National Institute on Drug Abuse

RESEARCH

MONOGRAPH SERIES

Reviewing the

Behavioral Science

Knowledge Base

on Technology

Transfer

U.S. Department of Health and Human Services • Public Health Service • National Institutes of Health

155

Reviewing the Behavioral

Science Knowledge Base on

Technology Transfer

Editors:

Thomas E. Backer, Ph.D.

Human Interaction Research Institute

Susan L. David, M.P.H.

National Institute on Drug Abuse

Gerald Saucy, Ph.D.

National Institute on Drug Abuse

NIDA Research Monograph 155

1995

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

National institutes of Health

National Institute on Drug Abuse

5600 Fishers Lane

Rockville, MD 20857
ACKNOWLEDGMENT

This monograph is based on the papers from a technical review on

“Reviewing the Behavioral Science Knowledge Base on Technology

Transfer” held on November 17-18, 1993. The review meeting was

sponsored by the National Institute on Drug Abuse.

COPYRIGHT STATUS

The National Institute on Drug Abuse has obtained permission from the

copyright holders to reproduce certain previously published material as

noted in the text. Further reproduction of this copyrighted material is

permitted only as part of a reprinting of the entire publication or chapter.

For any other use, the copyright holder’s permission is required. All

other material in this volume except quoted passages from copyrighted

sources is in the public domain and may be used or reproduced without

permission from the Institute or the authors. Citation of the source is

appreciated.

Opinions expressed in this volume are those of the authors and do not

necessarily reflect the opinions or official policy of the National Institute

on Drug Abuse or any other part of the U.S. Department of Health and

Human Services.

The U.S. Government does not endorse or favor any specific commercial

product or company. Trade, proprietary. or company names appearing in

this publication are used only because they are considered essential in the

context of the studies reported herein.

National Institute on Drug Abuse

NIH Publication No. 95-4035

Printed 1995

NIDA Research Monographs are indexed in the Index Medicus. They are

selectively included in the coverage of American Statistics Index,

BioSciences Information Service, Chemical Abstracts, Current Contents,

Psychological Abstracts, and Psychopharmacology Abstracts.

ii
Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Thomas E. Backer, Susan L. David, and Gerald Saucy

Assessing and Enhancing Readiness for Change:

Implications for Technology Transfer . . . . . . . . . . . . . . . . . . . . . . . . . 21

Thomas E. Backer

Collaboration and Diversity in Technology Transfer . . . . . . . . . . . . . 42

Kathryn H. Kavanagh

Risk Communication: A Tool for Behavior Change . . . . . . . . . . . . . 65

David B. McCallum

Diffusion of Drug Abuse Prevention Programs:

Spontaneous Diffusion, Agenda Setting, and Reinvention . . . . . . . . 90

Everett M. Rogers

Interorganizational Planning and Coordination as

Technology Transfer: Lessons From a Case Study . . . . . . . . . . . . . 106

Howell S. Baum

Organizational Change as Human Process, Not Technique . . . . . . . . 119

Michael A. Diamond

Rethinking Organization Stability as a Determinant for

Innovation Adoption and Diffusion . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Alan M. Glassman

Technology Transfer as Collaborative Learning . . . . . . . . . . . . . . . . 147

Ramkrishnan V. Tenkasi and Susan A. Mohrman

Reducing Impediments to Technology Transfer in

Drug Abuse Programming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Barry S. Brown

A Field-Based Dissemination Component in a

Drug Abuse Research Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186

James L. Sorensen and Wayne W. Clark

iii
Technology Transfer in the Criminal Justice Field:

Implications for Substance Abuse . . . . . . . 198

Paul Gendreau

Creating Strong Attitudes: Two Routes to Persuasion . . . . . . . . 209

Richard E. Petty

Transferring Research Findings on Persuasion to

Improve Drug Abuse Prevention Programs . . . . . . . . . . . . . . 225

William J. McGuire

Developing Effective Behavior Change Interventions:

Some Lessons Learned from Behavioral Research . . . . . . . . . . 246

Martin Fishbein

Synthesis of Behavioral Science Learnings About

Technology Transfer . . . . . . . . . . . . . . . . . . . . . . . . 262

Thomas E. Backer and Susan L. David

iv
Introduction

Thomas E. Backer, Susan L. David, and Gerald Soucy

Knowledge is of little use when confined to mere

speculation” But when speculative truths are reduced to

practice, when theories, grounded upon experiments, are

applied to common purposes of life . . . knowledge then

becomes really useful.

Preface, Transactions: The Journal of the

American Philosophical Society (1771)

THE CHALLENGE OF TECHNOLOGY TRANSFER

While there are currently many gaps in basic knowledge about drug abuse

treatment and prevention (and about human immunodeficiency virus

(HIV)/acquired immunodeficiency syndrome (AIDS) related to substance

use), there also are important gaps between the knowledge gained from

research or community-based demonstrations and everyday practice in

the field by individual practitioners, treatment and prevention programs,

and communities. Getting access to the right information at the right time

for the right purpose is often difficult. This is sometimes due to limited

dissemination of research findings or new practices and sometimes to too

much information, with no way to efficiently sort out what is relevant to

meeting a particular need in the field. Faced with either prospect,

practitioners, service institutions, and communities often choose to

continue current practice.

But the difficulty does not end there. Even with relevant new knowledge,

actually implementing a new program or practice is difficult and may

take a long time. Potential users of drug abuse treatment or prevention

innovations must overcome a host of financial, psychological, and

organizational challenges to have new technologies implemented in their

settings.

Traditionally, efforts to close the gap between knowledge and practice

have focused on education, training, and dissemination of information

through conferences, journal articles, and reports or brochures. These

activities typically are directed at researchers and academics, the

1
developers of such knowledge. The National Institute on Drug Abuse

(NIDA), which has central responsibility within the National Institutes of

Health (NIH) for generating new knowledge regarding drug abuse and

related HIV/AIDS treatment and prevention, has a long history of

research dissemination activities. NIDA has enjoyed considerable

success in this area during its 20 years of preclinical, clinical, and

community-based drug abuse research.

However, while valuable, such dissemination-focused activities by

themselves usually fall far short of producing the individual and systemic

change that state-of-the-art knowledge makes possible. For the maximum

chance of success in promoting improvement in drug abuse treatment or

prevention practice, technology transfer activities must: (1) gather certain

types of information in addition to knowledge about the technical aspects

of an innovation, (2) do the gathering in ways that address certain

characteristics of potential users of innovations and their environments,

and (3) provide assistance to potential users in addition to simply making

the new knowledge available.

The concept underlying these principles is that improvement in drug

abuse treatment and prevention practices involves a human process

which, if successful, leads to individual and organizational change.

Gaps between knowledge and action in the adoption of worthwhile

innovations occur for reasons quite similar to those that make it difficult

to change individual behavior related to substance abuse and other types

of health-related behavior. Incentives to change, resistance to change,

and many other human factors significantly influence the outcome of

efforts to change behavior. This is true whether the behavior is avoidance

of street drugs by a teenager or adoption of a new prevention technology

by a community-based program. This more comprehensive approach to

technology transfer is driven by a set of empirically derived principles

coming from several disciplines, including behavioral science.

Behavioral Science Knowledge and the Objective of the

Technical Review

Over the last 70 years, a significant behavioral science knowledge base

has developed about how to facilitate individual and organizational

behavior change. This knowledge base has great relevance to technology

transfer. But academic researchers in social and clinical psychology, and

in related fields such as management sciences and communications,

seldom have the chance to share this knowledge base with individuals

2
and agencies developing technology transfer programs designed to reach

individual practitioners, service organizations, and communities.

NIDA convened a technical review meeting on November 17 and 18,

1993, in Washington, DC, to review and synthesize this behavioral

science knowledge base. The technical review focused on four major

topical areas:

• Communications-based behavior change,

• Organizational behavior change,

• Behavior change in substance abuse agencies and practitioners, and

• Individual and interpersonal behavior change.

Fourteen senior researchers in behavioral science prepared papers for

presentation at this conference, and the final versions of their papers are

contained in this monograph. The table of contents lists these researchers

and the topics they addressed. A synthesis at the end of this monograph

reviews the major concepts, principles, and issues derived from their

papers, with implications for the future evolution and evaluation of

NIDA’s Technology Transfer Program.

The Knowledge Base On Technology Transfer

Comprehensive analyses of the literature on technology transfer

(currently estimated to contain more than 10,000 citations; see Backer

1991; Backer et al. 1986; Dunn and Holzner 1988; Glaser et al. 1983;

Havelock 1976; Rogers 1983; Zaltman et al. 1973) confirm from both an

empirical and analytic perspective the validity of some basic principles

necessary for effective technology transfer. Much of this literature comes

from behavioral science. As summarized in Backer (1991), which

describes technology transfer initiatives undertaken by several Federal

departments and agencies, four fundamental conditions must be met in

order for technology transfer activities to result in individual or systemic

change:

1. Individuals and organizations must be aware that the new knowledge

exists and have access to it (dissemination).

3
2.

3.

4.

There must be credible evidence that behavior change (e.g., the

adoption of a new prevention program) will lead to improved practice

without either excessive costs or undesirable side effects. (Prior

success in transferring the technology may be the best evidence.) In

particular, evidence is needed about the readiness of the innovation to

be transferred, the readiness of adopters and their communities to

receive it, and the innovation’s potential for continued success over

time (evaluation).

The money, materials, and personnel needed to implement the new

technology or practice must be available (resources).

Active interventions are required to overcome resistances, fears, and

anxieties about change among the people who will need to implement

the innovation, and these must be coupled with efforts to develop

user involvement or ownership in shaping the new technology or

practice, and to reward individuals and groups for adopting the

innovation (human dynamics of change).

From these principles follow six key strategies, which also have been

well validated in the aforementioned knowledge base:

1. Interpersonal contact. To get an innovation used in new settings,

there needs to be direct, personal contact between those who will be

adopting the innovation and its developers or others with knowledge

about the innovation.

2. Planning and conceptual foresight. A well-developed strategic plan

for how an innovation will be adopted in a new setting, including

attention to possible implementation problems and how they will be

addressed, is essential to meet the challenges of innovation adoption

and sustained change.

3. Outside consultation on the change process. Consultation can

provide conceptual and practical assistance in designing the adoption

or change effort efficiently and can offer useful objectivity about the

likelihood of success, costs, possible side effects, and so forth.

4. User-oriented transformation of information. What is known about

an innovation needs to be translated into language that potential users

can readily understand, abbreviated so that attention spans are not

4
5.

6.

exceeded, and made to concentrate on the key issues of “Does it

work?” and “How can it be replicated?”

Individual and organizational championship. An innovation’s

chances for successful adoption are much greater if influential

potential adopters (opinion leaders) and organizational or community

leaders express enthusiasm for its adoption.

Potential user involvement. Everyone who will have to live with the

results of the innovation needs to be involved in planning for

innovation adoption, both to get suggestions for how to undertake the

adoption effectively and to facilitate ownership of the new program

or activity (thus decreasing resistance to change).

Furthermore, the literature on technology transfer reveals that the human

dynamics of change must be addressed not only at the individual level,

but at the community, organizational, and system levels as well. This

means utilizing stategic planning, interorganizational networking, and

other management science-based strategies for introducing change at the

system level. Health communications research has helped to establish the

importance of these organizational strategies (Backer and Rogers 1993).

Adoption of innovations takes place within a large, complex environment, which must be carefully assessed if technology transfer efforts are

to be successful.

There is a learning curve in this body of work. Studies in the 1960s and

early 1970s established that information dissemination alone usually is

not enough to stimulate sustained change in individuals or organizations.

Studies conducted in the 1970s and early 1980s explored more active

methods for promoting utilization and established the effective strategies

that are presented here. In the 1990s much of the empirical work is

concerned with consolidating these principles into programmatic

strategies, examining the proactive role of the user in shaping technology

transfer, and revisiting what works and what does not in these more

complex, resource-poor times.

Also, recent empirical studies of major health communication campaigns

in substance abuse prevention and other areas have extended understanding of how to influence both individuals and communities to adopt

prevention-oriented behavior. At least one exploratory study also has

5
been done to confirm the importance of organizational and interorganizational factors in the success of prevention-oriented health behavior

change campaigns (Backer and Rogers 1993).

A survey of State drug abuse treatment and prevention agencies (Lipton

and Appel 1984) indicates that practitioners frequently have difficulty

interpreting research findings so that they fit into programmatic

applications. Often researchers or community program developers lack

expertise or interest in promoting wider adoption of their findings or

programs; publication in scientific journals (which research has shown

are read by very few practitioners) and presentations at professional

conferences are often assumed to be sufficient means of dissemination.

A 6-year study of the Job Seekers Workshop (see Sorensen et al. 1988 for

an overview) also confirmed the importance of these principles in the

drug abuse treatment and prevention field. The study was conducted in

the 1980s and focused on a method for providing employment-related

training for ex-drug abusers. The method was extensively studied and its

efficacy verified through empirical research conducted under NlDA

support by Hall and associates at the University of San Francisco

(Sorensen et al. 1988). In the first of the subsequent utilization studies,

Sorensen and colleagues (I 988) compared three methods for promoting

the adoption of the Job Seekers Workshop for drug treatment clients.

Their research found that dissemination methods employing personal

contacts (site visits and conferences) produced significantly more

adoptions than did printed materials alone.

There were also adopter site differences: Residential treatment programs

were more likely to adopt the workshop method than were drug-free

outpatient or methadone maintenance programs. This finding suggests

that technology transfer activities need to be sensitive to the type of

substance abuse treatment setting in which the practitioner works. In a

subsequent study using the same innovation, Sorensen and colleagues

explored the impact on technology transfer of involving State drug abuse

agencies in designing and implementing the utilization strategy. The

degree of involvement of the State agency, and the type of involvement

strategy used, had a significant impact on the outcome of the utilization

effort. The results empirically confirm the importance of involvement of

State agencies in technology transfer activities.

Brown and Backer (1988) report a NIDA-supported empirical study

regarding substance abuse treatment and prevention professionals’

6
receptiveness to learning about innovations through a variety of

strategies. Among the 117 professionals in this study, live, team-oriented

teaching was considered to be the most effective learning format,

followed by videotaped learning packages, print materials, and

audiocassettes. Findings from the research also identified the specific

learning formats that practitioners prefer. For example, research

respondents preferred the training approach that tells a story about reallife situations and problem solving.

NIDA’s Technology Transfer Program

NIDA’s Public Information Branch established the Technology Transfer

Program in 1989. The program disseminates effective, research-based

interventions and service protocols emanating from NIDA research to

drug abuse treatment and prevention practitioners and encourages the

application of these technologies in the drug abuse field. The goals of

this program are to reduce demand for drugs by improving prevention

and treatment practices and to enhance drug abuse-related HIV/AIDS risk

reduction.

The program follows a systematic process for its activities. The process

includes a review of literature on candidate technologies; a needs

assessment conducted with practitioners and policymakers; assessment by

researchers of the scientific readiness for transfer of identified

technologies; review of the candidate technologies of the technology

transfer study by the NIDA Technology Transfer Committee; and

approval of the technology transfer study by the NIDA Director.

Transfer activities and products developed through this process include:

• National conferences on research and practice. These conferences

use a highly interactive, practitioner-oriented conference format to

present NIDA’s research findings to practitioners in the fields of drug

abuse and HIV/AIDS treatment and prevention. Conferences have

been held in 1991 and 1993.

• Videotape series. These series raise awareness about clinical

applications of NIDA-sponsored research findings and motivate

audiences to use NIDA’s technology transfer materials. Topics

include relapse prevention, dual diagnosis, and treatment issues for

women.

7
• Technology transfer packages. These packages include sets of

materials to describe an intervention protocol for a treatment or

prevention approach found effective through research. The materials

address administrative and other common implementation issues and

provide inservice training materials for program staff. Current

packages are focused on topics such as the Addiction Severity Index

as an assessment tool and family dynamics and interventions related

to substance abuse.

• Clinical reports. These are reviews of research on selected topics

presented in a practical format and language to encourage adoption of

intervention strategies. Current topics include the biological bases of

addiction, family therapy approaches, and dual diagnosis of mental

illness and substance abuse.

Since its inception, NIDA’s Technology Transfer Program has become

one of the most effective of the Federal efforts analyzed by Backer (1991)

in a recent published review of several dozen such programs. Technology transfer activities for practitioners are part of a comprehensive

program of research dissemination to scientists, policymakers, and the

general public.

There are several reasons for the success of NIDA’s Technology Transfer

Program:

• Strategic planning methods have been used to develop an integrated

system supporting this program’s mission and activities, including

establishing an ad hoc internal advisory group and obtaining input

from a wide range of technology transfer experts (e.g., conduct of a

planning workshop at the 1990 annual conference of the Knowledge

Utilization Society, conduct of the technical review reported here).

• Program strategies are empirically based, coming from more than

70 years of research on technology transfer.

• Adequate resources have been made available to support the

program’s initiatives, and there has been effective endorsement of its

importance by leaders such as NIDA’s Director.

• Multiple interventions to promote technology transfer have been

used, following empirical evidence that adoption of health-related

8
information requires multiple media and interpersonal methods

(Backer et al. 1992).

• The program’s placement in NIDA’s Public Information Branch has

encouraged an orientation toward education and systemic change as

well as alliances with ongoing NIDA public affairs and

professional/community education activities (e.g., the Community

Education on Research and Practice Project).

In 1993 NIDA commissioned a 3-year empirical evaluation of its

Technology Transfer Program to analyze the reasons for the success of

these activities. As part of this effort, a literature review and telephone

interview study concluded that this program is currently one of the few

Federal efforts of its type undergoing significant program evaluation.

Further information can be obtained from NIDA staff person Dr. Gerald

Saucy (phone: 301-443-1124).

Seven years from its inception, NIDA’s Technology Transfer Program is

at a crossroads for the following reasons:

NIDA is now part of the NIH. This move has increased its

responsibilities for providing primary and allied health care

practitioners with relevant substance abuse treatment and prevention

information and placed the Technology Transfer Program into the

larger setting of the numerous technology transfer efforts at the

various Institutes (as reviewed in a recent telephone interview study

conducted as part of the evaluation).

Health care reform activities now being undertaken by the States and

the private sector, plus new Federal initiatives being considered, will

reshape drug abuse and HIV/AIDS treatment and prevention services

significantly, affording important new opportunities for technology

transfer.

Technology transfer contained in clinical practice guidelines and their

active dissemination is already reshaping health care through the

activities of the Agency for Health Care Policy and Research and

many other entities. More than 1,400 guidelines are already on file in

the National Library of Medicine databank (Sechrest et al. 1994).

Technology transfer activities are also being reshaped in other

Federal programs, ranging from those at the Center for Substance

9
Abuse Prevention and the Center for Substance Abuse Treatment,

NIDA’s counterparts in the Substance Abuse and Mental Health

Services Administration. to programs in other health-related agencies,

such as the Department of Veterans Affairs.

• NIDA’s diverse constituencies-communities of color, consumers of

drug abuse- and HIV/AIDS-related services, the prevention and

treatment service workforce, and others-require sensitive, culturally

appropriate technology transfer activities (as seen in the work of the

Community Education on Research and Practice Project and the

NIDA Hispanic Research and Technology Transfer Work Group: see

Alegria et al. 1994).

• The knowledge base on technology transfer is continuing to grow,

stimulated by the Clinton administration’s emphasis on the

technology transfer activities of Federal laboratories and other

defense-related entities, such as the Advanced Research Projects

Agency (Wierengo 1994), and the emergence of support for these

activities (e.g., use of the information superhighway for Federalprivate sector technology transfer collaboration) (Technology

Transfer Business 1994).

• Non-Federal funders of drug abuse and HIV/AIDS research and

service demonstrations, such as private foundations, are taking an

increasingly active role in promoting technology transfer (Backer

1994a, 1995; Backer and Koon 1995; Backer and Shaperman 1993).

• Federal policy on technology transfer has been significantly reshaped by legislation (e.g., provisions for educational dissemination

in the recently passed Goals 2000: Educate America Act; see Backer

1994b) and by congressional study (e.g., the 2-year Office of

Technology Assessment study of health care technology assessment,

which included an examination of medical information

dissemination: see Office of Technology Assessment 1994).

• Reliable information about how NIDA’s constituencies want

technology transfer efforts tailored to them is emerging from the

evaluation and experiences from NIDA’s Research and Technology

Transfer conferences and from many other activities.

Thus, this technical review monograph is intended to support the overall

evolution of NIDA’s Technology Transfer Program. Key factors or best

10
practices from behavioral science are reported in this volume. These best

practices can be used to guide development of technology transfer

strategies, setting them in the larger context of partnership efforts with

NIDA’s community constituencies and overall changes in health care and

information technology. Approaching program transformation in this

way will continue the integrated systems approach NIDA has used since

the beginning of this effort in 1988.

AN OVERVIEW OF THE CHAPTERS

NIDA’s interest in bringing together a group of scientists from different

but related disciplines-communications, management sciences, and

behavioral research-was to consider the relevance of their studies and

experience at changing behavior in the individual, the organization, or the

community. This group provides a broader perspective regarding

technology transfer and research dissemination and possibly some

theoretical and experiential guidance for NIDA’s future efforts in this

area.

As a research institute, NIDA seeks a scientific basis for all its activities,

including those related to technology transfer. NIDA also seeks the

ability to contribute to the literature with the results of the program’s

evaluation. The chapters in this monograph by eminent scholars and

practitioners in their respective fields are a rich source of guidance for

anyone interested in undertaking behavior change programs at any level.

Communications-Based Behavior Change

Chapter 1 by Dr. Thomas Backer, the coeditor of the monograph,

emphasizes the importance of readiness as the key to change in

organizations or the individual. Backer summarizes the research by

saying that people (including groups of people in organizations) have to

believe that change will make a difference, and that adopting a particular

innovation will help, before they are likely to commit to change. They

need to see the potential rewards before they will consider whether they

will begin the change process. Backer provides guidance to program

planners in developing effective interventions by helping them to

(1) understand the need to assess readiness for change, (2) recognize that

individuals are part of the organization and have their own perceptions of

the need for change, and (3) develop approaches that can enhance

readiness for change and at the same time overcome resistance to change.

11
Backer then reviews the wide-ranging literature on readiness for change

in a variety of organizations and settings.

Chapter 2 by Dr. Kathryn Kavanagh posits that technology transfer must

incorporate collaboration with the consumer and appreciation for diverse

populations as one focus for change in drug abuse treatment programs.

Kavanagh presents a broad definition of diversity among service

consumers that incorporates ethnic, cultural, experience, age, gender,

sexual orientation, and socioeconomic differences, which can further

complicate the difficult job of behavior change in programs. The chapter

discusses how these factors need to be addressed in designing and

implementing technology transfer that works.

Kavanagh challenges traditional hierarchical approaches to drug abuse

treatment and other health services by suggesting an interactive, bottomup process. Kavanagh argues that “As the focus of intervention, the front

line serves as the bottom line in technology transfer, for it is there that

knowledge as technology is tested and either utilized or rejected.” The

front line includes providers and consumers (i.e., clients). “Effective

drug abuse prevention and treatment require a climate of flexibility,

openmindedness, trust, objectivity, and respect for diverse viewpoints. .

[it should provide] a forum for participants to have a voice and to

experience opportunities to build self-esteem and experience success.”

Kavanagh suggests that closure of the gap between knowledge and

practice depends upon reducing process and content barriers to improve

the applicability and acceptability of the technology generated. Collaboration among the leadership and the front line will be necessary for

successful adoption of the innovation.

In chapter 3, Dr. David McCallum provides an overview for developing

risk communications programs based on the development of national

environmental public awareness campaigns for the Environmental

Protection Agency. McCallum argues that individuals cannot change

without knowledge of the alternatives and consequences and without the

motivation, skills, and support systems to do so. McCallum describes the

following steps for the design and implementation of risk communication

campaigns: (1) establish clear goals and objectives; (2) understand the

target audience’s perception of risk; (3) understand target audience’s

attitudes and behaviors to determine motivators for change; (4) develop

effective, tested messages; (5) use credible spokespeople; (6) use mass

media, which is the primary channel to reach an audience with health

12
risks; (7) reinforce messsages and behaviors; and (8) use evaluation

methods at each stage of the process.

In chapter 4, Dr. Everett Rogers describes real-world examples of

technology transfer, including planned program diffusion, spontaneous

diffusion without planning, the media’s role in setting the national

agenda, and reinvention, which is the adaptation of an innovation by

adopters for their own use. As an example of planned diffusion, Rogers

describes the spread of Project DARE (Drug Abuse Resistance

Education), a curriculum taught by uniformed policemen, which began in

Los Angeles in 1983 and in less than 10 years reached over 5 million

children. To explain spontaneous diffusion. Rogers describes how the

very successful communitywide drug abuse prevention program, Project

STAR, spread from its original site in Kansas City to other parts of

Kansas and Missouri without any actions on the part of the developers.

These other sites simply heard about the program and adopted it. Rogers

also describes how diffusion benefits from and contributes to agenda

setting by local and national media. If daily news coverage convinces the

public that the issue is important, then they will want and support

prevention programs. Finally, Rogers describes reinvention as the degree

to which an innovation is changed by adopters. Rogers raises the issue of

whether reinvention makes the program more, less, or equally effective as

the original.

Organizational Behavior Change

The next four chapters look at organizational change and how it can be

implemented. In chapter 5, Dr. Howell Baum presents the importance of

having a psychodynamic view of the meanings of organizational

structures when implementing new programs. Baum points out that

research has shown that one must address the organizational culture and

the individuals who are part of that culture, and warns against an

oversimplification of the relationship between organizational meanings

and organizational members. This research assumes a single, coherent

culture and passive members who internalize and react to the culture. It

also posits that organizational meanings that matter to members concern

conscious and rational needs and are consciously understood.

In contrast, the psychodynamic view posits that individuals “experience

unconscious as well as conscious aims and needs . . . and act both

consciously and unconsciously to achieve their aims and satisfy their

needs.” Paying attention to organizational participants’ perceptions,

13
social incentives, and internal psychological conflicts can help in the

process of organizational change.

Baum details a case in which these psychodynamic principles were

ignored-the reorganization of a city’s social services system. The city’s

government established local human services coordinating councils to

improve service delivery to the neediest populations. Despite the positive

goals of the program, which many in the system felt were appropriate,

there was no clear-cut description of what these councils would do, the

authority and responsibility of the council members was ambiguous, the

human services director was autocratic and related poorly to others, and

there were few incentives to adopt the new approach. Consequently, the

new program was a failure. Baum recommends ways to improve the

adoption of this and other new organizational approaches.

Chapter 6 describes the attempted installation of an advanced computer

system in a State government agency. The overarching problem in

technology transfer, Dr. Michael Diamond argues, is the fact that most

technical managers ignore the underlying psychological dynamics of

organizations when they try to institute new systems in an organization.

Diamond makes four points in the chapter. First, technology transfer is

often based on the notion of the technician as expert authority. Thus,

training is not an interactive, collaborative effort, but rather top-down

learning. Second, technology transfer ignores the normal employees’

resistance to change, which is often a conflict between cognitive learning

and emotional security. Third, technology transfer similarly denies the

organizational psychodynamics of change. Employees need to develop

ownership of and endorse the rationale behind the technology transfer.

Fourth, technology transfer often ignores the organization’s culture,

which can be receptive or resistant to change. Technology transfer must

have a “transitional space,” which allows time and opportunity for the

individuals who need to change to work through the emotional and other

psychological reactions to making the change.

Dr. Alan Glassman in chapter 7 underscores the need for “learning

organizations” that are capable of adapting to everchanging conditions

and managers who must be able to manage conflict and ambiguity. If

organizations are going to survive and prosper. a new paradigm is

needed-one that embraces the notion of bounded instability, which

allows the inherent tension and conflict of instability to provoke

innovation. Glassman also describes the need for organic organizations,

which encourage and promote innovation, as opposed to bureaucratic

14
organizations, which strive for stability and thus discourage innovation.

Glassman feels that most attempts at bureaucratic reorganization result in

only marginal changes rather than wholesale restructuring that would

make a difference.

In chapter 8. Drs. Ramkrishnan Tenkasi and Susan Mohrman call for a

fundamental reorientation of thinking on technology transfer. Their

approach is based on a different set of assumptions about the nature of

knowledge. one that appreciates that knowledge is subjectively

constructed and subjectively consumed, requires contextual adaptation,

and is incomplete without a synthesis of the perspectives of all of the

adopters who will use the knowledge. This synthesis results in the

creation of new knowledge through a collaborative and mutual learning

process. This is particularly important in the area of soft technologies,

which can be primarily procedural (i.e., how something is done), where

the adopter must be part of the innovation process. By involving the

adopter, the new approach rejects traditional information transmission

approaches, which are often one-way communications from the developer

to the user, and accepts technology transfer as a collaborative learning

process.

Behavior Change in Substance Abuse Agencies and

Practitioners

The next three chapters in the monograph focus specifically on

technology transfer in the substance abuse treatment and prevention field.

Dr. Barry Brown in chapter 9 describes a unique and unprecedented

outreach effort sponsored by NIDA to educate injecting drug users about

HIV risk reduction outside of the institutional setting of the drug abuse

treatment clinic. Brown summarizes six elements derived from the

literature that are essential to research utilization: relevance, timeliness,

clarity, credibility, replicability, and acceptability. Brown then describes

how the program attempted to maximize these principles in its implementation. The outreach models were summarized in manuals that were

made available to States and other organizations. Extensive training and

technical assistance were provided to assist in replicating the most

effective methods. A newsletter publicized the positive outcomes and

annual meetings of program administrators and other practitioners kept

professionals in the substance abuse field informed of research results and

ways to use the results effectively. Brown also suggests that research

grants incorporate a technology transfer component to assist in the

15
dissemination of research results and to offer an incentive to researchers

to focus on the practical application of their findings.

In chapter IO, Drs. James Sorensen and Wayne Clark describe the

integration of technology transfer activities into a drug abuse research

center. The research center provided community liaison, policy, and

dissemination functions. Activities included conducting small colloquia

between clinicians and researchers, developing policy analyses relevant to

treatment practitioners and policymakers, convening a large annual

dissemination forum on research results, offering an instructional

videotape to assist in staff training, and employing a science writer to

develop articles about the center’s research for newsletters aimed at

clinicians. The authors describe some of the limitations in accomplishing

all of these efforts, but agree with Brown that research centers should take

on this important dissemination responsibility.

In chapter 11, Dr. Paul Gendreau points out some of the barriers in

transferring technology and knowledge across the related fields of

criminal justice and substance abuse. Gendreau explains that there is

little communication of research results across these fields, despite the

fact that both deal with the same population-substance abusers.

Gendreau summarizes the principles of effective (and ineffective)

interventions with offenders, which could improve offender rehabilitation

from both drug abuse and criminality. Some of these include

(1) intensive services, primarily behavioral in nature; (2) program

contingencies and behavioral strategies enforced in a firm but fair

manner; (3) proper matching of offender/client, therapist, and program;

(4) properly trained therapists: (5) program structure and activities that

disrupt the delinquency network; (6) relapse prevention training to

prepare the offender to integrate into the community; and (7) a high level

of advocacy to find adequate community support services when the

person leaves the institution.

Individual and Interpersonal Behavior Change

The final three chapters review the scientific literature on individual and

interpersonal behavior change to identify effective methods to change

drug abuse and other health-related problem behaviors in individuals. In

chapter 12, Dr. Richard Petty describes the Elaboration Likelihood Model

of Persuasion, which attempts to distinguish two different ways individuals develop attitudes about situations: the central route and the

peripheral route. The central route focuses on cognitive activity whereby

16
the person draws upon prior experience and knowledge to carefully

scrutinize and evaluate the issue-relevant arguments presented in the

communication. In contrast, the peripheral route uses simple cues to

either elicit an affective state (such as happiness) associated with the

advocated position (as in classical conditioning) or trigger a simple

inference that a person can use to judge the validity of the message

(e.g., a message from an expert fits the person’s judgment that experts are

generally correct). Petty points out that while peripheral messages can be

powerful, centrally processed messages tend to endure longer and become

more integrated into the person’s behavior. This chapter presents

examples that show that it is important to understand whether a change in

attitude or behavior occurs through a peripheral or central process in

order to assess whether a program will have a long-term impact.

In chapter 13, Dr. William McGuire presents the well-known

Communication/Persuasion Matrix as a process by which the vast

scientific literature on persuasive communication can be translated into a

form usable by practitioners. The Communication/Persuasion Matrix is

composed of 12 dependent variables involving the person who receives

the message and 5 independent variables involving the communication

sent-source, message, channel, audience, and target. McGuire shows

how this matrix can help program developers review each component in a

campaign or information program and relate it to the perspective and

context of the potential receiver (e.g., do they understand the message?

have they acquired the necessary skills to effect the change?) to maximize

its effect on changing attitudes or behavior. McGuire also strongly urges

program developers to conduct formative research to learn about their

audience and to test their communication vehicles before releasing the

campaign.

The last chapter provides an overall review of lessons learned about

behavior change from behavioral science research, with a specific focus

on HIV and AIDS prevention programs. Dr. Martin Fishbein summarizes

eight variables that appear to account for most of the variation in any

given behavior: intentions, skills, environmental constraints, attitude,

norms, self-standards, emotional reactions, and self-efficacy. The first

three factors are viewed as necessary and sufficient for producing any

behavior. That is, for behavior to occur, one must have a strong positive

intention to perform the behavior in question, one must have the skills to

perform it, and the environment must provide the opportunity or be free

of constraints. The remaining five variables are viewed primarily as

factors influencing the strength and direction of intention. For instance,

17
one will not form a strong intention to perform a given behavior unless

one has a strong positive attitude toward performing that behavior.

Fishbein summarizes this theory by stating that intentions are most

proximal to behavior: thus, to produce the best results it is critical to

measure intentions prior to developing an intervention. Fishbein also

underscores the importance of developing communications that address

the differences in attitude and behaviors among different populations.

CONCLUSION

Each chapter in this monograph provides a unique perspective about

changing behavior in communities and society in general, in

organizations as part of innovation and improved productivity, and

among individuals, whose unique personality and psychological makeup

must be understood and addressed in effective programs. Technology

transfer involves all of these areas because it requires people to change

their own behavior, usually in an organizational environment, which also

must change. This leads to uncertainty and considerable anxiety. New

technologies must offer encouragement and positive rewards (e.g., better

outcomes for clients, improved salaries, educational credits) that outweigh the negative costs of learning new ways to perform. Effective

technology transfer involves strong, targeted communications that

respond to potential barriers and encourage support for more effective

individuals and more productive organizations.

REFERENCES

Alegna, M.; Amaro, H.; Backer, T.E.; Diaz, E.; Mata, A.;

Rodriguez, G.M.; and Villa-Barton, C. Policy Report: AIDS and Drug

Abuse Research and Technology Transfer in Hispanic Communities.

Rockville, MD: National Institute on Drug Abuse, 1994.

Backer, T.E. Drug Abuse Technology Transfer. Rockville, MD: National

Institute on Drug Abuse, 1991.

Backer, T.E. Replication may be the sincerest form of philanthropy.

Chronicle of Philanthropy, March 8, 1994a. pp. 54-55.

Backer, T.E. Readiness for Change, Educational Innovations, and

Education Reform. Washington, DC: Office of Educational Research

and Improvement, U.S. Department of Education, 1994b.

18
Backer, T.E. Adding Value to Grantmaking: Dissemination and

Utilization Strategies for Foundations. Kansas City, MO: Ewing M.

Kauffman Foundation, 1995.

Backer. T.E., and Koon, S.L. Sharing the wealth of ideas. Foundation

News and Commentary 36(2):28-34, 1995.

Backer, T.E., and Rogers, E.M., eds. Organizational Aspects of Health

Communication Campaigns. Newbury Park, CA: Sage, 1993.

Backer, T.E., and Shaperman, J. Knowledge utilization activities of

foundations supporting health research and demonstrations. Knowl

Creat Diffus Util 14(2):59-67, 1993.

Backer, T.E.; Liberman, R.P.; and Kuehnel. T. Dissemination and

adoption of innovative psychosocial interventions. J Clin Consult

Psychol (1):111-118, 1986.

Backer, T.E.; Rogers, E.M.; and Sopory, P. Designing Health

Communication Campaigns: What Works? Newbury Park, CA: Sage,

1992.

Brown, V.B., and Backer, T.E. The substance abusing mentally ill

patient: Challenges for professional education and training. Psychosoc

Rehabil J 10:14-19, 1988.

Dunn, W.N., and Holzner, B. Anatomy of an emergent field. Knowl Soc

1(1):3-26, 1988.

Glaser, E.M.; Abelson, H.; and Garrison, K.N. Putting Knowledge to

Use. San Francisco: Jossey-Bass, 1983.

Havelock, R.G. Planning for innovation Through Dissemination and

Utilization of Knowledge. Ann Arbor, MI: University of Michigan,

Center for Research on Utilization of Scientific Knowledge, Institute

for Social Research, 1976.

Lipton, D.S., and Appel, P. The state perspective. In: Tims, F.M., and

Ludford, J., eds. Research Analysis and Utilization System. Rockville,

MD: National Institute on Drug Abuse, 1984.

Office of Technology Assessment. Identifying Health Technologies That

Work: Searching for Evidence. OTA-H-608. Washington, DC: Supt.

of Docs., U.S. Govt. Print. Off., 1994.

Rogers, E.M. Diffusion of Innovations. 3d ed. New York: Free Press,

1983.

Sechrest, L.; Backer, T.E.; and Rogers, E.M.; Campbell, T.F.; and

Grady, M.L., eds. Effective Dissemination of Clinical and Health

Information. Rockville, MD: Agency for Health Care Policy and

Research, 1994.

Sorensen, J.L.; Hall, S.M.; Loeb, P.; Allen, T.; Glaser, E.M.; and

Greenberg, P.D. Dissemination of a job seekers’ workshop to drug

treatment programs. Behav Ther 19:143- 155, 1988.

19
Technology Transfer Business. NII: Information superhighway. Spring:

22-34, 1994.

Wierengo, D.E. “A Convergence Model Approach to Technology

Transfer and Inter-organizational Communication: Federal

Laboratory-Industry Communication Masters thesis, University of

New Mexico, 1994.

Zaltman. G.; Duncan, R.: and Holbek. J. Innovations and Organizations.

New York: Wiley, 1973.

AUTHORS

Thomas E. Backer, Ph.D.

President

Human Interaction Research Institute

1849 Sawtelle Boulevard

Suite 102

Los Angeles, CA 90025-7007

Susan L. David, M.P.H.

Chief

Public Information Branch

Gerald Saucy, Ph.D.

Public Health Analyst

Public Information Branch

National Institute on Drug Abuse

Parklawn Building, Room 10A5600 Fishers Lane

Rockville, MD 20857

2 0
Assessing and Enhancing

Readiness for Change:

Implications for Technology

Transfer

Thomas E. Backer

INTRODUCTION

Many of the challenges of innovation and change reflect complicated

human dynamics. People need to feel rewarded for changing and to be

involved in planning for changes that will affect them. They need to

work through their fears, resistances, and anxieties about change. When

ignored, this human dimension often causes technology transfer efforts to

fail or to have a reduced impact (Backer 1991), because successful

technology transfer requires individuals and organizations to change.

Readiness for change is one of these challenges-one often neglected in

planning and implementing technology transfer.

In this chapter, concepts and practices concerning readiness for change

are discussed as part of the larger frame of technology transfer interventions. Methods for assessing and enhancing change readiness are

presented as part of this discussion, followed by an analysis of applications to drug abuse and human immunodeficiency virus (HIV)/acquired

immunodeficiency syndrome (AIDS) treatment and prevention.

The behavioral sciences literature addresses readiness for change both at

the individual and organizational levels. Schein (1979, p. 144) asserts

that “The reason so many change efforts run into resistance or outright

failure is usually directly traceable to their not providing for an effective

unfreezing process before attempting a change induction.” Beer (1980,

p. 80) states that the failure to analyze and deal with readiness issues “can

lead to abortive organization development efforts.” Woodman and

Tolchinsky (1985) observe that change interventionists usually do not

measure and incorporate expectations-a central component of

readiness-in organizational change interventions. Fullan (1982), writing

in the field of education, asserts that successful change has distinct stages,

the first of which is “initiation,” defined as making the decision to change

and beginning to think about how it will occur.

21
DEFINITION AND IMPLICATIONS OF READINESS FOR

CHANGE

In a recent comprehensive review, Armenakis and colleagues (1993)

define individual and organizational readiness for change as involving

people’s beliefs, attitudes, and intentions regarding the extent to which

changes are needed and their perception of individual and organizational

capacity to successfully make those changes. Readiness is a state of mind

about the need for an innovation and the capacity to undertake technology transfer; it is the cognitive precursor to behaviors of either

resistance or support for the actual transfer effort. Readiness (referred to

as “unfreezing” behavior) is the first part of the natural cycle of change in

the model advanced by Lewin (1947). Defining readiness for change in

this way has six important implications, discussed below, for the design

and implementation of technology transfer interventions in drug abuse

treatment and prevention.

Readiness Can Be Enhanced

Readiness for change is not a fixed element of individuals or systems. It

may vary due to changing external or internal circumstances, the type of

change being introduced, or the characteristics of potential adopters and

change agents. Thus, interventions to enhance readiness are possible and

can increase the overall success of technology transfer. Change can occur

under conditions of low readiness. of course, but behavioral science

research indicates that the probability of success is reduced when low

readiness leads to low motivation to change or to active resistance.

Readiness Can Be Assessed

Even though readiness is a cognitive state that leads to overt behavior

only later in the cycle of change, it can be measured using a variety of

behavioral science approaches. Interventions can be designed based on

assessment results. In some cases. change agents may decide to forgo

technology transfer efforts because assessed readiness for change is low.

Assessing readiness is particularly important for what Kanter (1983) calls

the proactive change agent. Traditionally, internal or external change

agents have responded to challenges that the environment already

presents. The proactive change agent seeks out potential problems, such

as low readiness for technology transfer, and intervenes before this

cognitive factor results in active resistance to change. Intervening means

22
attempting to influence the beliefs, attitudes, and intentions of drug abuse

agency staff, community leaders, or others who must participate in the

change technology transfer requires.

Individual Readiness and Organizational Readiness

This discussion treats individual readiness for change as part of

organizational readiness for three reasons. First, substance abuse

prevention and treatment services typically are provided by service

agencies or systems, so that the organizational context is always relevant.

Second, the interventions discussed here emphasize assessing and

enhancing individual readiness using organizational strategies, such as

surveys or organization development (OD) interventions.

Third, behavioral science knowledge indicates that creation of readiness

for organizational change goes beyond individual cognitions. For

instance, Griffin (1987) and others who study social-information

processing assert that individual readiness is shaped by the readiness of

others, as perceived and discussed in a group setting such as a drug abuse

agency.

Readiness Is a Cognitive Characteristic

What counts in assessing readiness for change is what people believe.

Readiness for change involves people’s perceptions of whether they (or

their colleagues or organization) have the financial support, the welldefined mission and leadership structure, the cohesive work team, or the

technical skill level needed to adopt a particular innovation. The actual

existence of these resources, however, is a matter separate from readiness.

Perceptions may relate either to a specific innovation being considered

for transfer or to change in some more enduring aspect of the organization, such as its overall management style.

As used in this chapter, readiness for change does not refer to the

readiness of the innovation to be transferred (e.g., the degree to which it

is readily adaptable to different environments of use, the nature of the

innovation) or to the readiness of the innovation developers or other

change agents to deliver the innovation into new settings (e.g., the degree

to which innovation developers have the time available to offer technical

assistance to potential adopters). These types of readiness are important

to the process of technology transfer, but they are not part of the focused

definition of cognitive processes of adopters used here. These

23
distinctions are crucial, lest readiness for change include every aspect of

the complex process of technology transfer.

Thus, readiness is only part of the overall cycle of innovation and change.

This larger cycle includes determining the relationship between the

perception of readiness and the true reality. In many cases, failure to

achieve technology transfer results because, although people have a high

readiness, the resources to implement change do not exist.

Readiness Is Not the Same as Resistance

According to Armenakis and colleagues (1993), a number of researchers

have discussed the importance of readiness, but few have recognized it as

distinct from efforts to reduce resistance to change. Intervening to

counteract resistance to change has a long history in the behavioral

sciences (Kotter and Schlesinger 1979), beginning with Coch and

French’s (1948) classic experiment in reducing resistance, which

demonstrated the value of encouraging people to participate in designing

the change that they will undergo. However, successful efforts to

enhance readiness can prevent active resistance from occurring in the first

place. Resistance reduction is not the same as readiness.

Needs Assessment Is Not Readiness Assessment

Organizational and community assessments typically have focused on the

needs of various individuals and groups related to a particular innovation.

While assessing and interpreting these needs may be critical for

successful technology transfer, needs assessment is not the same as

readiness assessment. In fact, there may be a very high level of perceived

need, yet very little readiness to engage in the changes necessary for

effective technology transfer. Innovations in the prevention of AIDS and

drug abuse are frequently subject to this need-readiness gap.

BEHAVIORAL SCIENCE KNOWLEDGE BASE

In “The Change Masters,” Kanter (1983, p. 281) asserts that

“Organizational change is stimulated not by pressures from the

environment . but by the perceptions of that environment and those

pressures held by key actors.” Moreover, the felt urgency and energy

required for change are emotional issues. People and organizations

develop the energy to change when faced with real pain (Armenakis et al.

24
1993), whether the nature of change is personal or work related. Thus, a

range of behavioral science fields, including social psychology,

organization development, organizational transformation, and planned

change, are relevant to assessing and enhancing readiness.

The concept of readiness for change has some of its origins in social

psychology, especially in work on the human dynamics of change among

individuals and groups and work on resistance to change and methods for

overcoming it. Lewin (1947) developed force field analysis, which

argues that change is not an event but a dynamic balance of forces

working in opposite directions. Readiness assessment and enhancement

methods have drawn heavily upon such work.

There is an extensive literature on individual readiness for change

(e.g., the importance of expectations and other cognitive factors, the

significance of behavioral rehearsal and other skill-based components of

developing readiness). For instance, Bandura (1982) has conducted

extensive empirical work supporting self-efficacy theory as an

interpretive framework for cognitive change. Bandura defines selfefficacy as the individual’s judgment of his or her ability to perform

certain tasks, and notes that groups have a sense of efficacy and that both

group and individual efficacy must be considered in strategies for

enhancing change readiness.

A recent synthesis of research on behavioral variables associated with

behavior change (Bandura et al. 1991) reveals eight key factors:

intention, environmental constraints, ability, anticipated outcomes,

norms, self-standards, emotion, and self-efficacy. Intention and the latter

five factors (all assumed to influence intention) are cognitive factors tied

closely to the concepts of readiness for change presented in this chapter.

Many methods for promoting adoption of innovations in education and

other fields reflect the significance of these cognitive factors. For

instance, one of the most widely used frameworks for educational

innovation, the Concerns Based Adoption Model of Hall and Loucks

(1978), posits that different levels of innovation adoption reflect differing

cognitive concerns of educators that result in differing levels of readiness

for educational change.

Six major reviews have been published since 1974 in the “Annual

Review of Psychology” on the fields of organization development,

organizational transformation, and planned change. In the most recent

25
review, Porras and Silvers (1991, p. 51) indicate that, while there are

many intervention methods and case studies, these fields are still in an

early stage of development: “Planned change that makes organizations

more responsive to environmental shifts should be guided by generally

accepted and unified theories of organizations and organizational

change-neither of which currently exists.”

Porras and Silvers (1991) present a tentative model for planned change

that emphasizes the importance of both cognitive and behavioral change

of individuals within the organizational setting. Targets of change efforts

are organizational visions and work settings, and the ultimate desired

outcomes are both improved organizational performance and enhanced

individual development.

Another model for types of organizational change (Nadler and Tushman

1989) suggests that change can be classified on two dimensions:

anticipatory versus reactive and incremental versus strategic. As table 1

shows, four types of change interventions result, ranging from low to

high intensity in this order: fine-tuning, adaptation, reorientation, and

re-creation. Nadler and Tushman argue that readiness for change may be

more limited for the more intense levels of change, and they advocate

diagnosing readiness as part of planning for change at all four levels.

TABLE 1. Model for organizational change.

Anticipatory

Reactive

Incremental Strategic

Fine-tuning Reorientation

Adaptation Re-creation

SOURCE: Nadler and Tushman 1989.

Readiness concepts also appear in many behavioral science-based

interventions for managing planned change. For example, the four basic

elements of organizational diagnosis (Levinson 1972) constitute a

26
well-developed method for assessing organizational dynamics prior to

instituting change:

• Recognition and interpretation of the problem and assessment of the

need for change,

• Determination of the organization’s readiness and capability for

change,

• Identification of managers’ and employees’ resources and

motivations for change, and

• Determination of the change strategy and goals.

Information needed for diagnosis of readiness for change may be

gathered by questionnaires, interviews, and observation; from the

organization’s records: or by a combination of these. Moreover,

organizational diagnosis practitioners such as Levinson recognize that the

information-collecting process itself increases awareness of change and,

if done properly, can help increase readiness.

MODEL FOR ENHANCING CHANGE READINESS

Armenakis and colleagues’ (1993) conceptual model for enhancing

change readiness has been adapted here (figure 1) to guide discussion

about assessment and enhancement interventions. An overall analysis of

readiness assessment is followed by the presentation of specific assessment techniques taken from the recent behavioral sciences literature and

social marketing methods that can be used for strategic planning of

readiness assessment. Then the elements defining efforts to enhance

change readiness are discussed. These include contextual factors,

message characteristics, and communication approaches that can be used

to deliver them; attributes of change agents; interpersonal and social

dynamics of the organization in which change is to take place; and

specific enhancement interventions, including those rooted in the broader

behavioral science knowledge base on technology transfer.

27
(1) ASSESSING READINESS

Specific assessment methods

Planning for assessment: Social marketing

(2) CONTEXTUALIZING READINESS

Message characteristics: Discrepancy and efficacy

Change agent attributes

Potential adopter characteristics

Larger context for innovations

(3) ENHANCING READINESS

Active participation

Persuasive communications

Management of external information

FIGURE 1. A model for enhancing change readiness.

Assessment Methods

A number of behavioral science-based methods have been employed for

assessing readiness for change:

• Survey instruments,

• Focus groups,

• Clinical interviews.

• Site visits, and

• Community profiles, leading to a comprehensive community

assessment.

28
Seven applications of these assessment methods are presented below.

A VICTORY. A VICTORY is an 8-factor model for assessing readiness

for change (Davis 1978) converted into a 75-item rating scale. The eight

factors are ability (resources), values, information (about the innovation),

circumstances and timing, obligation (felt need to change), resistances,

and yield (rewards that can come from implementing the innovation).

This assessment can be administered through interviews or selfadministered to develop a profile of attitudes and beliefs both for individuals and the organization as a whole. Davis recommended obtaining

independent ratings of change readiness by an outside consultant as well,

as part of a four-step intervention process called Decision Determinants

Analysis, which includes planning interventions needed to elevate lowreadiness factors on the initial profile, implementing the change, and

following up to evaluate success in technology transfer.

A VICTORY has been used for readiness assessment in mental health,

correctional, social service, and general health care settings. In addition

to Davis’ rating scale, at least two other instruments have been developed

for assessing readiness for change using this framework. Javorek and

colleagues (1979) created a questionnaire for use in mental health

settings, Strommen (1985) developed an instrument with 20 subfactors

based upon an analysis of responses from surveys taken in 191 service

organizations; the resulting instrument has been applied to mental health

and social service organizations, colleges, and youth-serving

organizations.

A VICTORY also has been used in the business world. For instance,

Barabba and Zaltman (1991) suggest applying the A VICTORY

framework as part of an inquiry center, a method for addressing market

strategy questions in business firms. The A VICTORY factors help

determine how information can be used to ask fundamental questions

about the services or products a firm provides and about the ways in

which innovations are introduced into the organization and into its

customer environment. This approach has been applied in a number of

traditional business organizations.

School Context Analysis Form. D’Amico and Corbett (1988)

developed the School Context Analysis Form to measure the readiness of

schools to participate in planned change. The form includes items

measuring eight contextual factors: resources, incentives and disincentives, linkages, priorities, factions, turnover, current practices, and prior

29
projects. This instrument has been used to assess the readiness of

teachers and administrators to engage in systemic reform of educational

systems.

Clinical interviews for America 2000 Educational Reform. Peterson

(1992) used unstructured interviews with teachers and administrators in a

Nebraska school district to measure readiness for educational reform

conducted as part of the America 2000 program. The interview process

measured (1) reactions to changes that had been undertaken recently,

(2) general attitudes of the respondent toward change, and (3) desire for

specific changes under the new initiative. The culture (i.e., beliefs and

values) of teachers and administrators was the focus of these interviews.

Results were synthesized and presented to the local school board and

other decisionmakers to use in designing the change program. Findings

indicated that teachers desired a greater voice in decisionmaking and

wanted better coordination and articulation of change at the school level.

The study concluded that making these changes would increase readiness

for change.

Georgia School Change Survey. In a similar study, Roberts (1991)

assessed readiness for change in 42 Georgia schools, using a written

survey that measured (1) ability to implement the innovation (e.g., need,

clarity, complexity, practicality), (2) leadership strength (e.g., active

principal support), (3) stages of concern and levels of use, (4) collegial

interaction, and (5) barriers to change (e.g., lack of commitment,

inadequate feedback, negative attitudes about change). Results from the

survey were reported to decisionmakers responsible for designing the

change program.

Social Reconnaissance. Developed by Saunders and elaborated by

Nix, social reconnaissance has been adapted by the Henry J. Kaiser

Family Foundation to assess health promotion needs and priorities in the

southern United States (Williams 1990). This method involves identifying felt needs or problems of a community, prioritizing them, and then

developing and implementing an action plan to address them. Assessment of readiness for change is part of this process. The foundation

awarded planning grants to fund these assessments at the community

level prior to awarding grants for projects that would address health

promotion. This provided an opportunity for assessing readiness for

change and addressing barriers that might prevent later success.

30
Social reconnaissance is based conceptually upon the PRECEDE/PROCEED model developed by Green and Kreuter (1991) for planning,

implementing, and evaluating health education programs. The Planned

Approach to Community Health (PATCH) is a similar model developed

by the Centers for Disease Control and Prevention for community health

programming (Green and Kreuter 1992). EMPOWER, a computer

software system developed by Green (personal communication, May 4.

1993) under funding support from the National Cancer Institute, brings

communities together to diagnose readiness for change and actual needs

for change through computer interactions in six areas: situation analysis,

social diagnosis, epidemiological diagnosis, behavioral diagnosis,

educational diagnosis, and administrative diagnosis.

Mental Hospital Diagnostic Survey. Pond and colleagues (1984)

developed a diagnostic survey of readiness for change for use with

employees of a large mental hospital. Each item included four subparts

concerning organizational climate, expectation of changeability,

importance, and employee satisfaction with the aspect of climate

measured. It was found that expectation of changeability, which is

central to readiness for change, could be measured independently from

the other three components in this study.

