but when questioned, readers did not mention knowledge of Alzheimer's Disease or its management" (p. 23).
• Schensul also reports that, because elderly Latinos tend to fear the diagnosis of Alzheimer's disease, standard presentations on the disease that include discussions of etiology, symptoms, natural history and management, "will not be received and may in fact reduce the likelihood that seniors and their families will report symptoms to a physician. Any technique which uses informal dialogue about daily or historical aspects of participants' lives will be more successful in opening the door to 'discovering' dementia" (p. 26).
• Ward et al. (1993) describe a study of targeted media campaigns designed to address the underutilization by racial and ethnic minorities of a telephone-based cancer information service. They found that, among all audience groups, television was the most effective medium in increasing the number of telephone inquiries. However, they also found that the effects of the special promotional campaigns, whether via television or other media, tended to be short term.
• Online technologies represent an increasingly important dissemination strategy, but many people still lack access. Although some studies suggest that racial differences in computer and Internet use are shrinking in the U.S., differences persist. Wilhelm (1996), for example, reports on computer use among Latinos in the U.S. and notes that "civic networking" via the Internet "is evolving into an important public space" via networks such as LatinoNet and ChicanoNet. However, even after controlling for variables such as income and education, "Latinos still experience lower levels of computer access than do non-Latinos" (p. 23). In another report, Wilhelm (1995) notes that "overall, there are still 4.4 million households in the U.S. that go without a phone. Among Latinos, 13.3 percent of all households function without immediate access to a telephone" (p. 3).

---

Top