Designing for Dissemination: For Rimer, Driving Application Means Using a New Map

IN PERHAPS THE SPIRIT of Frank Lloyd Wright, master architect, urging a client to accept the stylistic dialogue between his building and its surrounding environment, Barbara K. Rimer is urging the scientific community to identify dissemination as inextricable from the research process, and therefore a fundamental part of the landscape.

“What I’m doing is really trying to build [dissemination] into studies from the start,” Rimer said. “The mantra of ‘designing for dissemination’ I’m really trying to live.”

A professor of health behavior and education at University of North Carolina, Chapel Hill, Rimer prefers the term ‘dissemination’ to the more pervasive ‘translation,’ because the latter implies a divorce between clinic and community that she does not believe exists.

” ‘Translation,’ to me, oversimplifies the process,” Rimer said. “It’s not a two-part process. It really is circular.” This process mirrors her own career, which began in 1975 at the National Cancer Institute, where she was part of a group asked to develop a program to disseminate cancer control interventions across the country. “I realized how difficult it was [to disseminate],” she recalled. It was during these formative years that she also realized “how little of a roadmap there was to teach people.”

This realization prompted Rimer to pursue a doctorate, only to return to NCI in 1997. As director of the division of population sciences, she established the very first leadership position responsible for dissemination at the National Institutes of Health.

Using experience as her guide, Rimer believes the philosophy of designing for dissemination must be inculcated into training behaviorist youths. “It’s going to have to be built into training,” she said. “Until [dissemination] starts getting into training programs, I don’t think it’s going to happen adequately.” Too many young researchers begrudge dissemination as the “third-rate” appurtenance to the glamour and recognition of discovery.

So how do behaviorists ever stand a chance of converting the new generation? “We have to make it exciting and sexy,” she said. “It has to do with prestige. You’re not recognized for dissemination. As we do for other behaviors we want to encourage. We must reward, recognize, and nurture dissemination.”

Rimer argued that these problems are largely cultural. “There’s really no infrastructure in this country for dissemination,” she said, urging influential spokespeople from all disciplines to emerge as champions of the important cause. This will be a difficult battle, however, as the society that finds itself unwilling to encourage dissemination design is the same one demanding results.

“The American public and Congress now expect a return on the investment of doubling at NIH,” Rimer said. “I think people know that if we don’t start delivering, then not only will there not be another doubling at some point, but that it’s going to be hard to sustain even a modest increase in the budget.”

Yet Rimer views this sense of urgency – largely the result of the major financial boost Congress recently supplied to NIH – as a call to action rather than a somber fate. She cited journals, RFAs, training, and even dissertation awards as vehicles to help legitimize dissemination and breed a culture of scientists incapable of separating research from application.

Another essential support will come from what Rimer called a “trials infrastructure,” preferably one that’s cross-institute, given the general tendency toward inter-disciplinary research. She emphatically related that behaviorists could learn this infrastructure from their clinical colleagues. “The clinical trials infrastructure … would be wonderful if it was applied to behavioral science, because every time we do a study we have to reinvent the informatics, the database.” Rimer considered the variable nature of behavioral encounters, and the difficulty such variability causes for data replication, serious concerns.

She even set forth a challenge for the American Psychological Society and the rest of the behavior community to become involved in the design – the new roadmap – that keeps innovative research from finding a real world dead end. “This is a place where APS could really make a difference, by lobbying and trying to influence policy makers,” she said. “If we don’t start having some shift in the portion of money we spend on dissemination, then people aren’t going to reap the benefits of all those discoveries.”