Public Health Service Diagnostic Survey. Fox and colleagues (1988)

conducted a major OD intervention for the Department of Health and

Human Services that focused on a research component of the Public

Health Service. Prior to the intervention, a standardized human resource

management index was administered to participants to obtain general

information about management conditions, organizational climate, and

other issues. The index included a specially developed five-item

readiness for change scale. This scale measured the work group’s

willingness to make improvements in procedures and solve problems.

Other organizational surveys might also use this readiness for change

scale by appending it to other item content.

Social Marketing

Strategic planning for the assessment of change readiness may be

facilitated by applying concepts of social marketing. Based on marketing

concepts from the business sector (Kotler and Roberto 1989; Walsh et al.

1993), social marketing provides a management framework for

systematic efforts to understand the characteristics of an audience being

targeted for change (e.g., the group of people in an organization or

31
community being targeted to adopt an innovation) using standard

marketing methods such as audience segmentation and audience analysis

using focus groups.

For instance, Golden and Johnson (1991) describe an application of

social marketing to creating a strategic plan for AIDS prevention

education. Integrating important aspects of the Health Belief Model and

using the national distribution of the Surgeon General’s booklet on AIDS

as a vehicle for testing some assumptions. this study presents a clear

vision of how social marketing can provide a guiding framework for the

development of a change effort, including its assessment component.

Social marketing can perform the following.

• Identify types of information about people and institutions that need

to be gathered through an assessment process;

• Provide assessment tools to assist with data gathering;

• Provide a framework for planning the campaign and understanding

both how it will work and what results it may achieve;

• Offer specific marketing methods that may help to orchestrate the

media approaches that are used; and

• Provide a framework for integrating related theoretical constructs,

such as the Health Belief Model. and other input from related fields,

such as health education.

Contextual Factors

Readiness for change is influenced by people’s attitudes and beliefs about

the larger context in which a new idea or technology is to be implemented. What other changes, or calls for change. are occurring within the

organization or community at the same time? Are people feeling

energized or overwhelmed by these other changes?

Armenakis and colleagues (1993) suggest that most organizations can

sustain a maximum of three major types of change at any one time.

Message clutter can lower readiness for change if people are being asked

to change on too many fronts at once. For instance, technology transfer

of an innovative drug abuse prevention program for public schools may

face low readiness among teachers and administrators if they are also

32
wrestling with the changes required by major budget cutbacks or

implementing educational reform. In addition, a refractory period of low

readiness for change may immediately follow a major change, even if that

change was successful.

Message Characteristics

In any technology transfer intervention, the message provided about an

innovation and its potential for adoption contains two components.

• Discrepancy: the felt need for change (the difference between what is

and some desired end-state) which often is experienced emotionally

as discomfort or pain. Bandura (1982) refers to unfavorable personal

consequences, which can be interpreted in the organizational context

as the threat of organizational failure.

• Efficacy: the ability of the individual or organization to correct the

discrepancy, or what Bandura calls self-efficacy. Bandura’s work

demonstrates that individuals will avoid activities they think exceed

their capabilities.

Communication strategies may be useful in conveying the message that

some new technology is needed and that the organization is capable of

changing in ways that will allow technology transfer to be successful. In

a comprehensive analysis of the literature on this subject, Backer and

colleagues (1992) identified a number of factors characterizing successful

communication strategies (e.g., use of multiple media rather than just one

channel, combining media and interpersonal strategies). Backer and

Rogers (1993) further identified interorganizational networking as a key

component of major communication campaigns concerning such topics as

drug abuse prevention. Such analyses may be helpful in designing

communication approaches for conveying what has been learned about

the need for change and the ability of the organization to undertake it,

especially if a large organization or community is involved.

Novelty also can be an element for success. For instance, Green’s

EMPOWER computer software system has potential partly because its

novel way of bringing communities together attracts attention, so that the

messages gathered about readiness will have a greater chance of actually

influencing productive change.

33
Change Agent Attributes

Most significant technology transfer efforts are initiated and coordinated

by internal or external change agents. Internal change agents can include

organizational leaders and staff persons selected by management to

spearhead the implementation of a new program or technology. External

change agents may be developers of the innovation to be transferred or

consultants with process expertise in innovation and change. Change

agents are often the individuals who make the initial communication

about change and guide the process of assessing and enhancing readiness

for change. Thus, their perceived credibility, trustworthiness, sincerity,

and expertise (both content expertise about the innovation and process

expertise about readiness enhancement and other stages in technology

transfer) can have an important impact on readiness for change within the

organizational setting (Turner 1982).

The organizational position of internal change agents can bear significantly on their influence upon increasing readiness for change. Topdown approaches to introducing change are often problematic, but so are

bottom-up approaches (Armenakis et al. 1993). Change agents who are

accepted opinion leaders within the organization. usually at the midrange

of authority, often are the most successful in assessing and developing

readiness (Backer 1991: Rogers 1983).

Interpersonal and Social Dynamics

Interventions to create readiness for change are attempts to mobilize

collective support by building and shaping awareness among organizational members about the existence of, sources of, and solutions to the

organization’s problems. Thus, interpersonal and social dynamics of the

organization or community play a key part in determining readiness.

Armenakis and colleagues (1993) refer to three theoretical perspectives

from the behavioral sciences that have important implications for

designing readiness interventions:

• Individual differences. Responses of individuals to readiness interventions vary because of their own differing cognitive structures.

• Social differentiation. Responses vary according to people’s cultural

or subcultural membership (e.g., position in the organization, racial

or ethnic group).

3 4
• Social relationships. Opinion leaders have a disproportionate

influence upon affecting readiness for change through the social

relationships they have with others in the system. Thus, beginning an

intervention by enhancing readiness in opinion leaders can stimulate

a snowball effect of increased readiness throughout the system.

Enhancement Interventions

At least three strategies can be used to increase change readiness for both

individuals and groups:

• Persuasive communication. Both oral and written communications

that persuasively address the issues of discrepancy and efficacy can

begin the process of enhancing readiness for change. As with any

organizational communication, issues of clarity, accessibility to the

target population (e.g., literacy levels), and user-friendly, attractive

formats all bear upon the effectiveness of these communications.

• Active participation. The literature on behavior change is replete

with evidence that people trust what they learn through their own

activities. Thus, getting people involved in early efforts to define

what change is needed, and how technology transfer can help, can

have an impact on readiness for change. Strategic interventions, such

as appointing a natural opinion leader to a strategic planning

committee, can have a mobilizing effect on all efforts to promote

readiness for change.

• Management of external sources of information. People’s readiness

to consider change within their organization may be influenced by

information that comes to them from outside the organization (e.g., a

diagnostic report by a consulting firm, information presented in the

public media). Organizations can manage such information flow

(e.g., through press releases to the media).

Active interventions to promote readiness for change also can occur

throughout the process of technology transfer. In fact, the potential

impact of readiness for change does not end with the initial actions by

users to adopt some new program or technology. Readiness for change

actually includes both the initial readiness of innovation developers

(e.g., researchers) to get involved in technology transfer activities and

long-term efforts to promote durability of innovation once they have been

transferred effectively into some new setting (Backer 1991).

3 5
Applications to Drug Abuse and Drug Abuse-Related

HIV/AIDS

A number of approaches to assessing and enhancing readiness have been

undertaken in the drug abuse and drug abuse-related HIV areas. For

example, the Center for Substance Abuse Treatment (CSAT) has initiated

statewide needs assessments that are used for strategic planning of service

delivery, including those services funded by CSAT. Many elements of

these needs assessments provide clear indicators of readiness for change

that can be addressed through technical assistance. technology transfer,

and other activities sponsored by CSAT (Backer and Goodstein 1993).

NIDA has developed a program to help communities identify readiness

for change with regard to siting drug abuse treatment facilities in their

areas. The Overcoming Barriers to Treatment Program incorporates

many of the readiness concepts addressed here into a community action

format (NIDA 1989).

UNRESOLVED ISSUES: READINESS AND DRUG ABUSE

TECHNOLOGY TRANSFER

Several unresolved issues emerge from this discussion of assessing and

enhancing readiness for change as part of the process of drug abuse

technology transfer. These issues can be the focus of future efforts to

adapt the larger behavioral science knowledge base to this particular

arena.

1. Readiness assessment and enhancement must become a regular part

of technology transfer interventions. Worthwhile innovations and

promising methods for technology transfer (e.g., technical assistance

consultation, the technology transfer packages NIDA is developing)

may fail to yield the desired results if potential adopters are low in

readiness for change--especially if no efforts are made to address

limited readiness. If potential users are planning for change when

they are not ready for the innovation, resistance and even sabotage

can result. Preliminary interventions can help prevent these negative

reactions. In addition, assessment and enhancement of readiness

needs to be built into legislation and administrative policies that

guide the replication or dissemination of new programs and

technologies, just as change agents may work at the policy level to

promote technology transfer (Hall and Hord 1984).

36
2. Assessing and enhancing readiness for change is especially critical

for dealing with the public bureaucracies in which most drug abuse

agencies operate. Such systems often do not readily reveal lack of

readiness for change, and staff can engage in resistance to change in

many ways that are protected by civil service rules and other features

of Governmental organizations. Perhaps even more damaging, these

human service environments may carry a tacit, yet inaccurate,

assumption of readiness because of the service orientation of both the

individuals and the agency. Yet dedication does not automatically

lead to readiness for change.

3. Durability of innovations implemented through technology transfer

interventions may be significantly affected by early inattention to

readiness for change. In many cases, it may be possible to adopt an

innovation (e.g., through legislative mandate or administrative order).

However, if the adoption occurs prior to achieving a reasonable level

of staff and community readiness, the new program or technology

may have great difficulty surviving over time due to unenthusiastic

implementation or sabotage.

4. A systems approach is needed to integrate readiness assessment and

enhancement into the technology transfer process. Strategic planning

is usually needed given the scope of change required for most

significant technologies.

5. Management style in the organization has much to do with the impact

of readiness for change and its assessment. For instance, Robertson

and Briggs’ (1993) case studies indicate that the implementation of

school-based management enhances readiness for change by affecting

school decisionmaking processes and culture. School-based

management may provide a receptive environment for technology

transfer because it works to enhance overall readiness for change.

The current emphasis on reinventing government at Federal, State,

and local levels also can have a significant impact-both positive and

negative-on readiness.

6. Readiness for unexpected change raises special issues such as crisis

management, as revealed in the work of management scientists such

as Mitroff and the Crisis Management Institute at the University of

Southern California.

37
7. When multiple adoption sites for technology transfer and different

measured levels of readiness exist, significant strategy decisions must

be made. Does the change agent responsible for making multiple

interventions select those most ready for change, leaving those not

ready without any help? Should resources be devoted to enhancing

readiness among those less ready for change? If so, should the

change agent select the cases requiring only minor movement or use

significant resources to address the greater challenges?

8. Staging change to facilitate readiness necessitates strategy decisions.

For instance. community organizers since the 1960s often have used

a strategy to create readiness for major change by organizing people

around a small issue that was likely to be successful. Once the

community achieved success. they were much more likely to be

ready for the major change. Practical approaches such as this need to

be integrated into the behavioral science knowledge base on how to

assess and enhance readiness for change in drug abuse treatment and

prevention.

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40
AUTHOR

Thomas E. Backer, Ph.D.

President

Human Interaction Research Institute

1849 Sawtelle Boulevard

Suite 102

Los Angeles, CA 90025-7007

4 1
Collaboration and Diversity in

Technology Transfer

Kathryn H. Kavanagh

Understanding relationships between behavioral science knowledge and

technology transfer in the area of drug abuse treatment calls for appraisal

of the technology, how it is generated and applied, and how it fits with

the needs of practice-level providers and consumers. Additionally,

maximizing technology utilization necessitates critical scrutiny of the

assumption that the technology and its transfer should be the locus of

concern. In addition to scrutiny of relationships between drug abuse

intervention and the major theories and practices used in that aspect of

health care, one must ask whether the ethos of implementation rather than

transfer of new knowledge most acutely needs attention.

This chapter addresses broad relationships between society and drug

abuse intervention and explores the likelihood that the challenge of drug

abuse prevention and treatment is perpetuated by neglect or disregard of

already available knowledge and technology. The unavoidable

conclusion is that new knowledge is less needed than are strategies that

will assist in implementation of what is already known but is devalued

because change requires confrontation of basic social processes intrinsic

to traditional intervention situations. Increased efficacy in drug abuse

intervention, in short, hinges on redefinition of the interactive circumstances of that intervention. Only then can other knowledge and

strategies be fully accepted and utilized.

THEORY, CONTEXT, AND PRAXIS

The role of theory in practice always has been problematic. Health care’s

struggle with whether the theories used should come from practice-based

or theory-testing scientific paradigms (Hoshmand and Polkinghome

1992; Staats 1993; Steenbarger 1993) is a consequence of the field’s

positivist legacy. The science-practice rift fuels continued controversy

over the viability of unifying academic and applied perspectives and

roles. Although the generators of scientific theory usually are interested

in testing their hypotheses, typically they are not held accountable for

designing and testing outcome-oriented interventions involving the

42
results of that theory testing. The direct relevance of theory to practice

often remains, therefore, more presumption than fact.

It is increasingly argued that development of theories and methods useful

in drug abuse treatment should not be constrained by assumptions that the

processes of physical science are automatically appropriate to mental

health intervention (Eliason 1993; Kim and Berry 1993). Most theories

must be applied cautiously to health and illness-related behaviors to

improve chances of development and operationalization of relevant and

acceptable intervention approaches. To accomplish this improvement, in

light of today’s escalating population diversity as well as society’s current

preoccupation with political correctness, frameworks for understanding

and knowing how to manage drug-related phenomena must be adequately

broad and flexible to lend themselves to formation of contextualized

intervention approaches.

Both theoretical and empirical knowledge, to be useful, must help to

account for observations through the redefining of the unknown in terms

of the known. Contemporary thinking along postmodem lines promotes

examination of the value of practitioners’ experiences over theory.

However, this approach neither counteracts the lack of credibility

attributed to experience in generating outcomes (Steenbarger 1993) nor

explains how to fill the gaps left in prevention and health care delivery

when clinicians do not have adequate theories to guide them (Facione

1993). While lack of substantive theoretical frameworks to support

understanding and explanation risks distortion and misuse of intervention

strategies, theoretical approaches without adequate flexibility inhibit

implementation of potentially useful interventions. Drug use is spread

through behaviors that are personally as well as socially and culturally

meaningful. Past experiences, social interaction patterns, institutions,

norms, and values shape both individual and collective responses to drugrelated phenomena (Leap and O’Connor 1993; Nelkin et al. 1991). The

everyday significance of multidimensional drug-related behaviors has the

potential to facilitate effective prevention and intervention. However,

attitudes and behaviors embedded in basic social processes involving the

distribution of power and recognition of diversity impede development,

communication, acceptance, and implementation of potentially useful

knowledge and effective strategies. Based on critical examination of the

current gap between research knowledge and its utilization in practice,

this chapter asserts that the obstacles to technology transfer are more

basic than the level at which they are generally examined. This chapter

further asserts that collaboration in the form of empowerment and

43
management of diversity are essential constituents in drug abuse

treatment that is acceptable at the practice level. Without these

components. both the process of technology transfer and the

implementation of transferred technology remain curtailed.

Whether originating in science or practice. only context-sensitive and

population-specific approaches can bridge gaps formed by multiple

conceptualizations and methods generated by the interface of myriad

disciplinary, experiential, and ethnocultural perspectives (Andrews 1992;

Facione 1993: Kavanagh and Kennedy 1992; Kenney 1992: Pedersen

1988). The contemporary sociolegal movement toward participatory

health care and patient self-determination corroborates the relevance of

contextualized collaborative. advocacy. and empowerment models of

intervention. Such approaches encourage client empowerment through

involvement in goal and strategy development, responsible decisionmaking, and the experience of the consequences of those decisions

(Connelly et al. 1993: Kavanagh 1993: Moxley and Freddolino 1990).

The empowerment paradigm emphasizes interactive systems and those

who learn and know, both individually and collectively, over knowledge.

Health-related empowerment involves enabling persons to become well

and whole, to develop potential. and to add quality to life (Jones and

Meleis 1993). Interpreted for practice. this approach involves rights to

resources, identification and maximization of strengths, transformation of

negative attitudes and behaviors (Ponterotto and Pedersen 1993), personal

and collective responsibilities, and the availability of options that address

root causes. Whereas traditional intervention models often replicate the

physical sciences and medicine’s emphasis on pathology and alleviation

of symptoms. many newer approaches address long-neglected needs for

social action. Developing ways to employ knowledge realistically entails

exposing contradictions and distorted understandings embedded in both

traditional research and practice (Lather 1986).

Empowerment as a theoretical framework acknowledges knowing and

praxis as socially constituted, historically contextualized, value based,

and multidimensional (Lather 1986; Schoem et al. 1993). Achievement

of goals is less important than the opportunity to experience, and the

actual experience of, empowering processes that lead people to believe in

their own efficacy (Connelly et al. 1993; Kavanagh 1993; Northrup

1993). This belief leads to increased energy, sense of well-being, and

effectiveness in realizing health potential (Jones and Meleis 1993), all of

which allow people and communities to gain mastery over their own lives

34
(Connelly et al. 1993; Rappaport 1984). However, whether couched as

advocacy, collaboration, enablement, or empowerment, the bottom-up

approach is challenging to implement due to its nonspecificity, flexibility,

and requirement that access to power be redistributed. Given that

society’s history with addiction has always been marked by political

conflict as well as confusion among moral, medical, and social

understandings and labels (Conrad and Schneider 1992) it is not

surprising that the United States today, already unsettled by the

unknowns and uncertainties of health care reform, has only unevenly

begun to accept this modification of the established model of treatment.

The contextualization and applicability that form the strength of

collaborative empowerment often are disconcerting and threatening in

traditional treatment settings. The nature of treatment has been

reductionistic. Focused on specific behaviors and on control, traditional

treatment approaches are oriented toward the expertise and competence of

providers and the failure of consumers to meet socially acceptable

standards of behavior. Collaborative empowerment requires rethinking,

reorientation to a consumer-based context, and attention to the diversity

found there.

Collaborative approaches and effective management of diversity at

multiple levels of health care hierarchies are practical and flexible media

for the transfer of technical knowledge from research to practice settings.

However, they can be expected to facilitate that process only when the

technical knowledge and strategies are recognizably appropriate and

relevant to practice. The medium for both collaborative treatment and

diversity management is mutual communication. Such communication

has the dual goals of producing respectful, culturally acceptable, and

effective clinical interventions and reducing the impediments that many

current structures impose on intervention processes. Whether attempts to

change norms and expectations come through top-down structural

alterations or from bottom-up attitude changes, face-to-face situations

serve as the critical intermediate links (Pettigrew 1993).

Providers and consumers meet at what is referred to in this chapter as the

“front line.” As the focus of intervention, the front line serves as the

bottom line in technology transfer, for it is there that knowledge as

technology is tested and either utilized or rejected. To be cost effective,

the technology must fit the needs and world views of consumers and

providers. Otherwise it will not be viewed as worth implementing. It is

important to realize that the front line is not composed of providers alone.

45
Interaction between providers and consumers (both individual and

collective) gives it purpose. In sum, given the interactive nature of drug

use and drug abuse treatment, one must understand interrelationships

among power. diversity, and the health care scene to appreciate the

potential for and obstacles to transfer of research knowledge to practice.

COLLABORATION: POWER AND POWER DIFFERENTIALS

Obstacles to effective technology transfer are not limited to the content of

available technology and its applicability. Despite increasing evidence of

the importance of collaborative and participatory health strategies,

barriers to empowerment are found at all levels of society, bureaucratic

and professional organizations, and provider-consumer interactions

(Connelly et al. 1993). Everyday discourse and social interactions

reinforce the ideological and structural status quo (van Dijk 1993). That

basic pattern, in a stratified society like the United States, includes group

dominance based on perceived and/or constructed social and cultural

differences. In a truly participatory democracy there would be no

segregation at the front line. Collaboration and respectful communication

would obviate distinctions between consumers and providers. But that is

rarely the case in treatment settings.

Patients are typically the most easily definable and censurable members

of health care systems (Kavanagh 1991). As long as the concept of

interactive otherness (that is. an us-them dichotomy) drives behavioral

assessment and intervention, the gap between knowledge and practice

remains very close to that potentially powerful but vulnerable front line.

Whether the line is drawn between consumer and front-line provider or

between front-line provider and agency hierarchy, only participatory

collaboration fully promotes the dialog essential to the transferability and

actual transmittal of technical knowledge.

Treatment providers may not associate the failure of empowerment

strategies with dissonance between themselves and the population being

treated (Ratner 1993). Open discussion in health care settings emphasizes

the need for effective intervention to be congruent with the perceptions

and interpretations of those who are designated as consumers. People

who experience any phenomenon (including addiction) understand

problems related to that phenomenon with different (and often greater)

sensitivity and knowledge than do even the most educated and perceptive

outsiders.

46
Individuals respond to others with whom they share commonalities

(Frankel 1993; Hadorn 1991; Jacobson 1987; Kavanagh and Kennedy

1992; Kurtz 1982; McDougall 1993: Tindall and Gray 1985; van Dijk

1993). Numerous grassroots advocacy and collaborative intervention

projects have proven to be successful (e.g., Bullard and Wright 1990;

Facione 1993; Kelly et al. 1993: McDougall 1993; Thomas 1991).

Collaborative approaches applicable to practitioner-consumer interaction

(e.g., Hahn 1991; Kavanagh et al. 1992; Quirk 1993; Reason 1994) have

been found particularly effective with historically devalued and

economically disadvantaged groups who are unwilling to accept

unquestioned goals and methods designed for the dominant population.

Peer counseling, self-help groups, development of base communities that

form action units, and other formats for collaborative participation are

practical mechanisms for client involvement in decisionmaking,

organized support systems, mutual and collaborative treatment strategies,

and civic action.

For all its simplicity, however, collaboration also is immensely complex.

In drug abuse treatment, use of personal experiences of service providers

has long been argued to contribute to risk-reducing behavioral changes

and health behavior patterns (e.g., Weeks et al. 1993). The addictions

field is somewhat unique in health care for its heavy dependence on

practitioners who have endured problems and social realities similar to

those of their clients. However, due to the hierarchical structure of most

health organizations, these roles also can leave practitioners ill-prepared

and unprotected as intermediaries whose potential to be advocates and

agents of empowerment is inhibited or obviated.

A basic tenet of empowerment is the belief that both providers and

consumers have the ability (that is, power and capacity) to meet their own

needs, to solve their own problems, and to mobilize the resources

necessary to feel in control of their own lives (Connelly et al. 1993;

Gibson 1991). Even when credentialed on a par with their hierarchical

superiors (which is often not the case), drug abuse treatment providers

serve “shock absorber” roles in which they often function as both

advocates and adversaries. They are generally realists whose jobs involve

buffering the health care industry’s hierarchy from the more socially

marginal of its consumers and protecting consumers from various aspects

of the health care hierarchy. Front-liners habitually question the

effectiveness of their work and of their treatment (Rhodes 1991), but they

answer to others (often those labeled “experts”) who are less likely to be

close to the front line. To strengthen predictability and control, the less

47
powerful attend to the more powerful (who control their outcomes) (Fiske

1993). Meanwhile, communication tends to flow downward from

hierarchical superior to subordinate (Kavanagh 1988, 1991; Kavanagh

and Kennedy 1992).

Organizations, as subcultures, reflect the values of the dominant culture

(Ray 1989). Traditionally, the structure of health care delivery has

helped maintain resistance to relinquishing power to providers or from

providers to consumers. Movement toward flatter organizational systems

has prompted somewhat greater scrutiny of social processes that play

forceful roles in the transfer of research-based technology to actual

practice settings. However, this scrutiny is not consistent across

organizations and seldom crosses (or attempts to rescind) the line drawn

between provider and consumer. Idealism aside, in most cases neither

organizational nor academic models push very hard to get real decisionmaking responsibility and control to the front line. Reconceptualization

of the goals of praxis as integration and action (Schoem et al. 1993; van

Dijk 1993) seldom receives much more than lipservice. Even

contemporary political correctness debates, like prevailing ideologies and

educational practices that underscore elite discourse, provoke more

passion than change (van Dijk 1993). Although corporations are

awakening to the fact that collaborative strategies with a diverse

workforce enhance productivity (Thomas 1991), in the health care arena

researchers typically do not, and practitioners often cannot, display the

same motivation to work collaboratively with front-line consumers. One

must ask in whose interest the system is perpetuated as it is as well as

what other possibilities exist.

Control in the health disciplines is an issue with more history than

resolution. As medicine essentially replaced religion as society’s most

powerful extralegal institution of social control, the issue of addiction

(along with numerous other categories of “deviance”) was conceptually

transformed from being a highly political sociolegal problem to being a

medical one (Conrad and Schneider 1992). The traditional ethos of

control in mental health settings involves tension between anxiety over

loss of control of the intervention, interaction, or organization and fear of

confusing therapeutic limit setting with callousness (Kavanagh 1991). As

long as clients are viewed as lacking the knowledge and capacity to merit

mutual and collaborative relationships with support providers or to

achieve real empowerment, social labeling preserves front-line staff and

client polarization, client dependency, and institutional apathy and

mistrust. Facilities continue, for the most part, to compel compliance to

48
rules and ideologies that inhibit empowerment and maintain powerlessness and subordinate status (Skoll 1992).

In bureaucratic organizations, power flows from official authority vested

in hierarchical roles to control the allocation and exchange of resources

(Blau 1974; Ray 1989; Thomas 1991). The front line is confronted with

the (often unspoken) reality that egalitarian ideals do not delete

ethnocentrism and other status differentials from clinical settings.

Hierarchical values (such as authority and organizational preservation)

reinforce inflexibility, which limits organizational recognition and

attention to diverse perspectives (Thomas 1991).

While society and organizational hierarchies tend to minimize the issue,

neither side of the front line can avoid the contradictions inherent in the

expectation of quickly treating people whose problems are symptoms of

broader serious societal and health care systems’ failure (McBride 1991).

The dynamics of circular victimization (Scott 1993) are striking in drug

abuse treatment contexts where hierarchical fear of manipulation

strengthens tendencies toward control and imposition. Consequently,

front-line providers often wearily view their roles as lacking authenticity

in respectful, collaborative client advocacy and/or participation. In such

circumstances, the arrival of research findings, particularly if based on

theory rather than practice, may be viewed as an irrelevant or even

impertinent intrusion.

Practitioners at the front line tend to hold unenviable positions. Drug

abuse treatment programs depend heavily on those who have successfully

managed their own addictions. Thus they may be haunted by a

generalized societal mistrust of drug users in combination with beliefs in

the fragility of associations between health-promoting knowledge and

risk-reducing behaviors (e.g., Baldwin and Baldwin 1988; Flaskerud and

Nyamathi 1989; Jemmott and Jemmott 1991; O’Connor et al. 1993).

While potential for breach of treatment protocol is aggressively suspected

of consumers of drug abuse treatment services and the more subtle

mistrust of providers remains submerged, overt collaboration between

front-line providers and consumers is sometimes viewed by the hierarchy

as unprofessional.

While providers who were previously consumers retain an element of the

negative stigma attached to the patient role, providers without personal

drug histories may have less credibility with consumers. In either case,

drug abuse treatment providers remain close to the bottom of the mental

49
health hierarchy and must fight for the power that is invested in more

valued and trusted (and often more overtly technically skilled) personnel

and that could result in significant enhancement of treatment outcomes.

In sum, to whatever extent and in whatever ways (empathetically,

dialogically, or experientially) they cross the metaphorical line between

themselves and consumers, front-line providers must endure the stigma of

working in socially devalued aspects of health care and with socially

devalued clients. This stigma has long been known to have significant

impact on communication and relationship patterns among health care

providers (Britain and Cohen 1980).

Those with authority in drug abuse treatment settings are more likely than

those at the front line to come from dominant cultures. Supervisors are

less likely than hands-on providers to be members of gender, ethnic, or

racial minority groups or to have experienced the subordinate statuses

associated with the health-related situations that the front-line provider is

there to manage and that the front-line consumer is there to receive help

managing (Pedersen 1988). Hierarchical superiors, who often are

attentionally overloaded and may have strong needs for dominance, also

typically know significantly less about their subordinates than vice versa

(Berreman 1962) and are, therefore, particularly vulnerable to stereotyping those groups (Fiske 1993). The interaction between power and

stereotyping is mutually reinforcing (Fiske 1993). Stereotypes risk the

mislabeling of problems and promote diagnoses that emphasize the

provider being right and the client being wrong (Eliason 1993).

Front-line providers are aware of strong associations between interpersonal relationships and health-related consequences. They share the

front-line consumers’ frustration with the urgency of addiction and its

steadfast fixations on survival and the present. They must deal with the

desperation of dependency, poverty, social alienation, mistrust, and

isolation as well as with the widespread dissatisfaction and unrealistic

expectations that reverberate from continuous but vicarious access to the

rarefied lifestyles promulgated by the media. Drug abuse treatment

providers cannot ignore the subtle but nefarious impacts of race, gender,

and class in social process or the imbalances in relationships at all levels

that contribute to vulnerability and discourage assertiveness and selfefficacy. But awareness of these phenomena does not necessarily help

management of their consequences.

Although indispensable, significant personal and group empowerment

tends to remain elusive for those at the front line. Providers are forced to

50
focus on consumers’ futile attempts to use drugs to protect or enhance

self-esteem and to decrease powerlessness rather than on movement

toward meaningful life goals. While only technical knowledge that

convincingly addresses these realities is likely to be useful or used, such

issues may or may not receive research attention, and, if explored, the

results (if they seem irrelevant to hierarchical superiors) may or may not

filter through the organization to the front line.

The knowledge and skills necessary for personal control over one’s life

do not develop through health care intervention if observations and

experiences are limited to “power over” relationships and do not facilitate

participatory, “power with” exchanges between individuals and within

communities (Kreisberg 1992). Nonetheless, commitment to collaborative practice remains generally weak in the area of mental health and

addictions, and “service” remains linked to compliance, terminal

objectives, and intervention programs focused on doing things “to”

consumers.

When service system goals are inadequately defined to state and promote

significant and meaningful positive outcomes, or they do not fit the needs

of those involved, responsibility continues to be confused and fragmented, and real social action is minimal (Paul 1993; Rose and Black

1985). For example, the first decade of discourse on acquired

immunodeficiency syndrome (AIDS) and the “AIDS service industry”

(both of which are intimately associated with drug use and users) has

been in large part about power, homophobia, and discrimination (Patton

1990). Today more programs are associating successful prevention and

intervention with emphasis on positive change in lieu of prevention of

negative behavior (Kavanagh et al. 1992; Sobo 1993). If effective

practice requires the transformation of consumers into producers, then

direct service programs must take more seriously the challenge to

maintain relationships with clients and former clients that will expand

knowledge and strategies related to real collaboration, advocacy, and

empowerment (Rose and Black 1985). Development of nonhierarchical,

community-oriented, and population-specific sources of support implies

transformation but not lessening of society’s role in promoting and

assuring care (Salsberry 1993).

51
DIVERSITY AND DIVERSITY MANAGEMENT

Diversity refers to variation found among people and occurs wherever

there is not sameness. Time is running out on the need for transformation

of health care from a structure that expects consumers to fit it to one that

accommodates the needs of its clienteles (Brislin 1993; Kavanagh and

Kennedy 1992; Lefley and Pedersen 1986; Pedersen 1988). In most

cases, the literature couches the diversity aspect of this need in terms of

cross- or transcultural sensitivity. However, to be truly effective,

diversity should be conceptualized more broadly. Diversity extends

beyond ethnicity and culture to differences in age, health status, race,

experience, gender, sexual orientation, and other aspects of social and

economic position (Kavanagh and Kennedy 1992). Each of these

noninterchangeable concepts contributes to the complexity of prevention

and intervention in an increasingly diverse population.

Diversity is a major dimension in relationships between research findings

and their utilization in practice because, if not managed effectively,

differences form barriers between those who do not view themselves as

having commonalities. These barriers can be expected to occur with the

same powerful intensity found when similarities serve to connect those

who recognize them (Frankel 1993). Any study of treatment processes is

incomplete without a clear understanding of variables responsible for

diversity among, between, and within the social categories involved.

Diversity both characterizes society and dictates a need for flexibility in

approaches to intervention. Lack of intercultural and diversity-sensitive

preparation by health care providers wastes substantial proportions of

resources that are already strained and limited (Andrews 1992; Pedersen

1988). With the 21st century promising increased confrontation with

demands for attention to diverse populations (Bullard and Wright 1990;

Locke 1992), drug abuse treatment that reflects respect for multiple

perspectives is more than a humanistic fad based on “conspicuous

compassion” (McManus 1993). However, although increasingly

recognized at the level of practice, diversity is seldom addressed in terms

of practitioners. In other words, there is generally greater cognizance of

the implications of diversity in relationships between front-line

consumers and providers (where diversity is likely to be used as an

argument against collaboration) than of diversity in terms of relationships

among providers at various organizational levels.

52
In addition to being challenged to manage widely varying consumer

needs and expectations, front-line providers must face, but may not be

prepared to manage, the diversity above as well as below them in the

hierarchy. For instance, they may or may not know how and to whom

they can voice the difficulties imposed when advocacy and intervention

strategies are viewed as essentially acultural, while clienteles are

decidedly cultural in orientation (Andrews 1992; Davidson and Ray

1991; Kavanagh 1993; Pedersen 1988; Ray 1989). The empowerment of

practitioners hinges on their competence and confidence as managers of

diversity.

Managing diversity is defined as helping each person reach his or her full

potential (Thomas 1990, 1991). The process does not involve manipulation but focuses on helping others achieve the best situation possible

given the circumstances. Diversity management does not imply a

supplementary effort to give relief to a system of negative consequences

but asserts a need to change the system and modify its core culture

(Thomas 1991). All of this management requires not only training and

knowledge but also self-awareness, permission, and encouragement (at

individual and collective levels) to develop multiple perspectives.

However, the requisite sensitivity, knowledge, and skills may not be

among those things that agency hierarchies currently can provide

effectively.

Culture, ethnicity, race, and other aspects of diversity are not restricted to

people of color; they involve and affect everyone. Diversity competence

requires knowledge about the processes that perpetuate social inequality,

since those processes continue to strongly influence people’s experiences.

In a society that values predictability and practicality, and in which

prejudice and discrimination have become increasingly subtle (Stanfield

1993), diversity has been viewed traditionally as a liability. Despite

valuing personal freedom, American society tends to promote oversimplified and practical routines for interventions that treat everyone as if

they were the same. Furthermore, biomedical ethics, which strongly

influence drug abuse treatment, are based on a philosophy that all people

have an essential core of humanity and deserve the same rights. This

philosophy reinforces the belief that every patient should be treated

equally (Eliason 1993). However, “equality” has traditionally been

interpreted to mean similar treatment rather than treatment that meets

client- or population-specific expectations to the same extent.

53
In a participatory democracy, all groups would have a voice and be able

to pursue their own interests while respecting those of other groups.

Positive change contributes to a pretense that everything is the same for

everyone and that everyone should be treated in exactly the same way. In

reality opportunities and experiences still vary widely: people are not all

the same, they do not all want to be, and they should not all be treated as

if they were the same. They have diverse needs that, to be managed

appropriately, must be met in different ways. The United States is

already the world’s most diverse society. A half-century from now, the

average person in this country will trace his or her ancestry to Africa,

Asia, the Pacific Islands, or the Hispanic or Arab worlds-or to a

combination of those-rather than to roots in Europe (Henry 1991). The

implications of such change for the potential redistribution of status,

power, and wealth are threatening to some and heralded by others. In any

event, this “browning of America” symbolizes a need not only to orient

health care toward a diverse population but also to acknowledge that, as

the century closes, people from diverse backgrounds expect, demand, and

are viewed as deserving opportunities to preserve their widely varied

lifestyles, beliefs, and practices (Wali 1992).

Treatment and care should be based on individual needs. However, this

widely held belief has been premised on the assumption that practitioners

can recognize and address these needs (Eliason 1993). In reality, health

care providers generally are prepared to identify solutions to problems

based on their own identifications and assessments of the problem

(Brislin 1993) rather than on those of consumers. Health care organizational hierarchies often do not reflect the ethnic and racial variation

found among the agencies’ clienteles. Providers often compromise their

credibility when they do not or cannot place clients’ problems into frameworks that are familiar or acceptable to them. Similar discrepancies are

likely to exist among those who generate knowledge applicable to health

care practice and those who directly provide or receive that information.

Unless all involved are prepared to manage these differences effectively,

diversity further confounds an already complex health care scenario.

There are two additional aspects of multiculturalism that refute the

efficacy of approaches that leave the locus of assessment and decision on

the provider’s side of the front line. One is that diversity provides a rich

source of creativity and ideas, a source that is lost when differences in

perspectives are overlooked or ignored (Wali 1992). Reconceptualization

of diversity as an asset and resource supports its effective management.

The other argument for multiculturalism is that failure to recognize and

54
acknowledge differences that are real can be painful and dehumanizingno matter on which side of the front line one is or where one is in the

hierarchy.

At this point, both the Nation and its health care face some tough

realities. Not only is the U.S. population incessantly changing, but

individuals and groups also increasingly celebrate their differences and

are increasingly more likely to reject treatment compromises that fail to

recognize or acknowledge what makes them unique (Thomas 1991).

Transformation toward a multicultural perspective will change thinking in

many arenas (Craige 1994), only one of which is health care. More

attention must be paid in research, treatment, and related educational

settings to both the process and content of the transformation toward

participatory and collaborative styles of care already underway.

Despite the obvious needs, there are strong social biases against effective

diversity management. Race is one of the most powerful of those biases.

On the basis of skin color, no one with a global perspective can tell where

one “race” ends and the next begins. Yet after a century of knowing that

race is biologically insignificant, society continues to use the concept in

daily discourse as if race had biological as well as social meaning,

although ethnicity, culture, and gender have all acquired new significance

as well (Locke 1992).

In addition to attending to diversity in the areas addressed above,

practitioners must learn (therefore must be taught) to work with both

groups and individuals. Although many health care disciplines focus on

providing care and treatment to individuals, this approach tends to

obscure understandings of group patterns and larger societal processes.

Whether formal or informal, groups help maintain identity and express

shared interests. These interests may not be considered acceptable at the

societal level (such as relationships based on illegal drug use), but group

identities can be intensely meaningful to consumers. In health and illness

one finds particular tenacity in retention of beliefs and practices that have

security-maintaining functions (Lefley and Pedersen 1986; Pedersen

1988). Regardless of the structure and organization of formal health care,

people continue to cope in traditional ways within their own social

networks and institutions. Comprehensive, balanced views must be

learned and must include both the strengths and the problems experienced

by groups and individuals. Ideally, information about a group comes

from that group, and information about individuals is tested against group

patterns and expectations (Kim and Berry 1993).

55
Unfortunately this area of formal education is one to which many adults

are not privy. Relatively few providers have been taught to learn, teach,

and counsel cooperatively and collaboratively; to facilitate dialog that

does not turn into power-differentiated debate: to confront conflict and

controversy constructively; to link micro- and macroanalyses; to

understand how political, social, and economic factors work together to

influence health care; essential dimensions of group process involved in

distribution of power at the community level: the potency of participatory

and cooperative action; objective group and self-evaluation; how to create

an atmosphere for open and informed discussion: and how to use dialog

and feedback for open learning and as ways to break down barriers

(Brislin and Yoshida 1994; Deutsch 1993; Pedersen 1988; Schoem et al.

1993).

Although diversity is not limited to culture, ethnicity often is used to

exemplify human differences. There are currently in the United States

more than 100 ethnic groups with thousands of interpretations of healthand illness-related phenomena among their members. Each group is

based on cultural orientations composed of shared and learned, but highly

variable, systems of meanings (Betancourt and Lopez 1993). Variations

within groups may be as great or greater than those between them.

Discrete traditional cultural orientations overlap as they are adapted to

accommodate the diversity of society or specific life circumstances.

Many Americans have blended identities involving more than one racial

or ethnic group. All have identities composed of multiple statuses and

roles. Stereotypic information about groups that number in the millions

and vary widely within is futile. The Nation is neither a melting pot nor a

collection of clearly distinct and separate subcultures (Galanti 1991).

Categories are arbitrary at best, but their meaning and significance in life

are real and powerful. Providers, meanwhile, often are prepared to

address only individuals and do not recognize social action as an

intervention role. Despite being integral to collaborative empowerment,

relatively few providers know how to work on behalf of populations and

to take into account the full impact of the social, political, and economic

influences that shape the health of society (Butterfield 1990).

Practitioners should accept the fact that they cannot and should not try to

know everything about every group. They must, on the other hand,

understand and acknowledge aspects of diversity that socialization

processes in this society tend to minimize. The essential consideration

here is that different groups have different values and norms. Health care

traditionally has represented the values and norms of the dominant

56
society-which is Western European in its value orientation and

predominantly middle class, Christian, and male in its thinking and

behavior.

Without specialized training to promote multiple perspectives, providers

learn to protect themselves from the complexity of multiple perspectives

by imposing variations of their own views on consumers. They also may

experience cross-cultural fatigue, a state that reinforces acceptance of ingroup values and standards as universal, loyalty among the in-group,

derogatory stereotyping of out-group characteristics (e.g., deficit theories

such as cultural deprivation or genetic inferiority [Nieto 1992]), and

hostile relations between in-group and out-group members (Seelye 1993).

Whatever the extent to which such diversity is acknowledged and

managed, understanding and caring for a diverse clientele require

comprehension of various perspectives used to interpret events or

behavior. These multiple perspectives do not come easily to already

harried practitioners guided from above by specific disciplinary

perspectives that are shaped (however unconsciously) by orientations

associated with specific ethnic and class characteristics and hierarchical

status expectations.

THE BOTTOM LINE

Sensitivity, knowledge, and skills are required for collaboration with

diverse populations at the front line and throughout health care

organizations. Effective drug abuse prevention and treatment require a

climate of flexibility, openmindedness, trust, objectivity, and respect for

diverse viewpoints; an approach to inquiry in which analytical thinking,

curiosity, decisiveness, and intellectual honesty are norms; and a forum

for participants to have a voice and to experience opportunities to build

self-esteem and experience success (Ponterotto and Pedersen 1993).

Formal mental health (as well as other health) services in the United

States have had a cultural bias favoring members of the dominant social

categories (Pedersen 1988). Even the dichotomy between psychological

and physical conditions and the identification of addiction within the

domain of medicine and health reflect those biases (Conrad and

Schneider 1992). Ethnic and minority communities have experienced

more than their share of the adverse effects of science and technology

(Frankel 1993). Recent evidence verifies that indigenous modes of

57
treatment often work better than strategies based on the dominant society

and imposed on others (Kim and Berry 1993: Pedersen 1988), but drug

abuse treatment providers are in large part unprepared to examine and tap

into those resources.

Given this scenario, effective intervention requires a balance of

sensitivity, knowledge, and skills (Brislin and Yoshida 1994; Kavanagh

and Kennedy 1992). The conventional emphasis on awareness and

sensitivity leaves providers powerless and frustrated because the

knowledge or skills needed by effective advocates are not provided.

Knowledge alone is similarly inhibiting, as simplistic stereotypes of

cultural groups fail to recognize variations within groups. If applied

insensitively or without appropriate skill, knowledge can be

counterproductive.

Although stereotypic expectations of cultural behavior are counterproductive, knowledge of expectable patterns of behavior is essential when

clientele are diverse or there are significant differences between providers

and consumers. The difference is that knowledge of expectable patterns

is used only as a starting place for comparison with actual observations.

Unlike stereotypes, actual knowledge changes as new information is

collected. Such information is empowering. It protects against stereotyping by couching actual data in terms of adaptable generalizations that

change with additional evidence. Although knowing general group

characteristics helps, flexibility and sensitivity are needed to understand

when those expectable patterns fit and when they do not as well as how to

intervene appropriately and effectively.

Collaborative, participatory health care is based on the premise that all

individuals and groups deserve respect. One need never fully accept

another view or replace one’s own with that view. On the other hand,

every view is worthy of respect as the reflection and result of specific

perspectives, experiences, and understandings. Sensitivity is needed for

awareness of these various perspectives, and knowledge empowers their

understanding. However, sensitivity and knowledge must be combined

with communication, assessment, and intervention skills for appropriate

and effective intervention to occur.

Many practical skills useful in managing diversity involve communication related to intervention. There are times when affirming and

managing diversity requires venturing into unknown and potentially

uncomfortable interactive situations. An atmosphere of safety and

58
comfort is essential for both provider and client to facilitate free

expression of attitudes and diversity of opinions (Schoem et al. 1993).

Usually the cost of inattention to and avoidance of multiple perspectives

is lack of effective communication and intervention. By avoiding topics

and viewpoints that have meaning to people and that may have significant impact on their lives, opportunities are eliminated for understanding

views and concerns. Conversely, lack of collaborative communication

opens the door to coercion. imposition, and exacerbation of barriers

traditionally associated with diversity.

Individuals and groups have relationships with their problems. Interventions, to work, must consider technical processes as well as the

perspectives of users and providers. Practitioners are unlikely to be

viewed as contributing to solutions if they do not understand and accept

(which does not mean they must agree with) consumers’ views of the

problem or if they impose their own views as if the alternatives did not

matter. In many organizations, the front-liners burdened with the task of

correctly communicating clients’ points of views to others have not been

prepared or permitted to do so. Socialized to accept professional standards as ideal, they must choose between supporting those standards

(therefore increasing the “otherness” of the consumers) or taking lonely

stands as unsupported advocates.

CONCLUSION

Health care reflects the society in which it occurs. It would not be

accepted and utilized if it did not reflect the cultural values and social

norms that predominate. While the values and norms that shape health

care and drug abuse treatment in the United States generally reflect those

of the dominant or majority culture, many subgroups within the Nation

have quite different (even conflicting) values and norms (DeVita and

Armstrong 1993; Stewart and Bennett 1991). The right to have these

differences acknowledged and considered in health care is increasingly

demanded and recognized. Although health care disciplines tend to have

the same values as middle-class Americans of European American

background, practitioners must be taught, allowed, and prepared to be

flexible enough to meet the needs expressed by a diverse society with

widely varying expectations and needs. Organizations (whether oriented

toward education, research, or practice) must allow for this flexibility.

Closure of the gap between knowledge and practice is contingent upon

reduction of both process and content barriers to the applicability and

59
acceptability of the technology generated. Effective intervention requires

enough equal-status contact for collaboration and empowerment to occur.

Issues and topics that have traditionally been avoided must be dealt with

openly and respectfully. Only with a collaborative and participatory

health agenda will barriers to effective technology transfer be dispelled.

Researchers must attend to the front line and learn to collaborate with the

diverse peoples found there if there is serious commitment to making

technology transferrable.

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AUTHOR

Kathryn H. Kavanagh, Ph.D.

Associate Professor

Univeristy of Maryland

Parsons Hall, #621

Baltimore, MD 21201

64
Risk Communication: A Tool for

Behavior Change

David B. McCallum

INTRODUCTION

The chain of events between providing information about risks and

benefits and behavior change in response to that information is a complex

and uncertain process. Commercial and social marketers have struggled

to design messages that deliver ideas that bind to the right receptors in the

decision process and produce predictable and reproducible behavioral

outcomes. Reduction of risk to individuals and to the community has

been the impetus for much of the social marketing effort. Terms such as

“risk analysis,” “risk management,” and “risk communication” have

joined terms like “cost-benefit analysis,” “decision analysis,” “technology

assessment,” and “technology transfer” to categorize the tools that are

used in the effort to optimize society. In the end, the power to change

behavior carries the immense ethical responsibility to use this power

wisely.

Risk analysis has been applied most often to environmental problems. It

grew out of the need for toxicologists, engineers, social scientists, and

policymakers to come together to address complex community risks.

More recently, it has been applied to other risks. In comparative risk

projects, it has been used to compare risks from personal health threats,

environmental threats, and other threats such as economic problems in an

effort to guide individuals and communities. The risk analysis process

has been divided arbitrarily into three components: risk assessment, risk

management, and risk communication (National Research Council 1983).

It is, however, useful to consider these three components as being interrelated, each with its own unique character but inseparable from the others.

Risk assessment provides an identification of the hazard (the type of

effect [e.g., cancer, birth defect] and the intensity of the effect for a unit

dose), an evaluation of the dose response and exposure (the amount that

reaches the exposed person), and a characterization of risk that integrates

the information about the previous parts of the process and translates the

risk into terms relevant to the risk manager (National Research Council

1983). If the assessor is not cognizant of the risk management options

65
and the public’s understanding or misperceptions of the problem, the risk

assessment is less likely to provide all the necessary information.

The major risk management tools are education. economic and social

incentives or disincentives, and regulatory and legal restrictions.

Selecting from the various risk management options, from least coercive

to most coercive, depends on the level of risk (risk assessment) and the

political and public acceptability of the management options (risk

communication).

Communication is pivotal in the process. Individuals cannot change

without the knowledge of alternatives and consequences or without the

motivation, skills, and support systems to do so. Even the most stringent

laws and regulations cannot function without broad-based public support.

The National Research Council (1989, p. 50) defined risk communication

as.

[A]n interactive process of exchange of information and

opinions among individuals, groups, and institutions. It

involves multiple messages about the nature of risk, and

other messages not strictly about risk, that express

concerns. opinions or reactions to risk messages or to

legal and institutional arrangements for risk management.

A better operational definition emphasizes the two-way nature of this

process: Nonexperts need access to information and need to gain

knowledge, while technical experts and officials need to learn more about

nonexperts’ interests, values, and concerns.

These definitions emphasize the complex nature of communication.

When programs to influence individual behavior are designed,

communication research seldom is given sufficient attention, particularly

when communication is not the primary component. In addition, the

linkage between the communication component and other program

activities is frequently handled ineffectively. contributing to program

failure.

According to Rossi and Berk (1988), the three main reasons for program

failure are:

• The program structure incorporates a misunderstanding of the

problem,

66
• The program is improperly designed, or

• The program cannot be delivered by a U.S. Government agency with

sufficient fidelity and at the proper dosage.

If the risk communication program designer misunderstands the problem,

the approach is unlikely to be effective. This error usually results from

lack of attention to the formative research necessary to understand the

target audiences and the leverage points that will be effective with those

audiences. For example, a poster campaign aimed at low-income women

that tested very well with the target audience appeared to be failing. The

posters were unusual in that they were fantasy oriented, and the program

used information cards rather than brochures. An evaluation showed that

doctors and nurses were uncomfortable with the material and needed to

be convinced that it would be effective, as well as instructed in how to

use the material. The gatekeepers, not the patients, were the problem

(Arkin, personal communication, April 21, 1993).

Program design not only suffers from lack of formative research, but also

from a tendency to use one particular approach (e.g., a public service

advertising campaign) rather than a comprehensive communication

strategy that employs all or many of the channels and sources available to

achieve and maintain behavior change.

Finally, either insufficient financial resources or inadequate technical

support can lead to the failure of local units to administer an effective

dose to the target audience when innovative programs are implemented.

Many times this occurs because the developers and early adopters of the

program have either more skill or more enthusiasm than later adopters.

Hence, the later adopters underestimate the resources required to produce

an effect with a broader audience and may require more support to

achieve the same results.

The evaluation literature is replete with examples of programs that make

one or more of these mistakes. Yet they can be avoided easily if program

managers follow an empirical approach to communication planning.

Drawing on the work of a number of researchers, this chapter outlines a

step-by-step approach to communication planning (see McNeil et al.

1989).

67
ESTABLISH CLEAR GOALS AND OBJECTIVES

Setting attainable goals based on a strong understanding of the particular

need for a risk communication program is a preeminent concern in

achieving behavior change. Setting objectives will help to identify gaps

in the information about the problem being addressed. Without clear

objectives, success cannot be measured. Furthermore, these objectives

should be flexible so that they can be adjusted in response to new

information gained from evaluation research during the planning and

implementation process.

The goals and objectives should emphasize the comprehensive nature of

most successful public health campaigns, which include the following

elements (Flay and Burton 1988):

• An integrated series of communication activities,

• Multiple activities and channels,

• The targeting of specific audience segments,

• Long duration, and

• A clear purpose.

The steps to success are easy to enumerate but difficult to achieve:

• Understand the risk

• Understand audience segment characteristics, including:

-Demographics

-Psychographics

-Information utilization characteristics

-Perceptions of risks

-Perceptions of information sources

• Develop and test messages

-Motivate audiences to attend to the messages

-Motivate audiences to want to change behavior

-Transmit skills necessary to achieve behavior change

68
• Deliver messages effectively

-Time messages appropriately

-Select appropriate channels

-Select appropriate spokespersons

-Deliver proper dosage

• Reinforce messages and behaviors

-Encourage interpersonal communication among target audience

-Encourage broader social change to support individual behavior

change

• Measure the effects of the campaign

To achieve success, communication program managers should implement

these steps as part of a process that includes development, implementation, evaluation, and any necessary midcourse corrections of the program.

UNDERSTAND THE RISK

The receptivity of populations and individuals to behavior change is, in

part, related to their perception of risk. Individuals and groups must feel

at risk to commit to or demand change. Many years of research have

produced a long list of characteristics that are associated with audiences’

perception of risks (see figure 1). Some examples of these characteristics

are (1) the level of internal control, (2) whether the risk differentially

affects children, and (3) whether the risk is voluntary or imposed. Many

of the characteristics relate to whether personal action or sacrifice is

needed to reduce the risk.

The implications of this research for behavior change are complex due to

the inability to determine whether the perception reflects a justification

for not making personal changes to reduce risk or whether the failure to

act reflects risk perception. Regardless of the causal relationship,

understanding public perceptions of risk provides useful information that

will help predict the barriers and opportunities for individual and societal

change.

69
• Catastrophic potential—

Fatalities and injuries that are

grouped in time and space

(e.g., airplane crashes) cause

more concern than fatalities and

injuries that are scattered or

random in time and space

(e.g., automobile accidents).

• Familiarity—People are more

concerned about risks that arc

unfamiliar (e.g.. ozone depletion

due to emissions of fluorocarbons) than about risks that are

familiar (e.g., household

accidents).

• Understanding— Activities

characterized by poorly understood exposure mechanisms or

processes (e.g., exposure to

radiation j cause more anxiety

than those characterized by

apparently well-understood

exposure mechanisms or

processes (e.g., pedestrian

accidents or slipping on ice).

• Uncertainty—Individuals are

more concerned about risks that

are scientifically unknown or

uncertain (e.g., recombinant

DNA experimentation) than

about risks that are relatively

well-known to science

(e.g., actuarially documented

automobile accidents).

• Controllability— Risks that are

perceived to be not under

individuals’ personal control

(e.g.. traveling as a passenger in

an airplane or automobile)

engender more concern than

risks that are perceived to be

under their personal control

(e.g., driving an automobile).

