When considering how the lessons learned from science can be used by those audiences who might benefit from them, the term “research dissemination” (Lomas 1993) has been coined to focus on the active process by which information gleaned from science is actively communicated to those audiences who are thought to be most likely to benefit from this information. However, there is considerable confusion in terminology among those who focus on this important issue. Thus, “communication,” “diffusion,” and “dissemination” are often used interchangeably to describe the processes by which information from science is moved into the public or practice domains. Similarly, when focused on the benefits of research dissemination processes, knowledge transfer, translational research, research translation, knowledge integration, and knowledge implementation are often presented as comparable outcomes from research dissemination.
With respect to research dissemination processes, the terms “communication,” “diffusion,” and “dissemination” have overlapping but different meanings. As such, they are often confused with one another. In simplest terms, communication is the provision of information through sounds and signs (sight) that can be transmitted to single individuals, small and large groups, organizations, communities, and mass populations. Communication can also be transmitted through other senses (e.g., touch, smell), but this is usually restricted to transmissions to a single individual or between individuals, and rarely extends to larger groups or populations. Dissemination simply means to scatter widely, and the term “diffusion” is often used as a synonym for dissemination. Diffusion, in the context of chemistry, is the spontaneous migration of substances from regions where their concentration is high to regions where their concentration is low.
Thus, in the context of information and knowledge, prior to the availability of mass communication technologies (e.g., the printing press) information and knowledge were largely concentrated within religious and private libraries, universities, and academies, and communication was limited to correspondence and the distribution of a limited number of handwritten texts (Eisenstein 1979; Chartier 1987). Diffusion of information, where it did occur, was also limited to storytellers (e.g., religious) and oral reporters of official information (e.g., town criers). With the advent of mass communication technologies, diffusion of information became more rapid, the ability to actively disseminate information to larger audiences became possible, and the ability to tailor the information for particular audiences became a reality.
Passive Versus Active Communication
In the modern context of communication, diffusion and dissemination reflect a different level of action or effort to perhaps achieve the same outcome (i.e., widespread exposure to information). Thus, diffusion is often conceived as a relatively passive process, whereby “natural” channels of communication (e.g., word of mouth, reading) allow information to diffuse through individuals and social networks into larger populations, albeit slowly over time. With respect to information related to new ideas or technologies, this process has been labeled the diffusion of innovation (Rogers 2003) whereby creators of new information or innovators pass information on to early adopters and information continues to be communicated and used over time following an S-shaped curve (from mid to late adopters) until all the population of potential information users have been exposed to the innovation and most if not all are able to use it.
Dissemination, on the other hand, is associated with more active efforts to accelerate the transmission of information beyond passive individual communication channels to reach a wider audience and larger populations more quickly than passive diffusion (Lomas 1993). Effective dissemination involves several steps: (1) identifying audience characteristics that may make them more or less receptive to, or interested in, the information being disseminated; (2) understanding the context in which the information is likely to be used; (3) framing the information to maximize audience receptivity and contextual relevance; and (4) creating feedback mechanisms that allow monitoring of information exposure and use, enabling modification of dissemination strategies as receptivity and context change over time.
Understanding Different Audiences
The audiences in communication are many and varied, and are often recognized by the channels through which communication takes place to them. Thus, for example, the media, both entertainment and news, are seen as a communication channel to reach the general public. While media do segment the general public (e.g., demographically, psychographically, and geographically) to address the different appetites for information, media communication is designed to reach masses of individuals in a wide variety of personal settings (e.g., home, work, recreation). With respect to research dissemination, the news media in particular are regularly contacted by research agencies to alert them to new findings. As such both the news media and the research community may usually be focused on novelty rather than the significance of new scientific knowledge.
Commercial communication also reaches out to market segments of the general public, and has a broader set of communication channels including point of sale, personal sales representatives, as well as traditional media outlets. With the advent of the Internet, and computerized tracking of purchasing behavior, commercial communication has the led the way in developing and implementing individually tailored communications that frames the information in the context of past purchasing behavior patterns based on market research data collection. Thus, for example, discount coupons provided at supermarket checkout counters are tailored to past purchases, increasing the probability that similar or related products will obtained. Similarly, Internet sales websites provide their customers with email reminders and other forms of electronic communications about new opportunities to purchase goods or services that reflect their interests and past purchasing behavior.
