Transforming the Face of Health Professions Through Cultural & Linguistic Competence Education:
The Role of the HRSA Centers of Excellence

Chapter 8: Dissemination

Cultural and linguistic competence is a matter of urgent importance not only for Centers of Excellence, but for health care professionals across the Nation. While the first priority for COEs is to provide culturally and linguistically competent education and training for students and faculty, there is an additional responsibility to export lessons learned to the broader health professions community. COEs may be able to reach this community at large by integrating dissemination into the outreach work they are already doing. The COEs can disseminate to other academic departments at the COE host institution. For example, they can work with other COEs, the health care community with which they interact, health professional organizations, students associations, graduate school programs, “donor” schools (such as community colleges and of feeder institutions affiliated with major universities), public and private organizations such as the government health department, patients, patients’ family members, and consumers. This chapter serves as a guide for developing and implementing a plan to disseminate cultural and linguistic competence to these and other audiences as appropriate. It discusses the reasons a COE would disseminate, the mechanisms for dissemination, and offers examples of an effective dissemination plan.

The first issue to address in any discussion about dissemination of a culturally competent curriculum involves defining the term “dissemination.” Kropf Design and Communication Services, Inc. (2003) defines dissemination as the aggressive sharing of expertise and as teaching others about best practices and new models of care. Not only do we want to teach others about what Huberman (1992) calls the “conceptual use” of cultural and linguistic competence, which involves the “changes in levels of knowledge, understanding, or attitude,” but also we want to encourage instrumental use of cultural and linguistic competence, or “changes in behavior and practice.”

There are numerous models for dissemination including those from the U.S. Department of Health and Human Services agencies, such as Health Research Services Administration (HRSA), the Office of Minority Health (OMH), and the Substance Abuse Mental Health Administration (SAMSHA)’s Center for Substance Abuse Prevention (CSAP). In addition to these models from governmental agencies, there are a number of models available from universities and private organizations, such as those that can be found by doing an Internet search. Among all of these models, the basic premises of dissemination are similar. Each one recommends that any organization disseminating information about cultural and linguistic competence needs to understand the scope of the project and the target group fully to ensure that the dissemination plan is achieved. When planning for dissemination, it is important to ask: Why disseminate?

I. Why Disseminate?

The organization that is able to develop and disseminate new and promising practices will automatically be seen as a leader in the arena of practice. In fact, COEs should aspire to be models for others in the area of cultural and linguistic competence by reporting their findings through educational scholarship such as in peer-reviewed academic journals and publications. Although COEs currently have varying levels of leadership in the area of cultural and linguistic competency, there is an expectation that the COEs will continue to accept such a leadership role. Furthermore, COEs must follow the same principles set by academic institutions by contributing to the evidence-based fund of knowledge and practices.

Additionally, Kropf Design and Communication Services, Inc. (2003) emphasizes that dissemination must be a priority not only for those organizations seeking to replicate the program in question but also for promoting promising practices. These promising practices, such as the COE’s cultural and linguistic competency curriculum, can improve the quality of health care, make positive social contributions, and “improve the excellence of our own services if we know others are watching.” The goal of any dissemination plan is utilization of the information, which in this case is the curriculum. Another reason for dissemination is that it is a requirement for recipients of most funds from HRSA and other organizations.

A simple dissemination model, such as the one adapted from the National Center for Dissemination of Disability Research NCDDR (2001), Developing an Effective Dissemination Plan, can be useful in planning ways to share successful programs and strategies.

II. Elements of an Effective Dissemination Plan

In Developing an Effective Dissemination Plan, the NCDDR says there are a number of elements making up an effective dissemination plan.

a.) Goals and objectives: Determine and document the goals of the dissemination effort for the proposed project. Associate each goal with one or more objectives of the dissemination activities.
b.) Users and audiences: For each of the objectives, describe the scope and characteristics of the “potential users” that the dissemination activities are designed to reach. The first users would be the staff, students, and faculty at the institution. Other audiences would be comprised of other nursing, pharmacy, or medical schools, or practice associations.
c.) Content: Identify the basic elements of the projected content to disseminate to each of the potential user groups identified.
d.) Sources: Identify the primary source or sources that each potential user group already uses or respects as an information source. Consider ways to partner with these sources in the dissemination efforts.
e.) Medium: Describe the medium or media through which the content of the message can best be delivered to the potential users and describe the capabilities and resources that will be required of potential users to access the content for each medium to be used.

f.) Success: Describe how to determine if the dissemination activities have been successful. If data are to be gathered, describe how, when, and who will gather it.
g.) Access and availability: Describe how to promote access to the information and how information that may be requested later will be archived. Consider that most people will use the project-related information when needed, not necessarily when one has completed the project.
h.) Identify strategies: Promote awareness of availability of the information and availability of alternate formats.
i.) Barriers: Identify potential barriers that may interfere with the targeted users’ access or use of the information and develop actions to reduce these barriers.

COEs should seek to develop or customize existing products for specific target audiences, such as students, faculty, or the organization. Additional methods of dissemination suggested by members of the Expert Team for dissemination of the COE curricula are:

• Use the HRSA Website
  
• Develop small modules for training of faculty and publish information about them or illustrate their use at conferences, meetings, and seminars
  
• Send material to medical and other health professions schools and residency programs through such organizations as the Association of American Medical Colleges (AAMC), osteopathic associations, and the Accreditation Council for Graduate Medical Education (ACGME), among others
  
• “Package” curriculum using diversity symbols and artwork to create a mini booklet that contains the consolidated curriculum in a nutshell
  
• Conduct informational workshops for local, regional, and National health profession conferences
  
• Create a “Strategies for Integrating Cultural and Linguistic Competency Education” listserve just for COEs. Listserves are easy and inexpensive to put in place and are excellent for dialogue and sharing

III. The Importance of Internal Dissemination

It is essential to include strategic planning as part of the internal dissemination plan. In this case, strategic planning means developing a way to share the information and knowledge in effective and well-planned ways, steps that will keep the promising practices developed as part of the cultural and linguistic competence curriculum from becoming lost. Too often, programs that have proved successful are lost after the funding ends. Faculty and students should be encouraged to share their successful strategies and models at faculty meetings and departmental workshops. A well-planned and executed internal dissemination plan will not only sustain the successful program within the COE institution, but also will provide motivation for making it available to other educational institutions as well. In ensuring that it is available to other institutions, the COE will be helping to make sure that service providers have the skills, knowledge, and attitudes to provide competent cultural services.