• Voluntariness of exposure—

Peopie are more concerned about

risks that they perceive to be

involuntary (e.g., exposure to

unlabeled food additives or to air

or water pollution) than about

risks that they perceive to be

voluntary (e.g., smoking, sunbathing, or mountain climbing).

• Impact on children—Activities

that are perceived as putting

children specifically at risk

(e.g., school bus accidents) cause

more concern than activities not

generally so perceived

(e.g., adult smoking).

• Effects on future generations—

People are more concerned about

activities that pose risks to future

generations (e.g., genetic effects

due to exposure to radiation)

than about risks that do not pose

risks to future generations

(e.g., skiing accidents).

• Victim identify—People are more

concerned about risks to identifiable victims (e.g., a yachtsman

lost at sea or a trapped coal

miner) than about risks to

statistical victims (e.g., statistical

profiles of automobile accident

victims).

• Dread—The public is more

concerned about certain dreaded

risks that evoke a response of

fear, terror, or anxiety

(e.g., exposure to potential

carcinogens from toxic waste

dumps or to nuclear radiation)

than about risks that are not

especially dreaded (e.g., common

colds and household accidents).

FIGURE 1. Factors affecting the public’s evaluation of risks.

70
• Institutional trust—Situations •

where the responsible risk

management institution is

perceived to lack trust and

credibility (e.g., criticisms of the

Nuclear Regulatory Commission

for its perceived close ties to

industry) cause more concern

than those where the responsible

risk management institution is •

perceived to be trustworthy and

credible (e.g., trust in the

management of recombinant

DNA risks by universities and

the National Institutes of Health).

• Media attention—People are

more concerned about risks that

receive much media attention

(e.g., airline crashes) than about •

risks that receive little media

attention (e.g., on-the-job

accidents).

• Accident history—People are

more concerned about activities

that have a history of major and

sometimes minor accidents

(e.g., nuclear power plant

accidents such as the accident at

Three Mile Island) than about

activities that have a history of

no major or minor accidents

(e.g., recombinant DNA •

experimentation).

• Equity—People are more concerned about activities that are

characterized by a perceived

inequitable distribution of risks

and benefits (e.g., offshore oil

exploration) than about those

characterized by a perceived

equitable distribution of risks

and benefits (e.g., vaccination).

Clarity of benefits—People are

more concerned about hazardous

activities that are perceived to

have unclear benefits

(e.g., nuclear power generation)

than about hazardous activities

that are perceived to have clear

benefits (automobile driving).

Reversibility— People are more

concerned about activities

characterized by potentially

irreversible adverse effects

(e.g., acid rain) than about those

characterized by reversible

adverse effects (e.g., injuries

from sports or household

accidents).

Personal stake—People are more

concerned about activities that

they believe place them (or their

families) personally and directly

at risk (e.g., drinking water

contamination due to local

dumping of hazardous waste)

than about activities that do not

place them (or their families)

personally and directly at risk

(e.g., dumping of hazardous

waste at sea or in other remote

sites).

Attributability— People are more

concerned about risks that are

perceived to be due to human

actions (e.g., industry accidents)

than about risks that are

perceived to be natural in origin

(e.g., acts of God).

FIGURE 1. Factors affecting the public’s evaluation of risks (continued).

SOURCE: Adapted from Covello and Merkhofer 1992. Based on Litai

et al. 1983; Renn 1981; Slovic et al. 1980: Vlek and Stallen

1981.

71
For example, cigarette smoking was changed from an issue of individual

behavior change to a social problem by identifying environmental

tobacco smoke as a risk to others. This provided antismoking advocates

with a reason and a means to put in place strong deterrents such as nosmoking regulations. Social acceptance of interference with personal

freedom is enhanced by identifying a present health risk to others as

opposed to a simple nuisance or personal risk imposed voluntarily, even

when that risky behavior has economic and social consequences for the

community.

Another example is the risk of injury in automobile accidents. The

feeling of personal control in drivers is enhanced by the perception that

their driving skill is superior to that of others. Almost all individuals rate

their driving skills as above average. In addition, most people attribute

collisions to accident, implying loss of control and therefore less personal

or equipment culpability. Laws and communication have successfully

produced behavior change: most people now use seat belts and child

restraints. Communication alone was less effective, but laws without

effective communication about the benefits of the change would have

resulted in less behavior change (Washington Post 1993).

In the environmental arena, problems that Americans believe they, as

individuals, can help solve are seen as much less serious. For example, a

survey found that litter and indoor air pollution ranked 16th and 17th in

terms of environmental anxieties, with more than 7 out of 10 people

saying that they can “do a lot” about these problems. Solid waste and

auto exhaust, which are largely caused by consumer behavior, ranked

8th and 1 Oth, respectively; however, fewer than half the people felt they

could “do a lot” about these problems (Roper Organization 1990).

Another possible conclusion to draw from this survey is that people

adjust their perception of risk and personal control to reflect their

willingness to act.

UNDERSTAND TARGET AUDIENCES

Target audiences need to be characterized in terms of both the perception

of risks and the specific leverage points that may be effective in

motivating changes in attitudes or behavior. In addition, credible sources

and effective channels need to be identified. Sources and channels may

vary according to the type of message as well as the type of audience.

Standard audience segmentation techniques, such as focus groups, central

72
intercept interviews, risk perception surveys, and psychometric studies

can be used to investigate audience characteristics (McNeil et al. 1988).

Empirical descriptive studies, both qualitative and quantitative, can guide

strategy development in the way that epidemiology guides clinical

research and practice. However, the effects of information on individuals

and populations, like those of pharmaceuticals, need to be tested and

monitored for effectiveness and side effects.

One technique that has been particularly effective in identifying the kind

of information that will be most influential has been the use of indepth

interviews to characterize how subjects make decisions (Edgar et al.

1992). By comparing the decision model of lay persons with the model

used by experts on a particular subject for evaluating the same situation,

the information that is not present in the lay model at the time of the

decision can be identified. At least one study on radon exposure

(Bastrom et al. 1992) suggests that communications interventions using

this approach are more effective in influencing decisions. This approach

has been dubbed “mental models” and assumes cognitive processing of

the information.

Determining whether audiences are processing information cognitively or

simply responding to external cues such as source credibility has a strong

influence on the selection of the message approach. Whether an issue is

personally relevant is a major determinant of whether an individual

invests the time and energy to use central processing instead of peripheral

processing (Hammond 1990).

The amount and kind of information in which a particular target audience

is interested is an important variable. For example, the amount of

information patients desire about prescription medications varies from

basic instructions for use to a full discussion of various alternatives and

effects (McCallum 1989a). Hence, characterizing audiences by their

receptivity to information is important in planning communication

strategies.

Finally, the interest some audience segments show is subject specific.

For example, target audience response to messages about marijuana can

be quite different from those about cocaine. Careful evaluation of the

differences in a target audience’s response by subject area for both

messages and spokespersons is necessary. Knowing where to target

generic messages about drug use, and where to target messages about

specific substances, can influence a program’s effectiveness.

73
DEVELOP EFFECTIVE, TESTED MESSAGES

Because of the two-way nature of risk communication, effective

messages about risks must contain the information the audience wants

included as well as the information the program designer wishes to

convey. In addition, the message should clarify information that

audiences might otherwise misunderstand and show sensitivity to the

emotions, concerns, and values of the audiences. Also, messages must be

tested to measure their likely effectiveness. Standard message-testing

techniques include focus groups, reading level evaluation, central

intercept interviews, and theater testing (McNeil et al. 1989). Choosing a

testing method depends on the size of the investment in the communication effort and judgment about the consequences of delivering an

ineffective message or the wrong message.

Language in the message has emotional and political impact as well as

cognitive value. Words such as “dump” or “medicine” elicit responses

very different from “landfill” or “drug.” The relationship between the

perception of illicit drugs versus ethical drugs is an interesting example.

In calling for clarity in messages about psychoactive substances, some

experts have suggested that there is a continuum of drugs that society

uses, ranging from prescription drugs to over-the-counter drugs and legal

and socially accepted drugs, such as alcohol, to illicit drugs, such as

marijuana, cocaine, and illicit prescription drugs. While the linkage

between licit and illicit drugs is controversial, it seems clear that language

should be chosen to minimize confusion. What is the interaction between

benefit messages about prescription and over-the-counter medicines

(e.g., take a pill to stop the pain) and risk messages about illicit drugs

(e.g., the public service announcement that states “this is your brain on

drugs” while an egg fries in a skillet) (McCallum 1989)? While there is

little evidence that the public is confused about these differences, and

illicit and ethical drugs may not be perceived as a continuum, the

selection of words does affect perceptions. In one focus-group study,

risks were evaluated as greater when prescription products were referred

to as “drugs” than when they were referred to as “medicine.” When

prescription products were referred to as “medicine,” the benefits were

rated as greater. Communicators can make their messages more effective

by choosing their words carefully (McCallum 1989b).

Motivational appeals, both to gain attention and to change behavior,

range from humor to fear to homophyly sources who are people everyone

would like to be, usually in slice-of-life situations. Fear has been one of

74
the more controversial options. Is it possible to scare people into healthful behavior or into avoiding risks? Fear has a cognitive component and

creates a state that can lead to behavior change. Whether the message is

processed or denied, or whether the potential thrill of the activity is

enhanced, depends on how it is incorporated.

In a national seminar, guidelines for the use of fear appeals were

developed (National Heart, Lung, and Blood Institute 1987):

1.

2.

3.

4.

5.

6.

7.

8.

9.

Realize that individuals may react differently-research among target

audiences is essential.

Choose a credible spokesperson; audiences may discount messages

from noncredible sources.

Make the message as personally relevant as possible: audiences must

feel vulnerable.

Encourage a sense of personal empowerment; audiences must believe

that they can protect themselves.

Aim for immediacy in the message; audiences respond more to

immediate consequences.

Be aware of the overall effect of the message. Fear of the problem

(e.g., acquired immunodeficiency syndrome [AIDS]) should not

overpower the message about the solution (e.g., safe sex).

Use appropriate channels for fear messages. Interpersonal channels

(e.g., the doctor-patient relationship) may be better than the media.

Consider the effect of fear appeals on other health influentials (health

practitioners and policymakers); fear appeals may drive the policy

process.

Realize that fear messages have a significant wear-out factor-too

much repetition can cause the audience to become desensitized.

10. Fear may be more effective in motivating an individual to avoid risk;

fear may not be the best way to reinforce positive behavior.

75
These guidelines illustrate the complexity and the number of issues that

have to be considered when using all emotional appeals. Emotional

appeals are risky; however, many messages require a creative,

emotionally engaging approach to be effective.

In addition to the motivational component of the message, it is necessary

to transfer the skills the audience needs to respond to the message.

Depending on the particular situation, this may be simple information,

such as where to seek services, or instruction in a complex set of

behaviors for self-care.

Linking the motivation to an action in a timely manner is where programs

can fail or succeed. In an asbestos notification campaign for shipyard

workers, awareness of hazardous exposure was linked to the need to take

a series of protective action steps (e.g., quit smoking) to reduce a synergistic risk (Freimuth and Van Nevel 1981). Linking these messages

provided a risk reduction strategy for those whose anxiety level was

raised by information that they had been exposed to a cancer-causing

substance. In another case, the effectiveness of substance abuse communications programs was lessened because people could not access drug

treatment services (White House 1989).

Timing and consumer convenience are critical issues as well. The desire

to overcome addiction. or the fear of the risk of not overcoming it, is

fleeting. Even relatively small barriers can counter the most effective

message strategy. One hospital was able to eliminate emergency

admissions due to improper insulin dosages by implementing a 24-hour

hotline so that patients could get their questions answered when they

needed the information.

EFFECTIVE MESSAGE DELIVERY

Spokespersons

Spokespersons influence audience attentiveness and their acceptance of

any message. The ability of a spokesperson to positively influence an

audience to accept a message is known as credibility. The use of

celebrity spokespersons has been popular because program developers

feel that they are credible. Using celebrity spokespersons requires linking

their image, or some other characteristic, to the message to assure

credibility on a particular subject.

76
Every spokesperson is judged on credibility. Perception of credibility has

been linked to the audience’s perception of a spokesperson’s caring,

competence, and dedication (Covello, personal communication, May 15,

1992), with caring ranking as the most important factor. In a tracking

study of six communities across the United States, respondents were

asked how much they used various sources of information, how

knowledgeable these sources were, and how much they trusted the

sources. The data (see table 1) show the independence of trust and

perceived competence. Doctors were the most trusted and were

considered somewhat knowledgeable, while industry officials were the

least trusted but were considered the most knowledgeable (McCallum and

Santos 1994). Between 1988 and 1992, there was a decrease in trust of

authoritative sources overall, but their relative positions remained the

same.

Health professionals are particularly trusted sources of information on

health and environmental issues. This has been exploited in programs

related to chronic diseases. However, physicians may miscommunicate

and reinforce misconception if they and their patients are not clear how

each is perceived. This can be a problem in lifestyle advice and other

areas that are not clearly medical.

A possible effect of a discrepancy in perception of role can be seen in the

following environmental example (McCallum 1992). In 1988 a survey of

the public questioned respondents about five common health problems

they might have experienced in the previous month: headaches; nausea;

eye, nose, or throat irritation; shortness of breath; and skin rashes. They

were then queried about whether they thought the symptoms were related

to chemicals in the environment and whether they went to a doctor for

treatment. After the respondents’ symptoms were reviewed, a strong

relationship was found between consulting a doctor and viewing the

environment as the cause of the problem (x2 = 141, df = 1, p < 0.001).

Approximately 4 1 percent of respondents who consulted a doctor about

symptoms saw the environment as the cause of the problem. On the other

hand, only 19 percent of those who experienced symptoms but did not

consult a doctor blamed the environment.

In 1989 a survey looked at the physician’s view. Physicians were queried

about patients seen in the previous week with headaches; nausea; skin

rashes; eye, nose, or throat irritation: or shortness of breath and about the

relationship of these symptoms to chemicals in the air, water, or soil. The

77
TABLE 1. Perception of information sources.

Amount of Info.

Received

(Percent

answering

“A Lot”)

Trust Knowledgeable

(Percent (Percent

answering answering

“A Lot”) “Very”)

1988 1992 1988 1992 1988 1992

News reporters

Environmental

groups

Friend/relatives

Local emergency

planning committee

State government

Local government

Federal government

Chemical industry

officials

Doctors

EPA

27

21

7

6

6

5

4

3

3

NA

25 27 18* 17 12

16 40 28* 53 44

9 34 32 9 11

6 28 18* 33 24

6 12 8 29 32

5 11 5 22 12

6 12 8 36 38

4 8 6 58 62

8 46 28* 27 23

9 NA 22 NA 52

KEY: * = p < 0.05; NA = not available.

SOURCE: McCallum and Santos 1994.

physicians had seen 1,741 patients with skin rashes in the preceding

week, an average of 3 patients per doctor. The physicians independently

attributed 5 percent to chemical exposure and reported that an additional

11 percent of the patients had told them the symptoms were environmentally induced. The doctors reported concurring with the patients’

attribution 80 percent of the time (McCallum 1992).

78
Each of the other symptoms produced about six patients per week.

Shortness of breath and eye, nose, and throat irritation were attributed to

the environment for about 14 percent of cases—10 percent by patients

and about 4 percent independently by doctors” Again, the physicians

concurred with the patients’ attribution to chemicals in over 80 percent of

cases. Nausea and headaches yielded lower chemical attribution rates by

doctors and a lower concurrence rate of doctor with patient. The great

disparity between the low rate of independent attribution of common

health problems to environmental causes and the high rate of concurrence

with the patient’s attribution to the environment suggests that the latter is

not based on a careful review of the exposure history, but is a casual

response to the patient’s concern.

Because doctors are viewed as the most credible authorities on health

risks, including environmental risks, a physician’s attribution of a

symptom to the environment can have a great impact on the patient. The

research suggests that many physicians do not understand the importance

that the public gives to the physician’s role in these matters. They seem

to treat a patient’s questions and comments about environmental health

risks as general conversation and do not see their own comments as the

authoritative medical statements the patient sees them to be. So, in many

cases, physicians allow their patients to go on blaming the environment

for symptoms that are probably linked to other causes. Lifestyle issues,

such as drug or alcohol abuse, may not be brought up by the physician,

even if he or she suspects a problem, because of their discomfort with or

their lack of skills in addressing the situation. Credibility is the most

important factor in audience response when the audience is not

sufficiently engaged to cognitively process the message. Therefore, the

message must be carefully crafted to avoid miscommunication.

Channels

The mass media is the primary channel through which health risk information gets to most members of the general public. The mass media

transmits health information through news coverage and programs such as

talk shows. Though the media and public health professionals share the

same clients-the public-they have conflicting priorities (see figure 2).

For example, in order to educate, health education campaigns require

repetition, which is the antithesis of news. A particular health issue can

graduate from occasional to frequent coverage, in part because the public

wants it, but it has to be packaged as news (see figure 3). In addition,

79
Presentations and discussions brought out some fundamental

differences between mass media and public health objectives.

Mass media objectives

To entertain or inform

To cover short-term events

To deliver salient pieces of

information

To reflect society

To address personal concerns

To make a profit

Public health objectives

To educate

To conduct long-term campaigns

To create understanding of complex

information

To change society

To address societal concerns

To improve public health

FIGURE 2. Conflicting priorities of the mass media and public health

professionals.

SOURCE: U.S. Public Health Service 1991.

through entertainment programs displaying stories involving health

issues, and through the behavior of actors, television is this country’s

major storyteller and prime agent of socialization. Television images

are sometimes positive, but more frequently they are negative (see

figure 4).

Both commercial advertising and public service announcements influence

attitudes about health and individual behavior. The placement of public

service advertising has become more difficult, and commercial messages

have increasing numbers of health claims, Two major problems are

misleading claims and advertising to vulnerable populations. Claims

more often than not are incomplete. Vulnerable populations such as

teenagers may be greatly influenced by cigarette and beer advertising.

80
• Human interest: Rock Hudson’s suffering from AIDS

• Different events that are related to some problem: Betty Ford’s

drug dependency, River Phoenix’s death

• Patience to keep the media’s attention

• Personal contacts with journalists can be important

• Local news has more time to fill

FIGURE 3. How health becomes news.

SOURCE: U.S. Public Health Service 1991.

• Physical illness is • Violence is frequently

romanticized without consequences

• Mental illness is villainized • Snacking and drinking

alcohol are responses to stress

• Physicians are powerful • Overweight people are rare

• Most health professionals are • Sex is adolescent and

absent titillating; little is done to

prevent pregnancy or

sexually transmitted diseases

FIGURE 4. Health images in entertainment programming.

SOURCE: U.S. Public Health Service 1991.

The ways in which some popular media reinforce negative images or

behaviors frequently lead advocates of social change to call for

guidelines. Yet, the media in general mirror rather than influence society

(Klaidman 1991). Thus, the process of encouraging positive behavior

81
must recognize the need to communicate directly to the target audience as

well as through the media. Also, as the use of multimedia channels

becomes more common, the definition of literature needs to be expanded

to include audio and video as well as print media. Schools and families

need to help future generations use these new forms of communication by

teaching young people to understand the symbols and become active

rather than passive users of these information sources.

REINFORCE MESSAGES AND BEHAVIORS

Behavior change is difficult. To be successful, a campaign must repeat

the message over and over. Further, the person making the behavior

change has to get personal satisfaction and receive positive feedback from

society.

Using interpersonal channels in addition to the media usually is more

effective than using either alone. As more and more people adopt the

behavior, it becomes the normative behavior for that group. The change

in attitude towards cigarette smoking took a long time-almost

30 years-but it happened. One major factor was the commitment to

keeping the health implications of smoking in front of the public over the

years; another was identifying smoking as a hazard to others. There are

certainly many examples of negative peer pressure in the campaign

against smoking. Portraying cigarettes as “uncool” has been one

approach. More and better creative strategies are needed.

The need for sustained effort is further illustrated by the recent increase in

drug use by high school seniors (Thomas 1994). The news report on a

survey by the University of Michigan shows an increase in marijuana and

tobacco and a decrease in alcohol use. This researcher suggests that each

new generation must overcome its naivete about drug use. Also, recent

campaigns against underage drinking may have resulted in some

substitution of other drugs. Other campaigns that have faltered because

of complacency about the gains being made include the fights against

tuberculosis and cigarette smoking among women.

EVALUATION

Evaluation should be part of any communication effort; without it, there

is no way to measure progress or to identify the need to make timely

82
changes. Evaluation can be an effective tool in making programs more

efficient and effective.

Problems and difficulties arise in the evaluation of risk communication

activities due to conflicts and misunderstandings over values, goals,

resources, and usefulness. Because the process of evaluation is a valueladen endeavor, significant practical and policy implications are likely to

occur (Fisher et al. 1991).

Goals and Values

A difficulty in evaluating risk communication programs is the challenge

of identifying appropriate goals (e.g., to raise awareness of an issue, to

bring about action, to increase participation). Only when program goals

and expected effects are defined clearly can there be significant

evaluation. For many programs, however, this level of specificity is

difficult to achieve. In addition, evaluators and program implementors

often disagree on the goals of the program as well as on which goals

should be evaluated. Communication goals must be agreed upon and

built into the risk communication program from the beginning.

Any risk communication program has many stakeholders-including

Government agencies, public interest groups, industry groups, and

individuals-who are interested in the conduct and effectiveness of the

program. Evaluators often are asked to respond to the interests and needs

of each group; however, an initial difficulty in any evaluation of risk

communication activities is to determine the perspective from which the

evaluation will be conducted. Upon completion of an evaluation, the

evaluator has a responsibility to identify the chosen perspectives and to

recognize the existence of other viewpoints. Different audiences have

different perspectives and goals and need different types of information.

In addition, different risk communication activities require different types

of evaluation studies.

Conflicts over values have sparked debate in the public health and

substance abuse treatment communities and among the public. The

designated driver campaign has reduced alcohol-related accidents, but

some feel that it implies acceptance of alcohol abuse or underage

drinking. In the quest to stop the spread of AIDS, needle-exchange

programs and sexually frank campaigns have sparked similar valuerelated controversy.

83
Evaluation information is seldom neutral. Differences in goals and

values can create conflict between the evaluator and program implementors. If the evaluator is part of the implementing team, tension may be

reduced but the evaluator’s vision may be clouded by prior experience

and his or her stake in the process. Therefore, when the results of the

evaluation are used to inform future program plans and dissemination

efforts, planners need to ask questions such as:

• What was the original goal of the project?

• Has a particular ideology shaped the project or the evaluation?

• What values framework will be used in the evaluation and

interpretation of the results?

• Are there competing points of view that need to be considered?

Resources

Ongoing evaluation of a program is important. With early and

continuing evaluation, implementors are able to receive feedback on the

effectiveness of the program; if the activities are not working as intended,

there is time to reevaluate the program and make corrections that, in the

long run, may save time and money.

In spite of its benefits, ongoing evaluation of risk communication

activities is often disregarded, especially if no evaluation has been

planned or budgeted for in advance. Managers often are reluctant to

evaluate programs. Many managers believe that it is an expensive

process that calls for skills beyond those present in the organization.

Some are unwilling to support research that might show that the program

is not working as intended. In addition, program managers often allocate

all the available resources to the risk communication activities without

considering if the activities are accomplishing the desired purposes.

Some strategies to bring about increased attention to, and usage of,

evaluation research in risk communication programs are:

• Integrate evaluation activities into the program from the

beginning;

84
• Use quick, simple, and informal evaluation methods, when

appropriate;

• Develop incentives for planners to fund evaluation activities;

• Encourage managers to develop clear evaluation plans; and

• Encourage implementors to record and share successes.

Usefulness

Evaluations often are criticized because the results are not used

immediately. However, current evaluation results, if not used at once,

may be used to indicate the direction in which future programs should go,

or on which to base future activities.

SUMMARY

This chapter presents some of the theories and models underpinning

effective communication practice. It also emphasizes the central role of

communication in achieving effective program implementation. Whether

the communication is aimed at changing the attitudes and behavior of

professionals, various segments of the public, or other target audiences,

the basic approach is the same. The following checklist provides a guide

to program planners (Arkin 1991):

• Commit adequate time, effort, and resources to communication

planning and pretesting.

• Begin by singling out specific issues and specific target

audiences. Then design messages based on the target audiences’

values, needs, and interests.

• Conduct (or review existing) market research on the target

audience to understand what will motivate them.

• Pretest messages and materials with the target audience to assure

understanding and relevance to their needs and interests.

85
• Make sure that messages and materials appear where the target

audience will pay attention to them (for sensitive issues,

community and interpersonal channels that allow interactive

discussion are very important).

• Produce public service announcements that are of high quality,

community specific, marketed to stations, and targeted to

audiences likely to see them when public service air time is

available (such as fringe viewing times).

• Combine public service announcements with news and other uses

of the mass media (e.g., building on related news) to increase

exposure to issues.

• Use a combination of the mass media and community channels

that will reach the target audience.

• Work collaboratively with other organizations, including drug

treatment facilities, law enforcement and social service agencies,

and other community organizations that have complementary

strengths. Begin to coordinate efforts as early as possible in

program planning.

• Use a multipronged communication strategy to focus on what an

individual should do, how the individual can start to change, and

factors that help reinforce individual change, such as peer

approval and community support.

• Track progress and identify when, and what kind of, changes are

needed in communications.

• Combine communications with other strategies needed to support

change (e.g., access to treatment or positive alternatives to drug

use).

• Set reasonable, short-term communication objectives to reach the

long-term goal. Then, commit to communications as one

program component over the long term. It is important to

remember that one-shot campaigns are unlikely to have a lasting

effect and that progress is incremental.

86
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increasing organ donation. In: U.S. Public Health Service. The

Surgeon General’s Workshop on Increasing Organ Donation.

Background Papers. Washington, DC: Division of Transplantation,

U.S. Public Health Service, 1991.

Bastrom, A.; Fischhoff, B.; and Morgan, M.G. Characterizing mental

models of hazardous processes. J Soc Issues 48(4):85-100, 1992.

Covello, V.T., and Merkhofer, M.W. Risk Assessment: Methods and

Approaches for Quantifying Health and Environmental Risks. New

York: Plenum, 1992.

Edgar, T.; Freimuth, V.; Hammond, S.; and Fink, E. Strategic sexual

communication: Condom use resistance and response. Health

Commun 4:2, 1992.

Fisher, A.; Pavlova, M.; and Covello, V.; eds. Evaluation and Effective

Risk Communications: Workshop Proceedings. Proceedings of the

Interagency Task Force on Environmental Cancer and Heart and Lung

Disease, U.S. Environmental Protection Agency. Washington, DC:

U.S. Environmental Protection Agency, 1991.

Flay, B.R.. and Burton, D. “Effective Mass Communications for Public

Health.” Paper prepared for a National Cancer Institute conference

entitled Mass Media and Health: Complexities and Conflicts. Rancho

Mirage, CA, September 17-19, 1988.

Freimuth, V.S., and Van Nevel, J.P. Reaching the public: The asbestos

awareness campaign. J Commun 31(2):155-167, 1981.

Hammond, S. “Issue Involvement and the Elaboration Likelihood Model:

A Field Experiment Using Environmental Risk Messages.” Ph.D.

diss., University of Maryland, 1990.

Klaidman, S. Health in the Headlines: The Stories Behind the Stories.

New York: Oxford University Press, 1991.

Litai, D.; Lanning, D.; and Rasmussen, N.C. The public perception of

risk. In: Covello, V.T.: Flamm, W.; Rodricks, J.; and Tardiff, R., eds.

The Analysis of Actual Versus Perceived Risks. New York: Plenum,

1983.

McCallum, D.B. (executive producer). Semantics of Prescription Drugs.

Videotape prepared for the Program on Risk Communication.

Washington, DC: Georgetown University, 1989a.

McCallum, D.B., and Yenney, S. Communicating the Benefits and Risks

of Prescription Drugs. Washington, DC: Georgetown University

Medical Center Institute for Health Policy Analysis, 19896.

87
McCallum, D.B. Physicians and environmental risk communication.

Health Environ Dig 6(1):3, 1992.

McCallum, D.B., and Santos, S.L. Public Knowledge and Perceptions of

Chemical Risks in Six Communities: Follow-up Survey Results.

Washington, DC: U.S. Environmental Protection Agency, 1994.

McNeil, C.; Arkin. E.B.; and McCallum. D.B. Toxic and Hazardous

Substances, Title III and Communities: An Outreach Manual for

Community Groups. Washington, DC: U.S. Environmental Protection

Agency, 1989.

National Heart, Lung, and Blood Institute. “Seminar Results: Fear as a

Persuasion Technique.” Unpublished proceedings from the

Conference on Fear Communications. December 1987.

National Research Council. Risk Assessment in the Federal Government:

Managing the Process. Committee on the Institutional Means for

Assessment of Risks to Public Health, National Academy of Science

and National Research Council. Washington. DC: National Academy

Press, 1983.

National Research Council. Zmproving Risk Communication. National

Research Council Committee on Risk Perception and Communication.

Washington, DC: National Academy Press, 1989.

Renn, 0. Man, Technology, and Risk: A Study on Intuitive Risk

Assessment and Attitudes Towards Nuclear Power. Report Jul-Spez

115. Juelich, German Federal Republic: Nuclear Research Center,

1981.

Roper Organization. “The Environment: Public Attitudes and Individual

Behaviors.” Report commissioned by S.C. Johnson & Son, Inc., 1990.

Rossi, P.H., and Berk, R.A. “A Guide to Evaluation Research Theory and

Practice.” Paper prepared for the Workshop on Evaluation and

Effective Risk Communication, Interagency Task Force on

Environmental Cancer and Heart and Lung Disease, 1988.

Slovic. P.; Fischhoff, B.; and Lichtenstein, S. Facts and fears:

Understanding perceived risk. In: Schwing. R., and Albers, W.A., Jr.,

eds. Societal Risk Assessment: How Safe is Safe Enough? New York:

Plenum, 1980.

Thomas, P. Illicit drug use rises among U.S. teenagers. Washington Post.

February 1, 1994.

U.S. Public Health Service. Mass Media and Health: Opportunities for

Improving the Nation’s Health. Washington. DC: U.S. Department of

Health and Human Services, 1991.

Vlek, C.A.J., and Stallen, P.J. Judging risks and benefits in the small and

in the large. Organ Behav Hum Perf 28:122-123, 1981.

Washington Post. Seatbelt use sets record. December 19, 1993.

88
White House. National Drug Control Strategy. Washington, DC: Supt. of

Docs., U.S. Govt. Print. Off., 1989.

AUTHOR

David B. McCallum, Ph.D.

Principal, FOCUS GROUP

Adjunct Professor of Public Health, Columbia University

Center for Risk Communication

1101 17th Street, NW

Suite 500

Washington, DC 20036

89
Diffusion of Drug Abuse

Prevention Programs:

Spontaneous Diffusion, Agenda

Setting, and Reinvention

Everett M. Rogers

INTRODUCTION

Drug abuse prevention programs cannot have an effect on individual

behavior until such programs are adopted and implemented by

communities, schools, workplaces, and other organizations.

Unfortunately, in previous research little attention has been paid to this

issue of diffusion of drug abuse prevention programs. The rate of such

diffusion should be related directly to the relative effectiveness of such

programs in decreasing drug abuse. A review of evaluations of drug

abuse prevention programs (some of which are detailed later in this

chapter) indicates that even when such programs are implemented

carefully, the results represent only a modest impact on drug use

behavior.

Given this somewhat limited effectiveness, why have drug abuse

prevention programs diffused so widely? For example, it is almost

impossible to encounter an elementary school or a middle school in

America that has not adopted Drug Abuse Resistance Education (DARE).

In a decade DARE spread from its beginnings as a pilot project in 30 Los

Angeles schools until by 1994 some 25 million U.S. schoolchildren were

being trained in DARE programs.

Many drug abuse prevention programs diffuse for reasons unrelated to

their proven effectiveness, as measured in evaluation research studies. In

fact, some programs diffuse even before their effectiveness in reducing

drug use has been determined. Clearly other factors than program

effectiveness must be involved in such diffusion. What are they? The

analysis of the diffusion of DARE in the United States suggests some

possible reasons.

90
TECHNOLOGY TRANSFER AND DRUG ABUSE PREVENTION

The mission statements of most U.S. private foundations state that one of

their important purposes is to grant funds to proposers in order to bring

about meaningful social change in society. Private foundations are

uniquely flexible in identifying and analyzing social problems in America

and in formulating solutions through the utilization of research-based

knowledge. However, many U.S. foundations have given little attention

to whether, and how, the projects they fund actually lead to meaningful

social change in society, thus solving social problems. This concern with

the eventual end results of foundation-funded research activities leads to

greater interest today in strategies for the diffusion of innovations and

their implementation. Several U.S. foundations today are beginning to

give more attention to dissemination and implementation.

The Kauffman Foundation is one of the leaders in this important change

in thinking. Its consultant has helped the foundation conceptualize its

concern with translating the results of foundation-supported projects into

action. Indeed, the Kauffman Foundation may become a leader among

U.S. private foundations in focusing on the issue of the utilization of

research to bring about social change. One of the Kauffman Foundation’s main concerns is with the social problem of drug use in America.

The National Institute on Drug Abuse (NIDA) is a pioneering Federal

agency in organizing effective technology transfer programs to

disseminate research-based information about drug abuse prevention and

treatment to individual practitioners and organizations. NIDA’s purpose

is to encourage the adoption and implementation of the findings from

drug abuse-related behavioral research.

So here is a situation in which a private foundation with considerable

experience in disseminating drug abuse prevention programs to schools

and communities, especially in the Midwest, shares a concern with an

important Federal agency that is centrally involved in research and action

on drug abuse problems in America. This collaboration has a high

likelihood of finding useful solutions to drug abuse problems.

The purpose of this chapter is to draw upon research that has been

conducted on the diffusion of innovations in order to suggest strategies

that might be used in transferring drug abuse prevention technologies into

adoption and implementation. A sizable number of research studies has

been conducted on the diffusion of innovations of all kinds (from hybrid

91
seed corn to contraceptives to consumer innovations to modem math in

schools), represented in more than 3,810 publications about diffusion

(Rogers 1995). However, only a handful of the many diffusion

publications deal with the spread of drug abuse prevention programs from

community to community, from school to school, and from organization

to organization. No concerted attempt has been made yet to use the

diffusion model to explain the spread of drug abuse prevention programs.

While there are unique aspects of drug abuse prevention behavior that

may affect the diffusion and adoption of innovations concerned with drug

abuse prevention, the assumption here IS that the diffusion model can be

applied usefully.

PROJECT SMART AND ITS MANY “CHILDREN”

During a decade of teaching at Stanford University (1975 to 1985) this

author served as a principal coinvestigator for the Stanford Heart Disease

Prevention Program (SHDPP), a well-known health communication

campaign carried out in selected California communities. Through a field

experimental design, the SHDPP was evaluated carefully in terms of its

resulting effects on the risk of heart disease among the populations of

several California communities.

The SHDPP served as a kind of father (or mother) for Project SMART

(Self-Management and Resistance Training), a drug abuse prevention

intervention carried out in selected Los Angeles schools by the Health

Behavior Research Institute (HBRI) at the University of Southern

California (USC). From 1985 to 1993, while teaching at the USC

Annenberg School for Communication, this author was involved with the

Kauffman Foundation’s Project STAR (Students Taught Awareness and

Resistance), an intellectual descendant of Project SMART (and,

indirectly, of SHDPP). The USC research evaluating the impacts of

Projects STAR and the companion project in Indianapolis (I-STAR) is

supported by a grant from NIDA, with the drug prevention program

funded by the Kauffman Foundation. Project STAR spread from Kansas

City and Indianapolis to the school-based Corporation Against Drug

Abuse program in Washington, DC, in 1989 and to Communities for a

Drug-Free Colorado. Figure 1 shows this family tree of health promotion

and drug abuse prevention projects or at least the first several generations

of this ancestry.

92
FIGURE 1. The family tree of community-level preventive health

and drug abuse prevention interventions.

93
Project STAR spread to several of the control schools in Kansas City

during the early years of the project (in the mid-1980s). Such

spontaneous, unplanned dissemination obviously marred the research

design for Project STAR, but it was a bonanza to Project STAR’s

dissemination and utilization. Such unplanned diffusion of an intervention program prior to completion of the intervention’s evaluation is,

of course, a cause for worry among evaluation researchers. For example,

what if the evaluation shows that the treatment was ineffective after the

treatment has diffused to other sites? Ideally an evaluation of a program

ought to be completed prior to dissemination of the intervention program

to other locations. Unfortunately, this time order is not always what

occurs in real life. especially in the case of drug abuse prevention

programs.

The USC director of evaluation for Project STAR was urged by this

author to investigate the unplanned diffusion of the STAR program to the

control schools in Kansas City and to other schools throughout Kansas

and Missouri, which also occurred in the mid-1980s (and which was

assisted by the Kauffman Foundation in response to a request from State

officials in Kansas who were responsible for drug abuse prevention).’ An

account of the diffusion of Project STAR (Pentz and Valente 1993) was

subsequently written.

That 1993 publication also contains a chapter on the amazingly rapid

diffusion of Project DARE, another descendant of Project SMART, that

has had a phenomenal spread throughout the United States and abroad

(figure 2). DARE differs from Project SMART (and Project STAR)

mainly in that uniformed police officers teach a 17-hour curriculum on

drug abuse prevention to fifth and sixth grade students. DARE began in

1983 when Los Angeles Police Department (LAPD) Chief Daryl Gates,

in collaboration with Los Angeles Unified School District health

educators, created the first DARE program by training 30 police officers

in the DARE curriculum. The program spread like wildfire. In less than

10 years, over 25 million schoolchildren were trained in the DARE

program, and it continues to diffuse (see figure 2).

Thus one general model for preventive health behavior has diffused very

widely and very rapidly through its reformation in a sequence of health

prevention programs, each of which is a variation on a basic theme. For

example, all of the drug abuse prevention programs deliver their

educational intervention by means of training schoolchildren in their

regular classroom. Exactly who provides this training differs,

94
FIGURE 2. Cumulative number of police officers trained in how to

teach the DARE Program.

SOURCE: Rogers 1993.

however: uniformed police officers in the case of DARE, and

schoolteachers in the case of Project STAR and I-STAR.

The general experience of Project STAR in Kansas City leads one to

wonder if field experiments go awry through spontaneous diffusion more

often than one thinks. Sometimes the research results may be more

valuable than if the field experiment had gone exactly as planned.

THE AGENDA-SETTING PROCESS FOR THE DRUG ISSUE

Why did the DARE program and Project STAR spread so rapidly? The

drug problem ranked very high on the national agenda as a result of the

extensive coverage of crack cocaine by “The New York Times” (due, in

part, to a conversation between Rev. Jesse Jackson and the editor of “The

Times” in 1985), the 1986 death of All-American basketball star Len

Bias; First Lady Nancy Reagan’s “Just Say No” campaign; and private

and Federal funding for drug abuse prevention programs such as through

the U.S. Department of Justice (to police departments for DARE

training), the U.S. Department of Education, and other agencies like

95
NIDA and the Office of Substance Abuse Prevention (OSAP). Extensive

media coverage of the crack attack (a drug of increasing use at that time

in America) boosted the drug issue up the media agenda, led by actions of

the White House and “The New York Times” (figure 3a). In mid-1989,

54 percent of the U.S. public indicated in a Gallup Poll that they regarded

drugs as the most important problem facing America (figure 3b). Four

years previously to 1989, this percentage was zero. By 1991, only

4 percent of the U.S. population thought that drugs were the most

important problem facing America (Dearing and Rogers, in press). Drugs

were pushed down the agenda by other issues, especially the Nation’s

economic difficulties at the end of the 1980s decade and by the 1991 Gulf

War. Thus the public agenda for the drug issue rose and fell in just a few

years.

In local communities, public concern about the drug problem meant that

parents, teachers, and school administrators were very eager to adopt a

drug abuse prevention program in their schools. Hence the widespread

public interest in programs like Project STAR and DARE. And the

timing of these drug abuse prevention programs was exquisite, coinciding

with the dominant position of the drug issue on the public agenda.

What put an issue like the drug problem on the national agenda in the late

1980s? It was not a real-world indicator, an objective measure of the

seriousness of this social problem. Since 1980 (and for several years

previously), a long-term decline has been occurring in the annual number

of deaths due to drugs in the United States. However, one cause of drugrelated deaths, crack cocaine (a new form of drug abuse in the mid1980s) increased sharply. The death of Len Bias due to a drug overdose

was a tragic event that the mass media covered in great detail, helping the

U.S. public generalize it into a high priority for the drug problem.

Television documentaries like “Twenty-Four Hours on Crack Street”

helped drive home the drug problem.’

In general, studies of the agenda-setting process for various issues (the

War on Drugs. the environment, AIDS, the 1984 Ethiopian drought, etc.)

suggest that “The New York Times” and the White House are the two

most powerful forces in putting an issue on the national media agenda.

This process often is triggered by a tragic personal event (for example,

the death of Len Bias or Rock Hudson, Ryan White’s exclusion from his

school in Indiana, the Exxon Valdez oil spill, etc.). Real-world indicators

for an issue make sense to the media and to the public when they are

given meaning by personal tragedy. Thus the agenda-setting process in

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FIGURE 3a. Number of drug war stories in the “Washington Post”

by year: The media agenda.

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FIGURE 3b. People who said that drugs are the main problem

facing the U.S.: The public agenda.
the United States is one of social construction through which people

gradually give meaning to an issue (Dearing and Rogers, in press).

The agenda-setting process is the way in which an issue achieves a high

priority on the media agenda (measured as the amount of media attention

given to the issue), on the public agenda (measured as the relative number

of people who say that the issue is the most important problem facing

America), and on the policy agenda (measured as the passage of laws, the

voting of appropriations, etc.). Usually the media agenda influences the

public agenda, which in turn influences the policy agenda. What sets the

media agenda? An objective, real-world indicator (like the number of

deaths due to drug abuse) for the drug issue seldom has much direct

influence on the media agenda. More important is a personal tragedy like

the death of basketball star Len Bias. And, as stated previously, “The

New York Times” and the White House have considerable influence in

setting the media agenda for many issues. As Cohen (1963, p. 136)

stated, “The press may not be successful much of the time in telling

people what to think, but it is stunningly successful in telling its readers

what to think about.”

The position of an issue on the national agenda affects the rate of

diffusion and adoption of an innovative program by local organizations

and communities that promise to deal with the national issue. The high

priority of the drug issue in the late 1980s boosted the spread of DARE

and other drug abuse prevention programs in the United States. Has the

disappearance of the drug issue from the national media agenda and the

public agenda in the 1990s adversely affected the further diffusion of

drug abuse prevention programs to schools, communities, and other

units? Perhaps such drug abuse prevention programs are already so

widespread (that is, a critical mass has been reached) that they continue to

spread, even though the drug issue’s salience on the national agenda has

evaporated. Perhaps the agenda-setting process for the War on Drugs

was mainly important in launching the diffusion process for drug abuse

prevention programs, and now that a maintenance stage has been reached,

the position of drugs on the national agenda has little impact on local

decisions.

The Kauffman Foundation’s Project STAR did not set the national

agenda for the issue of drug abuse, although the Foundation’s activities

helped raise the drug problem on the local agenda in Kansas City. On

certain occasions, a private foundation can identify a social problem and,

by means of the attention that the foundation gives to the issue (either

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locally or nationally) help boost that issue up the agenda. This role is a

very powerful one indeed for private foundations and for the mass media.

American democracy might function more effectively if there were an

early warning system for the detection of issues that will (or should)

climb the national agenda. At present many issues get on the agenda by

haphazard and accidental means. Many, many other issues that may

deserve to get on the agenda do not. How could the agenda-setting

process be rationalized so that deserving (on some objective basis) issues

survive, while others do not? What role do private foundations presently

play at the national and local community levels in the agenda-setting

process? How could they play a more important role? These intriguing

problems deserve further attention.

REINVENTION

The spontaneous diffusion of Project STAR in Kansas City is a case in

which the drug abuse prevention program’s diffusion outran its

evaluation, as mentioned previously. The NIDA-supported USC

evaluation of Project STAR indicated that the intervention had effects in

delaying the onset of cigarette smoking, drug use, and alcohol drinking

by the Kansas City students trained in Project STAR.

The evaluation of Project STAR in Kansas City showed that among the

target audience of sixth and seventh graders, compared with the control

schoolchildren, cigarette smoking was 25 percent less, alcohol drinking

was 20 percent less, and marijuana use was 30 percent less. However,

when the same substance abuse prevention model was implemented in

Indianapolis as Project I-STAR, only a few percent less of the treatment

schoolchildren used these substances than did the children in the control

schools. Project STAR and Project I-STAR cost from $15 to $25 per

student. Project I-STAR achieved the rather modest effects on prevention

behavior typically found for most drug abuse prevention programs in

schools.

The nontreatment schools in Kansas City that adopted Project STAR

often modified, adapted, and reinvented the STAR approach, presumably

to customize the model to their particular circumstances and available

resources. In a parallel sense, considerable reinvention of Project STAR

seems to have occurred as it spread to Indianapolis, Washington, DC, and

Colorado, just as Project SMART was adapted earlier into Project STAR

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and into the DARE program, which in turn was reinvented to a certain

degree as it spread across America and beyond (see figure 1).

Reinvention is the degree to which an innovation is changed by adopters

as it diffuses and is implemented. Why does reinvention happen? Does

such reinvention lead to programs that are more effective, or less

effective, in reaching program goals (that is, in the case of Project STAR,

in decreasing drug abuse)? What elements of a program are reinvented,

and which elements are transferred intact, in the typical process of the

diffusion of an innovative drug abuse preventron program? For instance,

the resistance-to-influence training component of Project SMART

continued in Project STAR, the descendants of Project STAR, and in the

various versions of DARE implemented in local communities. However,

who does the in-class training (trainers were health educators from USC

in Project SMART, uniformed police officers in Project DARE, and

schoolteachers for Project STAR) differed from program to program. Is

there a core or template of elements of an innovative drug abuse

prevention program that is not reinvented as it diffuses, while only the

bells and whistles change? Finding out would be useful.

The headquarters office of DARE America seeks actively to discourage

the reinvention of this drug abuse prevention program. The original Los

Angeles version of the DARE program is regarded officially as the

correct template which should be followed exactly by other communities

when they adopt the program.

Wulf (1987) of the University of Southern California found that

34 percent of a sample of 84 police departments carrying out DARE

programs did not teach all 17 hour-long DARE lessons. For example,

about one-fourth of all local DARE programs did not teach the lesson on

resisting gang pressure (presumably those schools thought they did not

have a gang problem). Reinvention aided the rapid diffusion of the

DARE program among U.S. schools. Whether such reinvention

adversely (or positively) affected the impacts of the DARE program on

its participants is an important research question that should be

investigated. One wonders how much reinvention of innovative drug

abuse prevention programs occurs when they are implemented in schools

and in communities.

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PROGRAM EFFECTIVENESS AND THE RATE OF DIFFUSION

Previously mention was made of the worrisome possibility that a drug

abuse prevention program might diffuse into widespread use, only for

evaluation research to show later that the program was relatively

ineffective. Generally, evaluations of the school-based drug abuse

prevention programs find only a modest degree of program effectiveness.

What role does program effectiveness play in the diffusion of drug abuse

prevention programs?

One answer is available from an analysis of the diffusion of Project

DARE in the United States (Rogers 1993). As shown previously (see

figure 2), the rate of diffusion of Project DARE was very rapid. Was this

speedy diffusion due to the proven effectiveness of DARE in combating

drug abuse? Hardly. Evaluation studies (for example, Evaluation and

Training Institute 1988; Nyre 1985) generally showed that students who

were trained in the DARE program have a lower rate of cocaine use than

non-DARE students. The rate of use of other drugs was also consistently

lower for DARE-trained students. However, the differences between

DARE and non-DARE students were rather small. DARE made a

difference, but not a very big one, in prevention behavior. The research

designs used to evaluate the effectiveness of DARE training have

methodological problems, particularly a high dropout rate of DARE and

non-DARE students in the year-to-year cohorts (Rogers 1993). Thus

evaluating the long-term effects of DARE is methodologically difficult.

Some evaluations of Project DARE show only very modest effects indeed

(for example. Clayton et al. 1991). A meta-evaluation of the effectiveness of DARE, and of other drug abuse prevention programs, is needed.

The DARE experience suggests that the timing of an evaluation study

may be almost as important as its findings. A particularly influential

evaluation study was conducted by DeJong (1987), who gathered data

from several hundred seventh graders in four Los Angeles middle schools

who had received the 17-lesson DARE curriculum during their sixth

grade. Compared with a non-DARE control group, the DARE seventh

graders reported lower use of alcohol, cigarettes, and other drugs. This

difference was especially marked for boys.

DeJong’s DARE evaluation study was influential in convincing officials

of the U.S. Department of Justice to fund DARE programs through police

departments in local communities. The National Institute of Justice (NIJ)

of the U.S. Department of Justice had funded DeJong’s (1987) evaluation

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study of DARE in Los Angeles. LAPD Chief Daryl Gates requested help

from the director of NIJ for Federal assistance in promoting DARE. NIJ

published DeJong’s evaluation research findings in “NIJ Reports.” which

is distributed to every chief of police in the United States. The political

climate for DARE’s diffusion at that time was just right. The U.S.

Department of Justice was receiving budget increases from the Reagan

White House, while funding for other domestic programs in the United

States was being cut. The War on Drugs was the number one priority on

the national agenda in the late 1980s. The media were telling the U.S.

public that the drug problem was serious, and the use of crack cocaine

attracted massive news coverage. At this point a new drug abuse

prevention program, DARE, that had been launched by a well-known

police chief, Daryl Gates of the LAPD, was found to work by an

academic scholar, DeJong, at a prestigious institution, the Harvard School

of Public Health.

Small wonder then that Project DARE was widely and rapidly adopted by

U.S. schools. They were being pressured by parents to do something,

anything about the drug problem. DARE was not a budget cost to the

local school, as U.S. Department of Justice funding for DARE was

channeled through police departments. Whether DARE programs have

modest versus major effects on drug abuse by students was not so

important as whether DARE has any effects. The DeJong (1987)

evaluation study showed that DARE has some beneficial effects on the

prevention behavior of school children.

Here is evidence of the role of evaluation research on program effectiveness in influencing the rate of diffusion of a drug abuse prevention

program. Had DeJong’s (1987) evaluation shown that DARE had no

effects, the U.S. Department of Justice might not have promoted the

spread of DARE programs, and the rapid rate of diffusion in the late

1980s might not have occurred. Had the War on Drugs not been so high

on the media agenda and the public agenda, DARE and other drug abuse

prevention programs might not have been so high on the policy agenda.

Even though the rate of drug-related deaths was not increasing (contrary

to popular belief) during the 1980s. drug abuse was an important social

problem in America (so the real-world Indicator was of at least some

importance). Had this importance not been the case, the White House

and “The New York Times” would hardly have championed the drug

issue.

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Program effectiveness, as determined by scholarly research, seems to be a

minimum factor in a program’s diffusion, along with such other

minimum factors as a priority on the national agenda, evidence of the

social problem’s objective importance, and available funding from

government or other sources. Each of these factors seems to be

necessary, but not alone sufficient, for the diffusion and adoption of a

drug abuse prevention program. Note also that these factors are socially

constructed by a network of actors who give meaning to a new program

like DARE and to a social problem like drug abuse in America. It is not

the objective fact of a real-world indicator like drug-related deaths in the

United States, or of the measured effectiveness of a program like DARE,

that matters most in determining the rate of adoption. Instead, it is the

subjective meaning of such social facts, worked out through a social

process of interaction among key actors, that determines the rate of

adoption of a new idea. Understanding how this microprocess of social

interpretation is worked out at the local level and the adoption,

reinvention, or rejection decision that results, is fundamental for coping

with the drug problem facing American schools, communities, and work

organizations today.

CONCLUSIONS

What conclusions can be drawn from the research evidence and program

experiences about the diffusion and adoption of drug abuse prevention

programs that have been related in this chapter?

1. Key factors in enhancing the dissemination of drug abuse prevention

programs are that these programs provide perceived solutions to a

social problem on the national, or the local, agenda. This matching

of a program with a perceived social problem is a process of social

construction.

2. Evaluation research to determine the effectiveness of drug abuse

prevention programs ideally should be completed before dissemination begins (although this ideal time order does not always occur).

3. The spontaneous diffusion of a drug abuse prevention program

before its evaluation is completed happens more frequently than one

realizes. One needs to be more aware of its occurrence than in the

past and be prepared to prevent it or to capitalize on it.

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4.

5.

6.

Evaluation research on the effectiveness of a drug abuse prevention

program is only one factor, along with such other factors as the

priority of drug abuse on the national agenda, in determining the rate

of diffusion and adoption of such programs by communities, schools,

and other organizations.

Boosting an issue (a social problem) on the national or local agenda

is a very powerful force in encouraging the diffusion of programs that

seek to cope with the social problem. Drug abuse prevention

programs diffused very widely during the late 1980s when the War

on Drugs was of highest priority on the national agenda.

A successful drug abuse prevention program often is reinvented

during its diffusion, so that the second- and third-generation

programs may be quite different from the original program that was

evaluated and disseminated.

Finally, it is important to understand more fully how drug abuse

prevention programs diffuse and are adopted and implemented by local

communities, schools, work organizations, and other units. At this micro

level of investigation, more should be learned about how an innovative

drug abuse prevention program is put into use, leading to utilization of

research-based knowledge in order to prevent drug abuse or to provide

more effective treatment for drug-related problems.

NOTES

1. By 1993 Project STAR had spread to 80 percent of all school districts

in Kansas and Missouri. And 100 percent of the middle schools in

the Greater Kansas City Metropolitan Area had STAR teachers in

then middle schools.

2. In a similar sense the Centers for Disease Control’s monthly reports

on the growing number of AIDS cases in the United States did not

put the issue of AIDS on the media agenda from 1981 to 1985 until

such human tragedies as those of Rock Hudson and Ryan White

changed the meaning of AIDS for the media and for the public in

early fall of 1985. Thereafter media coverage of the AIDS issue

escalated, the issue of AIDS quickly climbed the public agenda, and

increased government funding rapidly followed.

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REFERENCES

Clayton, R.C.; Cattarello, A.: Day, L.E; and Walden, K.P. Persuasive

communication and drug prevention: An evaluation of the DARE

Program. In: Donahew, L.; Sypher, H.E.: and Bukoski, W.J., eds.

Persuasive Communication and Drug Abuse Prevention. Hillsdale,

NJ: Lawrence Erlbaum Associates, 1991.

Cohen, B.C. The Press and Foreign Policy. Princeton, NJ: Princeton

University Press, 1963.

Dearing, J.W., and Rogers, E.M. Agenda-Setting. Newbury Park, CA:

Sage, in press.

DeJong, W. A short term evaluation of Project DARE: Preliminary

indications of effectiveness. J Drug Educ 17(4):279-294, 1987.