Political communication, to promote candidates for office or political ideologies, has also adopted many of the commercial communication strategies of market research, market segmentation, and message framing to shape the information to fit the values or beliefs of target constituencies. While not nearly as sophisticated as either commercial or political communication, government and nongovernment organization communication efforts to reach the general public (e.g., to promote health, social well-being, and national security) have also attempted to take advantage of new communication technologies to improve the receptivity of information being communicated. While communication interventions vary widely in the extent to which information about the audience shapes the messages being communicated, they all share one thing in common: broad reach is more important than the magnitude of the response to the information communicated. Thus, for example, a small percentage increase in sales or change in voting behavior across a large population is considered more significant than a large impact in a relatively small proportion of the general population.
Dissemination on the other hand, while sharing many of the same concerns about audience characteristics as communication, is much more focused on the context in which information is used, and as such seeks to achieve a larger impact on a relatively limited population of information users who share the same practice context. For example, in the health arena, there are three very different practice contexts in which information may be used: public health, primary care, and disease specialty care practice. Disseminating research information about new approaches to promote health and prevent disease to public health practitioners, needs to recognize: (1) the level of training of most public health practitioners (e.g., masters or bachelors trained) to translate information into practical knowledge that can be applied in public health practice context; (2) the variation in resources in international, national, state, and local public health practice contexts that make possible or make difficult the implementation of public health interventions based on new health promotion information; and (3) the extent to which public health practitioners working for long periods of time in resource-limited practice contexts may or may not be amenable to change.
Similarly, in clinical practice settings, dissemination of research information to improve quality of care must be designed with three factors in mind: the rate of the dissemination for new clinically relevant information, the time constraints of clinical practice, and the variation in clinical infrastructure resources. With the explosion of access to research information and other information sources (e.g., patient blogs, professional associations) available to patients and providers from the Internet, a key challenge for both patients and providers is to sort through the enormous amount of information to separate the wheat from the chaff. For example, if the words “heart disease” are inserted into a Google search, 87,300,000 hits are returned. Similarly, if a search is made for “cancer control,” one gets 116,000,000 hits. Thus, for two of the leading causes of death in the developed world, there are over 200,000,000 links to information on the web from which to choose. In any service delivery context, but particularly in the clinical care context, this is a great deal of information to sort through and integrate into practice.
In the primary care practice context, the communication and dissemination challenges are even greater because patients may be coming in with any number of signs or symptoms of a health-related problem, in contrast to the disease specialty context where the focus of both patients and providers is on one group of diseases or disorders. In primary care practice, patients may or may not be as motivated to search the web to find out more about their potential problem, compared to patients with a pre-existing condition seeking a specialist. For primary care practitioners, the challenge is not only to have the latest information on the signs or symptoms of the problems being presented at the point of patient contact, but also to have the time to review with the patient their broader personal and family health history information and a set of preventive medicine strategies designed to also promote health (e.g., smoking cessation, improved diet, increased physical activity).
New information management and communication technologies like the electronic medical record (EMR; with information from the practice) and the electronic health record (EHR; with information from the patient) hold the promise of providing real-time communication between practitioners and their patients, as well as providing the opportunity to disseminate to practitioners, at the point of patient contact, key decision aids based on patient-specific information such as test results or patient self-reported health status. It remains unclear to what extent current practitioners and patients will be willing to adopt these new forms of electronic communication and dissemination. To date the adoption of both EMRs and EHRs has been slow, particularly among smaller freestanding practices unaffiliated with large health-care systems.
In more specialized care contexts, the knowledge gap between the practitioner “expert” and the patient continues to narrow, as many patients take advantage of open access to health and illness research information available through the world wide web. Highly motivated patients will seek out and attempt to digest large amounts of treatment and follow-up information, frequently sharing this research information in their communications with their practitioners. This, in turn, can put a special burden on the practitioners who must not only become familiar with this research information but must also integrate it with their own tacit knowledge from practice experience as well their own efforts to keep up with the new information emerging from research.
As such, the process of shared decision-making and knowledge integration may become more the norm in the future, which in turn may help speed the process of research dissemination and use of new knowledge as it emerges from research innovations. As new generations enter the health service delivery workforce and become adult patients, the familiarity and comfort with electronic forms of communication, information seeking, and the electronic tools for increasing channels for communication and dissemination may lead to expanded shared decision-making between practice experts and knowledgeable patients. New approaches for integrating explicit knowledge from science with tacit knowledge from practice and patient experience will be needed (Kerner 2006).
Research Information and Practice Knowledge
As noted above in the context of health-care, the communication and dissemination of research information can lead to new knowledge, when the information is either put to immediate use or is understood in the context of a practice framework. Thus, information may or may not lead to new knowledge depending on how it is presented and how it is understood. Prior to the twentieth century, communication and diffusion of information were relatively slow processes that depended on the spoken or written word. This permitted time to deliberate about new research information and put it into context, and may have provided more time for information to be transformed into knowledge. Since the advent of modern communication technologies (radio, television, the Internet), more and more information from research and other sources is being transmitted with less and less time to digest the information. As such, one unintended consequence of the explosion of information available seven days a week, 24 hours a day, is that there is a signal-tonoise ratio problem with too much information being processed and too little time to contextualize the information into knowledge.