Evaluation and Training Institute. “DARE. Longitudinal Evaluation

Annual Report, 1987-88.” Report prepared for the Los Angeles Police

Department Chief of Police, 1988.

Nyre, G.F. Drug Abuse Resistance Education (Project DARE) in

elementary schools: Police as teachers. In: Berkevitz, I.H., and

Selinger, J., eds. Expanding Mental Health Interventions in Schools.

Los Angeles: Kendall/Hunt, 1985.

Pentz, M.A., and Valente, T. Project STAR: A substance abuse

prevention campaign in Kansas City. In: Backer, T.E., and

Rogers, E.M., eds. Organizational Aspects of Health Communication

Campaigns: What Works? Newbury Park, CA: Sage, 1993. pp. 37-60.

Rogers, E.M. Diffusion and reinvention of Project DARE. In: Backer, T.E.,

and Rogers, E.M., eds. Organizational Aspects of Health Communication Campaigns: What Works? Newbury Park, CA: Sage, 1993.

pp. 139-162.

Rogers, E.M. Diffusion of Innovations. 4th ed. New York: Free Press,

1995.

Wulf, K.M. “A Study of the Implementation of the DARE Program in

Law Enforcement Agencies.” Paper presented to the Crime Prevention

Advisory Council, Los Angeles, School of Education, University of

Southern California, May 17, 1987.

AUTHOR

Everett M. Rogers, Ph.D.

Professor and Chair

Department of Communication and Journalism

University of New Mexico

Albuquerque, NM 87131-1171

105
Interorganizational Planning and

Coordination as Technology

Transfer: Lessons From

a Case Study

Howell S. Baum

INTRODUCTION

In the human services, the technology is what a practitioner does. It is

how a practitioner interacts with a client or a coworker. However, the

term “technology” should not be misunderstood to connote routine or

mechanical procedures. A practitioner’s execution of a technology

depends not only on the collaborative actions of the client or coworker,

but also on the practitioner’s skills and personality as well as the

practitioner’s organizational setting.

Technology transfer is an effort by one practitioner to change another’s

performance. Technology transfer is an interaction and is itself a

technology. At its best, technology transfer is voluntary, not coercive,

and the practitioner adopting a new technology may be said to learn it.

But what is it that is learned? It may be a routine or way of organizing

actions. It may be a skill or repertoire of skills. It also may be a new way

of acting-more than a routine or skill, less than a personality transformation; a conceptualization of relations with a client, an approach to

communicating with a client, or assumptions about the allocation of

responsibility and authority vis-a-vis a client.

Successful technology transfer depends on the relationship between a

practitioner who wants to change another’s actions and the other. The

former must provide meaningful instructions about how to act differently.

Equally important, he or she must model rhe new actions-and in a way

that seems attractive enough to imitate. Whether the latter adopts the

proposed actions depends, first, on whether they are decipherable and

compelling. Beyond that, the latter practitioner must have the abilities to

enact them. Still further, the organizational or broader social setting must

provide incentives to act differently. The proposed new technology will

alter relations with clients. It will probably change relations with

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coworkers, among others, and the practitioner must have the discretion to

give up old relations and establish new ones.

This chapter describes an effort by a mayor’s office to introduce a new

technology into city agencies. The technology, interagency coordination

and planning, was simultaneously a new way to think about and address

urban problems and a new configuration of organizational relations. This

example illustrates how all technological changes affect practitioner

relationships. The case shows how any technology transfer must provide

organizational supports for new individual practice.

HUMAN SERVICES COORDINATING COUNCILS

A mayor was concerned about growing problems of poverty and social

disorganization among city residents. Anticipating no significant growth

in the city budget, the mayor considered reorganizing the planning and

delivery of services to focus limited fiscal and human resources on the

neediest populations. The human resources director proposed human

services coordinating councils. The city was divided into 33 neighborhoods, and councils were established to plan and implement service

programs that would especially fit each neighborhood’s needs. City

human services agencies were directed to send representatives to each of

the 33 councils.

Agencies involved included such conventional departments as social

services, the public schools, health, juvenile services, planning, the

police, housing and community development, manpower, and the library.

In addition, individual councils included other public or voluntary service

providers and neighborhood residents.

The councils represented two significant changes in human services

planning and delivery. First, agencies would decentralize activities to

focus on neighborhoods, with the expectation of providing different

services to different populations. Second, agencies would coordinate

actions with other agencies.

About 1 year after initiating this program, the human resources director

called this author to consult. Several problems were reported. Fundamentally, the councils were not accomplishing much. Many met

irregularly, many had considerable member turnover, and few people

107
seemed to take them very seriously. The director wanted to know what

could be done to make the councils work.

The Organizational Setting for Innovation

The councils program can be seen as an effort at technology transfer,

where the human resources director wanted service agency staff to think

and act differently in planning and implementing programs. The director

was asking what had gone wrong. This author interviewed council

members and attended council meetings.

Some of the difficulties were straightforward and should not surprise

anyone. One difficulty, quite simply, was that the human resources

director had never developed or promulgated a clear idea of how the

councils-the new technology-would work. Although the director had

named 33 chairpersons and directed that agencies send representatives to

act in decentralized and coordinated ways. many details had not been

spelled out. The director did not delineate, for example, how programs

emanating from the councils would relate to agencies’ normal work.

Were the councils meant to be the lever for comprehensive reform of city

agencies, or were they simply supposed to supplement the regular

programs with a few targeted to neighborhoods? Were all councils

expected to do the same things, or could they choose directions fitting

their neighborhoods? Should the councils develop comprehensive

neighborhood social pians, or should they concentrate on discrete

projects? Should the councils devote their energies to long-term

planning, or were they supposed to be a new channel for patronage from

the mayor’s office to neighborhoods? Simply, what success of the

councils program would mean was not clear. Moreover, these questions

led quickly to other discoveries: The program clearly was not working,

and participants were trying to keep it from working.

Nearly every council member readily described the human resources

director as autocratic. In this respect, the director was a perfect match for

the mayor, and they had risen in city politics together. Both ordered

people to do things and expected them to produce immediate, visible

results. The director had issued an edict for councils and awaited the

returns. At the least, vague directions were unlikely to guide basic

innovation, but the director’s use of authority had a negative effect as

well.

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Authority and Responsibility-Unequal and Ambiguous

The human resources director was an advisor to the mayor. The mayor

had asked the director to coordinate human services activities in the city,

but the director had no formal authority over any agency. Indeed, some

city agency staffs were State employees, and many agencies received

funds from the State or Federal governments. The director had no direct

control over private, nonprofit agencies. Lacking organizational

authority over agencies, the director tried to get collaboration by mixing

appeals to service missions and the needs of city residents, judicious

allocation of political rewards, and liberal use of intimidation. Thus

authority with respect to agency directors was ambiguous, subject to

ongoing negotiation.

The councils program was the incarnation of ambiguity about authority

and responsibility. Although the human resources director asked agency

heads to send representatives to councils, the councils were accountable

to the director. Many agency directors saw the councils as either a drain

on mandated or important activities or, more simply, a waste of time. As

a result, they often sent low-level staff to serve on the councils. Sometimes the first person asked passed the assignment to someone still more

subordinate. Because there were 33 councils, some people became

members of as many as a half-dozen councils, most meeting biweekly.

Members of a typical council might include public agency staff of widely

varying rank, representatives of voluntary agencies, and a few neighborhood residents. While some council members had considerable authority

within their organizations, few came authorized to act on behalf of their

agency within the council, and what authority members of a council

collectively could exercise was unclear. If anything, they seemed to have

little authority vis-a-vis either their home agencies or the mayor’s office.

Council members’ responsibilities also were ambiguous: What

‘elaboration of the councils program’ meant was not clear. How those

responsibilities were related to primary work assignments was not clear

either. For example, performance evaluations in home agencies included

nothing related to the councils.

Finally, in this murky context, responsibility and authority seemed mismatched. For example, social services caseworkers or police community

relations officers were asked to coordinate their home agency’s actions

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with other agencies in deciding which services should be delivered to a

neighborhood.

Autonomous Authority

This situation might have been laughable, except that the human

resources director kept issuing demands for results and threats about the

consequences of failure. Few council members could describe the threats

any more specifically than the demands for results, but the director

seemed definitely dangerous. Implicitly, jobs could be on the line.

The vagueness of demands and threats in part reflected the reality that the

director’s goals were undefined and people could not be compelled to do

very much. But the vagueness also reflected the distance between the

director and the approximately 200 persons involved in the councils. The

director was responsible for a number of human services projects, in

addition to serving the mayor as a political lieutenant. The councils

program was important, but so were other programs, especially those that

were producing results.

Since the director did not have time to oversee the operations of the

councils program, a program director and a coordinator were appointed to

work with the councils from day to day. While these two represented the

director with council members, they had uncertain authority (not to

mention that both were borrowed for the mayor’s office from the staffs

and budgets of human services agencies). They ambiguously mixed

evocations of the director’s authority with acknowledgments they could

not exercise much of his authority.

Thus, as far as council members could see, the human resources director

remained their boss, but was rarely seen. If they had been so inclined,

they would have had difficulty getting to talk with the director about

expectations. Indeed, while ordering them about, the director did not

seem to need them. Reasonably trying to ascertain how the director

would judge them, they filled in a picture on the basis of inferences,

guesses, and hunches. The clear image that most discovered was

definitely threatening.

The Predicament

The councils program was a proposed technology transfer. If council

members wanted to adopt the new technology-that is, if they wanted to

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move toward collaborating with staff from other organizations to plan

programs for neighborhoods-they needed clearer bounds for action.

Thus they should try to clarify responsibility and authority and to match

them with each other. Such a step would require them to talk and

negotiate with one another, the human resources director, and agency

directors.

They did not do so for several reasons. One reason simply was that few

council members found the program rewarding. To the contrary, the

work was invisible, taking time from what they wanted or were expected

to do in their employing organizations. For this reason alone, many

avoided council meetings or devoted time to forestalling decisions that

would require them to give more time.

Beyond this reason, however, the relationship between the human

resources director and council members seemed to make any movement

toward implementing the program dangerous. On the one hand, responsibility and authority were ambiguous and unequal. However, the director

seemed unchallengeably powerful and punitive. Hence council members’

authority always looked likely to be less than their responsibility. If

anything, authority seemed to grow ambiguously small at the same time

that responsibility loomed ambiguously large. If the director were likely

to punish for failure to meet responsibilities, any responsibility was

dangerous. And yet council members lacked the authority to limit their

responsibility. The alternative, many concluded, was to avoid as much

responsibility as possible. When they could not do so directly, they tried

instead to make their ambiguous responsibility yet more obscure. Two,

they suggested, could play at this game (Baum 1991).

Sure enough, the result was that, as the director complained, the program

did not work.

The Councils Program as Technology Transfer

The human resources director did not succeed in transferring a

technology of interorganizational coordination and planning to human

services agency staff. Many of the reasons are transparent in this

example:

1. The director did not have a clear idea of the technology to transfer.

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2. The director did not have a clear idea of to whom to transfer the

technology.

3. The director did not provide organizational incentives to those asked

to adopt (or invent) a new technology. For example, the director

neglected to give them free time. link work on the new technology to

organizational performance evaluations. and negotiate with

department heads to change organizational structures and relations in

ways consistent with implementing the new technology.

Yet ambiguities and inequalities of responsibility and authority—

combined with the director’s distant, autonomous authority—also created

psychological disincentives for council members to proceed toward

clarifying or improving the situation. Consideration of the influence of

an organization’s psychological structure on members’ action is useful.

The section below describes organizational psychological structure.

ORGANIZATIONAL PSYCHOLOGICAL STRUCTURE

Organizational psychological structure consists of patterns of typical

emotional responses to the social structure of organizations (Baum 1987).

Diamond (1993, p. 77) uses the term “organizational identity” to refer to

manifestations of the psychological structure in “repetitive patterns of

individual behavior and interpersonal relationships that, when taken

together, comprise the unacknowledged meaning of organizational life.”

Students of organizational behavior commonly refer to this phenomenon

in terms of organizational culture (e.g., Deal and Kennedy 1982; Frost et

al. 1985; Peters and Waterman 1982: Schein 1992; Smircich 1983).

Studies of organizational culture argue for two important considerations.

First, human beings act on the basis of the meanings they find in social

phenomena. Second, through formal managerial communications,

structural relationships, the evaluation of work, and the like,

organizations convey meanings that influence how workers act.

With few exceptions, however, studies of organizational culture

oversimplify the relations between organizational meanings and

organizational members in three ways. (For exceptions, see Baum 1993;

Diamond 1991; Hirschhom and Bamett 1993; Kunda 1992; Schneider

and Dunbar 1992; Schwartz 1985). First, they assume organizations have

single, coherent cultures. Second, they assume members passively

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internalize and react to organizational cultures. Third and crucially, they

assume all organizational meanings that matter to members concern more

or less conscious and rational needs and are more or less consciously

understood.

In contrast, a psychodynamic view of the meanings of organizational

structures proceeds from different assumptions. (In addition to the

exceptions noted above, see Baum 1987; Hirschhom 1988; Kets de Vries

and Miller 1984; Levinson 1972; Schwartz 1990). First, organizational

participants, as all human beings, experience unconscious as well as

conscious aims and needs, think about these aims and needs both

consciously and unconsciously, and act both consciously and unconsciously to achieve their aims and satisfy their needs. Second, persons in

organizations attribute and contribute meanings to organizational

experiences, although the salience of particular organizational features

and similarities in personality characteristics can lead to finding widely

shared meanings in aspects of organizations. Third, conflicting systems

of social incentives in organizational arrangements as well as internal

psychological conflicts in members can lead to the coexistence of

conflicting schemes of organizational meanings or cultures.

In the psychodynamic view, transference is a principal means by which

individuals endow organizations with meaning. Transference is an

unconscious process of equating contemporaries with persons in one’s

past (Freud 1977 [originally published 1917]; Orr 1954; Racker 1968).

In encountering others, people try to learn about them, to understand how

they will act and react. Realistic inquiries may help, but they may not

provide crucial information, and some people may lack the time or

interest to do such research. They then may fill in missing details by

analogy from past experiences. Sometimes these comparisons are

realistic. At other times, particularly when someone seems important but

unique, people unconsciously equate them with persons in their past who

are only superficially similar. Strong emotional meanings of childhood

relations with parents and siblings especially encourage adults to

unconsciously act toward contemporary others as if they were these

family members.

For example, workers may unconsciously associate a boss with an early

authority figure in childhood, a parent, by thinking of the boss as the

child may have thought of the parent: as omnipotent, omniscient, and

omnicompetent. Similarly, they may equate coworkers with siblings

(e.g., Baum 1987; Diamond 1993; Hodgson et al. 1965; Kets de Vries

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and Miller 1984). While such analogizing may distort contemporary

reality, people think this way because doing so offers benefits of

apparently certain knowledge about someone who is important in

everyday life, in addition to unconscious pleasure in being close to those

from earlier in life with whom the contemporary is identified.

The Councils Program as a Case in Conflicting Structures and

Meanings

The human resources director’s failure to spell out what the councils

program should do or look like crippled the program, as did failure to

negotiate appropriate mixtures of authority and responsibility for council

members. However, members did not try to work out the implementation

of a program, the goals of which many endorsed. Instead, they fled from

involvement, labored to forestall any action, or did their best to obscure

their responsibilities, role, and existence.

These actions were conscious and unconscious reactions to the social

structure of the program. Overtly the director ordered participants to

implement a councils program. The formal structure of the program was

ambiguous and did not provide the organizational resources needed to put

the program in place. At the same time, the director’s actions—

imperious, menacing, and distant-seemed to arouse images and

memories of childhood encounters with a seemingly omnipotent, punitive

parent. Such unconscious associations affected council members’

actions. Since the director demanded success, they assumed the director

knew what success looked like. Their shortcomings, not the director’s

instructions or the program structure, confused them. Threatening

unpredictably to punish them for failures only clipped their sense of

competence further.

Strikingly, many council members described the director as a huge person

despite relatively short stature. Over time, they spent increasing effort

pondering the director’s motives and less designing or implementing the

program. Within a steeply hierarchical organizational setting, the

director’s actions encouraged council members to feel anxious about

being shamed for failure and personal inadequacy (Baum 1987).

People’s first experience of shame anxiety comes early in life when the

child can do little and is dependent on the approval of apparently

omnicompetent parents for a self-esteem that feels like the essence of life

itself (Chasseguet-Smirgel 1985). To defend against shame anxiety, a

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child may try to avoid being judged or even observed. When an adult

experiences shame anxiety, he or she unconsciously feels drawn back into

early childhood and may conclude that an adult contemporary, such as

the director, is in fact treating him or her like a child. This insult, added

to the anxiety of shame, contributes to rage about being so devalued

(Kohut 1972). If, as in this case, adults feel acting angrily toward the one

who humiliates them is dangerous, they will avoid relations if they can or

may become depressed if they cannot. Neither reaction encourages

program implementation or technology transfer.

Recommendations for Improving Implementation and

Technology Transfer

As consultant, this author recommended actions both to rationalize

authority and responsibility in relation to program aims and reduce

unconscious dynamics that discouraged council members from acting.

This author framed the approach as building council members’

psychological ownership of the program. The following were the main

objectives and recommendations:

1. Clarify the purposes and expectations of the councils, including

consulting with councils about these matters and encouraging

different councils to serve different purposes.

2. Give councils authority consistent with their responsibilities,

including negotiating with agencies to delegate council

representatives sufficient authority to accomplish council purposes

and designating council chairpersons as an executive committee

empowered to make policy for the program.

3. Offer training and organizational development assistance to councils,

including developing a program guidebook, arranging ongoing

consultation and periodic workshops, and training council

chairpersons.

4. Establish incentives to encourage individual participation in councils,

including providing public recognition and making council work part

of regular performance evaluations.

These recommendations directly addressed the purposes and

organizational structure of the program. Indirectly, they aimed to change

the psychological structure to encourage the work that formal structural

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changes could allow in three ways: by involving the director more

closely in councils’ work, by making the director more visible and

accountable to them, and by letting council members see that the director

needed them as much as they needed the director (see also Diamond

1993; Hirschhorn 1988; Kets de Vries and Miller 1984).

The fate of these recommendations told still more about the difficulty of

change. During a discussion of the recommendations just after the

director endorsed the concept of psychological ownership, an assistant

interrupted and described problems with another program. The director

immediately answered that the assistant should simply order people to

work harder. By personality and role, the director seemed unlikely to

change this approach to the councils. At any rate, 2 weeks later, the

director resigned for a job in another city. Although this author and the

director never discussed the reasons, the director seemed to feel stuck in

an organizational situation where initiative was difficult. Regardless of

inclinations, the director could not make the changes necessary for

decentralized, coordinated planning.

CONCLUSIONS

This case shows that seeing technology transfer simply as knowledge

utilization would be a mistake. Framing the process in that way puts the

focus on abstract knowledge and devalues a professional’s practice in a

specific context. It implies a would-be change agent can know what

targeted practitioners ought to do without consulting with them.

Focusing on the latter’s readiness for change suggests they could use the

new knowledge if only they were sufficiently open minded, when reality

is more complex. The case shows that the knowledge that affects a

practitioner’s decision to change is both conscious and unconscious,

involves assumptions about the would-be change agent, and includes an

assessment of organizational incentives for and against change.

A risk in thinking of technology transfer as simply knowledge utilization

is that the would-be change agent comes to think of him- or herself as

acting on, even against, those he or she means to change rather than

collaborating with them-not just to understand how to utilize certain

knowledge but to define the problem. if any, in the first place. That is, in

fact, what occurred in this case. In other words, an intervenor must give

as much attention to the transference process (pun intended) as to the

technology if he or she wants to encourage practitioners to act differently.

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This case describes a proposed technology transfer that failed. Some

errors are so obvious that readers may be tempted to conclude they would

never commit them. And yet these are normal ways innovations often are

introduced into hierarchical settings. Few would dispute this process is

typical bureaucracy. Moreover, the director’s approach resembled

common ways professionals and managers think about human

relationships and problems. Practitioners often assume they must identify

and solve problems unilaterally rather than admit uncertainty and join

with others in learning and planning (Argyris 1982; Argyris and Schön

1974, 1978). This attitude, in turn, reflects a combination of common

organizational norms, conventional professional socialization, and

personality characteristics that lead to choosing and are reinforced by this

socialization and these norms.

The case illustrates both consciously and unconsciously meaningful

aspects of organizational structures that can support or inhibit technology

transfer. The recommendations point to conditions necessary for

successful transfer. At the same time, the outcome of the case encourages

sophistication, humility, and a collaborative sense of experimentation in

working with practitioners to enable them to act differently.

REFERENCES

Argyris, C. Reasoning, Learning, and Action. San Francisco: JosseyBass, 1982.

Argyris, C., and Schön, D.A. Theory in Practice. San Francisco: JosseyBass, 1974.

Argyris, C., and Schön, D.A. Organizational Learning. Reading, PA:

Addison-Wesley, 1978.

Baum, H.S. The Invisible Bureaucracy. New York: Oxford, 1987.

Baum, H.S. How bureaucracy discourages responsibility. In:

Kets de Vries, M.F.R., ed. Organizations on the Couch. San

Francisco: Jossey-Bass, 1991.

Baum, H.S. Organizational politics against organizational culture.

In: Hirschhom, L., and Bamett, C.K., eds. The Psychodynamics of

Organizations. Philadelphia: Temple, 1993.

Chasseguet-Smirgel, J. The Ego Ideal. Barrows, P., transl. New York:

Norton, 1985.

Deal, T.E., and Kennedy, A.A. Corporate Cultures. Reading, PA:

Addison-Wesley, 1982.

Diamond, M.A. Dimensions of organizational culture and beyond.

Political Psychol 12(3):509-522, 1991.

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Diamond, M.A. The Unconscious Life of Organizations. Westport, CT:

Quorum, 1993.

Freud, S. Introductory Lectures on Psychoanalysis. Strachey, J.. transl.

and ed. New York: Norton, 1977.

Frost, P.J.; Moore, L.F.; Louis, M.R.; Lundberg, C.C.; and Martin, J.

Organizational Culture. Newbury Park, CA: Sage, 1985.

Hirschhom, L. The Workplace Within. Cambridge, MA: MIT, 1988.

Hirschhom, L., and Bamett, C.K., eds. The Psychodynamics of

Organizations. Philadelphia: Temple, 1993.

Hodgson, R.C.; Levinson, D.J.; and Zaleznik, A. The Executive Role

Constellation. Boston: Harvard University, The Graduate School of

Business Administration, 1965.

Kets de Vries, M.F.R., and Miller, D. The Neurotic Organization. San

Francisco: Jossey-Bass, 1984.

Kohut, H. Thoughts on narcissism and narcissistic rage. Psychoanal Stud

Child 27(3):360-400, 1972.

Kunda, G. Engineering Culture. Philadelphia: Temple, 1992.

Levinson, H. Organizational Diagnosis. Cambridge: Harvard, 1972.

Orr, D.W. Transference and countertransference: A historical survey.

J Am Psychoanal Assoc 11(4):621-670, 1954.

Peters, T.J., and Waterman. R.H., Jr. In Search of Excellence. New York:

Warner. 1982.

Racker, H. Transference and Counter transference. New York:

International Universities Press, 1968.

Schein, E.H. Organizational Culture and Leadership. 2d ed. San

Francisco: Jossey-Bass, 1992.

Schneider, S.C., and Dunbar, R.L.M. A psychoanalytic reading of hostile

takeover events. Acad Manag Rev 17(3):537-567, 1992.

Schwartz, H.S. The usefulness of myth and the myth of usefulness.

J Manag 11(1):31-42, 1985.

Schwartz, H.S. Narcissistic Process and Corporate Decay. New York:

New York University, 1990.

Smircich, L. Concepts of culture and organizational analysis. Admin Sci

Q 28(2):339-358, 1983.

AUTHOR

Howell S. Baum, Ph.D.

Professor of Planning

Urban Studies and Planning Program

University of Maryland

11 17 Lefrak Hall

College Park, MD 20742

118
Organizational Change As Human

Process, Not Technique

Michael A. Diamond

INTRODUCTION

Having practiced and written on organizational development and change

for a number of years, this author has had many opportunities to observe

technology transfer both in public and private organizations. The

overarching problem is that efforts to introduce computer systems and

advanced telecommunications often fail because technical experts and

managers ignore the underlying psychological dynamics of organizational

change and innovation (Baum 1987; Diamond 1993; Hirschhom 1988;

Shapiro and Carr 1991).

Take this example: One State agency undergoing enormous expansion in

public works projects looked to the State’s data processing people to

design a better computer system to assist project managers (PMs). The

agency director and deputies met with the State’s data processing people

several times to convey their technological needs and requirements. The

data processing agency for State government then went to work on

developing a computerized project management program for the public

works agency.

Here is what happened: The system was designed and installed 6 months

later. After another 6 months, the PMs were not using the new system.

In fact, the system was incomprehensible to them-only the data

processing experts understood how to access it. Not only had little

training of the PMs taken place, but the data processing experts never

consulted the PMs on the actual design and implementation of the

computer management system. Although trained to use the new system,

the PMs found it to be cumbersome, excessively time consuming, and of

little value to them. In fact, it seemed to have value only to the

accounting office as a tool for budgetary review and evaluation on

projects and as a tool for upper management in assessing progress on

construction sites. The PMs had very little incentive or motivation to use

the new system, because it did not help them manage projects. On the

contrary, they viewed it as additional work because it required more time

for them to update the computer on construction progress and budgetary

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matters. Because they viewed it as an effort by upper management to

establish greater controls over their work, the PMs came to view the

technology with either disdain or cynicism that often took the form of

humor. PMs were known to joke about the time they spent playing

various computer games on their terminals.

What went wrong here? This case exemplifies a common problem in

technology transfer: the denial of change and innovation as a human

process and the consequential resistance to change and learning, which

often is combined with workers’ anger and resentment at the experts and

the technical manner in which the innovation is introduced.

In what follows, four major points will be made. First, technology

transfer often is based on the notion of technician as expert authority.

The result is a control-oriented, information-dominated, top-down,

hierarchic, and defensive approach to innovation, which limits learning

and responsiveness to clients and customers (users) of technology.

Second, technology transfer ignores the psychological fact of resistance

to change based on a central and unavoidable human conflict between

cognitive learning and emotional (interpersonal) security. Third,

technology transfer similarly denies the organizational psychodynamics

of change, which acknowledges that change at work implies emotional

and cognitive loss among organizational participants. This experience of

loss suggests that change efforts must include some process for workers

to develop ownership and endorse the rationale behind the technology

transfer and some opportunity to separate emotionally and cognitively

from the old way in order to assume the new way of doing things.

Fourth, technology transfer seems to ignore the degree to which the

organization’s culture is receptive or resistant to change-the need for a

“transitional space” to facilitate the innovation. In other words, the

degree to which the organization is defensive and bureaucratic rather than

resilient and capable of systemic learning needs to be taken into

consideration as a critical factor in measuring the potential for successful

technology transfer. Finally, the transitional space (frequently called the

holding environment) is the necessary psychological and organizational

context for empathic acknowledgment of the human process of change.

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THE PROBLEM OF EXPERT AUTHORITY IN TECHNOLOGY

TRANSFER

In the case of the public works agency and State data processing

described above-the experts were in data processing and the nonexperts

were the PMs and their executive team-the work groups had polarized.

The executives asked data processing for a more sophisticated tool for

project management. Without consulting PMs, data processing acted as if

they knew what that system and program would look like. Their design

was simply the product of the executive request and their technical,

rational notion of what the agency needed for more efficient and effective

project management.

This process of introducing new technology into the workplace was not a

collaborative, participative endeavor. Rather, it was a hierarchic, unilateral process in which information was shared but little communication

occurred between the users of technology and the designers. Furthermore, little reflective and systemic thinking and innovation took place.

The executives (customers) contracted the services of data processing,

and data processing reinforced the image of expertise by developing a

highly sophisticated computer system for project management that had

questionable relevance for the PMs’ actual work. In other words, the

experts acted as if they knew what the PMs needed without talking

directly to them, and, as experts, the data processing people were in

charge. Authority and technical expertise are most often synonymous in

instances of technology transfer. Thus, in this example, the task of

developing technology for the public works agency was delegated to data

processing, and they, in turn, told the PMs what information was needed

to design the program.

Criticizing the limits of technical rationality, Schon (1983, p. 40) suggests

the need to pay more attention to the human process of “problem setting”

in addition to the technique of problemsolving. Schon writes:

They [professionals] are coming to recognize

that although problem setting is a necessary

condition for technical problem solving, it

is not itself a technical problem. When we

set the problem, we select what we will treat

as the “things” of the situation, we set the

boundaries of our attention to it, and we

impose upon it a coherence which allows us to

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say what is wrong and in what directions the

situation needs to be changed. Problem setting

is a process in which, interactively, we name the

things to which we will attend and frame the context

in which we will attend to them.

Technical problemsolving differs fundamentally from problem

setting-the latter, as Schon (1983) suggests, is an interactive and

reflective process that questions the status quo of governing norms and

values that name and frame what one looks at. In the example cited

above, the data processing group may have engaged in problemsolving

but clearly not problem setting. Consequently. their nonparticipative,

technical approach shut out the potential for learning about the

uniqueness of the problem and thus limited their effectiveness.

Technical rationality comprises an ideology of expert-as-authority, and

this belief system is governed by the scientific norms of positivism and

empiricism. As a framework for rigorous research and problemsolving, it

is nonreflective and nondialectic and ignores the psychological side of

innovation and technology transfer. Thus, it does not acknowledge the

possibility that technical processes for problem solving, which exclude

participative feedback and reflective thinking, can themselves be

defensive in nature-a social defense against the anxiety over loss of

control and (the assumed position of) authority. (The notion of

technology transfer as a social defense is discussed later in the chapter.)

This chapter now looks at the individual response to organizational

change as it relates to technology transfer.

PSYCHOLOGICAL RESISTANCE TO ORGANIZATIONAL

LEARNING AND CHANGE

Technology transfer, like many different kinds of organizational

innovations, often runs into employee resistance. One reason many

technology transfers are unsuccessful is that they tend to ignore the

inevitability of psychological resistance to change in the status quo.

Asking people to approach their work differently requires cognitive shifts

in the naming and framing of problems (as noted in the previous section)

and places emotional demands on their feelings of self-competence and

self-confidence—their self-esteem at work.

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As noted in the example above, the introduction of many new

technologies into the workplace usually is handled by technicians or

computer experts. Typically, these experts are not only insensitive to the

human component of change but assume that rational people should

comprehend readily the efficiencies and virtues of adopting the latest

technology. This author’s experience with large-scale technology

transfers and organizational change efforts contradicts these assumptions,

particularly at the emotional level of experience. Attempts to innovate

and adopt new technology ought to combine the instruction of technical

knowledge with the facilitation of organizational change as a fundamentally psychosocial process. This combined approach to technology

transfer operates on the assumptions that the human personality is

conflicted about learning and interpersonal security and that change

works to stimulate the anxiety associated with the inherent conflict.

What is meant by this statement? The fact that individuals desire to learn

and be competent on the one hand and wish to feel secure psychologically and anxiety-free on the other hand is a universal but often ignored

human dilemma for workers. This predicament is triggered by the

imposition of organizational change and workplace innovations. In other

words, the dilemma is there all along in a latent form-it needs only the

anxiety of uncertainty associated with change to activate it.

In 1986 this author stated:

The problem of psychological resistance to change is

well known to psychologists. Both the psychoanalytic

psychologist’s conception of unconscious defensive

techniques as modes of adaptation and the cognitive

psychologist’s notion of limited learning and of

contradictions in what people say and what they in fact

do illustrate compulsive, repetitive, security-oriented,

error-inducing, and self-sealing human behavior. These

defensive and adaptive tendencies usually protect the

status quo and, therefore, block learning (Diamond 1986,

p. 543).

The successful adoption of innovations and technology transfer depends

upon the individual’s openness to learning and change, and that openness

requires minimal defensiveness and adequate self-competence.

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Stress is a factor here. If individuals experience the change as stressful

due to uncertainty, lack of information, and insufficient participation,

they will feel disrespected, angry, and resistant to learning. Moreover,

the degree to which these stressful circumstances trigger neurotic anxiety

will negatively affect their self-esteem at work.

Technology transfer and innovations often leave workers feeling

powerless-more so than before the change—specifical because the

technology transfer has been imposed on them. Frequently they are not

involved in change efforts such as technology transfer that directly affect

their jobs. Thus, one way to minimize the defensive reactions to

technology transfer is to make certain that personnel participate in the

designing (framing and naming) of the new systems. Workers must be

part of the selection of new technologies and the reasoning behind their

acquisition and implementation.

This chapter now focuses on the psychological fact that individuals

experience change as loss. One may consider the value in designing a

transitional space (or holding environment) at work in which

organizational members can work through their feelings and thoughts

about the change and assume responsibility for it.

CHANGE AS EMOTIONAL AND COGNITIVE LOSS

Technology transfer often represents a fundamental change at work and,

thus, a transformation in the way people experience and interact with

their tasks and the organization’s mission. Successful adoption of

technological innovations requires the internal commitment of workers,

who need to endorse the rationale behind the innovation.

The human process for adoption of new technology ought to provide

organizational members with an opportunity to examine where they are,

where they have been, and where they are going-an emotional and

cognitive map of the organization. This process of mapping requires

facilitation of workers’ thoughts and feelings about the change. An

outside organizational consultant may be helpful in providing participants

with a safe, nonpunitive environment-a transitional space-in which

they can explore the implications of change.

At a deeper emotional level, workers will need to acknowledge what they

are losing and, subsequently. what they will gain. This process often

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involves some degree of grieving over the way things were, then letting

go of the old way and trying on the new way of working on tasks. In

addition, the opportunity to deal both emotionally and cognitively with

this technological innovation often promotes reflective learning (problem

setting and problemsolving) and internal commitment to the change.

Workers are able to acknowledge the problems with the old system and

consider the degree to which the transfer of technology will help to solve

these often annoying problems. The extent to which organizational

members engage in this sort of learning will positively influence their

willingness to commit to the innovation and use of new technology.

Moreover, the provision of a transitional space can offer workers an

opportunity to confront their fears and anxieties related to organizational

change. A psychodynamic approach to organizational change takes

seriously the disruption of everyday work routines, rituals, processes, and

procedures. People attach themselves emotionally to the predictability of

organizational structures and procedures, and that attachment is severed

with the introduction of change at work. This separation produces

anxiety drawn from the stress of uncertainty and the phases of emotional

loss.

Finally, and most critically, this author challenges the assumption that

technological change is always an appropriate solution to organizational

problems. More often the case, technological change is a defense against

organizational problems. Indeed, the phases of grief and mourning can

be viewed as a metaphor for organizational change.

Grief, according to the experts, comprises four phases:

1. Numbing-a sense of shock and outrage.

2. Yearning-a search for what is lost, anger and disbelief that it has

occurred.

3. Disorganization and despair-a discarding of old patterns of

thinking, feeling, and acting; a redefinition of oneself.

4. Reorganization-a reshaping of one’s internal world and a reframing

of social reality (Bowlby 1982).

In organizations, the numbing phase may be a near paralysis of

operations and a general state of confusion. The yearning phase follows

in which members act as if the change has not occurred. Suppression and

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denial are common defensive reactions, as is a nostalgic orientation to the

past. These defenses conceal the underlying anger and outrage among

workers.

Once participants are able to confront their anger and outrage over the

loss of old routines and procedures, they experience the phase of

disorganization and despair. Here they not only start letting go of old

thinking, feeling, and acting in order to incorporate the new, but they also

feel the despair of helplessness and lack of control. And, although their

participation and collaboration in planning can aid the process, they must

face the reality of a constantly changing environment over which they

have little or no control. This knowledge is depressing and precedes

reparation and organizational renewal.

During the reorganization phase, there is a willingness to experiment with

new ideas and feelings-problemsolving, error detection, and correction

now are possible. Organizational reality testing leads to an open system

capable of what Argyris and Schon (1978) call single- and double-loop

learning. That means organization members are capable of making

changes, even when these include reexamining beliefs, norms, rules, and

practicing values. They respond to shifts in their environment by

reflecting on and making public their underlying operational assumptions

and the associated behavioral consequences. Moreover, they can do so,

in part, as an effect of acknowledging their psychological resistances to

change and loss (Diamond 1992).

This chapter now looks at the role of organizational culture in technology

transfer and innovation. When is it resistant to change, and when is it

responsive to change?

ORGANIZATIONAL CULTURE: DEFENSIVE OR RESILIENT

Bureaucratic organizational cultures are unintentionally constructed on

the model of psychological defenses-what might be called externalized

ego defenses. These particular organizational cultures originate and then

are perpetuated by ritualistic defenses that limit the processing of anxietyproducing information and thereby minimize the potential for learning

and change. In these defensive organizations, information and feedback

that oppose the status quo of norms, policies and procedures, or data that

contradict planned schedules and routines, are typically censored. The

organizational story of the public works agency and the State’s data

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processing division exemplifies the tangibility of externalized and

ritualistic organizational defenses that not only obstruct technology

transfer and innovation but also promote selective inattention to deeper

structural and psychodynamic problems at work among organizational

participants.

Ritualistic organizational defenses act as blinders to reality-defensive

screens that conceal problems, deny conflicts, and resist change. Human

energy (cognitions and emotions) that might otherwise be channeled into

the correction of errors and actual problemsolving often is displaced by

the influence of anxiety onto substitute objects, promoting the illusion of

safety and security without substantive reflection and change. Under the

stress of uncertainty and anxiety, form [procedures, regulations,

impersonal rules, red tape, etc.) takes precedence over organizational

mission and substantive output (problemsolving, provision of services,

personal responsibility, and the quality of product). Managerial control

and accountability take priority over organizational learning,

collaboration, and problemsolving.

Technological transfer and workplace innovations produce excessive

levels of worker stress. Thus, a process of intervention that assists

participants in acknowledging and working through their social defenses

is crucial because resistance to change is psychological at its roots.

Technical approaches to innovation tend to ignore the psychological

anchors of attachment to prevailing ways of working and to bureaucratic

organizational cultures.

What then does one need to know about the relationship between the self

and the organization to safeguard his- or herself against excessive reliance

on the ritualistic defense? Organization theorists often depict organizational action as ritualistic. A psychodynamic perspective enables one to

see the contradictory relationship between the individual and the

organization. Bureaucratic organizations reinforce defensive human

needs for psychological security and self-esteem. In bureaucracy, this

desire is signified by ritualistic behavior intent on maintaining the status

quo, avoiding anxiety-provoking conflict, and denying realities of

shifting political pressures, technological innovations, and market

demands. Exaggerated ego defenses and ritualistic actions perpetuate the

organizational culture by encouraging resistance to insight and change.

This defensive organization censors anxiety-producing information

antithetical to the status quo. Technology transfer represents a challenge

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to organizational equilibrium. More important, however, is the fact that

technology transfer often is itself a manifestation of these defenses and

frequently is mistaken for a solution to cultural, systemic, and interpersonal problems at work. In these instances, technology transfer is a

camouflage for more deeply rooted organizational pathologies.

Organizations are constructs of the mind; they acquire a reality of their

own through the individual’s reliance on their structures for protection

and security against anxiety. In extreme situations, modem organizations

consume individual initiative and will. As the above case example

demonstrates, proponents of technology transfer will find it helpful to

consider the subjective experiences and reflective knowledge (rooted in

the actual practice) of organizational members prior to purchasing,

designing, and installing the new technology.

This chapter now examines the concept of organizational resilience as a

culture and leadership style more receptive to learning and change.

ORGANIZATIONAL RESILIENCE

Organizational resilience stands for a minimally defensive social system

of collaboration and participation that is capable of responding to change.

In fact, based on this author’s observations as an organizational

consultant to change, organizational resilience is the result of exploring

resistances and grieving the loss caused by change. It is the result of

what Klein calls reparation, a term stemming from Kleinian object

relations theory, which emphasizes the human desire for connectedness

and integration signified by the human effort to make whole that which is

broken (Klein and Riviere 1964).

Organizational resilience is characterized by leader-follower relations that

are minimally defensive and nonauthoritarian. In this sort of organizational culture, in contrast to the aforementioned case, leaders share

information and decisionmaking with staff, and staff are in turn willing to

give and receive critical feedback and take responsibility for their actions.

Both supervisors and subordinates feel affiliated with the same system

and are committed to a common mission. Many organizations lacking

resilience are characterized by insecure and compulsive human relations

in which individual members have only a partial comprehension of the

total system and its public. Consequently. they are alienated and

disconnected from the greater whole of the system, and their efforts are

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viewed with little significance. In the case study, this set of assumptions

operating in the defensive organizational culture discouraged upper

management and data processing from consulting PMs in the design and

implementation of a new computer system.

In practice, organizational resilience requires trust and mutual respect

among organizational members, which stand or fall on their collective

esteem. Organizationally resilient leaders and followers relate primarily

on the basis of consciously shared meaning and purpose rather than on

unconscious emotional needs. While they care about one another as

fellow human beings, they are not driven to each other for psychologically compensatory and narcissistic motives. Despite being under the

pressures of stress and the uncertainty of perpetual technological

innovations, each leader’s sense of self is integrated adequately and does

not require constant aggrandizing from staff and the public. Organizationally resilient leaders do not attract subordinates who are driven

primarily by emotional deficiencies-indeed, such leaders may promote

greater self-worth among those with low self-esteem.

To promote organizational resilience, organizational leaders must be

aware of self-and-other boundaries in their interpersonal relationships at

work. They cannot have a pressing emotional need to displace bad

feelings onto others, and they must be aware of the tendencies of others

to do the same to them. Unconscious displacement and projection of bad

feelings are more common under stressful conditions. Thus, organizational leaders able to manage interpersonal boundaries and minimize

defensive tendencies will foster healthier and more productive interactions with and among their staff. They will tend to consult staff when

necessary and delegate authority and responsibility appropriately. In

addition, leaders of resilient organizations are aware of the unique

character, talents, and skills of individual staff members. Hence,

individuality and interdependence are values consciously stressed and

intended to counteract the regressive pull of homogeneity and uniformity.

CONCLUSION: THE CASE OF THE DATA PROCESSING

MANAGER GROUP

In conclusion, this author wishes to describe briefly an ongoing change

effort. The case of the data processing managers group is mentioned here

to reiterate this chapter’s central thesis that technology transfer and

innovation is a human process, not just a technical one.

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Data processing managers representing more than one dozen departments

and agencies are meeting for the first time in the State’s history to

integrate and design computer and telecommunications systems

throughout State government. Struggling against their departmental

tendencies to view themselves as separate entities with well-defended

boundaries, these managers are attempting to find common ground.

Reparation is at work.

Entertaining the idea of sharing resources and information across

divisions and departments to enhance technological innovations for all of

State government has forced managers to confront their anxieties over

loss of control and over protection of their perceived organizational

boundaries. As their consultant, this author is encouraging them to

publicly express their reservations and anxieties about integrating systems

and sharing resources. Monthly meetings have become the transitional

space in which they experiment with new ideas, thoughts, and feelings

related to a common mission to improve technological services for all of

State government.

In short, this effort has challenged the status of data processing managers

as expert authorities due to the requirement of participation and

collaboration. It has confronted psychological resistance to organizational change by acknowledging the feelings of insecurity associated with

reflective thinking and learning that challenge the status quo. It has

meant a public acknowledgement and letting go of the old way of

inefficient technology utilization so that the new way of technology

sharing and participation can be incorporated. Finally, it has meant

challenging directly the defensive culture of bureaucracy. Departments

can no longer view themselves as relatively independent from other

departments and agencies within State government. Technology and data

processing experts must learn about their counterpart agencies and the

technological needs of those agencies. Thus, they must come to accept

more complex roles as well as more integrative operations. Interagency

boundaries are being transcended and are becoming more flexible, less

forbidding. Collaboration based on mutual respect and a shared mission

eventually will facilitate a more resilient organizational culture. This

organizational culture is, then, better able to respond to change by

engaging shared resources and expertise to advance the appropriate and

effective use of technologies.

130
REFERENCES

Argyris, C., and Schon, D. Organizational Learning. Lexington, MA:

Addison-Wesley, 1978.

Baum. H.S. The Invisible Bureaucracy. New York: Oxford University

Press, 1987.

Bowlby, J. Loss. Vol. 3. New York: Basic Books, 1982.

Diamond, M.A. The Unconscious Life of Organizations: Interpreting

Organizational Identity. Westport CT: Quorum Books, Greenwood

Publishing Group, 1993.

Diamond, M.A. Hobbesian and Rousseauian identities: The

psychodynamics of organizational leadership and change. Admin Soc

24(3):267-289, 1992.

Diamond, M.A. Resistance to change: A psychoanalytic critique of

Argyris and Schon’s contributions to organizational theory and

intervention. J Manag Stud 23(5):543-562, 1986.

Hirschhom, L. The Workplace Within. Cambridge, MA: MIT Press,

1988.

Klein, M., and Riviere, J. Love, Hate and Reparation. New York: W.W.

Norton & Co., 1964.

Schon, D. The Reflective Practitioner. New York: Basic Books, 1983.

Shapiro, E., and Cart-, A.W. Lost in Familiar Places. New Haven, CT:

Yale University Press, 1991.

AUTHOR

Michael A. Diamond, Ph.D.

Professor and Chair

Department of Public Administration

College of Business and Public Administration

University of Missouri-Columbia

3 15 Middlebush Hall

Columbia, MO 65211

131
Rethinking Organization Stability

as a Determinant for Innovation

Adoption and Diffusion

Alan M. Glassman

Everything has changed but our ways of thinking, and if

these do not change we drift toward unparalleled

catastrophe.

Albert Einstein

People prefer the certainty of misery to the misery of

uncertainty.

Anonymous

INTRODUCTION

In “Preparing for the 2 1 st Century,” Kennedy (1993) asserts that the

world has entered an era of unprecedented turmoil, reflecting the

entwined forces of shifting demographics; rapidly occurring

technological, biotechnological, and communication advances; and

increasing global competition. Based on these forces, Kennedy

speculates on the winners and losers in an emergent two- or three-tier

world order, forcefully arguing that a key determinant will reside in

systems of learning:

If my analysis is correct, the forces of change facing the

world could be so far reaching, complex, and interactive

that they call for nothing less than the reeducation of

humankind (Kennedy 1993, p. 339).

Similarly, at the organization level, a remarkable transition in America is

transforming private, not-for-profit, and public organizations. Harris

(1985) estimates, for instance, that usable knowledge doubles every 5 to

7 years, while the media chronicles the latest advances in electronics,

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microprocessors, and lasers, promising a multidimensional information

highway. Commenting on the need for organizations to change, Bennis

(1988) asserts:

Most organizations reflect the uneasiness of transition for

they were built upon certain assumptions about man and

his environment. The environment was thought to be

placid, predictable, and uncomplicated. Man was

thought to be placid, predictable, and uncomplicated,

Organizations based on these assumptions will fail, if not

today, then tomorrow. They will fail for the very same

reasons that dinosaurs failed. The environment changed

suddenly at the peak of their success.

The breadth and difficulty of this change can be seen in the ongoing

disorder in such diverse fields as finance, transportation, high- and lowtechnology manufacturing, retailing, media, aerospace and defense,

health care, social services, education, and even Government itself. It

also can be seen in the usage of new language (i.e., shorthand) to describe

emergent organizational designs and practices-network or cluster

organizations, posthierarchial or flattened structures, transformational

leadership, and reinvented Government. It is an era of permanent white

water (Vaill 1989).

LEARNING ORGANIZATIONS

In such an environment, organizations can no longer focus resources and

managerial action on seeking stability or seeking better means of control;

rather, organizations must learn to plan under discontinuous conditions

and to develop leaders and managers who accept as a substantive part of

their role the management of conflict and ambiguity. As summarized by

Stacy (1992, p. 19), “The real challenge, therefore, is to develop a more

appropriate frame of reference through which to understand the unstable

dynamics . . . and design creative actions.” This is the antithesis of the

classical bureaucratic model that functions best in a predictable and

ordered environment. Many observers assert that this is nearly

impossible for public agencies (Shrivastava 1983).

The concept of learning organizations refers to “organizations that

continually expand their ability to shape their future” (Senge 1992a,

p. 3 1). Characteristics often associated with such organizations include

133
(1) employment of systems thinking that moves beyond simple

situational adaptation to examine complex, intraorganizational

relationships; these organizations seek to understand how their responses

to change and the resultant outcomes are influenced by the existing

structure and culture (Senge 1992a; Ventriss and Luke 1988); (2)

advocating learning as a shared responsibility of all organizational

members (not just key members of the hierarchy) and constructing

processes that encourage dialog, empowerment, and risk taking (Kiechel

1990; McGill et. al. 1992); and (3) developing new mental models to

prepare for the future and eschewing established frameworks for

comparison (Senge 1992b). Throughout, rather than concentrating on

discrete events, the commitment is to understanding the relationship

between incidents and incorporating new knowledge (Bennis and Nanus

1985; Garvin 1993; McGill et al. 1992). Thus, the focus is on the whole,

not on unit or individual achievement.

This chapter stems from the premise that the United States has entered a

new era of organizational revitalization and that old models of

organization need drastic change. It is contended that the fundamental

character and structure of most organizations are more appropriate to the

previous decades than to the demands of the forthcoming millennium and

that organizational learning and therefore innovation adoption are

inhibited by these structures. First, the chapter briefly reviews the

characteristics of the classical bureaucracy and the impact of bureaucracy

on innovation. This section also explores the emergent awareness of the

external environment as a critical determinant of organization design and

the implications for innovation adoption and diffusion. Second, the

chapter reviews recent findings on innovation and introduces the notion

of bounded instability in organization design. Third, the chapter

describes the characteristics of the new organization designs that seem

more favorable to innovation adoption and diffusion and challenges

political leaders to redefine themselves as change agents.

BUREAUCRATIC STABILITY AND INNOVATION ADOPTION

AND DIFFUSION

The dominant organizational mindset in the United States is the

bureaucratic paradigm that emerged in the early 1900s as a means of

bringing order to the expansion of industry and Government. In its most

developed form, a bureaucratic structure exhibits six defining

characteristics: (1) high functional differentiation: (2) rigid hierarchical

134
relationships; (3) bounded, specialized role responsibilities; (4) formal

interactive rules and regulations; (5) predominantly downward communication; and (6) centralized authority and decisionmaking. As initially

described, this form of organization leads to incomparable efficiency and

increased production (Urwick 1944; Weber 1947). The machine

metaphor became commonplace for the ideal bureaucratic organization.

This paradigm-with tight controls, specialized jobs, and clearly defined

interactions-was ideally suited to the early, simple factories of the

Industrial Revolution that had relatively stable operating environments

and uncomplicated information-processing needs. In Government,

bureaucratic structures were adopted to separate politics from the administrative functions. This generated a complex set of rules and regulations

to ensure a machine-like sameness to all similar concerns -efficient,

predictable, and stable.

As argued by Taylor and Van Every (1993, p. xv), “Once established, the

bureaucratic form of administration was practically invulnerable to

assault from outside or inside. In its own way, it was a fortress,

protecting the agencies of power from the vicissitudes of their

environment.” Indeed, throughout the first half of this century, as social

scientists and practitioners extended the understanding of organizations

through scientific management, administrative theory, social man and

human relations theory, systems theory, and situational management, the

bureaucratic paradigm adjusted to reflect these new leamings. That is,

individual discretion was limited, and uniformity and predictability were

ensured through the clearly defined systems governing work relationships

and actions.

Bureaucracy and Innovation

Bureaucracy is aimed at accomplishing similar tasks as efficiently as

possible on a recurring basis. Its success is dependent on strict adherence

to policies and rules, tight financial controls, and vigilant supervision. It

is structurally designed to emphasize narrow subtasks and functional

divisions, to be impersonal, and to centralize authority, information

gathering, and decisionmaking. Consequently, organizational units are

buffeted from each other and from external environmental impingements.

Under these conditions, the units will strongly defend the status quo

(often unconsciously). If one unit introduces a change, other units of the

organization will want to reject it-a change would disrupt the highly

efficient existing patterns. Diffusion becomes nearly impossible, since

135
the barriers are already institutionalized in the machine philosophy of

doing, not thinking.

When bureaucratic organizations do adopt innovations. they frequently

force the change into the existing structure, requiring compliance with

established regulations and relationships. Over time, the changes become

absorbed and, as often stated by employees, nothing really changes.

Bureaucracy and the Environment

For purposes of this chapter, an organization’s environment represents

anything outside the organization that may affect its operations or

performance outcomes. A review of some of the major research studies

of the past 30 years helps explain the critical role of the environment and

the structural responses and variations (from the machine-like

bureaucracy) now observable in many organizations.

Bums and Stalker (196 1) studied 20 manufacturing firms in Scotland and

England. Through indepth interviews with managerial personnel and

observation, they identified two distinctive structure types: mechanistic

and organic. The mechanistic organization was highly structured,

exhibiting precise definition of tasks, reliance on the formal chain of

command, and strict adherence to formal rules and regulations. Because

of these qualities, it was judged to be better suited to a stable environment. The organic structure was characterized by reliance on individual

knowledge and was found to function better in an increasingly unstable

environment. The researchers concluded by emphasizing the situationality of structures:

We have endeavored to stress the appropriateness of each

system to its own unique set of conditions. Equally, we

desire to avoid the suggestion that either system is

superior under all circumstances to the other. In

particular, nothing in our experience justifies the

assumption that mechanistic systems should be

superseded by organic in conditions of stability (Bums

and Stalker 1961, p. 125).

Lawrence and Lorsch (1967) studied 10 organizations in 3 different

industries (plastics, consumer foods, and standardized containers) to

determine their needs for differentiation and integration. Differentiation

was defined as “the differences in cognitive and emotional orientations

136
among managers in different functional departments, and the differences

in formal structure among the departments” (Lawrence and Lorsch 1967,

p. 11). Integration was defined as “the quality of the state of

collaboration that exists among departments that are required to achieve

unity of effort by the environment” (Ibid.).

Based on data from questionnaires and interviews with managerial

personnel, the researchers drew two major conclusions. First, the more

complex and uncertain the industry’s environment, the greater the degree

of differentiation. Thus, organizations in the plastics industry, which had

a rapidly changing technology and shifting markets, had greater

departmental differentiation than those in the moderately stable foods

industry; the latter had greater differentiation than organizations in the

very stable container industry. Second, regardless of industry, the more

successful the organization, the higher the degree of integration.

Woodward (1965) conducted a lo-year study of 100 organizations to

determine what characteristics were associated with economic success.

The organizations were characterized according to the type of technology

employed: unit, mass, or process. Woodward then determined that the

organizations in each of the three categories had different mean values for

such factors as number of management levels, span of control, number of

specialists, and degree of formality and delegation. Of major significance

was the finding that the successful organizations within each category

were those that were closest to their own group mean.

Using these studies as a foundation for questioning the suitability of

bureaucratic structure in environments where change is increasing at an

increasing rate, recent research has focused on the ability of organizations

to process external information. Galbraith (1977) argues that uncertainty

is the dominant variable as organizations seek to develop the fit between

the information-processing requirements of the organizational tasks and

the information-processing capacity of the structure. Research indicates

that in ill-defined situations, managers must be able to debate their views

and reach a common understanding of the needed requirements before

they engage in decisionmaking (Daft and Lengel 1986; Hambrick 1987).

In summary, it is commonly accepted that to determine the optimal

organizational structure, it is first necessary to understand the specific

environment of an organization. Moreover, as organizational

environments become increasingly complex, there is a need to move from

the machine-like classical bureaucratic structure to alternative structures

137
that allow interunit debate and integration, more integration across

boundaries, and greater interaction with the external environment. Given

the knowledge explosion, it follows that bureaucratic structures would be

inhospitable to innovation development. adoption, and diffusion.

Commenting specifically on the continual dominance of bureaucracy in

today’s world, Mills (1993, p. 13) states, “The traditional hierarchical

structure of our companies is more than just a system that has outlived its

usefulness-it is a clear and present danger.”

INNOVATION AND BOUNDED INSTABILITY

A special category of learning for organizations is deftness at perceiving

and evaluating potential innovations in the external environment and,

when appropriate, assimilating these innovations within the organization.’

Surprisingly, there is minimal research focused on innovation in either

the private or public sectors. but where data do exist, neither sector

displays greater adoption and diffusion rates than the other sector

(Roessner 1983; Taylor and Van Every 1993).

As described by Van de Ven (1993) and Van de Ven and Poole (1990),

the Minnesota Innovation Research Program (MIRP) was the most

important research study in the effort to develop a grounded theory of the

process of innovation development.’ The program, conducted from

1983 to 1992, involved 30 researchers organized in 14 interdisciplinary

teams utilizing a common methodology to compare results. Van de Ven

(1993, pp. 273-283) summarized the research findings:

1. The innovation process consists of numerous events

performed by many different people over an

extended period of time...[T]he innovation process

began with an extended gestation period that lasted

several years.

2. Concentrated actions to allocate resources and

initiate innovation development are triggered by

“shocks” (not mere persuasion) produced by direct

personal confrontation with needs or problems.

These shocks are sufficiently large to trigger the

attention and action of Organizational participants.

138
3. Once innovation development work begins, the process does not unfold in a simple linear sequence...

[T]he process diverges into multiple, parallel, and

interdependent paths of activities.

4. Setbacks are frequently encountered during the

innovation process These setbacks either signal

rejection of the innovation or opportunities for

learning through reinvention.

5. Innovation receptiveness, learning, and adoption

speed are facilitated when the innovation is initially

developed within the user organization, and they are

inhibited when end users are provided no opportunity to reinvent (or modify) innovations developed

elsewhere. Organization members not involved in

the development or reinvention of an innovation tend

to view it as an external mandate...[T]he adoption

process is facilitated by modifying the innovations to

fit the local situations, extensive top management

involvement and commitment to the innovation, and

the use of various techniques to maintain task

completion and momentum.

6. Management cannot ensure innovation success, but

can influence its odds. The odds of success increase

with experience and learning from past trials at

innovation and decrease with the novelty, size, and

temporal duration of the innovation venture.

The conclusions of the MIRP researchers clearly establish that innovation

development, adoption, and diffusion is a messy process. Focusing

specifically on the adoption of innovations, individual studies within the

MIRP offer the following helpful suggestions (Van de Ven 1993,

pp. 283-287):

1. Modify the innovation to fit the peculiarities of the

local setting.

2. Insure active involvement by top management.

139
3. Develop internal processes to facilitate coordination

among disparate groups needing to cooperate.

Van de Ven notes that other MIRP researchers suggest that a breadth

strategy is more effective than a depth strategy and that flexibility in

applying evaluation criteria is more appropriate than lockstep measures.

Summarizing, Van de Ven (1993, p. 285) asserts:

Be forewarned of the possible consequences of passive

acceptance of external dictates by those who strictly

follow the letter of the law; they may do so in “bad faith”

that may not achieve the results intended... Mere

compliance is insufficient...The “not mvented here”

syndrome is well known...Adopting agencies or

organizations that have not developed any sense of

commitment to those innovations may well behave

bureaupathically and simply do what the letter of the law

requires.

In contrast with the qualitative aspects of the MIRP study, Damanpour

(1991) conducted a meta-analysis of the relationship between structure

and innovation and reached some of the same conclusions. The results

indicated that: (1) organic structures promote innovation by decreasing

formalization and centralization, which encourages cross-fertilization,

adaptation to changing circumstances, and personal flexibility; (2) longterm managerial tenure offers the necessary leadership confidence to

attempt innovation; (3) slack resources provide a cost cushion that allows

for experimentation and even failure; and (4) use of task groups and

committees facilitates involvement, adoption and diffusion, and longterm commitment. Other studies have highlighted the importance of

entrepreneurial behavior within the organization, employee autonomy,

and individual champions and sponsors (Howell and Higgms 1990;

Kanter 1983). As stated by Peters and Austin (1985, p. 114) “The real

world of innovating is serendipitous and passions-filled.” Innovation

adoption and diffusion requires acute awareness to surroundings, in

contrast with the specialized bureaucratic (mechanistic) structures

designed for another era.

Bounded Instability

A common theme runs through all the writing on innovation adoption

and diffusion-conventional management wisdom that prescribes

140
stability (as defined by the traditional bureaucracy) as a touchstone for

success is not appropriate for today’s rapidly changing organizational

environment. Rather, there is a need to design organizational structures

that encourage ambiguity and stimulate individual actions and

organizational learning. Stacy (1992) states that organizations must

embrace instability and benefit from its inherent tension and conflict.

Stacy refers to this phenomenon as “bounded instability” and contends

that successful organizations use bounded instability to provoke

innovation. Similarly, Kanter and colleagues (1992, p. 53) state:

Successful companies...are always a little off balance.

Leaders deliberately provoke disequilibrium to challenge

people to argue for new ideas and new possibilities.

Resources are not permanently assigned to one group or

another; each must bargain for them in the marketplace

of ideas...Organizations with high rates of innovation

make it easier for people to challenge the established

allocation of resources and divert them or attract them to

their causes.

In summary, organizations must accept disorderly processes and lack of

outcome certainty if they wish to design structures that are receptive to

innovation adoption and diffusion. They must adopt a new frame for “the

correct” organizational structure. That is, if they want to foster

innovation, they must adopt the counterconventional notion that bounded

instability equals success and stability means failure. In this model,

everyone is a learner.

THE NEW ORGANIZATION

In an environment of increasing and unrelenting change, where

organizations must continually learn and innovate, “The traditional

organizational map describes a world that no longer exists” (Hirschhorn

and Gilmore 1992, p. 105). Consequently, researchers are beginning to

explore designs that will condone bounded instability and thus change

people’s mental models of organizations in profound ways. As stated by

Mills (1993, p. 69), “Adapting to the modem world means that the now

dominant hierarchy will assume a residual role, confined primarily to the

top-most reaches of the organization.”

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These new organizations, still emerging, are referred to as networks,

clusters, enterprise groups, or autonomous units. Hierarchy is eschewed

as employees work together in new, semipermanent, overlapping

arrangements that seek to maximize flexibility and innovations (Charan

1991; Hirschhorn and Gilmore 1992; Limerick and Cunnington 1993;

Mills 1993). From a study of 10 companies, Charan (1991, p. 106)

reports:

Unlike most teams and task forces, networks do not

merely solve problems that have been defined for them.

Networks are dynamic: they take initiative. They

become the vehicle to redirect the flows of information

and decisions, the uses of power, and the sources of

feedback within the hierarchy. They become a new way

of doing business and a new operating mechanism for

individual managers to make their presence felt.

It is important to emphasize that these new designs are not temporary.

They are not simply a quick-response effort to an immediate need (within

the conventional bureaucratic and hierarchical structure) that vanishes

after completing the assignment. These organizations represent the

emergence of a new paradigm.

Three characteristics seem to dominate these new, more flexible, and

innovative organizations. First, the workforce is truly empowered.

Inherent in the empowerment concept is that given the opportunity,

employees will initiate entrepreneurial behavior and take personal

responsibility for pursuing appropriate directions. This includes

negotiating agreements across traditional boundaries and initiating and

working in multiple collaborative arrangements at all levels of the

organization (Block 1987; Limerick and Cunnington 1993). Second, to

strengthen individual initiative, the information technology needed for

decisionmaking is available throughout the organization. By creating a

new computerization and telecommunication environment, these

organizations have forever altered the need for information to be

centralized for distribution; individuals can receive unfiltered

information. The sharing, however, must exceed the typical definition of

data:

The network must also share openly and simultaneously

each member’s experiences, successes, and problems,

soft information that can’t be captured in databases and

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spreadsheets...This is the kind of sharing that builds trust,

empathy, and secure relationships. It also broadens the

participants (Charan 1991, p. 112).

Third, the focus within the organization is on the improvement of

processes that cut across boundaries, not on functions and tasks. This is

the essence of the total quality management movement. Over time, this

process orientation creates a new social architecture or set of relationships

among employees in different areas that is vital to innovation adoption

(Hirschhorn and Gilmore 1992; Howard 1992).

Within these new organizations, the role of the manager also changes.

Rather than concentrating on control systems, so common in hierarchical

structures, managers adopt such unusual workplace roles as facilitator,

consultant, and resource integrator or coordinator. While these managers

maintain leadership in managing overall direction, they see their primary

job as supporting those doing the work; they accept that project authority

shifts based on needed expertise. Thus, at times, a manager may serve on

a team lead by a subordinate (Hirschhorn and Gilmore 1992).

LEAVING THE PAST

This chapter has briefly explored four interrelated streams of academic

exploration: (1) the increasing rate of change and turbulence in

organizational environments and the concomitant need for organizational

learning; (2) the relationship between organizational environment and

organization design; (3) the determinants of innovation development,

adoption, and diffusion; and (4) the characteristics of the new

organizations. It is contended that if organizations are going to survive

and prosper, a new paradigm is needed-one that embraces the notion of

bounded instability.

In discussing the new organizations, Mills (1993) notes that the greatest

resistance to change comes from managers who fear loss of control. Yet,

the problem may go even deeper. A high percentage of senior-level

managers in organizations only know the rules of the bureaucratic and

hierarchical structure and are most comfortable operating within its

parameters, regardless of the mounting evidence on the need to change; it

is the model in which they have been successful. Thus, the tendency is to

try to fix the model rather than change it.

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Moreover, even when the need to change is apparent, in unconscious

ways these managers return to the same familiar models. As summarized

by Argyris (1985. p. x):

Key individuals are able to define the characteristics of a

rigid organization. They agree they must create a new

organization relatively free from those characteristics.

They are given the resources to do it, and they succeed in

creating what they condemn.

Therefore, the challenge to leaders is to explore existing paradigms

regularly and to recognize that potentially better ideas emerge outside

current paradigms. As questioning becomes an acceptable norm, newer

models will receive a fairer hearing.

NOTES

1. The most often cited model for understanding innovation is the threestep (i.e., idea invention, development, adoption and diffusion)

sequential process put forth by Rogers (1962, 1983) and Rogers and

Shoemaker (197 1) based on the extensive examination of research

studies. While this model IS the bedrock of most continuing studies,

its focus is on the individual, not on the organization.

2 . The 14 interdisciplinary teams included hearing health, therapeutic

apheresis, naval system development contracts, school site-based

management, computer company startups, commercialization of

space, nuclear safety standards, Government strategic planning,

advanced integrated circuits, hybrid wheat development, corporate

mergers and acquisitions, State education reform, multihospital

systems, and human resources management.

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AUTHOR

Alan M. Glassman, Ph.D.

Professor of Management

California State University, Northridge

4855 Palo Drive

Tarzana, CA 91356

146
Technology Transfer as

Collaborative Learning

Ramkrishnan V. Tenkasi and Susan A. Mohrman

INTRODUCTION

The field of technology transfer studies has been traced back to the

European beginnings of social science (Rogers 1983). In the United

States, a wave of interest and activity began in the 1920s and continued

until the 1980s (Backer 1991). After a brief lull, the field has seen a

resurgence in the late 1980s and the 1990s (Backer 1991). From the

domains of business, government, and academia come uniform calls to

develop more creative approaches to the problem of technology transfer

(Breuder 1988; Reich 1989).

Although application of the term carries unique interpretations in

different domains such as government, business, economic development,

and health care, the common definition of technology transfer reflects the

transmission of ideas, knowledge, information, and equipment from the

developer (often a research laboratory) to the user (marketplace). The

implicit model of the process is a source-destination paradigm (Williams

and Gibson 1990) or a conduit model of communication with the

sender(s) transmitting information from one end and the receiver(s)

faithfully receiving it at another (Doheny-Farina 1992; Reddy 1979).

This chapter argues that this information transmission model is

inadequate to represent the realities and complexities involved in

effective technology transfer, irrespective of the domain of application,

and that a fundamental reframing of the understanding of the process

needs to occur for technologies to be adopted successfully. This is

particularly true of soft (Backer 1991), disembodied (Feeny 1985), or

dynamic (Greer 1988) technologies that are prevalent in the arena of drug

abuse-technologies that are not equipment based but rather involve

techniques, approaches, and methods, or what is commonly referred to as

procedural knowledge (Singley and Anderson 1989). A shift in frame

needs to take place from the view of technology diffusion as a problem of

knowledge and information transmission, or even knowledge utilization,

to one of contextual-collaborative knowledge creation through mutual

learning.

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The rest of the chapter briefly reviews the traditional transmission models

of technology transfer, points out the limiting operative assumptions of

this predominant information transmission paradigm, proposes a different

set of assumptions about the nature of knowledge that provide the

rationale for contextual collaborative knowledge creation through mutual

learning processes as an alternate model of technology transfer, examines

potential barriers to such mutual learning, and concludes by discussing

ways of facilitating contextual-collaborative knowledge creation for

technology transfer.

TRADITIONAL MODELS OF TECHNOLOGY TRANSFER

While technology transfer is an umbrella term that covers an entire range

of activities around development of technologies and their applications to

the marketplace, attempts to model the process can be classified into three

major approaches: the appropriability model, the dissemination model,

and the currently popular knowledge utilization model (Williams and

Gibson 1990). A fourth and emergent stream called the communication

model (Doheny-Farina 1992; Gibson et al. 1990; Williams and Gibson

1990) is closer to the notion of technology transfer presented in this

chapter. However, the image of communication, though definitely a step

above the information transmission approaches in capturing the dynamics

of transfer, still does not do justice to the complexities of the diffusion

process.

The appropriability model follows the logic that good technologies sell

themselves. It is really the quality of research and competitive market

pressures that promote the use of research findings (Devine et al. 1987).

Therefore, purposive transfer mechanisms are unnecessary. Once the

researcher develops the right idea and makes the results available through

various forms of mediated communication, such as technical reports and

professional journals, the customer will automatically show up at the

inventor’s door. Kozmetsky (1990, p. 23) summarizes the dominant

presumption of this approach as viewing technology transfer as “the

result of an automatic process that began with scientific research and then

moved to development, financing, manufacturing, and marketing. [One]

did not necessarily need to be concerned with linkages in the technology

commercialization process.”

The technology dissemination approach popularized by Rogers (Rogers

1983; Rogers and Kincaid 1981) takes the view that diffusion of

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innovations is best facilitated when experts inform potential users of the

technology (Williams and Gibson 1990). The situation is one in which

an expert transfers specialized knowledge to the user, who is normally a

willing receptor. The guiding assumption is that “once the linkages are

established, the new technology will flow from the expert to the

nonexpert much like water through a pipe once the channel is opened”

(Williams and Gibson 1990, p. 15).

The knowledge utilization model is an increasingly popular view of

technology transfer reflected in much of the current literature (Szakonyi

1990; Zacchea 1992). The knowledge utilization paradigm represents an

evolutionary step that focuses on strategies to put knowledge to effective

use in the recipient settings (Backer 1991). According to this model,

interpersonal communication between technology researchers and clients

plays an important role. Further, it also attempts to identify the organizational barriers or facilitators of technology transfer.

While this model shows an appreciation of the complexities of transfer, it

has been argued (Dimancescu and Botkin 1986) that the knowledge

utilization model suffers from a linear bias:

The stated or implicit notion is that basic research moves

from researcher to client, in one direction, to become a

developed idea and eventually a product. This model

reduces the transfer process to chronologically ordered

one-way stages, whereas practice shows the process to be

interactive and complex (Williams and Gibson 1990,

p. 5).

UNPACKING THE OPERATIVE ASSUMPTIONS OF THE

TRADITIONAL MODELS

The major argument against the predominant transfer approaches is that

they entail a one-way transmission of information, from source to

destination or from originator to receiver. Although this is a valid

criticism, this chapter posits further that the one-way transmission of

information is essentially a manifestation of three interrelated theses

about the nature of transferred knowledge that serve as operative

assumptions for the technology transfer field. The real challenge iies in

reframing these operative assumptions, particularly in relation to soft or

disembodied technologies. The authors believe such a cognitive turn is

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essential to engage the realities and complexities of the transfer process

and adopt a perspective of contextual-collaborative knowledge creation as

the heart of effective technology transfer.

The three conjoint operative assumptions about the nature of transferred

knowledge are that knowledge is objective. knowledge is universally

applicable, and knowledge is complete.

1. Knowledge can be objectively determined and will be objectively

consumed: The assumption behind this thesis is that truthfulness of

knowledge can be empirically determined. Thus, knowledge that has

been empirically determined is objective, has validity, and will be

seen as so by others. An example would be when a research finding

that high performers are driven by the need to achieve is taken as

truth and used to guide action.

2. Knowledge is applicable across contexts: An interrelated postulate is

that knowledge that has been objectively determined will apply

uniformly across contexts and time. An example would be the belief,

based on the aforementioned research, that all people trained in

achievement motivation will perform better.

3. Knowledge is complete: The assumption here is that knowledge can

be created in its complete form by people who have the expertise. A

single individual or group can hold all the requisite knowledge

necessary for productive action, and the issue is one of transmission

of this knowledge so that nonexperts (users) can put it to productive

use. This assumption would be embodied in approaches to the

diffusion of technology that involve packaging or instrumenting the

technology. Following the above example, this assumption might

lead the generators of the knowledge that high performers are driven

by the need to achieve to base selection tests, training, and counseling

interventions on this “truth.” The diffusion of quality circles in the

1980s as a methodology for involving people in making process

improvements in organizations is another example. Technology

developers packaged steps, structures, training, and role descriptions

in products they sold to the users.

The above operating assumptions about the nature of knowledge are well

reflected in the appropriability and the diffusion models of transfer. In

the first model, the users simply absorb the knowledge or technology, and

in the second instance, the absorption of knowledge is facilitated through

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instructions by an expert. One can infer that these one-way transmissions

of knowledge are guided by the implicit frames of objectivity, universal

applicability, and completeness of knowledge.

The knowledge utilization model does contain an element of two-way

communication. However, as Doheny-Farina (1992) and Dobrin (1989)

argue, the two-way communication is primarily oriented towards

maneuvering around the communication barriers between the originator

group and the user group. The assumption still is that there is “a body of

information, of objective facts, just lying there waiting to be communicated” (Dobrin 1989, p. 60). The underlying tenet is that knowledge is an

object that exists independently, is valid, is complete, and has universal

applicability. It is the job of the implementers to transfer the knowledge

correctly through the appropriate channels. If there are problems with the

user group adopting this knowledge, it is because they do not understand.

The solution would entail finding better ways of managing those channels

to achieve better dissemination or diffusion of knowledge.

If the foregoing assumptions about knowledge (objectivity, universal

applicability, and completeness) were true, then the information

transmission model would be the most appropriate. Then technology

transfer would be a simple process of moving innovations from the

source to the receivers. However, this chapter argues that a different set

of theses about the nature of knowledge are better able to capture and

manage the complexities of technology adoption. This alternate set of

assumptions presents a rationale to understand technology transfer as a

process of contextual knowledge creation through collaborative learning.

The next section will examine this alternate set of assumptions and

provide case examples to illustrate how they more accurately address the

complexities of the technology transfer process.

AN ALTERNATE SET OF ASSUMPTIONS ABOUT THE

NATURE OF KNOWLEDGE

In contrast to the generally accepted views of knowledge, the authors

posit that three different assumptions can provide a more relevant set of

operating assumptions to comprehend the technology transfer process:

knowledge is subjectively constructed, knowledge requires contextual

adaptation, and knowledge is incomplete. These are described below.

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Knowledge Is Subjectively Constructed and May Be

Subjectively Consumed

Knowledge is a belief or set of beliefs about a segment of reality that is

socially constructed by a community of knowing (Denzin 1989). It is

based on a set of assumptions about the nature of such a segment of

reality. Any information or knowledge, irrespective of how well it is

empirically determined by an outside authority, may still be subjectively

consumed. Each community of knowing (e.g., the development

community versus the marketing community) has its distinct interpretive

conventions, whether they be a “community of nuclear physicists. cabinet

makers, high school classmates, [or a] street comer society” (Brown and

Duguid 1991, p. 48). Kuhn (1970) calls this the incommensurability of

meaning systems among different communities of knowing.

Fleck’s (1979) concept of thought worlds is similar to Kuhn’s notion.

Thought worlds emphasize the unique interpretive repertoires of different

communities of knowing. The interpretive repertoire of each community

of knowing is characterized by two distinctive aspects: their fund of

knowledge, or what they know; and their systems of meaning, or how

they know. What is already known influences the method and content of

cognition. A thought world evolves in a community of knowing as an

internally shared system of meaning that provides a readiness for directed

perception. For example, a fund of knowledge can be primarily

conceptual (such as research and development) and acquired through

education, training, and laboratory experimentation, or practice based

(such as marketing) and acquired through direct interaction with

customers.

Ideas cannot be easily shared across thought worlds with different funds

of knowledge and systems of meaning. People in different thought

worlds will attempt to interpret each other’s ideas based on their unique

thought worlds. If such interpretation fails, then they may view the

other’s central issues as esoteric, if not meaningless.

A good illustration of this subjective construction and consumption of

knowledge in technology transfer is provided by Dougherty (1992). In a

study of transfer processes in 18 new product efforts, Dougherty found

that key players from development, manufacturing, and marketing

interpreted and understood issues around technology-market linking in

qualitatively different ways from one another. The technical (research)

group’s focus was on establishing the product’s performance

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specifications. They defined the market in terms of what the product

could do, stressing product features. However, when research transferred

their technology to marketing, the marketing group looked for what the

user wanted to do with the product, and the user needs were unique or

constantly changing. Manufacturing people’s concern was with

reliability, quality, and manufacturability, and they evaluated and defined

the product and the market in those terms. They believed that a higher

number of product features made it more difficult to establish reliability

and quality. When transferred products were very antithetical to what the

manufacturing or marketing groups defined as product requirements, the

process of transferring and adopting the technology became extremely

difficult.

Knowledge May Require Contextual Reconfiguration To Be

Adopted in the New Context, Otherwise It Could Be Rejected

Outright

For a community of knowing to adopt an idea, information, or knowledge

from a different community of knowing, the information or knowledge

may have to be reconfigured or adapted to fit in with the recipient

community’s meaning system. External ideas that may not fit in with

one’s system of meaning may be rejected outright (Fleck 1979).

Drawing on Giddens’ (1979) theory of structuration, Orlikowski and

Robey (1991) and Poole and DeSanctis (1992) call this reconfiguration

process the phenomenon of appropriation. The theory of structuration

essentially argues that human understanding and behavior are contextual.

Knowledge, cognition, and behavior in any social system are guided and

constrained by the contextual rules and resources resident in the social

structures. Actors use these rules to make sense of their own acts and

those of other people. The structurational conventions that condition

human understanding, behavior, and practices are constituted by three

interdependent structures, what Giddens (1979) terms the “modalities of

structuration.” These interdependent structures are interpretive schemes,

norms, and power relationships.

Interpretive schemes are standardized, shared stocks of knowledge and

beliefs that actors in a setting draw upon to interpret behavior and events.

Norms are the rules governing sanctioned or appropriate conduct. Power

enters into human interaction by providing humans the capabilities to

accomplish outcomes, and most social systems are marked by an

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asymmetry of power distribution. Frequently there is a defined pattern of

power relationships within a social system.

Technology, or any external knowledge or information, may be

appropriated by a social system within the context of its structurational

conventions. The structurational conventions can mediate the

appropriation process. If an idea is too antithetical to a system’s

structurational conventions, then the system could reject it. So the task

becomes one of reconfiguring the technology to fit the situational

contextual requirements or changing the structurational conventions of

the recipient group.

Kelly and colleagues (1993) illustrate how social norms of certain

communities stifle the adoption of technologies intended to combat

human immunodeficiency virus (HIV) infection. They argue that social

and peer norms that favor risk-taking behaviors have come in the way of

accepting safe sex practices and technologies. The drive now is to try to

create new norms of social responsibility to foster openness to safe sex

practices.

A good example of contextual adaptation of received knowledge is

illustrated in the global campaign to eradicate smallpox (Joseph et al.

1994), a dreadful disease known to mankind since the 12th century BC.

As the result of a 1 O-year effort spearheaded by the smallpox eradication

unit instituted by the World Health Organization. the last case of

smallpox was detected in Somalia in 1977. However, the technology (in

the form of a vaccine) to eradicate smallpox had been in existence for

over 177 years. In fact, several earlier attempts to combat the disease

failed; “a century and a half of vaccination attempts yielded only modest

results” (Fenner et al. 1988, p. 1346). One of the major barriers to the

earlier campaigns was that in many countries the indigenous system of

medicine held beliefs and advocated practices that interfered with the

concept of vaccination.

The earlier programs tried to force the vaccination technology without

understanding or acknowledging these local belief systems. However, in

the case of the successful campaign, some of the local leaders recognized

this problem and made an attempt to present the vaccination technology

as complementing the local knowledge and belief systems. For example,

in India the folk goddess of smallpox was a deity named Shitala Mata.

She was represented as riding on a donkey with a basketful of grain on

her head. In one hand she had a pitcher of water and in the other a

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broom. The belief was that when she shook her head, the grains that

spilled turned into smallpox pustules. The victim survived if she cleaned

the spilt grain with water, but did not if she only used the dry broom. To

incorporate the vaccination technology within this local meaning system,

hundreds of large posters were created where the water in the goddess’s

hand was replaced by a large syringe containing the vaccine.

In a similar vein, Brown and Duguid (1991) present interesting examples

of how repair service technicians effectively appropriated and modified

the prescribed and directive repair procedures and knowledge of the

company to develop local and often more effective techniques and

methods to fix malfunctions. This modified knowledge became part of

their community of interpretation.

Bruce and Peyton (1990) argue that such reconfiguration of received

knowledge is essential for successful innovation adoption. They posit

that the so-called distortion of innovations is in reality adaptation of

innovations to suit the local context. These perceived distortions are an

integral part of appropriating the technology or fitting it to the situational

context of the transfer domain. This might well be a prerequisite for

successful adoption of an innovation.

The prevalence of distortions of innovations is a clue that

the conventional model of implementation is inadequate.

The “distortions” arise because the innovation is not the

only active element. . . . In reality, the innovation is but

one small addition to a complex social system. Instead

of seeing it as the primary instrument of change, it is

better to see it as a bit of raw material that may stimulate

the creation of something new (Bruce and Peyton 1990,

pp. 172-173).

This leads to a different model for implementation of innovations. In this

model, the active agents are not innovations, but the participants in the

setting in which the innovation is placed. These participants develop a

perception of what the innovation is and then re-create it as they adapt to

fit with institutional and physical constraints and with their own goals and

practices. What they produce are different realizations of the original

innovation (Bruce and Peyton 1990).

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Knowledge Is Incomplete (Both Received and Contextual),

and Effective Contextual Adaptation May Require a Creative

Synthesis of Different Thought Worlds To Produce New

Knowledge

Hayek (1945), a Nobel laureate in economics, has argued that the

knowledge necessary for productive action rarely resides in any one

place, person, or group, but is divided throughout society. The

knowledge challenge society faces is how best to tap into and

communicate the additional knowledge required for effective action.

This premise implies that effective contextual reconfiguration of

knowledge cannot be purely based on the receiver’s thought world, since

it is as incomplete as the originator’s thought world. Knowledge for

effective action requires a fusion of distinct knowledge domains. As

Dougherty (1992) found, thought worlds can selectively filter

information and insights. Because of different funds of knowledge, a

certain thought world is likely to best understand certain issues but ignore

information that is equally essential to the total task. Relying on such

partial knowledge may result in ineffectual contextual adaptation.

One kind of ineffectual contextual adaptation is described by Poole and

DeSanctis (1992) in their notion of ironic appropriation. In their study of

adoption of computer technology by users, they found two types of

appropriation patterns. Faithful appropriation occurred when the

technology was adapted to the local requirements and was still consistent

with the spirit of the technology, defined as the designer’s intention

behind the technology. An ironic appropriation involved use of a

technology that was inconsistent with or violated the spirit of the

technology. They clarify the faithful-ironic distinction: “Ironic use of a

GDSS [Group Decision Support System] does not include using it in

creative ways different from those envisioned by the developer. It means

using the system in a way that violates or negates its spirit” (Poole and

DeSanctis 1992, p. 10).

Orlikowski (1991) provides a good illustration of such ironic

appropriation. This example describes a company that had implemented

new information technology aids designed by the developers with the

intention of enhancing productivity, delegating and enriching work at

lower levels of the organization by providing users with the requisite

knowledge to carry out more complex work, and facilitating better

communication among levels of the organization. However, in actuality

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the information system was used for electronic surveillance and constant

monitoring of employees by the managers. This ironic appropriation

resulted in producing the opposite effects of what was intended with the

introduction of the technology: lower productivity, less communication,

lower morale, and tighter controls. The managers were left wondering

what went wrong and blamed the systems development department for

giving them a technology that did not work.

Dougherty (1992) attests to the fact that effective contextual adaptation

was best achieved when there was a creative synthesis of distinct

knowledge domains. Successful product transfers involved a fusion of

the conceptual knowledge of the development group and the practicebased knowledge of the marketing group. The various actors established

collaborative mechanisms that took into account their unique interpretive

dynamics-their distinct thought worlds-and interactions at this core

level of understanding made possible joining of their knowledge domains

to produce new insights and new facts. Successful technology transfer

required the creation of new knowledge through collaboration and mutual

learning.

THE PROBLEM WITH SOFT TECHNOLOGIES

The subjectivity of knowledge, the need for contextual adaptation, and

dialoging at the level of values, assumptions, and beliefs takes on more

acute proportions with soft or disembodied technologies. Soft

technologies such as procedures or systems can be conceived of as social

practices that may reflect a specific system’s structurational conventions

about how to organize, work, or manage people. They are more abstract

than hard technologies, and the developer’s contextual assumptions

behind the nature of the technology have to be explicated and their

relevance examined in light of the contextual background of the recipient.

This combined approach may result in creative approaches to contextualize the technology productively.

Hofstede (1980) extends an interesting example of how attempts to

transfer management by objectives (MBO) to some other countries failed

miserably. Hofstede argues that MBO presupposes that subordinates are

sufficiently independent to negotiate meaningfully with their boss and

that performance is seen as important by both.

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When MBO was first introduced in France in the 1960s, people expected

that this new technique would result in the long overdue improvements in

productivity. However, by 1970 MBO was severely discredited in

France The reason. argues Hofstede, is that the French culture

encourages dependency relationships among superiors and subordinates.

The traditional hierarchical structure protects against anxiety, while MBO

generates anxiety.

As Hofstede (1980, p. 55) elucidates:

The reason for the anxiety in the French cultural context

is that MBO presupposes a depersonalized authority in

the form of internalized objectives; but French people,

from their early childhood onward, are accustomed to

large power distances, to an authority that is highly

personalized. And in spite of all attempts to introduce

Anglo-Saxon management methods. French superiors do

not easily decentralize and do not stop short-circuiting

intermediate hierarchical levels. nor do French

subordinates expect them to.

TECHNOLOGY TRANSFER AS CONTEXTUALCOLLABORATIVE KNOWLEDGE CREATION

These alternate sets of assumptions about the nature of knowledge

provide a different view of technology transfer-that it entails the

creation of new knowledge. If innovations have to be adopted

successfully, then knowledge has to be contextually adapted:

“Technology transfer demands the shaping of the technology to fit the

detail of the different system which comprises the new context...

contextual mapping to use the jargon of morphological analysts”

(Bradbury 1978, p. 112). Effective contextual shaping is best achieved by

a fusion of thought worlds that makes possible new knowledge, new

insights, and new facts through creative joint learning.

Viewed from this angle, technology transfer involves more than

information transmission or knowledge utilization. An evolutionary

move beyond the emergent communication images of technology transfer

to a learning notion is implied, since successful transfer and adoption

requires the creation of new knowledge. Webster’s “Seventh New

Collegiate Dictionary” defines the verb communicate as “to impart; to air;

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to make known,” while the verb to learn is “to understand, to discern, to

acquire knowledge or skill.” While communication is an essential aspect

of learning, it cannot replace learning. Learning is more than a message

exchange process; it is the act of dialoging at the level of interpretive

dynamics, the task of opening up one’s preconceptions, assumptions, and

meaning systems to oneself and to others (Habermas 1981).

In sum, collaborative learning requires a process of mutual “perspective

taking” in which distinctive individual knowledge, meanings,

assumptions, and beliefs are exchanged, evaluated, and integrated with

those of others (Duncan and Weiss 1979; Shrivastava 1983). Much of

social behavior is predicated upon the assumptions an actor makes about

the knowledge. beliefs, and motives of others. The knowing of what

others know is a necessary component for coordinated action to take

place. As Brown (1981) observes, understanding another requires that

the point of view of the other be realistically imagined. The fundamental

importance of taking the other’s point of view into account is seen in

Mead (1934), who referred to it as taking the attitude of the other and

equated one’s ability to be fully human with the ability to maintain an

inner conversation with a generalized other. This is the essence of the

process of perspective taking (Bakthin 1981; Clark 1985; Krauss and

Fussell 1991).

Barriers to Perspective Taking

Mutual perspective taking of each other’s knowledge and background is

fundamental for collaborative learning. However, it is a complex process

and can frequently break down. There are two principal and interrelated

barriers to mutual perspective taking. First, knowledge and meaning

systems of a community of knowing are often tacit and taken for granted.

Second, because such knowledge and meaning systems are tacit, and

one’s interpretative procedures are so automatic, most people assume that

the rest of the world’s perspectives are more similar to one’s own than

they actually are.

Know/edge as Tacit and Taken for Granted. At least part of the

knowledge, beliefs, meaning systems, and norms that form the structurational or interpretive conventions of any group or community of knowing

are tacit in nature. In other words, understanding and interpretation of

events in any group or community involve a great deal of knowledge that

is not explicit and cannot be stated explicitly. Such knowledge is framed

159
and embedded in communal conventions and practices that actors invoke

automatically in their conduct of daily life (Brown and Duguid 1991).

As Giddens (1979) elaborates, there are at least two levels of consciousness in any social system: discursive consciousness that involves

knowledge that actors are able to express at the level of discourse, and

practical consciousness that involves tacit stocks of knowledge that actors

are normally not able to formulate discursively, but draw upon in the

constitution of social conduct

Collins (1983) also notes the hidden nature of such processes, and argues

that many times it is only when the rules go wrong that a community of

knowing examines the nature of their interpretation. “Otherwise, our

giving of meaning to objects-out interpretative practices are [sic] so

automatic that we do not notice that any interpretation is involved”

(Collins 1983, p. 90).

False Assumption That Others’ Knowledge and Meaning Systems

Are More Similar to One’s Own than They Actually Are. Since a

group’s knowledge and meaning systems can operate outside the bounds

of day-to-day consciousness, there is a tendency to automatically assume

that others’ world views are more similar to one’s own than they actually

are. Fleck (1979) calls this the inherent tenacity of thought worlds to

focus on their own perspectives.

The false-consensus effect, in which subjects assume that others are more

similar to themselves than is actually the case (Ross et al. 1974), is a form

of bias particularly relevant to the perspective-taking process. Steedman

and Johnson-Laird (1980, p. 129 j propose that “the speaker assumes the

hearer knows everything that the speaker knows about the world and

about the conversation. unless there is some evidence to the contrary.”

This assumption should lead to overestimates of the extent to which a

speaker’s knowledge is shared by others.

Denzin (1989, p. 11) elucidates how this false-consensus effect can come

in the way of designing effective social programs:

In social life there is only interpretation. That is

everyday life revolves around persons interpreting and

making judgments about their own and others’ behavior

and experiences. Many times these interpretations and

judgments are based on faulty, or incorrect understandings.

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Persons for instance mistake their own experiences for

the experience of others. These interpretations are then

formulated into social programs that are intended to alter

and shape the lives of troubled people. But often the

understandings that these programs are based on bear

little relationship to the meanings, interpretation, and

experiences of the persons they are intended to serve. As

a consequence there is a gap or failure in understanding.

The programs don’t work because they are based on a

failure to take the perspective and attitude of the person

served.

Facilitating the Perspective-Taking Process as Mutual

Learning

Perspective taking cannot be fully facilitated by normal structures of

integration. As Dougherty (1992) experienced, the traditional integrative

mechanisms such as project teams and matrices- structures that are often

recommended for innovation and technology transfer (Tushman and

Nadler 1986)—did not achieve the mutual exchange of perspectives.

Rational tools and processes, the infusion of market research information,

and the redesign of organizational reporting structures, while important,

were not enough to manage the transfer process.

These traditional measures were not sufficient because they did not deal

with issues of interpretation; they did not provide for the opening of one’s

preconceptions, assumptions, and meaning systems to oneself and to

others (Habermas 1981). Becoming aware of tacit consciousness requires

self-reflexivity on the part of the actors. In Schutz’s (1964) terms,

reflexivity is the ability to suspend natural attitude periodically.

Interpretations normally given in a matter-of-course, natural way should

be suspended so that one will be able to notice the assumptions, beliefs,

and meanings that are the basis of one’s knowledge. Perspective taking

best happens when individuals interact with each other at the level of

interpretive dynamics.

Facilitating perspective taking requires interpretive spaces for mutual

learning and joint meaning making. According to Denzin (1989), the act

of interpreting creates the conditions for understanding. Thus,

interpretive spaces are interactional mechanisms that create the conditions

for understanding by intervening at the level of knowledge structures,

161
interpretive schemes, or thought worlds; bringing them to conscious

awareness; and facilitating their exchange in a process of mutual dialog.

Surfacing interpretive schemes enables the explication of hitherto tacit

knowledge (Polanyi 1967) and extends a space for deeper self-reflection

of one’s interpretations. The process can be evocative, since it can reveal

an individual’s cause-and-effect logic. This in turn forces the individual

to confront the reasonableness and validity of tacit cause-and-effect

understandings. Comprehensive understandings of a situation can be best

developed by makmg it possible for indrviduals to portray their original

understandings of a situation, self-reflect. reexamine these displays in the

process of exchange with others, and come away from these reexaminations with different interpretations and perspectives of what they might

mean (Weick 1990).

This need can be abstractly described, but the issue of practice is to

concretize it and make it actionable. The technologies for perspective

taking are just beginning to evolve. Three such approaches, discussed

below, support interpretive processes and collaborative learning. The

different approaches, though rooted in different disciplines (information

and decision sciences, organizational development, and sociology), are in

their own right interpretive spaces and mechanisms aimed at creating

conditions for understanding through mutual perspective taking between

disparate thought worlds.

Spider. Spider is a computer-aided interpretive environment for people

to portray in a structured way their interpretations and causal understandings of a situation, reflect on these interpretations, and share their

interpretations with others in dialog (Boland et al. 1994; Tenkasi et al.

1993).

Cognitive maps are one of the central elements in Spider that enable the

surfacing of tacit assumptions and knowledge. Also called cause maps,

belief nets, and influence diagrams, cognitive maps reveal the causal

logic behind a person’s view of a situation. The effectiveness of the

cognitive mapping model to elicit tacit knowledge has been well

documented. According to Weick and Bougon (1986), a cognitive map

provides an occasion to think carefully, deeply, and deliberately about a

situation, and the knowledge in such a cause map gives knowledge about

an organization.

162
Spider enables each actor to build a cognitive map of the factors that

influence his or her sphere of concern, and each factor in the map in turn

is linked to other maps, spreadsheets, descriptive notes, or graphs for

revealing underlying assumptions. The multiple forms of representing

one’s understanding enable an actor to build a multilayered and rich

depiction of a complex understanding. Individuals can mail their

understandings to other actors who are system users, who in turn can

contribute their own understandings in a mutually interactive learning

process.

Early experiments with Spider with a group of product planners have

shown that this computerized interpretive medium has been a source of

new understanding for the managers involved. The intellectual effort and

careful self-examination required to interactively construct a cognitive

map, and the process of exchanging understandings and comparing their

own assumptions, beliefs, and causal logics behind a situation vis-a-vis

others, have led to significant new leamings and collaborative approaches

(Boland et al. 1994).

Search Conferencing. An organization development approach

popularized by Weisbord (1987, p. 285), search conferencing is a

powerful method to “excite, engage, produce new insights, and build a

sense of common values and purpose.” It is an exercise in learning,

awareness, understanding, and mutual support.

Frequently in a search conference, all parties who are stakeholders to a

decision are brought together. Next the group conducts a series of

activities to examine their past and present, with a specific emphasis on

laying bare their understandings, assumptions, beliefs, and meanings to

themselves and one another. Participants use different devices, such as

stories, pictures, and skits, to help them explicate their tacit understanding

to oneself and to others. The group looks at this information, interprets

what it finds, and draws conclusions for action for the future. Successful

search conferences always uncover shared values, new possibilities, and

congruent action plans for the future.

Interpretive Interactionism. Grounded in sociological theory,

interpretive interactionism (Denzin 1989) is an approach to social

research that strives to clarify meanings. By producing meaningful

descriptions and interpretations of social processes from the subjective

point of view of different actors, interpretive interactionism attempts to

create conditions of understanding and “translate what is said in one

163
language into the meanings and codes of another language” (Denzin

1989, p. 32). It is a mode of research that can expose and reveal the

assumptions that support competing definitions of a problem.

The interpretive researcher uses naturalistic inquiry methods, such as case

studies and biographical approaches, to identify different definitions of a

problem and competing models of truth that may operate in an interactional setting. Armed with this rich data, the researcher then facilitates

the process of mutual perspective taking and collaborative learning

among the different parties.

CONCLUSION

This chapter argues for a fundamental reorientation of the current

understanding of technology transfer. This shift is based on a different

set of assumptions about the nature of knowledge: (1) knowledge is

subjectively constructed and consumed. (2) knowledge may require

contextual modification to be adopted in the new context, and

(3) effective contextual adaptation may warrant a creative synthesis of

different thought worlds to produce new knowledge. This shift implies a

move away from the traditional information transmission approaches to

understanding technology transfer as one of collaborative learning

through a process of perspective taking

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ACKNOWLEDGMENTS

Parts of this chapter have been supported by National Science Foundation

grant no. IRI 9015526 and a grant from the TRW Foundation.

AUTHORS

Ramkrishnan V. Tenkasi, Ph.D.

Research Assistant Professor

Susan A. Mohrman, Ph.D.

Senior Research Scientist

Center for Effective Organizations

School of Business Administration

University of Southern California

Los Angeles, CA 90089-1421

168
Reducing Impediments to

Technology Transfer in Drug

Abuse Programming

Barry S. Brown

INTRODUCTION

Few activities in the drug abuse field excite as much concern and are as

little undertaken as the transfer of research findings into clinical practice.

It is a concern that information regarding the refinement of treatment and

prevention strategies, obtained after years of costly study, is not finding

its way to those responsible for developing and administering drug abuse

treatment and prevention programs or, worse yet, that new models of

service delivery have been created, tested, and found efficacious only to

be interred on the shelves of academia or in the files of remote Federal

agencies.

Such concerns likely exaggerate that which research has to offer the

service delivery community and minimize the extent to which agencies

with inadequate budgets are, in fact, invested in technology transfer

efforts. Nonetheless, those concerns speak to the gulf seen as existing

between service providers and members of the research community-a

gulf dramatically widened by congressional action effecting a bureaucratic divorce between agencies responsible for substance abuse research

and agencies responsible for providing support and technical assistance to

staffs engaged in substance abuse treatment and prevention. Congress’

dissolution of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) has removed technical assistance from a base in

research and removed research from a base in service provider issues.

Fortunately, drug abuse agencies have taken some steps to repair the

damage brought by that legislation. The newly created Substance Abuse

and Mental Health Services Administration (SAMHSA) has made

frequent use of research consultants to clarify findings on different

aspects of service delivery, and the National Institute on Drug Abuse

(NIDA) has called upon service providers to contribute their thinking to

aspects of the NIDA research agenda. Nonetheless, the congressional

action to sever research from services, without requiring any

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collaboration, amplifies the dilemma confronting advocates of research

utilization in the drug abuse field.

This chapter will address the issues for research utilization that have been

described in the literature and speak to their application to the field of

drug abuse service delivery. In addition, it will explore issues not

addressed in the literature that are peculiar to the drug abuse field. The

chapter also will describe an effective research utihzation model recently

and successfully implemented by NIDA and will suggest strategies for

the support of technology transfer efforts that would entail modest

changes in NIDA’s current functionmg.

ISSUES IN RESEARCH UTILIZATION

A number of factors have been cited for their influence on research

utilization. Focus will be placed on the six factors that seem to emerge

most frequently in journal discussions of technology transfer. Each of

these will be addressed for its significance to research utilization by the

service delivery community.

Relevance

The acceptance of a novel intervention by a treatment or prevention

program depends largely on the extent to which that intervention is

viewed as appropriate to the mission and perceived needs of the program

(Averch 1975; Banta and Bauman 1976; Cox 1977; DiMaggio and

Useem 1979; Glaser et al. 1983; Leviton and Hughes 1981; Nielsen

1975; Williams and Wysong 1975). A program that views relapse as

inevitable may see its mission as making reentry into treatment a viable

alternative to reinvestment in addict behaviors and thereby have little

interest in a new aftercare model. By the same token, a program

concerned about its high dropout rate may have great interest in an early

retention initiative.

A number of authors (Backer 1991; Boyer and Langbein 1991; Carter

1971; Dawson and D’ Amico 1985; Glaser and Taylor 1973; Lobosco and

Newman 1992) have emphasized the utility of involving research

consumers, or stakeholders, in planning and conducting studies. They

argue that consumers achieve a level of ownership of the research

findings likely to be reflected in a greater interest in transferring research

findings to service initiatives. Leitko and Peterson (1982) also point out

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that staff involvement may either increase a study’s validity by increasing

respondents’ willingness to provide accurate information or reduce

validity by reducing objectivity of respondents or by making use of

inappropriately trained data collection staff.

Others (Brown 1987; Patton et al. 1977) have suggested developing a

process to transmit clinical concerns and issues to program research staff

or staff of Federal agencies responsible for setting and funding the

research agenda. Indeed, NIDA has solicited input from representatives

of the service delivery community in developing its strategic research

plans in clinical areas. The need for routine assessment of field concerns,

and feedback on the ways in which those concerns are incorporated in

program or agency planning, is essential on two counts. First, assessment

and followthrough on ideas from the field can lead to greater utilization

of research findings in accord with the joint ownership of both problem

and resolution that action implies. Second, such a process guarantees that

the research conducted is responsive to the concerns of the treatment and

prevention communities rather than to the interests of those more remote

from the field.

Any such effort to assess the research needs of the treatment community

must make use of a representative sample of treatment programs. All too

often reliance is placed on the opinions and suggestions of a core of

prestigious or politically prominent program or organization officials

whose thinking, while important, may or may not represent the thinking

of the larger service delivery community. Often, for example, those

influential programs are university affiliated and supported through grant

funding. They are thereby rich in terms of dollars and personnel relative

to the broad array of service delivery programs. Their research concerns

likely will reflect their advantaged status and may involve, for example,

an understanding of the efficacy of interventions to be provided through

staffing patterns available only to a few programs. While those research

issues should be heard and considered, other programs whose research

concerns may involve strategies for recruiting, training, and retaining

effective paraprofessional staff, also should be heard and addressed.

Timeliness

To exert maximum influence, research findings need to be received in

time to impact the planning or decisionmaking process (Banta ana

Bauman 1976; Boyer and Langbein 1991; Falcone and Jaeger 1976;

Florio et al. 1979; Guba 1975; Leviton and Hughes 1981; Siegel and

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Tuckel 1985; Weiss 1973). In the drug abuse field, timeliness is a

particularly significant and sometimes thorny issue. Currently, most

public funds to support treatment and research activities are processed

through the State (e.g., Federal block grant dollars) or come from the

State’s own tax revenues. In either event, it is the State that makes funds

available to support new initiatives. More particularly. the drug authority

in each State typically has responsibility for constructing State budgets

and plans regarding drug abuse and for dispensing and overseeing all

funds available to the State for drug abuse services. [In some instances,

that responsibility is passed on to local administrators.) Consequently, to

impact funding decisions, new initiatives are best proposed coincident

with the State budget preparation cycle, typically a year or more before

expected implementation. To make matters still more difficult, the States

operate on different funding and budget preparation cycles. These cycles

must be considered in planning a research utilization strategy.

Perhaps a larger issue with regard to timeliness is the time that elapses

between the identification of a problem and the development and testing

of an effective response to that problem. Research is necessarily reactive.

It is a response to an identified problem. Consequently, it always runs

late. Moreover, research is a deliberative process from the point of

approval of a study for funding, if public dollars are sought, to the time of

journal publication, if that stamp of acceptability is sought. Under the

best of circumstances, an identified problem will have run a significant

part of its course before research findings can clarify an effective

response. To respond to this situation, at least in some part, NIDA has

organized both a research newsletter-“NIDA Notes”-and technology

transfer conferences. Both initiatives disseminate research findings that

may be awaiting publication. Findings are couched in a language and

format intended to make them accessible to a service delivery audience.

Clarity

Using a language and format that make findings accessible is significant

in any field in which technology transfer is sought (Argarwala-Rogers

1977; Boyer and Langbein 1991: Glaser and Taylor 1973; Leviton and

Hughes 1981: Siegel and Tuckel 1985: Smith 1988; Windle and Bates

1974), but it may be particularly significant to the field of drug abuse

(Brown 1987). The common channel for sharing research findings is the

research literature, that is, scientific journals. However, in fields such as

mental health, journals are infrequently read by professionals (Sorensen

and Guydish 1991). Journals probably are read even less frequently by

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staff of drug abuse programs. In one study of technology transfer

initiatives targeted to drug abuse treatment programs, no programs

adopted an intervention available only in the research literature (Hall

et al. 1988; Sorensen et al. 1988).

Two characteristics of drug abuse programming are worth noting here.

First, drug abuse programming-particularly drug abuse treatment

programming-has a long history of reliance on paraprofessional

treatment staff. It is likely that the field of drug abuse employs more

graduates of its own programs than any human service program other

than education. In a few instances, those graduates have risen to become

program directors. More commonly, they are key program staff in the

delivery of treatment services. Their pathway to employment and to

promotion typically has been through experience. They are unlikely to

make significant use of the professional literature.

Second, reliance on paraprofessionals mirrors the reliance placed on

experience in the drug abuse field generally. When the drug abuse

treatment field came into being a little more than 20 years ago, there was

little in the way of a collected body of wisdom. The first methadone

maintenance program was less than 10 years old, the first therapeutic

community less than 15. The field was immersed in the process of

inventing itself. National conferences were organized, first as national

methadone conferences, then as national drug abuse conferences to which

all drug abuse workers were invited and at which papers based on

experience vied successfully with papers based on empirical research.

Arguably, some of the early feeling that if “you walk the walk, you can

talk the talk” still remains in the drug abuse field.

Thus, research journals are not readily accessible, either physically or

psychologically, to drug abuse treatment staffs. Nor would they be the

best medium of exchange if they were physically present.

A number of authors (Backer 1991; Boyer and Langbein 1991; Glaser

et al. 1983; Sorensen and Guydish 1991) argue for the importance of

interpersonal contact to encourage technology transfer, and several

studies support this position (Fairweather 1980; Fairweather et al. 1974;

Hall et al. 1988; Sorensen et al. 1988; Stevens and Tomatzky 1980). The

studies by Hall and colleagues are perhaps the most instructive because

they were targeted to drug abuse treatment personnel. Hall and

colleagues (1988) report adoption rates for an innovative treatment

intervention to be 28 percent for programs receiving training at the

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program site, 19 percent for programs involved in sending single

individuals to training workshops, 4 percent for programs receiving only

printed materials (i.e., manuals), and 0 percent for programs for which

materials were available only in the research literature. Adoption rates

for some, but not all, elements of the intervention were 3 1 percent for the

site visit, 26 percent for the workshop, 6 percent for printed material, and

0 percent for research literature. Differences in adoption rates for

programs receiving a site visit or workshop were not significant, but the

adoption rates for these two methods were significantly greater than the

rates for programs receiving only printed materials or research literature.

Credibility

To make an impact on a program, the research findings must be credible

both in terms of the message and the message-giver (Braskamp et al.

1982). Several studies emphasize that research methodology must be

able to withstand inspection and critique (Boyer and Langbein 1991;

Chelimsky 1987; Patton et al. 1977; Siegel and Tuckel 1985). For

example, Lobosco and Newman (1992) report that quantitative data has

more influence on educators than qualitative data. The researcher, too,

must be viewed as credible and objective (Boyer and Langbein 1991;

Patton et al. 1977).

By the same token, the advocacy of research findings and program

change by figures influential to program staff can increase the credibility

of findings and the value placed on program change (Boyer and Langbein

1991). Indeed, Sorensen and Guydish (1991) suggest that professional

societies as well as State and national organizations should assess the

evidence for the efficacy of drug abuse treatment interventions. These

assessments would place the weight of independent expertise behind both

the research and the intervention.

Replicability

The intervention studied and found efficacious in one setting must be

viewed as replicable in other settings. Replicability is dependent on the

availability of the necessary financial and human resources (Backer 1991;

Glaser and Smith 1971; Glaser et al. 1983; Leviton and Hughes 1981).

Innovation that demands funds or personnel which exceed program

resources is likely to be ignored.

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In addition, the perceived ability to replicate an intervention depends on

the extent to which the study population and setting appear comparable to

those of the proposed transfer site. Thus, one objective of technology

transfer efforts is to demonstrate comparability to assure program staff of

the feasibility of adopting novel strategies.

Acceptability

Even when an initiative is relevant, timely, credible, and replicable,

program staff must be psychologically ready to accept the new initiative

and the programmatic change it will entail. New initiatives can be

threatening to established organizations and their staffs (Davis and

Salasin 1977; Leviton and Hughes 1981; Siegel and Tuckel 1985; Weiss

1973). Siegel and Tuckel(1985) emphasize that an entrenched

organization can have an investment in maintaining the status quo. In

general, they argue, incremental change is likely to meet less resistance

than the effort to impose more sweeping change.