Instant messaging, instantly reviewing and replying to emails from PDAs (personal digital assistants), and the many and varied means by which people can now communicate with each other around the world, have provided multiple avenues for quickly sharing new information, reacting to changing situations in real time, and potentially speeding up the rate at which new information can be transformed into new knowledge by those with the time to deliberate about what the information may mean in their context. However, the shift from slow and deliberative communication and research dissemination technologies to instantaneous technologies may inadvertently contribute to the creation of a growing class of individuals who turn away from much of this new information and focus only on the things they can learn from their personal experience. The impact of such a disparity may be the creation of large “knowledge gaps” that could impact many aspects of society (Viswanath & Finnegan 1996).
Knowledge Transfer Versus Knowledge Integration
As more and more communication channels are opened, the temptation to push large amounts of research information out to as broad an audience as possible is great. The explosion of web links on the Internet with respect to virtually any topic imaginable is but one example of this high information push priority. All sectors of society are flooding the communication channels with new information resources, be they government, commercial, or NGOs. While facilitating communication and diffusion of information, these expanded communication channels also provide new challenges for disseminating information to those audiences who are most interested in the particular information being disseminated (i.e., pull), and have the resources (e.g., time, infrastructure) to transform this new information into knowledge that can be used.
In the field of research dissemination and implementation, the terms “knowledge transfer” and “knowledge integration” have been used to differentiate the push-only approach from the research dissemination approach which recognizes the importance of push, pull, and infrastructure to take advantage of new information and translate it into usable knowledge (Lomas 1993; Orleans 2002; Kerner 2006). A key to knowledge integration is to recognize the importance placed on information and knowledge gained from tacit experience in a practice context as well as explicit information and knowledge gained from research. In most knowledge transfer dissemination approaches, the assumption is often that the only information and knowledge worth disseminating is explicit. This may help to explain why the diffusion and dissemination of explicit new information from research falls on deaf ears when it contradicts or undermines long-held beliefs and assumptions based on experience within the context in which the information would be used.
Knowledge integration, on the other hand, recognizes that explicit information gained from research may or may not fit the context in which the information could be used and transformed into practice knowledge. As such, knowledge integration models for research dissemination require that an exchange of information take place between the advocates of explicit research information and those who value tacit knowledge from context specific experience. When such an information exchange is valued by both parties, an informed decision can be made within a particular knowledge use context that weighs the benefits and costs of using the information from both research and experience.
The explosion of new communication channels in the twentieth and twenty-first centuries have provided both great opportunities and great challenges in transforming research information into knowledge that can be applied to improve the human condition. Research dissemination, when focused on knowledge integration and communication exchange, can help the process of transforming large amounts of new information based on research and practice into knowledge that can be useful and applied.
However, with rapid innovation in communication technologies comes the real concern that disparities will be exacerbated between those ready, willing, and able to take advantage of the information revolution, and those who are left behind because of limited access to, and limited understanding of, the new communication technologies. Research dissemination strategies must be developed to sort out how best to integrate the information-disadvantaged. Thus, all can benefit from the opportunities provided by these new mechanisms for communication, diffusion, and dissemination of research and the integration of research with practice, particularly when focused on the underserved.
- Chartier, R. (1987). The cultural uses of print in early modern France (trans. L. G. Cochrane). Princeton: Princeton University Press.
- Eisenstein, E. L. (1979). The printing press as an agent of change: Communications and cultural transformations in early modern Europe, 2 vols. Cambridge and New York: Cambridge University Press.
- Kerner, J. (2006). Knowledge translation versus knowledge integration: A “funder’s” perspective. Journal of Continuing Education in the Health Professions, 26(1), 72–80.
- Lomas, J. (1993). Diffusion, dissemination, and implementation: Who should do what? Annals of the New York Academy of Sciences, 703, 226–237.
- Orleans, C. T. (2002). Designing for dissemination. Conference presentation, Washington, DC, Sept. 19, 2002. Available at http://dccps.nci.nih.gov/d4d/pdfs/challenge_translation.pdf, accessed June 15, 2007.
- Rogers, E. (2003). Diffusion of innovation, 5th edn. New York: Free Press.
- Viswanath, K., & Finnegan, J. R. (1996). The knowledge gap hypothesis: Twenty-five years later. In B. Burleson (ed.), Communication yearbook, vol. 19. Thousand Oaks, CA: Sage, pp. 187– 227.
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