Moreover, the introduction of new initiatives may be seen as questioning

the contributions and competencies of a service delivery staff who have

viewed themselves, and have been viewed by others, as capable and

productive. At a minimum, the introduction of new initiatives will

demand new learning and the development of additional work skills.

This may engender resistance in some and stimulate anxiety in many.

Those engaged in research utilization efforts should train staff in the

needed skills while reassuring them about their job performance.

RESEARCH UTILIZATION OF NIDA’S

OUTREACH/INTERVENTION INITIATIVE

In 1987, NIDA began two major initiatives designed to slow the spread

of human immunodeficiency virus (HIV) infection among injecting drug

users (IDUs). One was directed toward the treatment community and

involved support for projects investigating the efficacy of strategies

intended to make treatment more effective. The second went beyond the

boundaries of traditional treatment settings to explore the efficacy of

outreach/intervention strategies undertaken in the community and

designed to reduce risk-taking behaviors by IDUs who would not, or

could not, access treatment.

175
The latter initiative represented a sharp break with traditional treatment

and prevention programs. Consequently, to maintain funding beyond the

scheduled terminations of these demonstration programs, NIDA needed

to work closely with potential funding sources to ensure the continuation

of promising outreach/intervention projects. To this end, NIDA formed a

partnership with the National Association of State Alcohol and Drug

Abuse Directors (NASADAD) and established a committee containing

the directors of the State drug abuse authorities whose programs were

slated for the earliest termination NIDA coordinated its effort with the

Center for Substance Abuse Treatment (CSAT).

NIDA shared findings regarding its outreach/intervention initiative with

the drug abuse policymaking and planning communities through a

newsletter developed to report findings briefly and in a language free of

research jargon. The newsletter was delivered at no cost to all

organizations, State and Federal agencies, and officials interested in the

relationship between drug abuse and HIV infection, In addition, NIDA

sponsored annual meetings to report its findings and progress.

NIDA realized that it had to assume responsibility for technology transfer

efforts. Research publications, while lending credibility to the

outreach/intervention initiative, would not reach policymakers or service

providers. The essential role of translating research findings into clinical

applications had to be undertaken by the Federal agency. There simply

were no other actors with the mandate or interest to do so. At the same

time, NIDA encouraged its investigators and their staffs to contact State

drug abuse authorities to make them aware of individual programs.

Findings indicated that the outreach/intervention programs showed a

capacity to recruit out-of-treatment drug users and effected large-scale

change in their needle-using behavior and some aspects of their sexual

behavior. Three outreach/intervention models emerged as particularly

effective in modifying risk-taking behavior. (One of these models was a

compilation of several components found to be effective.) All programs

had been directed to develop implementation manuals describing the

conduct of the interventions, and NIDA worked with principal

investigators and their staffs to refine the manuals of the three most

promising models. The manuals were reviewed by service and policy

staff who were not affiliated with the program. Modifications were made

in the wording and structure as necessary. To lend credibility to the

intervention, each manual contained a brief description of the research

finding. In conjunction with NASADAD, CSAT, and the committee of

176
State drug abuse authorities, NIDA then embarked on a program of

technology transfer, making use of the manuals in association with

workshops to take potential users through program implementation.

The following discussion describes NIDA’s outreach/intervention

initiative using the six factors to be considered in research utilizations.

Relevance

The connection between HIV infection and injection drug use was well

known by the time results from NIDA’s outreach/intervention initiative

became available. Moreover, the drug abuse treatment community had,

by and large, accepted responsibility for playing a role in HIV prevention,

though that role typically was restricted to making treatment accessible

and as effective as limited budgets permitted. Indeed, the concern of drug

abuse treatment with a holistic approach to client care precluded ignoring

this latest and most significant risk to client health and survival. Moreover, health care agencies already had adopted an outreach/intervention

strategy to prevent the spread of disease through communities, and some

State drug abuse authorities had begun to adopt outreach initiatives in

relation to HIV infection. Still other drug abuse authorities had knowledge or experience regarding outreach designed to involve drug users in

drug abuse treatment.

In short, HIV infection was widely perceived as a dramatic new concern

to which the drug abuse community had to respond. The core technology

NIDA proposed-outreach/intervention-while not the preferred strategy

(i.e., not drug abuse treatment), was nonetheless known to be appropriate

and effective in containing the spread of disease and reaching out-oftreatment drug users.

Timeliness

The drug abuse community knew that time was not on their side in

meeting the challenge of HIV infection. The Centers for Disease Control

and Prevention (CDC) was reporting IDUs to be one of the fastest

growing populations infected with acquired immunodeficiency syndrome

(AIDS). Communities, particularly in the East, were witnessing dramatic

increases in rates of AIDS tied, in significant part, to the IDU population.

For most, the time to act was now; for some, the time to act was

yesterday.

177
Clarity

As has been indicated, NIDA distributed newsletters and scheduled

conferences designed to share research findings in user-friendly language

and format. The workshops it organized around successful models were

the culmination of that user-friendly effort at technology transfer. An

initial round of seven regional 1-day workshops were held with State

drug abuse authorities responding to an invitation issued jointly by NIDA

and NASADAD. The workshop was an orientation session regarding

outreach/intervention strategies found effective in NIDA’s research. In

all, representatives from 34 States and Puerto Rico attended. At those

sessions, an overview of the outreach/intervention initiative highlighted

four major points: (1) a substantial mmority of IDUs (41 percent) had

never entered drug abuse treatment, in spite of long histories of injection

drug use; (2) outreach/intervention strategies could locate tens of

thousands of out-of-treatment IDUs; (3) those IDUs were amenable to

efforts to modify their risk-taking behavior: and (4) there existed detailed

strategies that had been successful in reducing the risk-taking behaviors

of IDUs.

Each principal investigator or intervention/outreach program manager

provided manuals detailing the implementation of the model with which

he or she was associated. The presenter described the research findings

and the outreach/intervention strategy, including the resources required to

implement that strategy.

At the conclusion of the three presentations, NIDA indicated its willingness to provide State drug abuse authorities with in-State training workshops in the implementation of any or all the strategies about which they

had heard and whose manuals they now possessed. Two days would be

devoted to workshops in the implementation of each strategy chosen.

NIDA would pay for the trainers and the development of the training

workshops; the States would pay for the training facility and for travel

and accommodations for workshop participants. The State drug abuse

authorities were urged to send only those persons who held a level of

administrative responsibility that guaranteed they could develop an

outreach/intervention program if they found it appropriate to their needs.

In all, 17 training workshops were held for over 300 programs and more

than 500 participants. The training workshop was developed by an

experienced staff of trainers under contract to NIDA, the principal

investigators and their staffs, and NIDA staff. Currently, an evaluation is

178
underway to determine the nature and extent of implementation of the

outreach/intervention strategies provided.

Credibility

Efforts were made to lend credibility to the technology transfer activity

chiefly through sharing research findings, interpersonal contact with the

principal investigators and staff associated with the intervention, and the

support evident from the State drug abuse authority, NIDA, CSAT, and

CDC. In addition, NIDA (1) developed journal publication plans jointly

with grantees in the outreach/intervention program, (2) developed a

NIDA publication to report the initiative’s effectiveness (NIDA 1994),

and (3) edited a research volume describing major findings from the

outreach/intervention initiative (Brown and Beschner 1993).

Replicability

NIDA’s strategy from the outset was to encourage State drug abuse

authorities to expend scarce dollars on outreach/intervention programs to

fulfill their acknowledged responsibility to serve all drug users in the

community. Nonetheless, NIDA did not underestimate the difficulties in

having the States undertake an additional initiative. Indeed, a number of

States declined to send participants to the training workshops because

they felt unable to initiate new programs.

Two unexpected events occurred to free up Federal dollars for outreach/ intervention programming. First, in the reorganization of

ADAMHA into SAMHSA and NIDA, approximately $10 million was

transferred to CSAT as seed money for the development of an outreach/intervention program. CSAT conferred with NIDA about the

structure of that program and, as a part of its grant announcement,

stressed the importance of the three models developed in NIDA’s

program and gave information that allowed applicants and others to

obtain the manuals.

Second, in making dollars available for drug abuse treatment under the

provisions of block grant legislation for 1993, Congress required the

States to provide outreach to drug abusers not in treatment. The resulting

regulations, as promulgated by the Department of Health and Human

Services, state that “the Secretary requires the States to use outreach

models that are scientifically sound, so as to optimally maximize these

outreach programs” (Department of Health and Human Services 1993,

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p. 17064). The regulations then list the three manuals developed in

association with NIDA as “examples of scientifically sound models”

(Ibid.). The infusion of resources and the congressional mandate greatly

increased the replicability of outreach/intervention models.

Acceptability

The training workshops made use of group discussion, group exercises,

and role playing to give information on and develop experience in the

outreach/intervention strategy chosen. The goal was to make individuals

feel comfortable with the strategy (i.e., to gain acceptance of the new

initiative). Organizational readiness already had been undertaken through

work with the State drug abuse authorities. However, the use of workshop training, instead of individual site visits, meant that NIDA could not

address either organizational resistances at the local level or the nuances

involved in adapting the outreach/intervention to local conditions. As a

followup to the workshops, technical assistance through site visits was

available from principal investigators or their staffs, at the requestor’s

expense. (However, technical assistance was rarely requested.)

REMOVING SYSTEMIC IMPEDIMENTS TO TECHNOLOGY

TRANSFER

The point has already been made that the drug abuse research and service

delivery communities rarely talk to each other. It is not that they have

nothing to say. It is not always that they don’t know how to say it,

although that remains an issue. The research community, by and large,

has little interest and no incentive to communicate with their service

delivery colleagues. Rewards in the research community, in terms of

jobs, tenure, promotion, and salary, are earned through journal

publication and grant acquisition, not community service. The typical

researcher feels he or she has fulfilled all responsibility for technology

transfer by publishing findings in the research literature, despite the

shortcomings of that medium. Thus, the translation of research findings

into action steps becomes the responsibility of the funding agency.

Drawing the research community into the process of technology transfer

would require a modification in the grants process that permitted the

addition of incentives for technology transfer efforts. For example, grant

programs that, in the final year of funding, report success for a treatment

or prevention initiative would become eligible for a 1 -year supplement.

180
Those funds would be earmarked for work by the investigator and his or

her staff to develop, in conjunction with the funding agency, a detailed

manual for the implementation of that intervention as well as the planning, development, and conduct of a technology transfer strategy targeted

to appropriate audiences in the service delivery community. The decision

to award supplemental funding could be made by a committee of the

research staff at the funding agency or by a group of agency staff and

members of the agency’s grant review committees. Their decision would

be based on the adequacy of the research conducted and the robustness of

findings.

By providing research funds tied to technology transfer, the funding

agency could advance the utilization of its research findings and influence

research practice. The addition of a financial incentive could further

stimulate the involvement of some members of the research community

in areas of applied research and effect greater response by that

community to the needs and issues of the service delivery community.

Research has demonstrated that modifying rewards systems can lead to

changes in behavior.

In addition to creating a structure encouraging researcher involvement in

technology transfer initiatives, NIDA can develop the subject of technology transfer as an area of study. In spite of an expenditure of tens of

millions of dollars on many thousands of studies in drug abuse, there

remains only a single study on the efficacy of different strategies of

technology transfer with drug abuse treatment staffs. Even with the

availability of videotapes, audiotapes, and a burgeoning computer

technology, only the efficacy of technology transfer strategies based on

the print medium and interpersonal communication has been studied, and

only a minimal effort has been made in that area. In making technology

transfer the object of a research concern, the funding agency highlights

the significance it attaches to that activity.

Whether as a subject for research or as a program initiative, technology

transfer can only be facilitated through the active intervention of the

funding agency. Indeed, the commitment of research dollars to those

tasks, by an agency from which research dollars are competitively sought,

gives a clear signal of that agency’s interest in technology transfer.

181
CONCLUSION

In the field of drug abuse, the Government must take responsibility for

developing technology transfer initiatives. Separate industries of research

and of service delivery exist, and there is typically little incentive or

opportunity for the two of them to communicate. Moreover. there is no

technology transfer industry to effect that communication. Only the

Government, with its oversight and support of both research and service

delivery, can play such a role.

In accomplishing technology transfer objectives, the issues that must be

confronted are relevance, timeliness, clarity, credibility, replicability, and

acceptability of research findings for service program activity. The single

study on technology transfer in the drug abuse field suggests those issues

are best addressed by direct contact through workshops or site visits.

However, there remains a need for further research on technology transfer

to drug abuse service providers in order to develop credible and effective

strategies for allowing the clinical application of research findings.

Moreover, the use of additional incentives must be explored to draw the

research and service delivery communities into more effective partnership

on behalf of the client populations those communities have been

organized to serve.

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AUTHOR

Barry S. Brown, Ph.D.

Adjunct Professor

University of North Carolina at Wilmington

P.O. Box 1695

Carolina Beach, NC 28428

185
A Field-Based Dissemination

Component in a Drug Abuse

Research Center

James L. Sorensen and Wayne W. Clark

INTRODUCTION

Often an artificial separation exists between the professionals who are

conducting research investigations and the people who can apply these

findings in clinics. Sometimes clinical practice may be several years

behind the most current findings of research. Furthermore, research

shows relevant studies seldom reach the desks of policymakers (Millman

et al. 1990), and officials do not appear to rely heavily on policy analysis

from research organizations (Lester 1993). At the Federal level, the

commitment to disseminate knowledge has waxed and waned over the

years (Backer 1991). Signs of another upswing in both interest in, and

need for, knowledge utilization activities are visible (Backer et al. 1991).

When research areas such as drug treatment effectiveness develop

quickly, coordinating findings closely with clinical practice becomes

more important. This coordination is not always easy because researchers

and clinicians frequently seem to work in separate worlds with little time

to talk with each other. With the growth of substance abuse treatment

and research funds, a recent knowledge explosion has occurred in the

substance abuse area. Even a well-informed clinician or researcher may

have difficulty staying current in the other’s area. Consequently,

increasing calls have ensued to transfer the information and technology

between the research and clinical areas of expertise (Johnson 1993).

One approach to bridging the gap between research and practice is to

build dissemination techniques and other communications activities into

ongoing research projects. This chapter describes the implementation of

one such strategy in the field.

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SAN FRANCISCO TREATMENT RESEARCH UNIT

The functions of community liaison, policy development, and

dissemination to practitioners were integrated into the activities of a

center for drug abuse research. The setting for these activities was the

San Francisco Treatment Research Unit (TRU). The TRU was a research

center funded by the National Institute on Drug Abuse (NIDA), which

focused on reducing intravenous drug use as a means of lowering the

risks of acquiring or spreading human immunodeficiency virus (HIV).

The project’s long-term objective was to improve the effectiveness of

outpatient treatments for people addicted to opiates, cocaine, and other

abused drugs. The San Francisco TRU was created in response to a

request for applications (RFA) from NIDA. The NIDA RFA was

somewhat unique in asking respondents to combine treatment support

with research-to move the field along more quickly. A side benefit was

that the RFA brought research and treatment people more closely

together. In fact, closing the gap between researchers and clinicians was

an opportunity presented in the RFA, which stated, “The application also

should include an information dissemination plan, to assure that research

findings are communicated to the treatment field in a timely, efficient

fashion” (National Institute on Drug Abuse 1988, p. 4).

Dissemination activities were built directly into the specific aims of the

San Francisco TRU. These aims were (1) to conduct high-quality

research that evaluates innovative outpatient treatment strategies for drug

abuse as a means of acquired immunodeficiency syndrome (AIDS) risk

reduction; (2) to stimulate treatment research in associated community

clinics to improve the efficacy of outpatient treatment of opiate and

cocaine abuse: and (3) to foster collaboration and communications among

scientists and practitioners as a way to stimulate new research for

improving the efficacy of drug abuse treatment. Thus, there was an

explicit request to build dissemination activities into treatment research

units, and the San Francisco TRU proposal included an explicit and

central place for dissemination.

COMMUNITY LIAISON, POLICY, AND DISSEMINATION

COMPONENT

Following through on the preceding third aim, the TRU organized a

component that would create a link with the community, address policy

implications, and disseminate research developments to program

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professionals and scientists in the public arena. Within the TRU, the

leadership of the community liaison, policy, and dissemination (CLPD)

component was shared between the principal investigator of the TRU and

the director of San Francisco’s drug and alcohol treatment system (the

authors). They were assisted by a full-time dissemination coordinator

(a master’s level position), a psychiatrist/attorney whose involvement

writing policy analyses was part time. a policy assistant, and

administrative/clerical staff. The administrator of the TRU was actively

involved in making arrangements to allow the component to accomplish

its goals. Within the organization of the TRU, the CLPD component was

on an equal footing with research components; for example, one author

was a coinvestigator in the TRU with full participation in the TRU

Executive Committee.

Community Liaison

One activity of the CLPD component was to tie the TRU closely with the

community. The authors’ research (Sorensen et al. 1988) and that of

others (e.g., Backer et al. 1986). indicated that personal contact is more

likely than printed materials to produce the adoption of treatment

innovations. One author helped to form personal links between

researchers and the substance abuse and AIDS treatment projects.

Several activities helped to accomplish these community liaison aims.

First, community colloquia, which were aimed at reaching 35 to

100 practitioners in the San Francisco Bay area, occurred twice yearly.

The goal was not so much to showcase TRU research as to give special

attention to emerging problems that were central to the field. In the

5 years of the TRU, five community colloquia occurred. The colloquia

topics and attendance appear in table 1.

The colloquia generated considerable interest among both treatment staff

and researchers. Several policy papers stemmed from presentations at the

colloquia, with topics including chronic pain (Clark and Sees 1993; Sees

and Clark 1993) and tuberculosis (Clark et al., in process). Colloquia

also spawned at least one grant application. “Tuberculosis Chemoprophylaxis in Injection Drug Users: Methadone Treatment Versus Standard

Care.”

In addition to community colloquia, several aspects of professional

linkages and networking through interpersonal contact were designed into

this component. The dissemination coordinator often represented the

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TABLE 1. Community colloquia sponsored by the San Francisco

Treatment Research Unit.

Date Topic Attendance

4-91 Use of antidepressants in drug treatment

programs

70

11-91 Responding to recommendations of the 90

national AIDS Commission The twin

epidemics of substance abuse and HIV

5-92 Ethical issues in the treatment of 117

substance abusers with HIV disease

11-92 The tuberculosis problem with 50

substance abusing clients

4-93 The use of pain medications with 175

substance abusing clients

4-94 Substance abuse treatment in an age of 105

health care reforms

Attendance total 607

TRU at informational meetings and local conferences. The involvement

of the county drug program administrator as a broker for emerging and

new treatment issues, moreover, helped keep the TRU “on the radar” for

local policymakers.

Policy Development

The CLPD component also identified policy issues and developed

statements for programs. For example, in California, the laws about

pregnancy and chemical dependency were in flux, and the CLPD

component published a policy analysis (Clark and Weinstein 1993). This

component wrote policy articles about general treatment issues that were

disseminated to the field. During the years of the TRU, CLPD

component staff conducted several policy analyses which are listed in

table 2.

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TABLE 2. Policy analyses completed by the component.

1.

2.

Workplace drug testing (Clark 1990a, b; Clark and Sees 1992)

Chemical dependency and pregnancy (Clark and Weinstein

1993)

3. Safe use of benzodiazepines (Clark and Boatwright 1991)

4. Smoking cessation in drug treatment (Sees and Clark 1993)

5. Administration of substance abuse treatment (Clark et al. 1993)

6. Control of tuberculosis in sustance abusers (Clark et al., in

process)

Although several of these policy analyses were local in scope and, thus,

presented only at community meetings, others had national implications

and were published in professional literature. One author also

collaborated on policy analysis efforts that linked local and Federal

initiatives (e.g., Clark et al. 1993).

Dissemination Activities

One aim of the CLPD component was to disseminate research

developments to professionals, scientists and the public. Dissemination

activities focused on encouraging the adoption of innovations. The

component achieved these innovations with an annual dissemination

forum, the development of instructional videotapes, and articles about

TRU research that appeared in newsletters targeted for treatment staff.

Dissemination Forums. The TRU sponsored a forum annually about

treatment research developments for 100 to 400 San Francisco Bay Area

professionals. This conference provided updates about promising

treatment research developments, giving special attention to innovations

developed through the San Francisco TRU. The topics of these forums

follow (table 3).

The dissemination forums were consistently well attended, with 100 to

400 local treatment professionals, program administrators, legislative

staff, and others. The forums not only briefed these participants about the

current issues, they also provided a mechanism for disseminating research

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TABLE 3. Annual dissemination forums of the San Francisco Treatment

Research Unit.

Date Topic Attendance

8-90 Developments from the 6th 135

International Conference on AIDS

8-91 Psychosocial treatment of the 165

addictions: current developments

8-92 Women, substance abuse, and HIV 400

8-93 Detoxification in the age of HIV disease 130

8-94 Research and treatment developments in 220

substance abuse

Attendance total 1,050

findings from the TRU. For example, the 1993 forum featured results of

several TRU studies conducted in the innovative 6-month detoxification

research clinic (Banys et al., in press; Reilly et al., in press; Sees et al.

1993; Tusel et al. 1993). The 1991 forum resulted in a special lo-article

series in “Psychology of Addictive Behaviors” (volume ‘7, issues 2 and 3),

entitled “Psychosocial treatments of drug abuse: Current developments.”

Videotape. Development of an instructional videotape was another

dissemination activity. The original TRU proposal planned to produce

one video annually, beginning in year 2 of the grant. The purpose of

these videos was to inform practitioners about innovations shown as

efficacious in slowing the spread of HIV. The TRU is currently in the

final stages of producing a videotape, “Medical Management of HIV

Disease in Drug Treatment Programs,” which is intended for

professionals in drug abuse treatment programs, along with a companion

video that focuses on educating patients. The production of videotapes,

however, was extremely labor-intensive, and HIV terminology changed

rapidly. Based on this experience, project personnel chose to deemphasize this aspect of dissemination, focusing instead on using a science

writer’s newsletter articles directed at treatment staff.

191
Newsletter Articles. Articles in local, State, and national professional

newsletters constituted another dissemination activity. Contact with the

Science Writer Program at the University of California, Santa Cruz,

sparked the writing of newsletter articles, an idea not originally

anticipated (Wilkes 1990). Beginning in its second year, the TRU

empioyed a science writer intern-and subsequently graduates of the

Science Writer Program-to produce articles aimed at treatment staff.

These articles featured research findings from the San Francisco TRU and

other laboratories, written in lay person’s language. To date seven

articles have appeared in newsletters directed to counseling staff and

policymakers (table 4). These articles have been intended for a broader

audience than those of Journal publications: they extended the reach of

publications by making a wider variety of practitioners aware of research

developments.

TABLE 4. Newsletter articles by science writer and interns.

Topic

Antidepressant shows promise in

decreasing cocaine use

HIV disease in methadone

maintenance therapy

NIDA creates unique centers to

study drug abuse treatment

Relapse

Reducing risk among female

partners of injection drug users

Researchers make strides in

fluoxetine/cocaine dependence

studies

Publication outlet

“Cocaine Working Group

Newsletter”

“NIDA Notes”

“NIDA Notes”

“NIDA Notes”

“Focus on AIDS Research”

“The Counselor”

Shifting bleach recommendations:

the counselor’s dilemma

“The Counselor”

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The research projects used as topics for the science writer’s articles were

selected through an organized process that first screened to select only

published or “in press” articles. Those articles with a combination of

applicability to the field and likelihood of reaching large audiences

through their publications were then featured. These newsletter articles

helped to redistribute information about the TRU. Some were picked up

and further distributed in other newsletters, for example, “Invest”

published by NIDA.

CONCLUSIONS: TAKING RESPONSIBILITY FOR

TECHNOLOGY TRANSFER

The combined activities of the CLPD component were successful both in

fostering collaboration and communication among scientists and

practitioners and in stimulating new research about the effectiveness of

drug abuse treatment. Although the Alcohol, Drug Abuse, and Mental

Health Administration (ADAMHA) Reorganization Act of 1992

delegated to the Substance Abuse and Mental Health Services

Administration much of the responsibility for dissemination of

information on interventions known to be efficacious, the former

ADAMHA institutes continue communications about research

developments through dissemination activities. Nonprofit foundations

may be another significant source of funding for knowledge utilization

activities, as discussed by Backer and Shaperman (1993).

A need exists for research about the most effective ways to disseminate

innovations proven efficacious. One way to accomplish this task is

through sponsoring health services research, which was mandated by the

ADAMHA Reorganization Act. Field-based programs, such as the

present one, may be more timely in spreading the word locally.

Several limitations to this approach became evident. The research

enterprise moves slowly, and some frustration occurred due to the desire

to disseminate information before the results had been analyzed

thoroughly. Research does not always yield useful results that deserve

quick dissemination. Innovative research is frequently not a single

activity but, instead, a constellation of efforts leading in a certain

direction.

Similarly, one ideal of the program had been to foster two-way

communications. The component planned to have seminars involving

193
small groups of practitioners who would meet with research staff and

help scientists to plan their research ideas, with the goal of eventual

application to treatment programs” This aspect of collaboration really did

not evolve, in part because most TRU researchers are trained as clinicians

and already are familiar with the issues facing drug treatment staff.

Although interest was expressed by practitioners, most dissemination was

one way: from the TRU to the treatment community.

An additional limitation worth mentioning is dissemination requires

effort. Scientists may have heard complaints about their working in an

ivory tower, or they may have been chastised for publishing in obscure

research journals rather than in outlets aimed at the public. When the

CLPD component began approaching newsletters, the authors’ belief was

naive-if the TRU showed interest in disseminating research, the world

would beat a path to their door. This belief was far from reality.

Newsletters have their own editors, editorial boards, writers, and

publication lags. Acceptance of an article in a good newsletter can be as

difficult as acceptance in a reputable academic journal. The public

system is equally as competitive as academia, and academicians are on

unfamiliar turf.

The community liaison policy and dissemination activities of the San

Francisco TRU are only one example of what could be accomplished in

bringing research and the treatment communities more closely together.

Many other aspects of dissemination could be incorporated into programs

such as this one with sufficient resources. For example, the Center for

AIDS Prevention Studies in San Francisco has made excellent inroads

into teaching community-based organizations to conduct research about

important social problems as they affect the prevention of AIDS. In

addition, the TRU had a local focus. If a national program such as NIDA

or the National Institute of Mental Health provided more centralized

resources for dissemination of findings of their treatment research centers

and other research projects, doing so would be useful. NIDA has begun

one such program with its Community and Professional Education

Branch (David 1991). Continuing such efforts to promote wide adoption

of drug abuse research findings is important.

The authors emphasize that, given the opportunity, researchers can

integrate dissemination as a principal part of their research. This

procedure can shorten the distance between researchers and practitioners.

194
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Backer, T.E.; Liberman, R.P.; and Kuehnel, T.G. Dissemination and

adoption of innovative psychosocial interventions. J Consult Clin

Psychol 54:111-118, 1986.

Backer, T.E.; Salasin, S.E.; and Rich, R.F. Federal policy and knowledge

utilization: Issues for the new decade. Knowl Creat Diffus Util

12:220-224, 1991.

Backer, T.E., and Shaperman, J. Knowledge utilization and foundations

supporting health research and demonstrations: Initial explorations.

Knowl Creat Diffus Util 14:386-400, 1993.

Banys, P.; Tusel, D.J.; Sees, K.L.; Reilly, P.M.; and Delucchi, K.L.

Low-(40 mg) versus high- (80 mg) dose methadone in a 180-day

heroin detoxification program. J Subst Abuse Treat, in press.

Clark, H.W. The medical review officer (MRO) and workplace drug

testing. J Psychoactive Drugs 22:435-455, 1990a.

Clark, H.W. The role of physicians as medical review officers in

workplace drug testing programs: In pursuit of the last nanogram.

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drugs: The pharmacist’s duty to counsel. Am J Hosp Pharm

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Clark, H.W.; Nelson, L.J.; Sees, K.L.: and Sorensen, J.L. Ethics, public

policy, and the control of tuberculosis among substance abusers. In

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ACKNOWLEDGMENTS

This work was supported by National Institute on Drug Abuse grant no.

R18DA06097.

196
AUTHORS

James L. Sorensen, Ph.D.

Substance Abuse Services-Ward 93

UCSF at San Francisco General Hospital

1001 Potrero Avenue

San Francisco. CA 94 116

Wayne W. Clark, Ph.D.

Director

Community Substance Abuse Services

San Francisco Department of Public Health

1380 Howard Street, 4th Floor

San Francisco, CA 94103

197
Technology Transfer in the

Criminal Justice Field:

Implications for Substance Abuse

Paul Gendreau

INTRODUCTION

This chapter sets out to accomplish three things. First, it makes the case

that there has been a failure in technology transfer from the criminal

justice to the substance abuse field. Second, it suggests that one of the

root causes that challenges technology transfer in this instance is a

phenomenon known as knowledge destruction. Examples of how

knowledge destruction functions in the criminal justice area and may

apply to the substance abuse field are provided. Third, it outlines

strategies for combating knowledge destruction and effecting technology

transfer at the organizational and Individual levels.

TECHNOLOGY TRANSFER FROM CRIMINAL JUSTICE TO

SUBSTANCE ABUSE

The grounds for suggesting that the dissemination of knowledge has not

been readily transferred from the criminal justice to the substance abuse

literature requires some background. The author was involved in the

“addiction-prone” personality debate of a quarter century ago. (For a

summary of some of the classic studies in this regard, see Shaffer and

Burglass 1981). The author’s contention at that time was that the

psychodynamics of drug addicts who had serious involvement with the

law were, to all intents and purposes, indistinguishable from that of other

offenders. While it is recognized that the proposition that drug addiction

is simply a result of a criminal lifestyle, attitudes, and beliefs likely will

never be adequately resolved empirically (Nurco et al. 1985; Speckart

and Anglin 1986), the consensus now is that antisocial values and

behaviors form a very significant component of most substance abusers’

personality makeup (Nathan 1988; Nurco et al. 1993).

Given that there is such a substantial overlap between the clientele served

by both systems, it seems odd that, for so many years, the criminal justice

198
offender assessment and treatment literature has been virtually ignored by

substance abuse treatment professionals. Indeed, the gulf between the

two fields still exists. At the practitioner level. indications of failure of

technology transfer have been further reinforced by a detailed program

evaluation of 101 offender substance abuse programs in Canada, where it

was found that only 10 percent of the programs received a passing grade

on their knowledge of offender assessment and treatment techniques

(Gendreau et al. 1990). In addition, the author’s recent review of the

substance abuse literature for developing programs for substance-abusing

offenders in prisons revealed only three substance abuse research groups

cited the relevant criminal justice findings in the professional journals.

The basis for making an issue in this matter is that the criminal justice

literature has generated an ample database of several hundred studies

attesting to the fact that criminal behavior can be predicted with a

reasonably high degree of accuracy (70 to 85 percent range). As a result,

some very useful classification methodologies and psychometric

assessment instruments have been developed for various purposes

(e.g., predicting violence and general recidivism). In addition,

researchers have uncovered several principles associated with successful

and unsuccessful offender treatment programs. These principles are

based on just over 400 studies that employed true experimental designs or

matched/comparison groups controls. Successful programs reported

reductions in criminal behavior ranging from 20 to 60 percent for 1 - to

2-year followups.

The aforementioned literature has been published in well-recognized

periodicals and texts and dates back about 15 years (Gendreau and Ross

1979; Palmer 1978; Ross and Gendreau 1980), with periodic updates

appearing over the ensuing years (Andrews and Bonta 1994; Andrews et

al. 1990; Cullen and Gendreau 1989; Garrett 1985; Gendreau and Ross

1984, 1987; Gendreau et al. 1994; Lipsey 1992; Loeber and StouthamerLoeber 1987; Palmer 1992). Since 60 to 70 percent of all offenders have

past or current substance abuse histories, and substance abuse is also a

potent predictor of criminal behavior (Gendreau et al. 1995), surely some

of this knowledge base is deserving of transfer to the substance abuse

area.

199
THE CHALLENGES OF KNOWLEDGE DESTRUCTION

The obvious question is, Why has this knowledge not been transmitted to

the substance abuse field? Two likely reasons that account for this state

of affairs are self-evident. Brown has discussed these in a contribution to

this volume. First, many substance abuse treatment personnel are

paraprofessionals who “walk the walk and talk the talk” and are not

inclined to read their own professional journals, let alone that of another

discipline. Second, it is simply a matter of personal contact. What

people know often is determined by who they know and the system in

which they work. For example, of the three aforementioned research

groups, the senior researcher from each of these has had longstanding

professional contact with the author, and two of them initially began their

careers studying offender samples. Members of the substance abuse field

have little personal contact with criminal justice professionals.

There is, however, another rationale that prevents technology transfer. It

has become prevalent in the social sciences and the humanities and is

commonly known as theoreticism (Crews 1986); this chapter will focus

on a component of it called knowledge destruction (Andrews and

Wormith 1989). The illustration of the principles of knowledge destruction will be taken from the criminal justice field, specifically the topic of

offender assessment and treatment. After presenting the knowledge

destruction justifications, this chapter will discuss the possibility that

knowledge destruction may contribute to the reluctance of the substance

abuse field to incorporate the relevant criminal justice literature.

Knowledge Destruction: Definition

Essential to understanding how knowledge destruction works is

recognizing the fact that information can be accepted or rejected

according to the personal values of the observer. Personal values,

obviously, emanate from one’s identity and the social and cultural context

one lives in. Information sources can be very circumscribed, and it is

easy for a person to accept only a limited set of ideas that reinforces those

existing set of values and beliefs that are comfortable and nonthreatening.

Therefore, it is not surprising that deductive, rather than inductive,

reasoning becomes the preferred choice of logic for assessing facts.

Positivism is derided. This is the essence of theoreticism (Crews 1986),

and it is a very seductive process. Knowledge destruction, in turn, refers

200
to the specific pseudoscientific arguments used by theoreticists to

discount research findings not to their liking (Andrews and Bonta 1994).

Knowledge Destruction: The Historical Context and How It

Functions

Before specifying how knowledge destruction works in the offender

assessment and treatment area, one must appreciate the fact that

knowledge destruction does not exist in a vacuum. Understanding the

historical context is crucial in this regard. Within the criminal justice

field the historical context is as follows (Andrews and Wormith 1989).

Shortly after World War II, criminology became an independent

discipline and embraced sociological conceptualizations of mankind and

society. Biological and psychological explanations of criminal behavior

were looked upon with suspicion, even ridiculed (Jeffery 1979; Rowe and

Osgood 1984). According to Hirschi, who generally is regarded as the

preeminent sociological theorist on crime:

[T]he thrust of sociological theory has been to deny the

relevance of individual differences.. . [The] thrust of

criticism has been to discount research findings

apparently to the contrary. Devastating reviews of the

research literature typically meet with uncritical

acceptance.. .[N]ew criminologies are constructed in a

research vacuum (Hirschi and Hindelang 1977,

pp. 571-572).

These themes are still current today in many standard criminological

textbooks.

The motives behind knowledge destruction were both professional and

moral. They were professional in that much of sociological theory

posited that political economy and social location (i.e., offenders’

parents’ socioeconomic status, education level) are the best predictors of

criminal behavior, and they were moral in that if offenders are thought to

have defining characteristics on various psychological dimensions, then

the potential for abuse by the system exists. The reasoning is that if

offending behavior can be predicted, then offenders will be unfairly

targeted not only for criminal justice processing but also for treatment.

As the long-time editor of one of the influential criminological journals

said, “[P]sychobiological arguments are bleak in their implications,

201
leading to . penological policies of repression and terror” (Gibbons

1986. p. 5 10). In short. the prediction of criminal behavior is fruitless,

delinquents are not different from anybody else (Schur 1973), and

treatment does not work (Martinson 1974)!

What then are the types of arguments that have been forthcoming from

knowledge destruction to support the antiprediction and antitreatment

views? The following are the most popular that the author has collected

over the years from debates in the published literature, in public forums,

and from the persuasive writings of Gottfredson (1979), Andrews and

Bonta (1994). and Andrews and Wormith (1989). There are two

categories of knowledge destruction arguments: methodological and

philosophical.

Methodological Knowledge Destruction Arguments

1.

2.

3.

4.

5.

6.

Appeal to faulty theory: No theory can explain all the findings from

a set of studies.

Contaminate the treatment (e.g., the positive effects of treatment are

only due to the personal skills of the therapist or some other nontreatment-specific factor).

Stress the criterion problem: Why was not another outcome measure

used (e.g., self-report of criminal behavior rather than rearrest)?

Emphasize potential errors in measurement (e.g., no one measure of

criminal behavior is absolutely reliable or valid, followup periods are

too short).

Treatment effects are not large enough. Reductions in recidivism of

30 percent, which are frequently reported, are closer to 0 percent than

100 percent.

Many of the current reviews of the predictors of criminal behavior

and treatment of offenders that are positive are based on metaanalytic analyses. This type of analysis is dismissed as statistical

gymnastics.

202
Philosophical Knowledge Destruction Arguments

1. Massive efforts to deal with crime have failed. To think otherwise is

to live in a chimerical and utopian world. The problems are

intractable.

2. Treatment involves a monopoly of values and requires more control

than absolute freedom. Treatment is hypocrisy flourishing under a

cloak of benevolence.

3. The positive results of treatment may not be found in later years as

the social context of knowledge changes.

4. Evidence is needed that is better than that generated by contemporary

social science: Centuries of human experience have been ignored.

Finally, the classic knowledge destruction argument is that findings that

have demonstrated offender treatment programs reduced recidivism were

based on the fact that the designers of the programs wrote the published

reports themselves (Bailey 1966).

These arguments demonstrate how antiscience and antiprofessional

knowledge destruction can be. Each knowledge destruction argument

readily dismisses data that does not appeal to one’s preferred construction

of reality. Moreover, since certain professions are associated with the

generation of specific types of information (e.g., psychology and

behavioral interventions), the credibility of professional training also is

thrown into doubt.

The author believes that the implications of the aforementioned arguments are considerable and that knowledge destruction has contributed to

the “MBA syndrome” of criminal justice management. According to

Hamm and Schrink (1989), the new generation of prison and probation

administrators are generalists with little or no training in the helping

professions or are outright political appointees who cannot contribute a

well-reasoned, empirically based body of relevant knowledge to the

issues at hand. The consequences can be dismal indeed. Struckhoff

(1978, p. 337) put it bluntly: “A correctional system without a highcalibre professional component is basically a fraud...[S]ome states have

foundered so badly they have given up.” Indeed, many criminal justice

jurisdictions have totally abandoned any intelligent approach to

203
assessment and have embraced “get tough” policies that have been more

costly and had no effect on offenders’ recidivism (Gendreau et al. 1993).

In conclusion, policymakers and administrators who have little expertise

in the criminal justice field may be particularly resistant to acquiring new

knowledge. Not only can the prospect be personally threatening, but the

discipline needed and time required to obtain the necessary knowledge

may be beyond the capacity of most.

Implications for the Substance Abuse Field

The existence of knowledge destruction arguments in the criminal justice

field. however. does not mean they necessarily occur to the same extent

in the substance abuse field. The indepth analysis needed to answer this

question probably has not been carried out. Therefore, the author’s thesis

is tentative and rests on the intuition that, if pressed, some substance

abuse professionals who resist technology transfer from the criminal

justice area, or any other area, would employ variations on several of the

themes noted above. Methodological arguments 1, 3, 5, and 6 and

philosophical arguments I and 3 would be the most likely candidates in

this regard.

The next question is whether knowledge destruction affects policy in the

substance abuse field. Again, the author suspects that it does and that the

MBA syndrome also applies, but possibly to a lesser extent because of

the history of the medical model in the addictions area. On the other

hand, there is a large paraprofessional component in the field. The

substance abuse area has become highly political, so it is plausible that

there may be a sizeable coterie of poorly informed policymakers. It is an

issue that demands some sort of empirical enquiry.

STRATEGIES FOR ENABLING TECHNOLOGY TRANSFER

This section provides a brief outline on how the author and a colleague

have attempted to disseminate knowledge at the organizational level in

the criminal justice area. The criterion for success was whether the team

was able to assist agencies to establish new programs or procedures that

lasted for at least 2 years after the consultation was completed. The

agencies were in the prison. parole, community corrections, and police

bureaucracies. It should be noted that knowledge destruction probably

was not a major problem, if at all, in come of the settings. It is left to the

204
reader who is immersed in substance abuse issues to judge the applicability of these findings to encouraging technology transfer in his or her

sphere.

In 1979 the team reported on its first 19 attempts at technology transfer

(Gendreau and Andrews 1979); currently 65 case studies have been done.

It must be emphasized that the following guidelines are based on

subjective, retroscopic assessments of the reasons associated with

successful versus unsuccessful attempts at technology transfer. Also, it is

not possible to pinpoint cause and effect because the factors at play

covaried. Generally, however, the attempts were successful in the

majority of cases when the following criteria were met:

1. The team was action-oriented and worked intimately in a hands-on

fashion with agency staff in establishing and maintaining the program

for a period of time. Agency staff took ownership of the process in

fairly short order.

2. The agency had a senior administrator who identified with and

championed the changes.

3. The initiatives for change did not come from the top down in a

heavy-handed manner.

4. The sociopolitical and program values of the agency and the team

were moderately congruent.

5. The new initiatives were cost-effective and sustainable, and funding

came from within the host agency.

None of the above could have occurred unless, at the individual level,

practitioners had heard of the information in the first place. Therefore,

the team has continued its efforts to assist technology transfer by

promoting the accessibility of its knowledge base to the practitioner. The

methods the team uses have changed little over the years (Gendreau and

Andrews 1979). The most important of these are oral presentation

methods such as workshops and nonacademic conference presentations;

the use of professional associations to lobby for changes; universitybased training programs; and encouraging responsible, professional

media coverage. The team also publishes extensively in a variety of

forums in a style that is accessible to those practitioners who rarely scan

research journals. The team may also be reaching policymakers, if the

205
requests for information and consultations are a reliable index. Surveys

have reported that policymakers receive most of their information from

newsletters, digests. and the media (Light and Newman 1992).

These activities are tremendously time consuming but, so far, the team

has found no shortcuts. In this regard the author believes the team has

much in common with other contributors to this monograph (Backer, this

volume; Clark, this volume) who have accomplished technology transfer

in their respective fields

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AUTHOR

Paul Gendreau, Ph.D.

Professor of Psychology

Department of Psychology

University of New Brunswick

P.O. Box 5050

Saint John, New Brunswick E2L 4L5

Canada

208
Creating Strong Attitudes: Two

Routes to Persuasion

Richard E. Petty

INTRODUCTION

Numerous attempts have been made to produce changes in the drug use

behavior of individuals by providing information about the undesirability

of drugs and the potential harmful consequences associated with them.

For example, the U.S. Government has sponsored multimedia antidrug

campaigns, such as “Cocaine, the Big Lie,” developed by the National

Institute on Drug Abuse (NIDA) (Forman and Lachter 1989), and local

school and police organizations routinely conduct influence programs in

small-group settings (e.g., Project DARE) (DeJong 1987). In addition to

influencing the drug use of individuals, it might also be important to

change the drug treatment behavior of professionals in the field when

new treatment methods are developed. What does the accumulated

literature in social psychology say about changing the behavior of

individuals, whether they are drug users or drug treatment professionals?

Social scientists have identified a number of factors that serve as

determinants of behavior (Bandura 1986; Fishbein and Ajzen 1975;

Triandis 1980). Among the most important factors are:

• A person’s attitudes and goals,

• Perceptions of the attitudes of others (norms),

• Feelings of self-efficacy and actual competence, and

• Prior behaviors and habits.

This chapter focuses on the first of these factors, a person’s attitudes.

Changing individual attitudes is important for several reasons. First,

attitudes often have a direct impact on people’s behaviors. Second, if the

attitudes of a large number of individuals change, then societal norms

presumably will change as well. Normative pressure can produce

behavior change even if an individual’s own attitudes do not change.

Third, unless people’s attitudes are changed, they may lack the

motivation necessary to acquire the new skills or break the old habits that

allow new behaviors to occur.

209
Among the attitudes relevant to drug abuse prevention are attitudes

toward (1) oneself (e.g., low self-esteem may contribute to drug use),

(2) authority figures (e.g., parents, Government officials, and teachers

who eschew drug use or who advocate new treatment approaches),

(3) peers (e.g., friends and colleagues), (4) the drugs themselves (e.g., are

they seen as harmful or exciting?), and (5) new drug treatment programs

(e.g., are they seen as beneficial or ineffective’?). The attitude construct

has achieved a preeminent position in research on behavior change

because of the assumption that a person’s attitude is an important

mediating variable between the acquisition of new knowledge and

behavioral change. For example, initial drug abuse prevention efforts

were often based on the view that providing the facts about drugs would

lead to dislike of drugs and behavioral avoidance (Moskowitz et al. 1984;

Wallack and Corbett 1987). In fact, assessments of drug prevention

efforts sometimes have focused on the new knowledge acquired rather

than on attitude and behavior change per se. However, knowledge

change in the absence of attitude change is unlikely to result in behavior

change.

Over the past 50 years, numerous theories of attitude change and models

of knowledge-attitude-behavior relationships have developed (Eagly and

Chaiken 1993; Petty et al. 1994). There are a number of ways to

integrate the thousands of studies on attitude change in the social

psychological literature. One such approach, made popular by McGuire

(1985, 1989), is presented in this monograph (McGuire, this volume).

The present chapter outlines an alternative approach to organizing the

persuasion literature.

THE ELABORATION LIKELIHOOD MODEL OF PERSUASION

The goal of any psychological theory of attitude change is to explain how

different variables, such as those associated with the source of the

message (e.g., expertise), the message itself (e.g., number of message

arguments), the recipient (e.g., intelligence), or the persuasion context

(e.g., presence of distractions) influence the amount of attitude change

produced. That is, by what psychological mechanisms do certain

variables have their effects? The Elaboration Likelihood Model (ELM)

of persuasion (Petty and Cacioppo 1981, 1986), which is depicted

schematically in figure 1, attempts to provide an integrative framework

for understanding the antecedents and consequences of attitude change.

210
FIGURE 1. The Elaboration Likelihood Model of persuasion. This

figure depicts the antecedents and consequences of

central and peripheral routes to attitude change.

SOURCE: Adapted from Petty and Cacioppo 1986.

211
At its most rudimentary level, this model suggests that there are basically

two relatively distinct routes to persuasion, the central route and the

peripheral route. Many of the prior theories of attitude change focused on

either one or the other of these routes. Understanding these routes is

important, according to the ELM, because important consequences

depend on which route to persuasion is followed. This model also

suggests that attitude change is accomplished by variables that invoke one

of a finite set of psychological processes.

Central Route

According to the ELM, the central route to persuasion involves effortful

cognitive activity whereby the person draws upon prior experience and

knowledge to scrutinize and evaluate the issue-relevant arguments

presented in the communication (regardless whether the source is the

mass media or a friend, parent, colleague. or teacher). Under the central

route, the person actively evaluates the message. relates it to his or her

own life, and generates favorable or unfavorable thoughts in response to

it. For this to occur, the person must possess sufficient motivation and

the ability to think about the merits of the information. Many variables

can influence a person’s motivation to think about a message, such as

whether the message is perceived to be personally relevant (Petty and

Cacioppo 1979a). In addition, many variables can influence a person’s

ability to think about a message, such as how much distraction is present

in the persuasion context (Petty et al. 1976). If a person is both motivated

and able to think about the underlying arguments in a message, this

careful and systematic processing will result in an attitude that is well

articulated and integrated into the person’s belief structure.

Peripheral Route

In stark contrast to attitude change under the central route, some theories

of persuasion place little credence on the arguments in a message or on

issue-relevant thinking. Instead, they postulate a peripheral route

whereby simple cues in the persuasion context either elicit an affective

state, such as happiness, that becomes associated with the advocated

position, as in classical conditioning (Staats and Staats 1958), or trigger a

relatively simple inference that a person can use to judge the validity of

the message. For example, a message from an expert can be judged by

the inference that experts are generally correct (Chaiken 1987) without

the need for the recipient to devote much effort to assessing the actual

merits and implications of the information. Public service

212
announcements attempt to use this strategy when they rely on the

audience accepting a conclusion simply because it is associated with a

well-liked celebrity or sports figure. Peripheral approaches can be very

effective in producing changes in attitudes, at least in the short term.

To illustrate the two routes to persuasion, consider the results of an

experiment in which researchers varied the quality of the arguments in a

persuasive message and the variable that served as a peripheral cue-the

expertise of the message source (Petty et al. 1981). The subjects in this

study-college students-received one of four messages: (1) a message

with compelling arguments presented by an expert source, (‘2) a message

with specious arguments presented by an expert source, (3) a message

with compelling arguments presented by a nonexpert source, or (4) a

message with weak arguments presented by a nonexpert source. The

message was easy to understand and was presented without any

distractions. Thus, all of the recipients were able to think about the

message if they desired. However, the experiment manipulated the

motivation of the students to think about the message they received by

leading some of them to believe that the proposal, which advocated a

change in an important university regulation, would take effect next year

and, therefore, would have an impact on all current students. Other

students were told that the proposal would not take effect for 10 years,

which meant it would have no implications for current students. When

the message was highly relevant to the students, their attitudes toward the

proposal were based on the quality of the arguments in the message. The

expertise of the source made little difference. That is, when the message

was highly relevant, subjects followed the central route to persuasion and

carefully evaluated the merits of the issue-relevant information presented.

However, when the message was irrelevant, attitudes were not influenced

by message quality, but by the salient expertise cue. These lowinvolvement subjects followed the peripheral route to persuasion (see

figure 2). Many such simple cues have been shown to be highly effective

in changing attitudes when people are either unmotivated or unable to

think about the message. These cues can be associated with the source of

the communication (e.g., attractiveness), the message (e.g., the mere

number of arguments it contains), the message recipient (e.g., what mood

the person is in), or the persuasion context (e.g., the presence of rewards)

(Petty and Cacioppo 1986; Petty et al. 1994).

In sum, a number of variables that are potentially under the control of

health professionals constructing drug-relevant communications can have

an impact on persuasion by influencing a message recipients’ motivation

213
FIGURE 2. Personal relevance and the route to

persuasion. This figure shows that when

personal relevance is high, uttitudes are

more influenced by the quality of the

arguments than when relevance is low (top

panel). However, when personal relevance

is low, attitudes are more influenced by the

expertise of the source than when relevance

is high (bottom panel).

SOURCE: Adapted from Petty et al. 1981.

214
or ability to think about the communication. In addition to variables such

as the personal relevance of the message or the presence of distractions

that tend to affect information-processing activity in a relatively objective

manner, some variables are important because they influence the nature

of the thoughts that come to mind. Sometimes these variables influence

the nature of the thinking that takes place by introducing a systematic bias

to the information-processing activity. For example, telling a highly

involved audience that a message is attempting to persuade them

motivates active resistance and counterarguing rather than objective

processing (Petty and Cacioppo 1979b). On the other hand, when people

are motivated to think and are in a pleasant mood, they are biased toward

generating favorable rather than unfavorable thoughts (Petty et al. 1993).

Finally, in addition to variables influencing the amount or nature of

information-processing activity, variables also can serve as simple cues

inducing change without much effortful thinking about the substantive

merits of the information provided.1

Consequences of the Route to Persuasion

Why does it matter if a particular variable induces attitude change by the

central route (i.e., by increasing the likelihood of thinking about the

substantive merits of a particular position) or by the peripheral route

(i.e., by serving as a simple acceptance cue)? The ELM holds that the

route to persuasion is important because attitudes formed or changed by

the central route tend to have different consequences and properties than

attitudes modified by the peripheral route (Petty et al., in press). For

example, central route attitudes are more accessible than peripheral route

attitudes-that is, they come to mind more quickly. Because these

attitudes come to mind easily and are typically accessible upon the mere

presentation of the relevant attitude object, they are more likely to

influence behavior (Fazio 1990). For example, if a person’s antidrug

attitude comes to mind spontaneously on appropriate occasions, drugs are

more likely to be avoided than if the negative attitude requires

considerable cognitive effort to be retrieved. Studies have shown that

attitudes formed or changed as a result of effortful thinking are more

predictive of behavioral intentions than attitudes formed or changed with

little thinking (Petty et al. 1983; Verplanken 1991). Not surprisingly, the

attitudes of people who are highly involved with a health issue are more

predictive of their behavioral intentions regarding the issue than are the

attitudes of people who are less involved (Hoverstad and Howard-Pitney

1986).

215
Research also suggests that attitudes formed by the central route are more

persistent over time and more resistant to counterpersuasive attempts.

For example, two studies (Haugtvedt and Petty 1992) produced similar

attitude changes in people who differed in their need for cognition. Need

for cognition is measured by having people respond to a scale developed

to assess individual differences in the tendency to engage in and enjoy

effortful cognitive activity (Cacioppo and Petty 1982). In each study, all

participants were presented with a message containing strong arguments

presented by a credible source. Individuals with a high need for

cognition and individuals with a low need became more favorable toward

the position taken in the message following exposure, but presumably for

different reasons. That is, individuals with a high need for cognition,

who characteristically enjoy thinking, were expected to change because

of then careful thinking about the strong arguments that were presented.

Individuals with a low need for cognition, who act as cognitive misers,

were expected to change because of the positive source cue. In one

study, when attitudes toward the issue were examined just 2 days after the

initial persuasive message, recipients with a low need for cognition had

returned to their original attitude positions, but those with a high need

persisted in their new attitudes. In a second study, subjects’ new attitudes

were challenged just a few minutes after they were created. Subjects with

a high need for cognition resisted the attacking message to a greater

extent than did those with a low need. Attitude change is not particularly

valuable if the new attitude does not come to mind easily, persist over

time, resist countervailing pressures, and predict behavior. Thus, attitude

changes induced by the central route are preferable to attitude changes

induced by the peripheral route.

In research on drug abuse prevention and on the diffusion of new drug

abuse programs, many source, message, recipient, and contextual

variables have been, and will continue to be, examined. The ELM notes

that it is critical to understand the processes by which these variables

work. For example, some health education programs have noted that

peer-led discussion groups can be superior to groups led by authority

figures (Jordheim 1975). Even if research demonstrates that peers are

more effective than authorities in changing attitudes, it would be

important to know if this was because a peer source served as a simple

positive cue (e.g., “I like and trust people who are similar to me”) or if a

peer source enhanced the attention to and the processing of the

substantive arguments. If peers work by serving as simple cues to

acceptance, they can be effective in the short term, but if they work by

216
increasing thinking about and acceptance of the substantive arguments

raised, then the attitude changes induced will be stronger.

USING THE ELM IN DRUG ABUSE SETTINGS

Why Knowledge or Attitude Change Need Not Produce

Behavior Change

Figure 3 demonstrates many of the ELM principles by diagramming the

reactions of six hypothetical individuals to an antidrug public service

announcement presented on television. The campaign sponsors want

young people to learn that using marijuana is dangerous because it can

lead to the use of hard drugs. The spot features a popular celebrity who

tells about two friends who were seriously harmed by drugs (Petty et al.

1991).

As depicted in the figure, person A gets nothing from the message (and

will not be considered further). Persons B, C, D, and E all understand the

gist of the message and would pass a typical recall or comprehension test

on the specifics of the communication. Importantly, current models of

persuasion such as the ELM suggest that it is unlikely that one can judge

the effectiveness of a message solely by examining the knowledge

acquired from the communication. Rather, an individual’s idiosyncratic

thoughts and interpretations of the message are critical. For example,

person B actively counterargues the message, thinking that the people

described in the message are atypical. Person C thinks that the people in

the message may be typical but that he is invulnerable to the threat.

Thus, both persons B and C dismiss the message as irrelevant to them,

but for different reasons. Persons D and E have the initial response

desired by the campaign sponsors: both come to think that drug use

could be dangerous to them. However, person D likes danger and

excitement and thinks that the drug might be desirable. Person E, who

shows the expected response of disliking danger, comes to dislike the

drug. (See Fishhein and Middlestadt 1987 for further discussion of the

role of idiosyncratic beliefs in changing attitudes about drugs.) The

important point is that only one of the four people who processed the

message and would pass a typical knowledge test showed attitude change

in the desired direction. Thus, having the motivation and ability to

process a message is not sufficient to produce attitude change in the

intended direction. The substance of the message must elicit the desired

profile of thoughts.

217
FIGURE 3. Idiosyncratic reactions to an antidrug public service announcement. The figure

depicts the possible knowledge, thoughts, attitudes, and behavior of six hypothetical

individuals in response to an antidrug television commercial.

SOURCE: Adapted from Petty et al. 1991.
Person F misses the point about the potential danger of drugs entirely

(and thus would fail the comprehension test) but does learn that the

featured celebrity does not like drugs. Because person F likes the

celebrity, she also comes to dislike the drug mentioned in the

announcement. Finally, persons E and F have the same attitude;

however, as anticipated by the ELM, some attitude changes have greater

implications for subsequent behavior than others. Person E’s antidrug

attitude, induced through the central route of persuasion, produces drug

avoidance. but person F’s antidrug attitude, induced through the

peripheral route, does not.

In short, figure 3 demonstrates that:

Attitude change can occur in the absence of the presumably critical

knowledge (person F);

The critical knowledge can be acquired without producing any

attitude change (persons B and C);

The same knowledge can lead to opposite attitudes, depending on

how people evaluate the information (persons D and E); and

Attitudes that are ostensibly the same can have different implications

for behavior (persons E and F).

This analysis may help to explain why previous research on drug

education has often found that knowledge change was insufficient for

attitude and behavior change, or that attitude change was not followed by

behavior change (Kinder et al. 1980; Rundall and Bruvold 1988).

Using the ELM To Develop Attitude Change Treatments

How can the ELM be used to develop effective persuasion treatments? A

useful first step would be to elicit peoples’ thoughts and ideas on the

topic of the persuasion attempt. These thoughts and ideas would be

content analyzed to determine why people hold the attitudes that they do.

What are the key dimensions along which the target audience assesses the

issue? What factors would likely induce resistance to attitude change?

By using these thought listings, a persuasive message can be developed

that targets the relevant beliefs.

219
Step 2 is message construction. Here, the goal is to create a persuasive

message that is compelling for the target audience. Once an initial

message is developed, it needs to be tested in step 3 by instructing a

sample of individuals from the target audience to list their thoughts about

it. These thoughts are content analyzed to ascertain which aspects of the

communication elicit favorable thoughts and reactions and which are

resisted and counterargued. Based on this analysis, the message is refined

in step 4. The goal is to produce a message that maximizes favorable

thoughts and minimizes negative thoughts when people think about it.

In step 5, ability and motivational factors are considered. Regarding

ability, the goal is to ensure that the message is comprehensible to the

target audience and is presented in an environment that is free of

distraction and that fosters thinking. This is relatively easy. Motivating

careful information-processing activity can be more challenging.

However, this can be accomplished by increasing the personal relevance

of the materials and increasing personal involvement by having people

self-generate arguments and engage in various role-playing exercises.

In the final step, the full persuasion treatment is tested to examine the

extent to which the message produces attitude change in the desired

direction. In addition, the strength of the attitudes produced should be

examined. As noted earlier, strength can be assessed in a number of

ways. For example, one can assess the extent to which the attitude is

congruent with the person’s beliefs. how stable the attitude is over time,

how well the attitude stands up to attack when it is challenged, or how

quickly the attitude comes to mind. These procedures to assess attitude

strength are especially useful when comparing two competing persuasion

treatments. According to the ELM analysis, if one persuasion treatment

produces 2 units of change in the desired direction and the newly changed

attitude is strong (e.g., stable over time, resistant to change), whereas

another persuasion treatment produces 4 units of change and the attitude

is weak (e.g., not persistent, not resistant), the former treatment will

generally be preferable. In fact, a key insight of the ELM is that

producing 4 units of attitude change through the peripheral route may not

be as desirable as producing just 2 units of attitude change through the

central route.

220
CONCLUSION

Research on social influence has progressed a long way from the early

notion that providing antidrug information alone will prevent drug use.

Social influence is a complex, though explicable. process. The extent and

nature of a person’s thoughts in response to external information may be

more important than the information itself. In addition, attitudes can be

changed in different ways (central versus peripheral routes), and some

attitude change processes result in attitudes that are more accessible,

stable, resistant, and predictive of behavior than other change processes.

NOTES

1. It is important to note that, according to the ELM, any one variable

can serve in multiple roles in different situations. For example, when

the likelihood of thinking is very low, positive mood serves as a

simple peripheral cue and increases attitude change regardless of the

merits of the arguments presented. When the likelihood of thinking

is very high, positive mood biases the nature of the thoughts that

come to mind. When other variables in the persuasion setting have

not created a very high or a very low elaboration likelihood, a

person’s mood can determine how much thinking he or she does

(Petty et al. 1994; Wegener and Petty, in press).

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AUTHOR

Richard E. Petty. Ph.D.

Professor

Department of Psychology

Ohio State University

1885 Neil Avenue Mall

Columbus, OH 43200-1222

224
Transferring Research Findings

on Persuasion to Improve Drug

Abuse Prevention Programs

William J. McGuire

INTRODUCTION

The behavioral science knowledge whose transfer is discussed here

consists of the basic research findings on persuasive communication and

social influence, a topic domain heavily studied in the social and

behavioral sciences for a half century. The area to which the basic

research findings on persuasion are to be transferred is the development

of more effective programs to prevent drug abuse.

PREVENTION AS THE BEHAVIORAL AND YOUTH AS THE

AUDIENCE FOCUS

The persuasive communication knowledge base can be applied to

reducing the drug abuse problem primarily via prevention and

particularly in youth. Most practitioners recognize that prevention is not

the only approach to solving drug abuse problems: one could aim at

supply interdiction as well as demand reduction, and demand reduction

could involve treatment of the already addicted as well as prevention in

the nonaddicted. This chapter focuses on the latter branch, preventing the

unaddicted person from getting addicted because it is a goal especially

amenable to persuasion. Once a person has become hooked on drugs (by

physiological dependency or by social lifestyle), treatment calls for oneon-one counseling, medical intervention, and social support networks.

Mass persuasion serves programs treating the addicted only in peripheral

roles such as convincing people to call an 800 helpline number to learn

about available treatment programs or convincing them to stay off drugs

once they are detoxified. In supply interdiction programs also,

persuasion is confined to limited roles such as talking some youths out of

getting involved in the street-level distribution process (but with other

youths queuing up to take the vacated places). Hence this discussion of

persuasion campaigns will be aimed at demand reduction more than

225
supply interdiction and, within demand reduction. at prevention more

than at treatment.

The high-risk population on whom this chapter focuses is youth, not

simply to stay within the mandate of the Kauffman Foundation (one of

the sponsors of this technical review), but more because the familiar

adage. “There are no old drug addicts.” has a kernel of truth. Illegal

substance abuse is a young person’s game: if people can be gotten

through youth without their getting hooked on illegal drugs they are

probably home free, drug free. Admittedly addiction to legal (prescription) drugs (e.g., Valium) often starts later in life, but in that area the

prime prevention audience is the prescribing physicians as well as the

consuming public.

A BRIDGE BETWEEN POPPER’S WORLD 2 AND WORLD 3

Over the years conferences on substance abuse have brought together two

groups: applied professionals engaged in developmg campaigns to

persuade (young) people to stay off drugs and basic researchers studying

the persuasion process. These two groups have complementary domains

of expertise whose integration seems very promising. The professional

practitioners at these meetings exhibit a remarkable command over the

facts of substance abuse, able to thumb through their printouts to answer

questions about who uses which drugs at what time of day in Newark,

NJ, or what percentage of the Chicago jail inmates arrested for various

crimes was found to have been on which drugs during the past month.

However, these practitioners tend to lack general theoretical formulations

which would facilitate their using these factual data to devise effective

abuse reduction programs. The other group of participants, the basic

researchers on persuasion. show the opposite pattern of information,

possessing a rich lore of theories relevant to prevention of drug abuse

(e.g., dissonance theory, attribution theory, theory of reasoned action,

heuristic processing theory, social judgment theory, evaluation likelihood

theory) but are unfamiliar with the realities, with the factual data on drug

abuse. Bringing together two groups of professionals who have such

complementary knowledge patterns promises a productive synthesis. The

technology transfer on which this chapter focuses involves bridge

building between these two domains of expertise.

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The Information Overload Problem

The promising synthesis is hard to achieve: The two groups of specialists

converge at these conferences from different institutional settings and

tend to return to their noncommunicating cultural worlds to continue on

their separate ways. Organizational structures can promote collaboration,

but as the highly interdisciplinary social scientist John Dollard asserted,

ultimately interdisciplinary collaboration must be achieved within one

skull. For effective technology transfer there is need not only for

institutional structures that bring the two types of specialists together, but

also for a conceptual framework that provides antidrug practitioners and

their basic research collaborators with sufficient cognitive control over

the basic research findings to allow their creative use in developing

effective prevention campaigns.

The practitioners already are burdened with mastering the facts in their

own applied area of drug abuse reduction, and so it seems too much to

ask that they also master the basic research literature on persuasion so

thoroughly as to be able to make maximum creative use of it. The basic

research literature on the persuasion process is intimidatingly rich.

“Psychological Abstracts” now summarizes about 50,000 books and

articles per year, an annual harvest that has been accumulating for over

60 years. A half-million empirical studies are now available in the

computerized databases. Samples of the “Psychological Abstracts” taken

several times over the years indicate that between 5 percent and 8 percent

of the studies reported have close relevance to social influence and

persuasion. Thus, over 25,000 persuasion studies have now accumulated,

with 1,000 or 2,000 new ones added each year. Even the basic researcher

on persuasion, for whom the vast literature on social influence is

primarily written, is able to keep up with only a small fraction of it. How

then can professional developers of programs to reduce substance abuse

be asked to keep up with this vast literature on top of their other

responsibilities?

An Informational Retrieval and Organizing Solution

A solution is suggested by Popper’s analysis of the informational

universe in terms of Worlds 1, 2, and 3. World 1 is the actual world with

which people are trying to cope, in this case the actualities of substance

abuse. World 2 is one’s own personal mastery, as an individual

prevention professional in this field, including the relevant knowledge

regarding drug abuse prevention that one can retrieve from one’s own

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cognitive repertory and personal records. World 3 is the culture’s

depository of knowledge regarding the World 1 in question, including the

World 2 knowledge in oneself and in one’s colleagues in the culture with

whom one is networked, plus the information on the topic stored in

archival depositories that one can access. For the individual practitioner

to make effective use of the culture’s World 3 scientific research on

persuasion in devising programs to reduce substance abuse, it is not

necessary to enter the 25.000 studies into one’s personal World 2 but

only to have the tools to exploit this World 3 archived information as

needed.

For the individual professional to transfer the culturally available World 3

knowledge to creative World 2 working cognition as needed calls for

three kinds of mechanisms: (1) The vast World 3 compendium of

information on social influence must be archived and made accessible

(e.g., on CD-ROM): (2) efficient search procedures must be available to

allow the prevention professional to efficiently select from this vast body

of social influence research the findings that can help solve the specific

problems met in constructing antidrug campaigns; and (3) a conceptual

framework is needed to represent the retrieved information in a form that

allows the practitioners to use it creatively to solve specific problems

which arise in developing programs to reduce substance abuse. This

conceptual framework must serve by presenting options and providing

bases for choosing among the options.

The discussion in this chapter concentrates on the third of these three

transfer mechanisms. The first two mechanisms, accessing and selecting

the needed information from data depositories, are readily available and

will be generally familiar to many readers of this monograph. For those

wishing to know more about these first two transfer mechanisms, a useful

practitioner’s handbook is the new edition of Reed and Baxter (1992).

The focus here is exclusively on the less familiar and more specific third

mechanism, namely, providing a conceptual framework that allows the

practitioner to use the retrieved persuasion information creatively. As an

organizing framework that allows the substance abuse program designer

to make good use of the basic research on persuasion, the communication/persuasion matrix is proposed.

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THE COMMUNICATION/PERSUASION MATRIX

Basic and applied antidrug abuse professionals now have access to an

informational feast in the numerous computerized databases that make

available the vast research literature, including databases such as

Druginfo/Alcohol Use and Abuse (University of Minnesota), the

Addiction Research Service (Brown University and Dartmouth Medical

School), ERIC, PsycINFO, Sociological Abstracts, and MEDLINE.

Indeed the ocean of electronically available information may leave the

researcher who has asked for information feeling like the sorcerer’s

apprentice-in danger of being inundated by the flood of literature

retrieved. Fortunately, most of the databases offer sophisticated, highly

selective search procedures, and the researcher who persists in using these

databases becomes skilled in retrieving most of the relevant studies with a

minimum of irrelevant ones. The communication/persuasion matrix is a

powerful tool both for guiding an efficient search and especially for

making efficient use of the studies once they are retrieved.

The Nature of the Communication/Persuasion Matrix

When one is faced with so intimidating a cognitive task as transferring

the vast research literature on social influence into a form that presents

useful options to designers of prevention campaigns, a useful general

procedure is to break down the formidable overall problem into

components and subcomponents that make the total task more

manageable by allowing it to be solved piece by piece. Here, as often, a

useful first cut is an input/output analysis.

Input (Communication) Variables. Inputs to the communication/persuasion process are the independent variables, the various components

and subcomponents out of which a communication campaign can be

constructed. A popular input analysis utilizes Lasswell’s (1948)

interrogative depiction of communication as a matter of who says what

via which medium to whom for changing what behavior. Information

theory jargon translates this interrogative formulation into five broad

categories of communication input variables-source, message, channel,

audience, and target behavior-each of which can be subdivided

successively as illustrated in figure 1. For example, source variables can

be divided (and subdivided) into credibility (including expertise,

trustworthiness, etc.), attractiveness (including familiarity, similarity,

liking, beauty, etc.), and power (including means control, scrutiny, etc.)

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FIGURE 1. The communication/persuasion input/output matrix.
Message variables can be divided into types of appeal, forms of

arguments, inclusions and omissions, ordering of the included material,

style, number of arguments and repetition, extremity of claim, and so

forth, each of which subcategories can be further divided.

Output (Dependent) Variables. The output (that is, the mediating and

dependent variable) side of the communication/persuasion process

consists of the chain of responses by the intended audience that constitute

the process of their being persuaded. This process can be analyzed in

various ways and at different levels of refinement-from a simple threestep analysis (reception, agreement, and action) to a fine-grained analysis

into several dozen steps (McGuire 1978). Figure 1 presents an analysis

of intermediate complexity, identifying a dozen successive output steps

that make up the process of being persuaded.

Cells in the Matrix Array. This input/output analysis of the communication/persuasion process can be organized into the matrix array shown in

figure 1, with the five classes of communication input variables (and

several levels of their subcategories) constituting the column headings

and the dozen output steps constituting the row headings. In each cell in

the rectangle formed by these columns and rows, one can enter the

relation between the cell’s column heading (one of the communication

input variables) and the cell’s row output variable [one of the dozen steps

making up the process of being persuaded). For example, if one wants to

record information about how some message-style input variable (such as

literal versus figurative speech) affects some output step such as understanding the arguments (or agreeing with them or remembering them),

one enters the obtained relation as found in past research in the cell where

these column and row variables intersect. In the case of literal versus

figurative speech one enters in the cell the obtained relations showing that

similes evoke more agreement than literal statements, and metaphors

more than similes. In this way the communication/persuasion matrix can

provide a conceptual framework that makes manageable the vast body of

basic research findings on persuasion and the social influence process and

puts this information into a form that allows efficient transferral to practitioners for use in designing programs to deter people from drug abuse.

Uses of the Communication/Persuasion Matrix

Uses in Diagnosing and Improving an Existing Campaign. The

communication/persuasion matrix has a number of uses in developing

effective programs to reduce drug abuse. First, when one is trying to

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improve an existing prevention campaign. the matrix provides a diagnostic evaluation and suggests modes of improvement. One can use the row

output steps as a checklist to analyze the campaign regarding its promise

for evoking each of the dozen response steps contributing to persuasion.

Where the campaign appears to be weak in evoking one of these output

steps, a scan of the cells in that weak output row can identify a cell entry

that indicates a large positive relation to its cell heading. This cellheading input then can be added to the campaign to evoke the initially

neglected output step.

Uses in Constructing a New Campaign. A second use is for

designing from scratch a new campaign against drug abuse. The column

input variables and subvariables of the matrix lay out the communication

components from which the new campaign can be constructed. The

adequacy of one’s initial collection of tentatively selected inputs then can

be evaluated by tracing down each of their columns of cells and using the

cell entries in each column to ascertain whether these inputs together

elicit each of the dozen needed output steps. Typically one finds that the

tentative initial set of communication inputs for the new campaign will be

deficient in eliciting one or more of the dozen row response steps needed

for persuasion to occur. Then one can scan the cell entries in the missingresponse rows to identify other column input variables whose addition to

the campaign promises to be especially evocative of the initially

neglected output response.

Uses in Retrievable Storage of New Persuasion Findings. A third

use of the matrix is to retrievably store the new findings one comes upon

as one chronically or sporadically tracks the research literature on

persuasion. Instead of accumulating an indeterminable list of relations

between miscellaneous independent and dependent variables, one can

rather store each newly discovered relation of interest in the appropriate

matrix cell constituted by the relation’s independent variable column and

the dependent variable row. Input-output matrices constitute an efficient

method of information storage and retrieval.

Uses in Identifying Areas Needing Further Research. Fourthly, the

communication/persuasion matrix is useful to policymakers charged with

funding areas of basic research that promise high transfer to areas of

applied social needs such as the reduction of drug abuse. These policymakers can use the matrix by noting blank cells as indication that little is

known about the relation between the column input and the row output

(McGuire 1994). Funding priorities then can be set to channel research

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toward relatively neglected but promising relations, in preference to

research on variables whose cell entries indicate that their relations are

comparatively well understood.

Uses in Adjusting the Level of Detail. A fifth advantage of the

communication/persuasion matrix is that its analysis of the communication inputs into various levels of components and subcomponenrs

provides a zoom search feature. This feature allows one to begin

constructing or evaluating a substance abuse prevention campaign by

analyzing it in terms of broad input categories, as shown in figure 1, in

order to get the big picture. Subsequently one can zoom in to fine-tune

the campaign in terms of various sub-subcomponent inputs once the

general line of the campaign has been laid out. For example, when finetuning the audiovisual presentation style of the communicator of the drug

abuse prevention message, one may want to assure that this speaker is

sending the right nonverbal cues to evoke the audience’s perception that

the person is credible, likable, and powerful. One can zoom in on the

“nonverbal cues” subcategory under the “channel” category in figure 1

and expand it by singling out a fuller, more refined subcategorization of

nonverbal cue inputs that project the speaker’s credibility, likableness,

and power.

For example, zooming into a more refined, fuller list of subcategories of

nonverbal cues, as shown in figure 2, the columns of the matrix remind

one that these can be visual or vocal: and that the visual can include facial

expression, posture, kinesics (gestures and other movements), proxemics

(e.g., closeness, body orientation), and adornment (e.g., clothes, hairstyle). Facial expression can be subdivided into eyes, forehead, and

mouth; eyes can include eye contact (gaze) and pupil dilation. If the

program designer’s diagnosis of the campaign has indicated weakness in

the perceived likability of the expert source being interviewed, then the

designer can look across the “perceived likability” row of the fine-grained

nonverbal cues columns of figure 2 and note that in the cell where the

“perceived likability” row and the “gaze” column intersect, the entry in

this cell indicates that likability increases as eye contact goes up from

0 percent to about 80 percent (but may decline with further contact in the

80 percent to 100 percent range, which may be perceived as threatening

rather than liking). Hence the visuals can be modified to increase the

interviewee’s eye contact toward 80 percent in order to increase likability.

However, the program designer inspecting the entries in the cells in this

“eye contact” category may note in the “perceived power” row that

perceived power goes up with eye contact while speaking but down with

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FIGURE 2. Effect of various types of nonverbal cues (column headings) on the speaker’s perceived credibility, likability,

and power (row headings)
eye contact while listening. Hence the expert source being interviewed

should look away while being questioned but maintain high eye contact

while replying. The zoom capacity given by the communication/persuasion matrix also facilitates the campaign director’s delegating meaningful

and manageable subtasks to the different members of the campaign team.

Uses in Avoiding Common Fallacies. This matrix has a sixth use in

that it saves the practitioner from several fallacies commonly made in

persuasion campaigns by exposing these errors and revealing corrective

possibilities. The final section of this chapter will review a half-dozen

such common persuasion campaign fallacies that the matrix helps

prevent.

Shortcomings of the Matrix

Deficiencies in the Column Inputs (Independent Variables). Like

other information transfer mechanisms, the communication/persuasion

matrix has weaknesses, and these appear on both the input and output

sides of the matrix. On the input side one of the problems is nonequipotentiality of the input categories. For example, the “message” category

includes many more heavily studied variables than the “channel” or

“destination” categories. Information theory shows that equipotentiality

is optimal for efficient information transmission. In this case one can

achieve such transmission by dropping to sub- or sub-sublevels of the

richer categories. A more serious input shortcoming is that many of the

input variables interact (e.g., how a “message” variable such as the level

of fear appeal will affect persuasive impact depends upon “receiver”

variables like the chronic or acute anxiety level of the high-risk

subpopulation). This interaction complication interferes with the

information-processing ideal that one should be able to concentrate

separately on each component while ignoring the other components.

Deficiencies in the Row Outputs (Mediating and Dependent

Variables). The matrix has weaknesses on the output side also. For

example, the 12 response steps listed in figure 1 exaggerate the elaborateness with which audiences usually process persuasive communications.

In many domains of life the person is likely to settle for quick-and-dirty

processing of the incoming messages. In their chapters in this monograph, Petty and Fishbein describe alternative routes to persuasion

involving fewer processing steps. It is also likely that there are direct

connections between behavioral steps shown as far apart in figure 1. It is

likely even that the commonsense sequence of steps shown in figure 1 is

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sometimes reversed (McGuire 1985). Such weaknesses in the

communication/persuasion matrix should encourage one to improve (or

even replace) the model but should not inhibit one from using the model

for what it is worth. At the least, the model saves one from a great deal

of the floundering around and from the demoralization that is likely if one

is inundated by a tidal wave of research information without having any

conceptual framework within which to process it. More important, the

matrix helps to prevent a half-dozen errors commonly made in persuasion

campaigns.

CAMPAIGN FALLACIES THAT THE

COMMUNICATION/PERSUASION MATRIX REDUCES

When they work without the guidance of a conceptual framework,

designers of persuasion campaigns-ranging from commercial

advertisers of detergents to public health professionals responsible for

drug abuse prevention programs-all tend to make common errors from

which they might have been saved by using the communication/persuasion matrix. Here half a dozen such common fallacies in persuasion

campaigns will be described, and how they can be avoided when transfer

of basic research findings is guided by the communication/persuasion

matrix will be indicated.

The Great-Expectations Fallacy

The long series of steps which constitute the row headings of figure 1

indicates that any persuasion campaign to discourage drug abuse must

accomplish the difficult task of evoking a whole series of responses, each

one of which the campaign is likely to evoke with a probability falling far

short of the 1.0 certainty level. For example. the probability that a

prevention campaign will evoke step 11 (actually refraining from drug

abuse) in the target population is the product of the probabilities of its

evoking the 10 preceding steps. Because the probability of eliciting each

step is likely to be less than 1.00, their joint probability attenuates rapidly.

For example, even if the campaign works by a peripheral route involving

only five response steps and even if one assumes the campaign’s

probability of evoking each of the five steps to be a respectable 0.50, still

the probability of an effect on the final payoff step 11, behaviorally

refraining from drug abuse, would be only 0.03.

This attenuated-effects reality, starkly revealed by the communication/persuasion matrix, helps policymakers and program constructors

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appreciate and avoid the fallacy of great expectations. The net impact of

any one campaign will inevitably be slight, and the differential effects

among competing campaigns will be even slighter, considering that this

payoff impact is on a late behavioral output step (e.g., step 11) in the

figure 1 rows. The realization that the effect size of any one campaign is

likely to be modest should not cause one to give up but rather to mount a

full-court press of multiple programs that will chip away at the problem.

Technology transfer here does not promise a rose garden but rather a

harvest after one tills the soil with sweat on the brow.

The Distal-Measure Fallacy

Another error often made in developing a persuasion campaign is to

evaluate the campaign (or one of its components), absolutely or relative

to an alternative campaign, in terms of its effect on an intermediate row

step that is quite distal from the payoff step. For example, the true payoff

response step for commercial advertisers is step 11, the public’s actually

purchasing the product. Yet when ad agencies do copy testing to choose

among alternative ads, the most commonly used measures of efficacy are

ad liking and ad recall, steps 3 and 4 in the figure 1 chain of output (row)

responses needed for a successful campaign. The campaign is evaluated

in terms of such early steps, so distal from the payoff step 11 purchasing

response, because ad liking and ad recall (steps 3 and 4) are much easier

to measure than purchasing (payoff step 11). However, if a campaign

designer does copy testing to judge the relative efficacy of several

alternative ads to deter drug abuse and uses ad recall or ad liking as the

test criterion, then he or she may find a preference ordering among the

several ads which will be reduced or even reversed by operation of the

other row steps that intervene between these two convenient but distal

steps 3 and 4 evaluation measures and the ultimate payoff step 11.

Once forewarned by the communication/persuasion matrix of the

likelihood of this distal-measure fallacy when these early row steps are

used to evaluate a persuasion campaign or choose among campaign

options, the matrix suggests a corrective: one can reduce this fallacy by

also evaluating the ad’s comparative effects on the intervening steps

5 through 10. Even when resource limitations prevent measuring these

intervening steps empirically. one at least can do thought experiments to

estimate the relative effects on the alternative options of these intervening

steps.

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The Neglected-Mediator Fallacy

Without a framework like the communication/persuasion matrix,

campaign designers seeking to transfer basic research on persuasion to

the construction of an effective health promotion campaign often

overlook the likelihood that an input variable added to the campaign to

evoke one of the needed row output responses may have the undesirable

side effect of reducing persuasive impact by interfering with another of

the figure 1 mediating responses. For example, the campaign designer

who adds a captivating musical background to the ad in order to increase

attention to and liking for the message (steps 2 and 3) tends to overlook

the possibility that the music might be a distraction that interferes with

message comprehension (step 4) or might evoke related cognitions

(step 5) that interfere with message acceptance (step 7). The availability

of the communication/persuasion matrix allows the campaign designer to

run the proposed music input through its likely effect on each of the

string of a dozen row output steps to get a fuller perspective on how the

addition will affect the bottom-line persuasive impact via mediating

response steps in addition to the interestingness step 3 that motivated its

addition.

The Compensatory Principle

Several examples have been given where input variables increase

persuasive impact via one of the mediating output steps but reduce net

persuasive impact via other output steps. Such compensatory situations

are surprisingly prevalent in the relations of communication input

variables to net persuasive impact. A personality characteristic that

makes audience members vulnerable to persuasion via one mediating

output step tends to protect them from persuasion via other output steps.

For example, a target person’s low self-esteem might make him or her

more persuadable by increasing that person’s tendency to agree with

arguments but might make the target immune to persuasion by decreasing

attention to and comprehension of the arguments.

Developers of prevention campaigns who appreciate this complex set of

interrelations can cope with (and even take advantage of) these

complexities by modifying the campaign to increase the amount of

variance contributed by the mediating step that enhances the input

variable’s impact and by decreasing the amount of variance contributed

by its inhibiting mediating step.

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The Golden-Mean Implication

The preceding compensatory postulate asserts that many campaign inputs

are related to the payoff step 1 1 effectiveness in opposite directions via

different mediating row response steps, as shown in figure 1. It follows

algebraically that, under a wide range of conditions, such campaign

inputs will have an inverted-U relation to campaign effectiveness; that is,

maximum campaign impact is achieved by setting such input variables at

an intermediate level rather than at an exceedingly high or low level.

Even a seemingly clear-cut input variable such as source status, which

might be expected to have a monotonic increasing relation to campaign

effectiveness, is likely to have an inverted-U relation such that an

intermediate level of source status tends to be optimal for persuasive

impact. Source status increases persuasive impact by making the source

seem more credible but decreases impact by making the source seem

unattractively dissimilar to the target audience and distant from the

audience’s concerns. It follows algebraically under most conditions that

a source perceived as intermediate in status (a bit higher than the

audience’s status) would have the most impact, more than either a lowstatus source or a very high-status source. In general, this golden-mean

implication of the communication/persuasion matrix reveals as fallacious

the assumption that “if some is good, more is better.” For inputs as varied

as the source’s age discrepancy from audience, or the level of fear

motivation aroused by the message, or the number of arguments

presented, a more appropriate principle is that “if some is good, more

may be too much.” A high-status source such as the U.S. Surgeon

General has high impact, but may have even greater impact if the source

takes a humanizing pratfall or has funny whiskers.

An illustrative input variable is the age gap between the high-risk target

children and the student leaders who are giving messages against drug

abuse. Assume a Kauffman Foundation Student-Taught Awareness and

Resistance (STAR) project includes a module aimed at 14-year-olds in

which student leaders advocate certain techniques for resisting peer

pressure to experiment with drugs. How old should these student leaders

be (relative to the target 14-year-olds) to maximize persuasive impact?

As illustrated in figure 3, the older the leaders are, the more expert they

would be perceived (thus tending to heighten their persuasive impact),

but also the more dissimilar to themselves they would be perceived by

these younger 14-year-old targets (thus tending to lower their persuasive

impact). Combining these two functions algebraically yields the solution

that, under a wide range of conditions, the net persuasive impact (equals

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FIGURE 3. Effects of the age of student-leader spokespersons on how they are perceived by and persuade the

14-year-old middle-school children to adopt peer-pressure resistance techniques.
probability of perceived expertise multiplied by probability of perceived

similarity) will be nonmonotonically related to the spokesperson’s age,

maximizing when the student leader is 2 or 3 years older than the

14-year-old audience, and declining as the leader becomes an age peer or

younger, and also declining as the leader becomes 4 or more years older

than the targets.

The Situational-Weighting Implication

A sixth implication of the communication/persuasion matrix allows one

to be specific about the golden-mean fifth implication which asserts that

any column input variable is likely to have maximal persuasive impact

when set at some intermediate level rather than at a very high or very low

level. The situational-weighting implication helps specify what level is

optimal. For example, the nonmonotonic relation between the input

variable and the net persuasion impact often arises because the input

variable affects message comprehension (step 4) in the opposite direction

from that in which it affects agreement (step 7). This relation is the case

for input variables as diverse as amount of eye contact, audience anxiety

level, and amount of animation used.

In such cases an analysis of the circumstances of the campaign allows one

to ascertain whether the optimal intermediate level on the input variable is

toward the high or the low end by analyzing whether comprehension or

acceptance is the main barrier to campaign effectiveness. For example, if

one is developing a campaign to help young people resist peer pressure to

experiment with drugs and one is deciding how vividly to paint the

dangers involved, one should analyze the circumstances of the campaign,

especially as regards the extent to which the main determinant of

campaign effectiveness is mastery of the peer-resistance techniques

(step 6) versus willingness to use these techniques once mastered (step 7).

If the campaign has to teach complex peer-resistance techniques, one

might better lower the message’s fear arousal because fear increases

acceptance at the expense of interfering with this difficult skill learning.

On the other hand, if the resistance skills being conveyed are easy to

grasp but require considerable motivation to be utilized, then a high level

of fear arousal would be indicated. Figure 4 shows graphically why the

level of anxiety arousal in the message that is optimal for inducing use of

resistance skills is higher when the skill is easy than when it is hard to

master.

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FIGURE 4. Optimal level of anxiety-arousal in the message as a function of whether the resistance skill being taught is

easy or hard to master.
Devising an effective persuasion campaign is often a complex and

challenging process. Utilizing these implications of the communication/persuasion matrix makes these complications more manageable by

laying them out explicitly and indicating modes of coping with them.

CONCLUSIONS

Because this monograph was initiated by the National Institute on Drug

Abuse’s (NIDA) Technology Transfer Program to identify processes for

transferring the findings of basic research to forms in which they are

maximally useful for practitioners, this chapter has focused on process

rather than content. That is, the chapter describes the process by which

the vast scientific literature on persuasive communication can be

translated into a form usable by practitioners responsible for developing

effective programs to prevent substance abuse. The chapter has focused

on process and has discussed content only in providing illustrations of the

processes. Rather than discussing the content of this literature that is to

be transferred, the chapter has focused on the communication/persuasion

matrix as a useful conceptual framework in which to array the basic

research findings on persuasion, once retrieved, so they can be applied

effectively to the process of developing effective prevention programs to

reduce substance abuse. This presentation has been limited to describing

a communication/persuasion framework that allows practitioners to

organize past and present basic research, to keep up with future research,

and to use it effectively to develop prevention campaigns, but has not

described the content of the empirical findings and of the theoretical

models that would be transferred.

Those interested in the content of the persuasion literature, in the form of

confirmed empirical relations and theoretical principles, can find illustrative content in the chapters in this monograph by Petty and Fishbein.

Also, this relevant content has appeared in other publications. The

booklength “Handbook of Social Psychology” chapter on attitude change

(McGuire 1985) summarizes most of the persuasion findings in terms of

this communication/persuasion matrix. The article in the British “Health

Education Research” journal (McGuire 1991) presents 16 guiding-idea

theories of the person that can be used to introduce motivational content

into campaigns to prevent drug abuse; that article tries to answer a

question that even Freud did not dare ask, “What do drug addicts want?”

The chapter in the recent Australian review of drug abuse problems

(McGuire 1992) describes a seven-step procedure for using these contents

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to develop public health persuasion campaigns to prevent drug abuse.

The chapter in the volume on disseminating clinical health information

(McGuire 1994) presents a detailed analysis of the social influence

process in terms of the communication/persuasion matrix and works

systematically through the input columns and the output rows shown in

figure 1 to identify a wide range of recent content advances relevant to

what a public health prevention campaign should include in order to be

effective. That latter chapter also identifies a variety of recent content

advances as being particularly deserving of funding by health agencies

such as NIDA. An overview of the recommended process for developing

a public health program is provided in McGuire (1984).

REFERENCES

Lasswell, H.D. The structure and function of communication in society.

In: Bryson, L., ed. Communication of Ideas. New York: Harper, 1948.

McGuire, W.J. The communication/persuasion matrix. In: Lipstein, B.,

and McGuire, W.J., eds. Evaluating Advertising: A Bibliography of

the Communication Process. New York: Advertising Research

Foundation, 1978.

McGuire, W.J. Public communication as a strategy for inducing healthpromoting behavioral change. Prev Med 13:299-319, 1984.

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2d ed. Hyattsville, MD: American Psychological Association, 1992.

244
AUTHOR

William J. McGuire

Professor

Department of Psychology

Yale University

11 A Yale Station

New Haven, CT 06520-7447

245
Developing Effective Behavior

Change Interventions: Some

Lessons Learned from Behavioral

Research

Martin Fishbein

INTRODUCTION

The behavioral sciences have made a major contribution to the

understanding of behavior and behavior change. This chapter

summarizes some key findings, or lessons learned, from behavioral

research that have important implications for the design, implementation,

and evaluation of interventions directed at producing behavioral change.

LESSONS LEARNED

Behavior Can Be Changed

First, research has demonstrated that behaviors that were assumed to be

difficult to change can be changed. The past 10 years have witnessed

major changes in various sexual practices among some segments of the

gay community, as well as major changes in needle-use behavior (both

cleaning and sharing) among some intravenous drug users (IVDUs).

Although the behavioral sciences cannot take credit for most of the early

risk reduction behavior changes in these populations, there is growing

evidence that well-designed interventions can be effective in producing

such change (Kelly et al. 1993). For example, Jemmot and colleagues

(1992) developed a 5-hour intervention program for African-American

adolescent males that focused on education in acquired immunodeficiency syndrome (AIDS), condom-use attitudes and intentions, and skills

training. A 3-month followup assessment revealed that, relative to

control respondents, intervention participants were more likely to use

condoms and avoid unprotected sex. At the community level, early

findings from the Centers for Disease Control and Prevention’s (CDC)

AIDS Community Demonstration Projects (CDC, in press) have shown

that using community volunteers to deliver theory-based small-media

materials (i.e., newsletters and pamphlets containing role model stories

246
designed to change beliefs, attitudes, perceived norms, and self-efficacy)

can produce significant increases in both condom use and bleaching

among hard-to-reach, high-risk populations.

Information Can Produce Behavior Change

Second, contrary to popular belief, there is abundant evidence that

information in and of itself can produce behavior change (Ball-Rokeach

et al. 1984; Fishbein et al. 1980; O’Donnell et al., in press). Although it

is quite true that providing people with knowledge about a disease and

how it is transmitted may have little or no impact on their behavior, other

types of information (e.g., about the consequences of performing the

behavior, groups who support behavioral performance, or ways to

overcome barriers to behavioral performance) can be effective. Indeed,

what the behavioral sciences can offer AIDS prevention efforts is an

understanding of the kinds of information necessary to change behavior.

Specific Behaviors

Third, the most effective interventions will be those directed at changing

specific behaviors (Fishbein 1993). Changing people’s intentions to

reach goals (e.g., to avoid AIDS, to stay healthy) or to engage in

categories of behavior (e.g., to practice safe sex, to negotiate condom use)

does not ensure change in any specific behavior. In contrast, changing

someone’s intention to perform, or not perform, a specific behavior

(e.g., to always use a condom for vaginal sex with one’s main partner, to

tell one’s main partner to always use a condom) usually will be followed

by a change in that behavior.

The distinction between goals. behavioral categories, and behaviors is not

always obvious. For example, while condom use is a behavior for men, it

is a goal for women. But even among men, condom use is not a specific

behavior but a behavioral category. That is, one does not simply use a

condom. Instead, condoms are used for given sexual activities with

specific partners, and the factors influencing the use of a condom for

vaginal sex with one’s main partner or spouse, for example, are quite

different than those underlying the use of condoms for vaginal sex with

an occasional or one-time partner or the use of condoms for anal sex with

one’s main partner. For this reason, different interventions will be

necessary to change or reinforce different condom-use behaviors.

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Immediate Determinants of Intention and Behavior

Fourth, there is a growing consensus that only a limited number of

variables need to be considered in attempts to influence or maintain

behavior (Fishbein et al. 1992). Many of these variables are contained in

three theories that influenced much of the initial theory-based behavioral

research in the AIDS arena: the Health Belief Model (Becker 1974),

Social Cognitive Theory (Bandura 1986), and the Theory of Reasoned

Action (Fishbein and Ajzen 1975).

According to the Health Belief Model (Becker 1974, 1988; Janz and

Becker 1984; Rosenstock et al. 1994), two major factors influence the

likelihood that a person will adopt a recommended preventive health

action. First, the person must feel personally threatened by the disease;

that is, he or she must feel personally susceptible to a disease with serious

or severe consequences. Second, the person must believe that the

benefits of taking the preventive action outweigh the perceived barriers

to, or costs of, preventive action.

Social Cognitive Theory (Bandura 1986, 1989, 1991) also argues that

two major factors influence the likelihood that one will take preventive

action. First, as in the Health Belief Model. a person must believe that

the benefits of performing the behavior outweigh the costs (i.e., a person

should have more positive than negative outcome expectancies). Second,

and perhaps most important, the person must have a sense of personal

agency, or self-efficacy, with respect to performing the preventive

behavior. That is, the person must believe that he or she has the skills

and abilities necessary to perform the behavior under a variety of

circumstances-that he or she can perform the preventive behavior in

question.

From the perspective of the Theory of Reasoned Action (Ajzen and

Fishbein 1980; Fishbein 1980; Fishbein and Ajzen 1975; Fishbein et al.

1991). there is one primary determinant of behavior: the person’s

intention to perform it. This intention is itself viewed as a function of

two determinants: the person’s attitude toward performing the behavior,

which is based on his or her beliefs about the consequences of performing

the behavior (e.g., his or her beliefs about the costs and benefits of

performing the behavior), and the person’s perception of the social, or

normative, pressure exerted upon him or her to perform the behavior.

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To a large extent, these theories represent a public health, a clinical, and a

social psychological approach, respectively, to the prediction and

understanding of behavior. While there is no real competitor to the

Health Belief Model in the public health domain, there are other, wellestablished, clinical and social psychological behavioral theories. For

example, in the clinical domain, the Theory of Self-Regulation and SelfControl (Kanfer 1987) has received considerable attention. Within the

field of social psychology, the Theory of Subjective Culture and

Interpersonal Relations (Triandis 1980) is often viewed as a major

competitor to the Theory of Reasoned Action.

The Theory of Self-Regulation and Self-Control (Kanfer 1987; Kanfer

and Kanfer 1991; Kanfer and Schefft 1988) describes how self-regulatory

processes (i.e., self-observation, self-evaluation, and self-reinforcement)

lead either to satisfaction with behavioral performance and continuation

of the behavior or to dissatisfaction, which in turn leads to self-corrective

action or termination of the behavior. Although more of a process than a

predictive model, the theory identifies intentions, self-efficacy, outcome

expectancies, and affective states (such as mood and emotion) as

important determinants of behavior.

According to the Theory of Subjective Culture and Interpersonal

Relations (Triandis 1972, 1977, 1980), the likelihood of performing a

given behavior is determined by intentions, habits, and facilitating

factors. Intentions, in turn, are viewed as a function of perceived

consequences of performing the behavior (i.e., outcome expectancies),

social influences (including norms, roles, and the self-concept), and

emotions.

Taken together, these five theories have developed or contain almost all

of the variables that have been utilized in attempts to understand and

change a wide variety of human behaviors. In a recent meeting of the

developers or principal proponents of these theories sponsored by the

National Institute of Mental Health (Fishbein et al. 1992), consensus was

reached on eight variables that appear to account for most of the variation

in any given behavior: intentions, skills, environmental constraints,

outcome expectancies (or attitude), norms, self-standards, emotional

reactions, and self-efficacy. Generally speaking, it appears that for a

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person to perform a given behavior. one or more of the following must be

true:

1. The person forms a strong positive intention, or makes a

commitment, to perform the behavior;

2. There are no environmental constraints that make it impossible for

the behavior to occur:

3. The person possesses the skills necessary to perform the behavior;

4. The person believes that the advantages (benefits, anticipated positive

outcomes) of performing the behavior outweigh the disadvantages

(costs, anticipated negative outcomes)-in other words, the person

has a positive attitude toward performing the behavior;

5. The person perceives more normative pressure to perform the

behavior than to not perform the behavior;

6. The person perceives that performance of the behavior is more

consistent than inconsistent with his or her self-image or that it does

not violate personal standards;

7. The person’s emotional reaction to performing the behavior is more

positive than negative; or

8. The person perceives that he or she has the capabilities to perform the

behavior under a number of different circumstances-in other words,

the person has self-efficacy with respect to executing the behavior in

question.

The first three factors are viewed as necessary and sufficient for

producing any behavior. That is, for behavior to occur, one must

(1) have a strong positive intention to perform the behavior in question,

(2) have the skills necessary to carry out the behavior, and (3) be in an

environment that is free of constraints such that the behavior can occur.

For example, if a male IVDU is committed to using bleach every time he

shares injection equipment, has bleach available, and has the skills

necessary to use the bleach, the probability is close to 1.0 that he will

bleach before sharing. Similarly, if this same person has formed a strong

intention to always use a condom for vaginal sex with his spouse, has a

condom available, does not experience strong resistance to condom use

250
from his spouse, and has the necessary skills to use the condom, the

probability again will be close to 1.0 that he will use a condom when he

engages in vaginal sex with his spouse.

The remaining five variables are viewed primarily as factors influencing

the strength and direction of intention. For example, it can be argued that

one will not form a strong intention to perform a behavior unless one first

believes that he or she has the skills and abilities necessary to perform

that behavior-that he or she can perform the behavior. In other words,

self-efficacy may influence the strength of one’s intention. Similarly, it

can be argued that one will not form a strong intention to perform a given

behavior unless one has a strong positive attitude toward performing that

behavior (i.e., unless one believes that the advantages of performing the

behavior outweigh the disadvantages). It is important to recognize,

however, that one or more of these variables may also have a direct

influence upon behavior. For example, by influencing the amount of

effort one expends, and by influencing one’s persistence in the face of

barriers, self-efficacy may have a direct impact upon behavior.

It is also important to recognize that behavioral performance can

influence one or more of these five variables. One may form a positive

intention to perform, and may in fact perform, a given behavior partly

because the person believes that performance of the behavior will lead to

a positively valued outcome. When the person performs the behavior,

however, this outcome may not occur. Clearly, this information will

influence the person’s behavioral beliefs (or outcome expectations),

which may in turn influence intentions and future behavioral

performances.

To summarize briefly, intention. skills, and the absence of environmental

constraints are viewed as necessary and sufficient for producing any

behavior. In contrast, attitudes, norms, self-standards, emotional

reactions, and self-efficacy are viewed primarily as influencing the

strength and direction of intention, although they also may have a direct

influence upon behavior. Thus, it appears that intentions are most

proximal to behavior; the other seven variables may best be seen as either

influencing the formation and strength of intentions or influencing the

likelihood that one will act upon his or her intentions.

This theoretical analysis points out the necessity of measuring intentions

prior to developing an intervention. Clearly, very different interventions

will be necessary if a person (or group) has not yet developed a strong

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intention (or made a commitment) to perform a given behavior, than if

the person has formed a strong intention but is unable to act on it. For

example, if a person has formed a strong intention to perform a given

behavior but is not acting upon that intention, the intervention should be

focused upon improving skills or removing or helping one to overcome

environmental constraints. In contrast, if a person has not yet formed a

strong intention to perform a given behavior, the goal of the intervention

should be to strengthen the person’s intention to perform that behavior.

This could be accomplished by changing self-efficacy, outcome

expectancies (or attitudes), norms. self-standards, or emotions vis-a-vis

that behavior. The issue then becomes choosing which variable to target

in the intervention.

Behavior and Population Considerations

Fifth, behavioral research has demonstrated that the relative importance

of these variables as determinants of intentions and behavior depends

upon both the behavior and the population under consideration. While

some behaviors may be primarily Influenced by attitudinal considerations, others may be primarily influenced by norms, while still others

may depend primarily on self-standards, emotion, or self-efficacy.

Similarly, a given behavior may be primarily under attitudinal control in

one population. but under normative control in another population.

For example, while normative considerations were found to be most

important in determining condom-use intentions among a sample of

sexually experienced male college students in the Midwestern United

States, these same intentions were primarily under attitudinal influence

among a comparable sample of sexually experienced male college

students in Mexico City (Fishbein 1990). Thus, an intervention that

might be successful in the United States (i.e., one directed at changing

perceived norms) would be relatively ineffective in Mexico. Only by

assessing and investigating the relationships among the eight potential

determinants of behavior can one identify the one or two variables that

most strongly influence intentions to perform-and the actual

performance or—a given behavior in a given population. These

empirically determined variables should then serve as the primary focus

of an intervention. Little will be accomplished by directing an

intervention at a given variable if the variable is unrelated or only weakly

related to the behavior one is trying to change. Given the limited

resources available for prevention programs, it is essential that

interventions focus upon changing those variables that have the greatest

252
probability of influencing the likelihood that members of a given

population will engage in the desired behavior.

Substantive Content

Sixth, in addition to varying in relative importance, the substantive

content of some of these variables also changes as a function of the

behavior and the population under consideration. It is important to

distinguish between variables that have fixed contents and those that have

variable contents. To a certain extent, this distinction parallels the

distinction between etic (i.e., universal) and emic (i.e., populationspecific) considerations. That is, for some variables (e.g., intention) item

content is fixed, and the assessment question is not what to measure but

how to best measure the construct in a given population. For other

variables, however (e.g., behavioral beliefs, perceived barriers), item

content depends upon the population being considered, and one must first

work with a representative sample of the population being studied to

determine item content.

Thus, prior to developing any fixed-item assessment instrument,

formative qualitative research utilizing standardized elicitation procedures

(Ajzen and Fishbein 1980) and focus groups (Kruger 1988) is necessary

to identify four broad classes of variables: (1) perceived outcomes of

performing the behavior; (2) relevant referents (either individuals or

groups) vis-a-vis the behavior; (3) perceived facilitators of, and barriers

to. behavioral performance; and (4) characteristics, qualities, and

attributes of people who do and people who do not perform the behavior.

In addition, it is sometimes necessary to consider a fifth class of variables,

namely, (5) action alternatives.

Outcomes are necessary for developing measures of behavioral beliefs.

Relevant referents are necessary for developing normative measures.

Barriers and facilitators are necessary for assessing both environmental

constraints and self-efficacy, and personal characteristics are necessary

for assessing self-image and violations of self-standards. Action

alternatives help identify relevant behaviors that either define a

behavioral category (e.g., safe sex) or that identify skills or courses of

action necessary for goal attainment.

As indicated above, outcomes, referents, barriers, facilitators, personal

characteristics, and action alternatives will vary from behavior to

behavior as well as from population to population. For example, while

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pregnancy prevention is clearly an outcome of using a condom for

vaginal sex, it is not an outcome of using a condom for oral or anal sex.

Similarly, while many respondents say that using a condom for anal sex

makes them feel cleaner, this outcome is rarely elicited when one is

considering condom use for vaginal or oral sex.

Of even more interest are population-specific differences. For example,

as part of the CDC’s (in press) AIDS Community Demonstration

Projects, a sample of commercial sex workers was asked to indicate the

advantages and disadvantages of always using a condom for vaginal sex

with their clients. As reported by Fishbein and colleagues (1991). while

African-American, white, and Hispanic sex workers were equally likely

to say that using a condom for vaginal sex with clients will “protect me

from AIDS and other sexually transmitted diseases,” will “prevent

pregnancy,” and will “reduce my partner’s sexual satisfaction,” some

outcomes appeared to be population specific. While the Hispanic sex

workers frequently mention that using a condom for vaginal sex “is

painful” (i.e., creates friction, can lead to urinary tract infections, can

break and get stuck inside), this outcome was rarely mentioned by

African Americans or whites. Similarly, while African-American sex

workers frequently said that using a condom would “reduce my sexual

pleasure,” this outcome was rarely given by Hispanic or white sex

workers. Finally, while white sex workers often said that using a condom

for vaginal sex with their clients “makes them last longer,” this outcome

was rarely elicited from African Americans or Hispanics. Thus, it is

essential that open-ended elicitation questions be asked within a given

population for each of the specific behaviors one is attempting to

understand.

DEVELOPING EFFECTIVE INTERVENTIONS

The above lessons learned from behavioral research have important

implications for developing behavior change interventions. It must be

realized that behavior change interventions, like vaccines, take time to

develop. Unlike vaccines, however. effective interventions must be

tailored to both the behavior and the population being considered. In the

commercial world, interventions such as promotions and advertisements

are often based on extensive market research that attempts to segment the

market, to identify the needs of consumers in different segments, and to

identify the strategies that might influence consumer behavior. In

addition, the content of promotional messages and advertisements often

254
are extensively pretested and evaluated. In marked contrast, research of

this type is rarely conducted in the development of health-related

behavior change interventions. All too often, behavior change interventions are based on intuition concerning what needs to be changed and

unverified assumptions about how these changes can be accomplished.

This need not be the case. Based on the lessons from behavioral research

outlined above, a general strategy should be followed in developing

theory-based interventions.

The first step is to obtain knowledge of the target population. Thus, it is

often necessary to begin with ethnographic research to identify the size

and mobility of this population, to determine whether there are subpopulations that should be considered, to determine where and when one can

gain access to the population (or subpopulations), to understand the

language and customs of these subpopulations, and to determine the

prevalence of behaviors that are putting these subpopulations at risk.

The second, and perhaps most important, step is to identify and define the

behavior or behaviors one wishes to change or reinforce. As described

above, interventions directed at increasing the probability that one will

reach a given goal (e.g., avoid AIDS) or the probability that one will

engage in a class of behaviors (e.g., practice safe sex) are less likely to be

successful than those directed at changing specific behaviors that are

largely under an individual’s control.

For example, among IVDUs one might focus on decreasing the

probability of sharing needles, or on increasing the probability of always

using new or sterile needles. In addition, among male IVDUs one might

try to increase condom use with main or occasional partners, and among

female IVDUs one might want to increase the likelihood that they will

tell their main or occasional partners to always use condoms. Whenever

possible, one should use epidemiological data to guide the selection of

behaviors to be changed.

Once one or more behaviors have been identified, the third step is to

conduct formative research with a representative sample of the target

population. This research should have two main goals: to pretest

measures of fixed-content variables and to identify the content of

variable-content variables. Clearly, the particular variables that one will

consider will depend upon the theoretical framework from which one is

working. Based on the lessons learned from behavioral research,

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however, this formative research should pretest items or scales designed

to assess (1) the frequency with which the behavior is performed, (2) the

strength of intentions to perform the behavior, (3) relevant skills.

(4) attitudes toward performing the behavior, (5) norms concerning the

behavior, (6) self-standards with respect to the behavior, (7) emotional

reactions to performing the behavior. and (8) self-efficacy with respect to

performing the behavior. At the same time, elicitation procedures can be

used to identify salient outcomes, referents, facilitators, barriers, and

traits. That is, respondents can be asked to indicate (1) the advantages

and disadvantages of performing the behavior: (2) individuals or groups

who would support or oppose performing the behavior; (3) barriers to and

facilitators of behavioral performance; and (4) characteristics, qualities, or

attributes of individuals who do and those who do not perform the

behavior. Focus groups can be particularly helpful in evaluating the

degree to which members of the population understand, can use, and are

willing to respond to the fixed-content items.

If the sample is large enough, statistical analyses of the relationships

among responses to the fixed-content items can be used to identify the

variables that are most closely related to intention and behavior. In

addition, analyses of differences in the open-ended responses elicited by

those who do and those who do not perform the behavior(s) in question

can help to identify specific beliefs, referents, barriers, or traits that

should be targeted in the intervention.

If time and money permit, information obtained from this formative

research can be used to construct a fixed-alternative questionnaire that

contains not only revised items to assess fixed-content variables, but also

fixed-alternative items to assess the variable-content variables.

Illustrations of items (or scales) to measure all relevant variables can be

found in the work of Fishbein and colleagues (1992). This questionnaire,

which could be used for both baseline and postintervention assessments,

can then be given to a new representative sample of the population under

consideration. Statistical analyses of the data obtained from this

questionnaire can be used to guide intervention development.

For example, if a protective behavior is being performed with low

frequency, the information obtained from this questionnaire can be used

to determine whether this is related to weak or nonexistent intentions to

perform the behavior or if it reflects a failure of people to carry out their

intentions. In the latter case, the intervention should be directed at

improving the skills necessary to perform the behavior and/or at

256
removing environmental constraints or helping people overcome those

constraints.

On the other hand, if the data suggest that strong intentions to perform the

behavior have not yet been formed, the intervention should be directed at

strengthening intentions to perform the behavior. The information

obtained from the baseline questionnaire should permit one to determine

whether this intention is most strongly related to attitudes, norms, selfstandards, emotional reactions, or self-efficacy. The intervention should

then be focused upon the one or two variables that are most strongly

related to intentions to perform that behavior.

If attitudes are most strongly related to intention, then one should try to

identify behavioral beliefs (or outcome expectancies) that distinguish

between those who have and those who have not formed intentions to

perform the behavior. For example, one might find that those who

intended to always use condoms for vaginal intercourse with their spouse

believed that this was the responsible thing to do, while those who did not

intend to use condoms did not hold this belief. Similarly, those who

intended to use condoms might believe that always using a condom when

having vaginal intercourse with their spouse will protect them from

AIDS, while those not intending to use condoms might believe that

always using a condom when having vaginal intercourse with their

spouse will not protect them from AIDS. If this were the case, a

theoretically based intervention would stress responsibility and the health

consequences of always using a condom.

On the other hand, if norms were most highly correlated with intention,

one should try to identify differences in perceived norms between those

who have and those who have not formed intentions to perform the

behavior. For example, one might find that those who intended to always

use a condom for vaginal sex with their spouse perceived that their

spouse thought they should use a condom, while those who did not hold

this intention believed that their spouse was opposed to condom use.

Similarly, one might find that those who intended to use condoms

believed that their doctor thought they should always use condoms with

their spouse, while those without this intention perceived that their doctor

thought that consistent condom use with their spouse was unnecessary.

In this case, the intervention should focus on providing information

designed to change perceptions about the expectations of spouses and

doctors.

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By using data obtained from formative research or, preferably, from the

fixed-alternative questionnaire, it should be possible to determine which

variables need to be addressed in the intervention and to identify the

particular outcome expectancies, normative beliefs, perceived barriers, or

perceived traits that need to be addressed to produce changes in intentions

and behavior. One then must develop interventions to produce these

changes. That is, one must develop interventions that provide the target

population with the information necessary to produce these changes. One

also must determine the most effective ways of delivering this information to the target population (i.e., mass media, small media, groups, or

one-on-one interactions). In addition, one must determine where and by

whom the intervention will be delivered (e.g., in clinics, communitybased organizations, other fixed-location sites, “on the streets” by

volunteers or outreach workersj. Determining how and where to deliver

the intervention also should be guided by findings from the ethnographic

research.

The final step is pretesting the intervention. Whether the intervention is

directed at improving skills, removing or helping people overcome

barriers, or changing one or more cognitive variables, one must test to see

if the intervention does what it is supposed to do. The issue here is not

necessarily whether the intervention actually produces behavior change,

although this is obviously desirable whenever possible. Rather,

pretesting is necessary to determine whether the intervention is acceptable

to, and understood by, the target population and changes the variables it

was designed to change. For example, if the purpose of the intervention

is to improve skills. to change outcome expectancies, or to increase selfefficacy, then one should test whether the intervention does, in fact,

improve skills, change outcome expectancies, or increase self-efficacy

before implementing the intervention. Clearly, if the intervention does

not change at least the underlying theoretical determinants of behavior

that it was designed to change, it is unlikely to lead to the desired

behavior. Unfortunately, this final step is rarely undertaken in behavior

change research.

It is important to recognize that some of the above steps can occur

simultaneously. For example, if the ethnographic research clearly

indicates how and where the intervention should be implemented, then

one can begin to develop the mechanics of the intervention (e.g., recruit

and train volunteers, train counselors or outreach workers) at the same

time one is conducting formative research. While the above process is

often time consuming, frustrating, and difficult, it must be recognized

258
that, just as one cannot simply “throw together” a vaccine, one also

cannot simply “throw together” an intervention. Developing effective

behavior change interventions requires the willingness to put in the time

and effort needed to conduct the necessary research. Equally important,

an intervention must be given time to have an effect. Behavioral

interventions should not be viewed as a quick fix. Behavior change is not

an all-or-nothing phenomenon that occurs immediately or never at all.

Expectations must become more realistic about the amount of behavioral

change one can expect a given intervention to produce in a given time

period.

CONCLUSION

By using the lessons learned from behavioral science research, it is

possible to produce effective, theory-based, culturally sensitive,

population- and behavior-specific interventions. But effective

interventions will only be developed if behavioral scientists are given the

time and resources necessary to adequately accomplish this task. This

provides both a challenge and an opportunity for the National Institute on

Drug Abuse.

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pp. 197-259.

AUTHOR

Martin Fishbein, Ph.D.

Professor of Psychology

Department of Psychology

University of Illinois

603 East Daniel Street

Champaign, IL 61820

261
Synthesis of Behavioral Science

Learnings About Technology

Transfer

Thomas E. Backer and Susan L. David

A consensus is building that the U.S. spends too much of

its research budget on the search for new knowledge and

not enough on harnessing the knowledge already gained.

Time, November 23, 1992

INTRODUCTION

The success of the National Institute on Drug Abuse (NIDA) Technology

Transfer Program can be measured by the extent to which knowledge

from NIDA’s research is harnessed to improve drug abuse treatment and

prevention services in the United States, including those related to human

immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). One important path to that goal is through harnessing

knowledge from behavioral science about how to get innovations used by

practitioners, clients, and communities. Getting this behavioral science

knowledge used effectively by NIDA, its researchers, and support

contracts is, in fact, another technology transfer problem.

This chapter reviews a set of behavioral science findings derived from the

November 1993 NIDA Technical Review, “Reviewing the Behavioral

Science Knowledge Base on Technology Transfer.” This is not intended

to be a complete recapitulation of the arguments and conclusions drawn

by the authors of the 14 papers presented in this monograph. Rather, this

synthesis sets forth principles for action that NIDA may wish to consider

in the three arenas of individual/interpersonal, organizational, and

communications-based behavior change. The chapter then discusses six

overarching issues likely to affect implementation of these principles in

the drug abuse field. Finally, this chapter explores some implications of

the behavioral science knowledge base for NIDA’s current evaluation of

its Technology Transfer Program, for possible future expansion of this

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program, and for policymakers concerned with AIDS and drug abuse

treatment and prevention in the United States.

Methods for translating science into action need to be concerned not only

with the environment of application (e.g., drug abuse treatment facilities,

prevention agencies), but also with the environment of development-the

scientific community, which for drug abuse research is primarily situated

in universities. The academic research culture has a significant impact on

technology transfer. For instance, the reward system in academia is not

geared to promote technology transfer; articles in prestigious refereed

journals and conference presentations are the coin of the realm, not

evidence of field use. The communication channels favored by scientists

(e.g., scholarly journals, professional societies, informal interactions on

campus) tend to leave out practitioners, though this is changing with the

emerging information superhighway and other cutting-edge

communication technologies.

Even more important than these information dissemination issues are the

challenges of promoting actual use of research-based information once it

is received in the field. As has been stated repeatedly throughout this

volume, change is hard, and convincing practitioners, clients, and

communities to change means overcoming resistance and anxiety and

providing opportunities for reward and involvement. But here science

also provides a solution through the behavioral science knowledge base

summarized in this monograph. The wisdom presented here comes as

much from hard empirical science as from clinical or community

experience.

BEHAVIORAL SCIENCE KNOWLEDGE: KEY PRINCIPLES

FOR ACTION

Following are some of the main conclusions and recommendations that

may positively affect technology transfer and stimulate behavior change.

The principles are presented by author in the same order in which the

chapters appear in this monograph.

Backer

• Readiness for change is an important element of successful

technology transfer, and the readiness of both individuals and

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organizations to change through adoption of an innovation can be

enhanced.

Readiness for change can be assessed using a variety of observational, paper-and-pencil, and computer-based assessment devices:

making an investment in assessing readiness for change enhances

later chances for success.

Individual readiness for change is an aspect of organizational

readiness, particularly in the case of drug abuse treatment and

prevention innovations, which primarily are used in the organizational context of a service agency or community rather than by

individual practitioners working independently.

Readiness for change is a cognitive characteristic of innovation

adopters. What counts in establishing readiness is what people

believe, not what really is. Thus, efforts to measure the adopters’

subjective values. attitudes, and beliefs are critical to success.

Readiness is not the same as lack of resistance to change. Technology transfer efforts are more likely to succeed if they take account

of the positive characteristics of high readiness (e.g., enthusiasm for

change, willingness to endure some anxiety and startup problems in

order to adopt the innovation).

Assessment of need is not the same as the assessment of readiness.

Since readiness for change concerns people’s beliefs, technology

transfer efforts are likely to fail if they only assess the objective need

for change. Under some circumstances that need may be very high,

but if readiness for change is low, innovation adoption is unlikely to

succeed.

Kavanagh

Collaboration with persons who will have to live with the results of

change in an organizational or community setting is essential to

successful technology transfer, and collaboration is most likely to be

effective if it results in real empowerment of the relevant audiences.

The management of diversity (e.g., gender, age, race/ethnicity) is

important for the success of a technology transfer effort. Individual

characteristics of those who participate in a technology transfer

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intervention have to be assessed and responded to for the greatest

likelihood of impact.

McCallum

Risk communication is an essential element for the adoption of

innovations both by practitioners and clients; understanding the risks

of both the current behavior and that which is being proposed

through the technology transfer effort helps to shape both the

cognitive and attitudinal elements for change.

Having clear, precise objectives for a risk communication campaign

as part of a technology transfer effort is essential. These objectives

must state how the target audience or their communities will be

different if the risk communication is effective.

Critical to effective risk communication is understanding the

audience to whom risks are to be communicated, partly because there

is an emotional component to risk (as there is to change).

Risk communication success requires effective messages tested

through systematic interaction with target audiences (e.g., via focus

groups).

Credible spokespersons can add to the effectiveness of a risk

communication effort.

A number of media channels are now available to deliver messages

related to risk communication or technology transfer efforts, and they

must be carefully evaluated for potential impact and costeffectiveness.

Outcome evaluation of a risk communication campaign is essential to

increase the likelihood of success for future campaigns.

Rogers

Some innovations diffuse spontaneously, without any specific

technology transfer intervention behind them. In such cases,

followup activities (e.g., technical assistance on program operation or

securing of ongoing funding support) can increase the long-term

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success of technology transfer by supporting the impact of what has

already occurred.

• Spontaneous diffusion is sometimes the result of an issue moving

much higher on the public agenda, as drug abuse did in the late

1980s resulting in greater availability of public and private resources

to support innovation adoption and public policy pressure to take

action on the given subject.

• Most innovations that are transferred to a number of new adoption

sites are reinvented: that is, modifications are made in them to fit

varying local circumstances. This flexibility is often critical to

success.

Baum

• Complicated and subtle communication systems and interpersonal

dynamics typical of all organizations (often called organizational

culture) affect the prospects for success of technology transfer

interventions. These factors need to be diagnosed when planning for

an intervention so that the resulting strategy can attend to them

sensitively.

• Efforts to understand and measure organizational culture often fail

because they assume that each organization has a single, coherent

culture; that staff passively internalize and react to this culture; and

that all matters are dealt with at a conscious level. In fact, unconscious dynamics, such as the operation of transference (the tendency

to see characteristics of one’s own parents in organizational authority

figures), can also significantly affect the chances for success of a

technology transfer intervention.

Diamond

• Technology transfer often is based on expert authority, which tends

to result in control-oriented, information-dominated, top-down,

hierarchic, and defensive approaches to innovation transfer, all of

which are inimical to success.

• Technology transfer strategies often ignore the inevitability of

resistance to change, which is based on a central human conflict

between cognitive learning and emotional security.

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Technology transfer methods similarly may ignore the organizational

dynamics of change, which acknowledge that change at work implies

emotional and cognitive loss among organizational participants.

Technology transfer interventions are more likely to succeed if

provision is made for a “transitional space” to facilitate the innovation’s adoption. Transitions involve letting go of the old and

embracing the new, both at a cognitive and emotional level. In part,

this means acknowledging the real human processes at work

whenever people are asked to change.

In some cases the very rituals of bureaucracy, which exist in part to

provide a way of reducing anxiety and increasing certainty, can be

used to stimulate effective technology transfer, if the strategies used

work with these rituals rather than against them.

In designing any technology transfer intervention, knowing the taboo

subjects in the organization can have a significant impact on later

success. For instance, organizations that are averse to conflict may

have great difficulty in adopting new technologies because individuals are not allowed to talk about the conflicting feelings and

thoughts that are inevitable when some significant change is being

contemplated.

Sometimes technology transfer efforts are mounted because the

organization can avoid facing a deeper problem or conflict by

adopting some innovation. Technology transfer strategists must be

sensitive to this possibility in the field.

Glassman

Bureaucracies, such as those of service delivery organizations, are

traditionally resistant to innovation. To promote change in public

bureaucracies, management science has identified strategies that

specifically address these resistances so that they can be creatively

overcome.

Technology transfer strategies are more likely to succeed in organizations in which there is “bounded instability,” that is, encouragement

of a limited amount of instability to allow resources to be reallocated

to meet changing objectives, to promote open discussion of different

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ways of achieving the organizational mission, and to encourage the

free interchange of ideas.

In the private sector, a new type of organization is emerging in which

prospects for effective technology transfer may be greater. These

more flexible and innovative organizations empower their workforces, provide information technology to support them, and

encourage processes that cut across boundaries. The public sector is

likely to follow this example.

Tenkasi and Mohrman

Most drug abuse innovations involve procedural knowledge, not hard

technology, such as a new medical device. This distinction requires

some differences in the types of technology transfer strategies that

may be used.

In the real-world applications of technology transfer, most innovations are not adopted literally: they are put into use through a

process of “contextual adaptation,” which matches the dimensions of

the innovation to the dimensions of the environment. Often there is a

creative synthesis of other relevant knowledge related to a specific

innovation.

Knowledge is subjectively as well as contextually consumed: that is,

the values and feelings of those who are using the knowledge affect

how it actually is put to work in an organizational setting.

Brown

Critical characteristics of the innovation play a key role in whether

real behavior change occurs as a result of technology transfer efforts.

The sustained use of an innovation depends upon its relevance,

timeliness, clarity, credibility, replicability, and adaptability.

In order to design an effective technology transfer effort, input on

innovation characteristics must be obtained from potential adopters.

That is, what counts are the perceptions of the people who will have

to change their behavior in order for an innovation to get used, not

just the judgments of research scientists or other innovation

developers.

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The drug abuse field is unique in that many of its treatment service

staff are themselves recovering substance abusers. This factor needs

to be addressed in technology transfer programs and approaches.

To improve understanding of how technology transfer processes

work, NIDA should consider increasing funding for empirical

research on technology transfer.

To increase the motivation of researchers to engage in technology

transfer, supplemental funding for such activities should be made

available for those researchers with successful project results.

NIDA should also consider providing funding to study how to use

interactive technologies as part of technology transfer. These

technologies include computer-based learning systems (e.g., training

programs using CD-ROM technology), multisite interactive video

conferences, and electronic bulletin boards.

Sorensen and Clark

Operating an information dissemination unit in a NIDA-funded

research center can provide many opportunities for increasing the

application of research findings in the local treatment community.

Opportunities for national technology transfer also are increased by

awarding funds to major research projects for such a component.

Educational formats, such as a colloquium series operated by a NIDA

research project, can help stimulate technology transfer to professionals who are accustomed to learning in a structured setting.

Policy analysis studies and their subsequent publication in refereed

policy journals can use research findings to help shape policy on drug

abuse treatment.

Science writers can help to shape nonacademic publications that

present research findings in a user-friendly format for communication

to practitioners and community leaders.

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Gendreau

Technology transfer efforts can be sabotaged by “knowledge

destruction,” the tendency of scholars and research scientists to

dismiss research findings that do not fit congruently with their values

and belief systems. Therefore. strategic planning for technology

transfer should include careful examination of any prevailing

knowledge destruction tendencies within a given area of work so that

preventive responses can be constructed to help safeguard the

technology transfer intervention.

Technology transfer promoted through policy change can also be

endangered by the politicization of policymaker positions.

Appointed officials often are selected on the basis of ideology and

general management training, not for their content expertise in the

drug abuse or AIDS field. Planning for technology transfer needs to

include realistic examination of the playing field for policy change in

order to take account of this possibility and to try to identify

policymakers who do have the substantive knowledge necessary to

understand the science.

Petty

Interventions to promote adoption of drug abuse prevention and

treatment innovations need to include attention to the individual

attitudes and goals of potential adopters, perceptions of the attitudes

of others (norms), feelings of self-efficacy and actual competence,

and prior behaviors and habits.

While changing attitudes by a peripheral route (e.g., motivating

audiences to accept a message because it is delivered by a celebrity or

expert) can have powerful short-term effects on behavior, long-term

behavior change is more likely to be produced by a central route

(i.e., stimulating the person to engage in cognitive activity to evaluate

and hopefully to accept the validity of the message).

Attitude changes brought about by such central route activities are

more accessible; that is, they come to mind more quickly and are thus

more likely to influence behavior, and they are more likely to endure.

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McGuire

Technology transfer efforts can be facilitated by the strategic use of

an organizing concept based on social psychology theory called the

communication/persuasion matrix, which helps to integrate

persuasive communication and social influence interventions.

More successful technology transfer strategies can be generated by

bringing together drug abuse practitioners with social influence

theorists, since each can supply unique elements to strategy development. Practitioners know what is happening in the field, and theorists

have ways of overviewing and conceptualizing these elements to

make more efficient strategies possible.

Many technology transfer efforts fail because they fall prey to the

great-expectations fallacy: more is expected of them than is realistic

in terms of real behavior change among difficult target populations,

such as drug abusers.

Technology transfer efforts also fail because of the distal-measures

fallacy, in which the types of change that are measured as outcomes

of technology transfer are not the changes necessary to get

technology adopted.

Technology transfer efforts may fail because of the neglectedmediator fallacy: elements added to a complex transfer strategy for

one specific purpose may actually interfere with achieving the overall

purpose of behavior change. For instance, public service announcements aimed at teenagers increasingly use rock music scores or visual

special effects to get this audience’s attention, but such production

values may interfere with communicating the message.

Technology transfer efforts may fail because of compensatory

situations; that is, a personality characteristic that makes an audience

vulnerable to persuasion for behavior change via one type of

intervention may actually protect them from persuasion by other

interventions that are part of the overall strategy.

Technology transfer strategies are more likely to be successful if they

follow the golden-mean implication: the overall maximum impact is

likely if most or all intervention components are set at a medium

range of intensity, thus reducing the likelihood of interference effects.

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However, attention to situational weighting (i.e., specific circumstances surrounding the given intervention and its timing) may shape

some variation in how this rule is applied (e.g., some special

circumstance may strongly suggest emphasizing a particular

intervention component).

Fishbein

• It is possible to change complex and significant behaviors, such as

those related to preventing drug abuse or HIV infection, using

carefully designed behavioral science interventions. Technology

transfer programs, therefore, should not be too modest in establishing

their operating goals.

• Though it generally is difficult to stimulate behavioral change with

information alone, careful audience research can on occasion identify

audiences that may respond to information-based interventions,

especially when the information has been transformed to carefully fit

audience characteristics (also determined by research).

• Behavior change interventions are more likely to work if the targeted

behaviors are very specific and carefully defined in the early strategic

planning for a technology transfer intervention.

• A relatively small number of variables significantly determines

intention to change and actual behavior change, and the complex

interrelationships are best understood using unifying models such as

the Health Belief Model, Social Cognitive Learning Theory, or the

Theory of Reasoned Action. An effective technology transfer

program, therefore, should begin with a defined theoretical

perspective. following Lewin’s dictum, “Nothing is so practical as a

good theory.”

• The relative importance of the variables that influence behavior

change varies according to the characteristics of the people for whom

behavior change is desired (e.g., gender, class, ethnicity) and the class

of behavior that is being subjected to change intervention (e.g., work

performance, sexual behavior). Strategic planning for technology

transfer thus needs to include audience definition as well as target

behavior definition. The social meanings of these behaviors need to

be determined through qualitative research (e.g., focus groups) or

input from expert observers.

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OVERARCHING ISSUES

The following are six issues that are likely to have an impact on using

any of the principles described above in designing or implementing a

technology transfer intervention.

Technology Transfer Interventions Take Place in a Larger

Context of Change Within a Rapidly Evolving Environment

Drug abuse and HIV/AIDS treatment and prevention agencies are

constantly undergoing change in today’s world; limited resources,

increased demand for services, community pressures, and consumer

activism are just a few of the external forces to consider. But perhaps

even more importantly, these agencies exist within larger environments:

State drug abuse and AIDS authorities, State and local governments, and

a Nation wrestling with many of the same challenges. In such a complex

environment, any contemplated change must necessarily be seen in a

larger context of change.

Effective management of innovation and change increases when this

larger context includes global trends in the overall forces of change-the

increasing pace of change, diminishing resources, and patterns of

destabilization that mean nothing will ever be the same. There is also a

need to include in this larger context the increasing importance of

personal values and spirituality in innovation and change management for

drug abuse prevention and treatment communities.

People and organizations everywhere now face a range and intensity of

change that could scarcely be imagined even 5 years ago. Management

scientist Vaill describes this poetically: “We’re all living in permanent

white water” (Backer 1993). Today it seems people are unable to even

partly recover from one wave of change before another occurs. Twenty

years ago, management science literature was filled with references to

“planned change,” but now the best one can do is to manage all the

change thrust upon society by an increasingly chaotic environment.

Innovation production is constant in today’s world; more innovative

programs and products, which are increasingly sophisticated, are

emerging constantly. Moreover, advances in information technology

make sharing what is new easier and faster than ever before. The larger

environment of change in the world is fundamentally different today than

10 or 5 years ago in at least three significant ways.

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First, the pace of change is increasing. For instance, Drucker says

most jobs in the 21 st century have not been conceptualized yet and

will depend on technology not invented yet (Backer 1993).

Frequently change “sneaks” up on people without their comprehending its profound implications. For example, there are now more

English speakers in China than in the United States, forcing business

to redefine what is a “market,” just as they have had to with the

emergence of the “universal teenager.”

Second, an increasing amount of change involves both destabilization

and diminishing resources. For example, 850 of the Fortune

1,000 corporations have downsized in the last 3 years, and few public

organizations remain unaffected by repeated cycles of budget cuts

and decreasing stability.

Third, the nature of change itself is changing. In “Thriving on

Chaos,” Peters (1987) discusses a paradigm shift from an old set of

rules to not only a new set of rules but also a world in which at least

some rules are changing all the time, and in increasingly

unpredictable ways. Henderson, the economic futurist, says that

today’s fundamental logic error is assuming that anything will ever

go back to the way it was (Backer 1993). Yet how many activities

are subtly geared to the belief that if one tweaks the system just right,

equilibrium will return.

Technology Transfer Interventions Must Be Seen Within Their

Larger Internal Context

Effective technology transfer involves multiple strategies focused on

three broad areas:

The characteristics of the innovation;

The characteristics of the potential user (e.g., individual clients or

practitioners, treatment/prevention agencies, government

bureaucracies, communities): and

The characteristics of the technology transfer process, including the

personal characteristics of those conducting the change effort.

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Effective Technology Transfer Is an Interdisciplinary Effort

Drawing Not Only Upon Behavioral Sciences, but Also on

Management Science, Policy Studies, and Many Other

Disciplines

Given the complexity of desired change, it is not surprising that

knowledge from many domains is needed.

Technology Transfer Strategies in the Areas of Drug Abuse

and HIV/AIDS Are Highly Contextual and Need to Be

Designed, Implemented, and Evaluated in Their Own Context

Successful technology transfer strategies from other content arenas must

be carefully appraised before even considering their use in the

complicated environment of drug abuse and HIV/AIDS prevention and

treatment.

Some Technology Transfer Strategies Must Be Seen in a

Larger Time Context

Many factors play into how technology transfer strategies are implemented over a long time frame. For example, organizations have life

cycles, and political and consumer activism have time courses. Initial

low-level expectations for success, with the likelihood of greater impact

3 to 5 years down the road, may be the appropriate goal for a particular

technology transfer effort.

There Are Some Important Barriers to Technology Transfer

Success That Have Nothing to Do with the Excellence of the

Innovation or the Need for It

In addition to resistance to change and other psychologically based

barriers, there are also barriers of larger scope, such as:

• Access to information. Often there is limited access to new

information because scientists want to complete peer-reviewed

publication (which often requires 2 to 3 years) before releasing

information to the public.

• Influence of professional guilds. If a new technology appears to

threaten the status of or the access to opportunity in a profession,

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there can be serious systemic resistance to it, regardless of the level of

local professional support in the application’s environment.

• Pessimism about the chances for success. Many practitioners and

scientists are skeptical about whether technology transfer efforts will

work and thus may be resistant not just to a particular innovation, but

to the whole idea of spending their energies on technology transfer.

• Differing definitions of the goals and challenges of technology

transfer itself. In this monograph many authors distinguished

between different categories of technology transfer strategies, but

there was an underlying assumption that the ultimate goals and the

underlying challenges of these interventions were the same.

However, as Baum (personal communication, January 1994) pointed

out in a posttechnical review commentary, the 14 papers represent a

diversity of goals (i.e., changing “the system” in which services are

delivered versus changing the services themselves) and underlying

challenges (i.e., convincing people to use a technology that has

proven its value versus exploring whether the technology can make a

contribution to solving perplexing problems in a treatment or

prevention environment).

IMPLICATIONS AND FUTURE INITIATIVES

As mentioned in the introduction. NIDA’s Technology Transfer Program

is at a crossroads both in terms of its mtemai development and its place

within the overall goals and activity structure of NIDA. This monograph

has mined the richness of behavioral science research to identify many

specific strategies by which technology transfer can be enhanced.

However. there are also some overarching themes NIDA may wish to

consider in shaping its future technology transfer initiatives.

1. The central importance of constituent input. Time and again, the

behavioral science knowledge base reveals how important it is for the

people who will have to live with change to give input on how

change can best occur. NIDA has recently reaffirmed its organizational commitment to its constituencies in the community

(e.g., clients and their families, practitioners). In times of

diminishing resources and instability, when so much energy is

focused on just coping and surviving, getting input from constituents

is difficult but ultimately essential, not only to meet policy goals but

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also to shape the dimensions of a technology transfer effort so that it

will have maximum impact.

Therefore, NIDA may wish to explore ways to integrate its methods

for obtaining constituent input on technology transfer. The current

NIDA Technology Transfer Program evaluation can appraise

approaches such as focus groups and surveys and identify the best

and most cost-effective techniques. Upcoming events can afford

opportunities for creative dialog in a more unifying environment.

NIDA may wish to take the model of constituent input one step

further by engaging early involvement by constituents in designing

how that input should be provided.

2. The central importance of well-defined goals. The behavioral

science evidence also indicates that technology transfer success is

facilitated by having specific, clearly defined goals that are set in the

context of a larger vision. NIDA may wish to encourage an internal

dialog, bringing together leaders of its various divisions and the

Public Information Branch to discuss how technology transfer can

contribute to achieving research objectives and vice versa. At such a

meeting, the importance of the NIDA Technology Transfer Program

can be reemphasized by NIDA leadership and put in the larger

context of parallel activities throughout the National Institutes of

Health. Also, findings from the evaluation of NIDA’s Technology

Transfer Program can be presented to document the impact this

program has had thus far.

3. The central importance of research. As a research agency, NIDA

and its staff hardly have to be convinced that research is important,

but the value of increased research on technology transfer needs to be

analyzed and conveyed to those who still may be skeptical about the

relevance of such a program to a research agency. Good empirical

research is being funded by other Federal agencies; for instance, the

Agency for Health Care Policy and Research has funded a 3-year

empirical study that looks at how the infrastructure of HIV/AIDS

service agencies in San Francisco has affected the adoption of

innovations.

4. The central importance of diversity. Different technology transfer

strategies are required for different communities (e.g., Hispanic,

African American, Asian American, Native American, elderly, gay,

lesbian). NIDA recently has made an expanded commitment to

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technology transfer and systems change activities within the Latino

communities of the United States. This effort uses a powerful model,

first created in 1989. that brings together researchers, practitioners,

and community leaders with NIDA (and other Federal agencies

sponsoring activities in the areas of drug abuse and HIV/AIDS) to

bring science to the community. Variations of this model may be

useful with other communities as well.

In meeting the challenges of change through the increased use of

innovative drug abuse and HIV/AIDS technologies, NIDA will remain at

the forefront of research and practice by addressing these themes of

constituency input, internally well-defined goals, increased research, and

sensitivity to diversity.

CONCLUSION

Technology transfer today is still somewhat of an art form, even though it

is informed and guided by science. That means that the principles for

action discussed here must be applied by practitioners, communities, and

organizations such as NIDA with a combination of rigor and flexibilityrigor because there is science to be evaluated and applied, flexibility

because there is still much that is not known about how to change

behavior or how to identify the environmental conditions under which the

likelihood of behavior change is greatest. There also is much that IS not

known at this time about how the characteristics of the innovation itself

affect the likelihood of successful innovation adoption or about how all

these factors interact to produce effective technology transfer.

Treatment and prevention agencies, and other entities concerned with

technology transfer (including NIDA), may be more likely to succeed in

this endeavor if they manifest the combination of rigor and flexibility.

Incorporating the contributions of behavioral science in all aspects of

planning, design, implementation, and evaluation of technology transfer,

and providing the opportunity to users to contribute their own knowledge

and perceptions in order to adapt these new technologies to the real-world

setting, should ultimately provide the best opportunity to make NIDA

research useful and important to those who need it.

278
REFERENCES

Backer, T.E. “Managing Innovation and Change: Common Messages

from Business and Spirituality.” Address to California State

University, Long Beach, College of Health and Human Services

Convocation, August 1993.

Peters, T. Thriving on Chaos: Handbook for a Management Revolution.

New York: Harper Collins, 1987.

AUTHORS

Thomas E. Backer, Ph.D.

President

Human Interaction Research Institute

1849 Sawtelle Boulevard

Suite 102

Los Angeles, CA 900257007

Susan L. David

Chief

Public Information Branch

National Institute on Drug Abuse

Parklawn Building, Room 10A-39

5600 Fishers Lane

Rockville, MD 20857

279
While limited supplies last, single copies of the monographs may be

obtained free of charge from the National Clearinghouse for Alcohol and

Drug Information (NCADI). Please also contact NCADI for information

about availability of coming issues and other publications of the National

Institute on Drug Abuse relevant to drug abuse research.

Additional copies may be purchased from the U.S. Government Printing

Office (GPO) and/or the National Technical Information Service (NTIS)

as indicated. NTIS prices are for paper copy: add $3.00 handling charge

for each order. Microfiche copies also are available from NTIS. Prices

from either source are subject to change.

Addresses are:

NCADI

National Clearinghouse for Alcohol and Drug Information

P.O. Box 2345

Rockville, MD 20852

(301) 468-2600

(800) 729-6686

GPO

Superintendent of Documents

U.S. Government Printing Office

P.O. Box 37 1954

Pittsburgh, PA 15220-7954

(202) 738-3238

FAX (202) 512-2233

NTIS

National Technical Information Service

U.S. Department of Commerce

Springfield, VA 22161

(703) 487-4650

For information on availability of NIDA Research Monographs from

1975-1993 and those not listed, write to NIDA, Community and

Professional Education Branch. Room 10A-39, 5600 Fishers Lane,

Rockville. MD 20857.

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THE BEHAVIORAL ASPECTS OF SMOKING.

Norman A. Krasnegor, Ph.D., ed. (Reprint from 1979 Surgeon

General’s Report on Smoking and Health.)

NCADI#M26 NTIS PB #80-118755/AS (A09) $27.00

THE ANALYSIS OF CANNABINOIDS IN BIOLOGICAL

FLUIDS. Richard L. Hawks, Ph.D., ed.

NCADI #M42 NTIS PB #83-136044/AS (A07) $27.00

COCAINE: PHARMACOLOGY, EFFECTS, AND

TREATMENT OF ABUSE. John Grabowski, Ph.D., ed.

NCADI #M50 NTIS PB #85-150381/AS (A07) $27.00

TESTING DRUGS FOR PHYSICAL DEPENDENCE

POTENTIAL AND ABUSE LIABILITY. Joseph V. Brady, Ph.D.,

and Scott E. Lukas, Ph.D., eds.

NCADI #M52 NTIS PB #85-150373/AS (A08) $27.00

PHARMACOLOGICAL ADJUNCTS IN SMOKING

CESSATION. John Grabowski, Ph.D., and Sharon M. Hall, Ph.D.,

eds.

NCADI #M53 NTIS PB #89-123186/AS (A07) $27.00

MECHANISMS OF TOLERANCE AND DEPENDENCE.

Charles Wm. Sharp, Ph.D., ed.

NCADI #M54 NTIS PB #89-103279/AS (A19) $52.00

ETIOLOGY OF DRUG ABUSE: IMPLICATIONS FOR

PREVENTION. Coryl LaRue Jones, Ph.D., and

Robert J. Battjes, D.S.W., eds.

NCADI #M56 NTIS PB #89-123160/AS (A13) $36.50

COCAINE USE IN AMERICA: EPIDEMIOLOGIC AND

CLINICAL PERSPECTIVES. Nicholas J. Kozel, M.S., and

Edgar H. Adams, M.S., eds.

NCADI #M61 NTIS PB #89-131866/AS (A11) $36.50

NEUROSCIENCE METHODS IN DRUG ABUSE RESEARCH.

Roger M. Brown, Ph.D., and David P. Friedman, Ph.D., eds.

NCADI #M62 NTIS PB #89-130660/AS (A08) $27.00

PREVENTION RESEARCH: DETERRING DRUG ABUSE

AMONG CHILDREN AND ADOLESCENTS. Catherine S. Bell,

M.S., and Robert J. Battjes, D.S.W., eds.

NCADI #M63 NTIS PB #89-103287/AS (A11) $36.50

PHENCYCLIDINE: AN UPDATE. Doris H. Clouet, Ph.D., ed.

NCADI #M64 NTIS PB #89-131858/AS (A12) $36.50

WOMEN AND DRUGS: A NEW ERA FOR RESEARCH.

Barbara A. Ray, Ph.D., and Monique C. Braude, Ph.D., eds.

NCADI #M65 NTIS PB #89-130637/AS (A06) $27.00

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OPIOID PEPTIDES: MEDICINAL CHEMISTRY.

Rao S. Rapaka, Ph.D.; Gene Bamett, Ph.D.; and

Richard L. Hawks, Ph.D., eds.

NCADI #M69 NTIS PB #89-158422/AS (A17) $44.50

OPIOID PEPTIDES: MOLECULAR PHARMACOLOGY,

BIOSYNTHESIS, AND ANALYSIS. Rao S. Rapaka, Ph.D., and

Richard L. Hawks, Ph.D., eds.

NCADI #M70 NTIS PB #89-158430/AS (A18) $52.00

RELAPSE AND RECOVERY IN DRUG ABUSE.

Frank M. Tims, Ph.D., and Carl G. Leukefeld, D.S.W., eds.

NCADI #M72 NTIS PB #89-151963/AS (A09) $36.50

NEUROBIOLOGY OF BEHAVIORAL CONTROL IN DRUG

ABUSE. Stephen I. Szara, M.D., D.Sc., ed.

NCADI #M74 NTIS PB #89-151989/AS (A07) $27.00

THE ROLE OF NEUROPLASTICITY IN THE RESPONSE TO

DRUGS. David P. Friedman, Ph.D., and Doris H. Clouet. Ph.D.,

eds.

NCADI #M78 NTIS PB #88-245683/AS (A10) $36.50

STRUCTURE-ACTIVITY RELATIONSHIPS OF THE

CANNABINOIDS. Rao S. Rapaka, Ph.D., and

Alexandros Makriyannis, Ph.D., eds.

NCADI #M79 NTIS PB #89-109201/AS (A10) $36.50

NEEDLE SHARING AMONG INTRAVENOUS DRUG

ABUSERS: NATIONAL AND INTERNATIONAL

PERSPECTIVES.

Robert J. Battjes, D.S.W., and Roy W. Pickens, Ph.D., eds.

NCADI #M80 NTIS PB #88-236138/AS (A09) $36.50

OPIOIDS IN THE HIPPOCAMPUS. Jacqueline F. McGinty,

Ph.D., and David P. Friedman, Ph.D., eds.

NCADI #M82 NTIS PB #88-245691/AS (A06) $27.00

HEALTH HAZARDS OF NITRITE INHALANTS.

Harry W. Haverkos, M.D., and John A. Dougherty, Ph.D., eds.

NCADI #M83 NTIS PB #89-125496/AS (A06) $27.00

LEARNING FACTORS IN SUBSTANCE ABUSE.

Barbara A. Ray, Ph.D., ed.

NCADI #M84 NTIS PB #89-125504/AS (A10) $36.50

EPIDEMIOLOGY OF INHALANT ABUSE: AN UPDATE.

Raquel A. Crider, Ph.D., and Beatrice A. Rouse, Ph.D., eds.

NCADI #M85 NTIS PB #89-123178/AS (A10) $36.50

OPIOID PEPTIDES: AN UPDATE. Rao S. Rapaka, Ph.D., and

Bhola N. Dhawan, M.D., eds.

NCADI #M87 NTIS PB #89-1584301AS (A11) $36.50

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MECHANISMS OF COCAINE ABUSE AND TOXICITY.

Doris H. Clouet, Ph.D.; Khursheed Asghar, Ph.D.: and

Roger M. Brown, Ph.D., eds.

NCADI #M88 NTIS PB #89-125512/AS (A16) $44.50

BIOLOGICAL VULNERABILITY TO DRUG ABUSE.

Roy W. Pickens, Ph.D., and Dace S. Svikis, B.A., eds.

NCADI #M89 NTIS PB #89-125520/AS (A09) $27.00

TESTING FOR ABUSE LIABILITY OF DRUGS IN HUMANS.

Marian W. Fischman, Ph.D., and Nancy K. Mello, Ph.D., eds.

NCADI #M92 NTIS PB #90-148933/AS (A17) $44.50

PHARMACOLOGY AND TOXICOLOGY OF AMPHETAMINE

AND RELATED DESIGNER DRUGS. Khursheed Asghar, Ph.D.,

and Errol De Souza, Ph.D., eds.

NCADI #M94 NTIS PB #90-148958/AS (A16) $44.50

PROBLEMS OF DRUG DEPENDENCE, 1989. PROCEEDINGS

OF THE 5 1 st ANNUAL SCIENTIFIC MEETING. THE

COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE, INC.

Louis S. Harris, Ph.D., ed.

NCADI #M95 NTIS PB #90-237660/AS (A99) $67.00

DRUGS OF ABUSE: CHEMISTRY, PHARMACOLOGY,

IMMUNOLOGY, AND AIDS. Phuong Thi Kim Pham, Ph.D., and

Kenner Rice, Ph.D., eds.

NCADI #M96 NTIS PB #90-237678/AS (A11) $36.50

NEUROBIOLOGY OF DRUG ABUSE: LEARNING AND

MEMORY. Lynda Erinoff, Ph.D., ed.

NCADI #M97 NTIS PB #90-237686/AS (A11) $36.50

THE COLLECTION AND INTERPRETATION OF DATA

FROM HIDDEN POPULATIONS.

Elizabeth Y. Lambert, M.Sc., ed.

NCADI #M98 NTIS PB #90-237694/AS (A08) $27.00

RESEARCH FINDINGS ON SMOKING OF ABUSED

SUBSTANCES. C. Nora Chiang, Ph.D., and

Richard L. Hawks, Ph.D., eds.

NCADI #M99 NTIS PB #91-141119 (A09) $27.00

DRUGS IN THE WORKPLACE: RESEARCH AND

EVALUATION DATA. VOL II. Steven W. Gust, Ph.D.;

J. Michael Walsh, Ph.D.; Linda B. Thomas, B.S.;

and Dennis J. Crouch, M.B.A., eds.

NCADI #M100 GPO Stock #017-024-01458-3 $8.00

RESIDUAL EFFECTS OF ABUSED DRUGS ON BEHAVIOR.

John W. Spencer, Ph.D., and John J. Boren, Ph.D., eds.

NCADI #M101 NTIS PB #91-172858/AS (A09) $27.00

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ANABOLIC STEROID ABUSE. Geraline C. Lin, Ph.D., and

Lynda Erinoff, Ph.D., eds.

NCADI #M102 NTIS PB #91-172866/AS (A11) $36.50

IMPROVING DRUG ABUSE TREATMENT.

Roy W. Pickens, Ph.D.; Carl G. Leukefeld. D.S.W.; and

Charles R. Schuster, Ph.D., eds.

NCADI #M106 NTIS PB #92-105873(A18) $50.00

DRUG ABUSE PREVENTION INTERVENTION RESEARCH:

METHODOLOGICAL ISSUES. Carl G. Leukefeld, D.S.W., and

William J. Bukoski, Ph.D., eds.

NCADI #M107 NTIS PB #92-160985 (A13) $36.50

CARDIOVASCULAR TOXICITY OF COCAINE:

UNDERLYING MECHANISMS. Pushpa V. Thadani, Ph.D., ed.

NCADI #M108 NTIS PB #92-106608 (A11) $36.50

LONGITUDINAL STUDIES OF HIV INFECTION IN

INTRAVENOUS DRUG USERS: METHODOLOGICAL ISSUES

IN NATURAL HISTORY RESEARCH. Peter Hartsock, Dr.P.H.,

and Sander G. Genser, M.D., M.P.H., eds.

NCADI #M109 NTIS PB #92-106616 (A08) $27.00

MOLECULAR APPROACHES TO DRUG ABUSE RESEARCH:

RECEPTOR CLONING, NEUROTRANSMITTER

EXPRESSION, AND MOLECULAR GENETICS: VOLUME I.

Theresa N.H. Lee, Ph.D., ed.

NCADI #M111 NTIS PB #92-135743 (A10) $36.50

EMERGING TECHNOLOGIES AND NEW DIRECTIONS IN

DRUG ABUSE RESEARCH. Rao S. Rapaka, Ph.D.;

Alexandros Makriyannis, Ph.D.; and Michael J. Kuhar, Ph.D., eds.

NCADI #M112 NTIS PB #92-155449 (A15) $44.50

ECONOMIC COSTS, COST EFFECTIVENESS, FINANCING,

AND COMMUNITY-BASED DRUG TREATMENT.

William S. Cartwright, Ph.D., and James M. Kaple, Ph.D., eds.

NCADI #M113 NTIS PB #92-155795 (A10) $36.50

METHODOLOGICAL ISSUES IN CONTROLLED STUDIES

ON EFFECTS OF PRENATAL EXPOSURE TO DRUG ABUSE.

M. Marlyne Kilbey, Ph.D., and Khursheed Asghar, Ph.D., eds.

NCADI #M114 NTIS PB #92-146216 (A16) $44.50

METHAMPHETAMINE ABUSE: EPIDEMIOLOGIC ISSUES

AND IMPLICATIONS. Marissa A. Miller, D.V.M., M.P.H., and

Nicholas J. Kozel, M.S., eds.

NCADI #M115 NTIS PB #92-146224/11 (A07) $27.00

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116 DRUG DISCRIMINATION: APPLICATIONS TO DRUG

ABUSE RESEARCH. R.A. Glennon, Ph.D.;

Toubjörn U.C. Järbe, Ph.D.; and J. Frankenheim, Ph.D., eds.

NCADI #M116 NTIS PB #94-169471 (A20) $52.00

117 METHODOLOGICAL ISSUES IN EPIDEMIOLOGY,

PREVENTION, AND TREATMENT RESEARCH ON DRUGEXPOSED WOMEN AND THEIR CHILDREN.

M. Marlyve Kilbey, Ph.D., and Kursheed Asghar, Ph.D., eds.

GPO Stock #017-024-01472-9 $12.00

NCADI #M117 NTIS PB #93-102101/LL (A18) $52.00

118 DRUG ABUSE TREATMENT IN PRISONS AND JAILS.

Carl G. Leukefeld, D.S. W.. and Frank M. Tims, Ph.D., eds.

GPO Stock #017-024-01473-7 $16.00

NCADI #M118 NTIS PB #93-102143/LL (A14) $44.50

120 BIOAVAILABILITY OF DRUGS TO THE BRAIN AND THE

BLOOD-BRAIN BARRIER. Jerry Frankenheim. Ph.D., and

Roger M. Brown, Ph.D., eds.

GPO Stock #017-024-01481-8 $10.00

NCADI #M120 NTIS PB #92-214956/LL (A12) $36.50

121 BUPRENORPHINE: AN ALTERNATIVE TREATMENT FOR

OPIOID DEPENDENCE. Jack D. Blaine, Ph.D., ed.

GPO Stock #017-024-01482-6 $5.00

NCADI #M121 NTIS PB #93-129781/LL (A08) $27.00

123 ACUTE COCAINE INTOXICATION: CURRENT METHODS

OF TREATMENT. Heinz Sorer, Ph.D., ed.

GPO Stock #017-024-01501-6 $6.50

NCADI #M123 NTIS PB #94-115433/LL (A09) $27.00

124 NEUROBIOLOGICAL APPROACHES TO BRAIN-BEHAVIOR

INTERACTION. Roger M. Brown, Ph.D., and

Joseph Fracella, Ph.D., eds.

GPO Stock #017-024-01492-3 $9.00

NCADI #M124 NTIS PB #93-203834/LL (A12) $36.50

125 ACTIVATION OF IMMEDIATE EARLY GENES BY DRUGS

OF ABUSE. Reinhard Grzanna, Ph.D., and

Roger M. Brown, Ph.D., eds.

GPO Stock #017-024-01503-2 $7.50

NCADI #M125 NTIS PB #94-169489 (A12) $36.50

126 MOLECULAR APPROACHES TO DRUG ABUSE RESEARCH

VOLUME II: STRUCTURE, FUNCTION, AND EXPRESSION.

Theresa N.H. Lee, Ph.D., ed.

NCADI #M126 NTIS PB #94-169497 (A08) $27.00

127 PROGRESS AND ISSUES IN CASE MANAGEMENT.

Rebecca S. Ashery, D.S.W., ed.

NCADI #M127 NTIS PB #94-169505 (A18) $52.00

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STATISTICAL ISSUES IN CLINICAL TRIALS FOR

TREATMENT OF OPIATE DEPENDENCE.

Ram B. Jain, Ph.D., ed.

NCADI #M128 NTIS PB #93-203826/LL (A09) $27.00

INHALANT ABUSE: A VOLATILE RESEARCH AGENDA.

Charles W. Sharp, Ph.D.: Fred Beauvais, Ph.D.; and

Richard Spence, Ph.D., eds.

GPO Stock #017-024-01496-6 $12.00

NCADI #M129 NTIS PB #93-183119/LL (A15) $44.50

DRUG ABUSE AMONG MINORITY YOUTH: ADVANCES IN

RESEARCH AND METHODOLOGY. Mario De La Rosa, Ph.D.,

and Juan-Luis Recio Adrados, Ph.D., eds.

GPO Stock #017-024-01506-7 $14.00

NCADI #M130 NTIS PB #94-169513 (A15) $44.50

IMPACT OF PRESCRIPTION DRUG DIVERSION CONTROL

SYSTEMS ON MEDICAL PRACTICE AND PATIENT CARE.

James R. Cooper, Ph.D.; Dorynne J. Czechowicz, M.D.;

Stephen P. Molinari, J.D., R.Ph.: and Robert C. Peterson, Ph.D.,

eds.

GPO Stock #017-024-01505-9 $14.00

NCADI #M131 NTIS PB #94-169521 (A15) $44.50

PROBLEMS OF DRUG DEPENDENCE, 1992: PROCEEDINGS

OF THE 54TH ANNUAL SCIENTIFIC MEETING OF THE

COLLEGE ON PROBLEMS OF DRUG DEPENDENCE.

Louis Harris, Ph.D., ed.

NCADI #M132

GPO Stock #017-024-01502-4 $23.00

NTIS PB #94-115508/LL (A99)

SIGMA, PCP. AND NMDA RECEPTORS.

Errol B. De Souza, Ph.D.; Doris Clouet, Ph.D., and

Edythe D. London, Ph.D., eds.

NCADI #M133 NTIS PB #94-169539 (A12) $36.50

MEDICATIONS DEVELOPMENT: DRUG DISCOVERY,

DATABASES, AND COMPUTER-AIDED DRUG DESIGN.

Rao S. Rapaka, Ph.D., and Richard L. Hawks, Ph.D., eds.

GPO Stock #017-024-01511-3 $11.00

NCADI #M134 NTIS PB #94-169547 (A14) $44.50

COCAINE TREATMENT: RESEARCH AND CLINICAL

PERSPECTIVFS. Frank M. Tims, Ph.D., and

Carl G. Leukefeld, D.S.W., eds.

GPO Stock #017-024-01520-2 $11.00

NCADI #M135 NTIS PB #94-169554 (A13) $36.50

ASSESSING NEUROTOXICITY OF DRUGS OF ABUSE.

Lynda Erinoff, Ph.D., ed.

NCADI #M136

GPO Stock #017-024-01518-1 $11.00

NTIS PB #94-169562 (A13) $36.50

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BEHAVIORAL TREATMENTS FOR DRUG ABUSE AND

DEPENDENCE. Lisa Simon Onken, Ph.D.; Jack D. Blaine, M.D.;

and John J. Boren, Ph.D., eds.

GPO Stock #017-024-01519-9 $13.00

NCADI #M137 NTIS PB #94-169570 (Al5) $44.50

IMAGING TECHNIQUES IN MEDICATIONS

DEVELOPMENT: CLINICAL AND PRECLINICAL ASPECTS.

Heinz Sorer, Ph.D., and Rao S. Rapaka, Ph.D., eds.

NCADI #M138

SCIENTIFIC METHODS FOR PREVENTION INTERVENTION

RESEARCH. Arturo Cazares, M.D., M.P.H., and

Lula A. Beatty, Ph.D., eds.

NCADI #M139

PROBLEMS OF DRUG DEPENDENCE, 1993: PROCEEDINGS

OF THE 55TH ANNUAL SCIENTIFIC MEETING, THE

COLLEGE ON PROBLEMS OF DRUG DEPENDENCE, INC.

VOLUME I: PLENARY SESSION SYMPOSIA AND ANNUAL

REPORTS. Louis S. Harris, Ph.D., ed.

NCADI #M140

PROBLEMS OF DRUG DEPENDENCE, 1993: PROCEEDINGS

OF THE 55TH ANNUAL SCIENTIFIC MEETING, THE

COLLEGE ON PROBLEMS OF DRUG DEPENDENCE, INC.

VOLUME II: ABSTRACTS. Louis S. Harris, Ph.D., ed.

NCADI #M141

ADVANCES IN DATA ANALYSIS FOR PREVENTION

INTERVENTION RESEARCH. Linda M. Collins, Ph.D., and

Larry A. Seitz, Ph.D., eds.

NCADI #M142

THE CONTEXT OF HIV RISK AMONG DRUG USERS AND

THEIR SEXUAL PARTNERS. Robert J. Battjes, D.S.W.;

Zili Sloboda, Sc.D.; and William C. Grace, Ph.D., eds.

NCADI #M143

THERAPEUTIC COMMUNITY: ADVANCES IN RESEARCH

AND APPLICATION. Frank M. Tims, Ph.D.;

George De Leon, Ph.D.: and Nancy Jainchill, Ph.D., eds.

NCADI #M144

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NEUROBIOLOGICAL MODELS FOR EVALUATING

MECHANISMS UNDERLYING COCAINE ADDICTION.

Lynda Erinoff, Ph.D., and Roger M. Brown, Ph.D., eds.

NCADI #M145

HALLUCINOGENS: AN UPDATE. Geraline C. Lin, Ph.D.,

and Richard A. Glennon, Ph.D., eds.

NCADI #M146

DISCOVERY OF NOVEL OPIOID MEDICATIONS.

Rao S. Rapaka, Ph.D., and Heinz Sorer, Ph.D., eds.

NCADI #M147

EPIDEMIOLOGY OF INHALANT ABUSE: AN

INTERNATIONAL PERSPECTIVE.

Nicholas J. Kozel, M.S.; Zili Sloboda, Sc.D.;

and Mario R. De La Rosa, Ph.D., eds.

NCADI #M148

MEDICATIONS DEVELOPMENT FOR THE TREATMENT OF

PREGNANT ADDICTS AND THEIR INFANTS.

C. Nora Chiang, Ph.D., and Loretta P. Finnegan, M.D., eds.

NCADI #M149

INTEGRATING BEHAVIORAL THERAPIES WITH

MEDICATIONS IN THE TREATMENT OF DRUG

DEPENDENCE.

Lisa Simon Onken, Ph.D.: Jack D. Blame, M.D.; and

John J. Boren, Ph.D.. eds.

NCADI #M150

SOCIAL NETWORKS, DRUG ABUSE, AND HIV

TRANSMISSION. Richard H. Needle, Ph.D., M.P.H.;

Susan L. Coyle, Ph.D.; Sander G. Genser, M.D., M.P.H.; and

Robert T. Trotter II, Ph.D., eds.

NCADI #M151

MEMBRANES AND BARRIERS: TARGETED DRUG

DELIVERY. Rao S. Rapaka, Ph.D., ed.

NCADI #M154

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157 QUALITATIVE METHODS IN THE PREVENTION OF DRUG

ABUSE AND HIV RESEARCH. Elizabeth Y. Lambert, M.Sc.;

Rebecca S. Ashery, D.S.W.; and Richard H. Needle, Ph.D.,

M.P.H., eds.

NCADI # M157

158 BIOLOGICAL MECHANISMS AND PERINATAL EXPOSURE

TO ABUSED DRUGS. Pushpa V. Thadani, Ph.D., ed.

NCADI #M158

289




NIDA

NATlONAL INSTlTUTE

ON DRUG ABUSE

NIH Publication No. 95-4035

Printed 1995