An evaluation or surveillance system can become a meaningless exercise in data collection unless the findings motivate key stakeholders, including policymakers, program managers, and the surveyed communities, to take action to reduce HIV transmission. Thus, broad dissemination of the findings in formats that promote responses is an essential component of any data collection system. However, dissemination is often treated as an afterthought, receiving only limited attention after the results have been analyzed and formal reports generated. Some people even consider their dissemination work complete with the publication of a detailed final technical report. However, if dissemination is to produce necessary actions on the part of the key stakeholders, it will involve much, much more. Indeed, effective dissemination is an ongoing process that begins when a survey or evaluation project is formulated–namely, at the proposal and development stage–and continues throughout the life of the project.

The elements of this process include:

• Building consensus among various stakeholders about the communities to be surveyed, the data to be collected and disseminated, and the forms of dissemination. This helps to build a sense of ownership of the findings and ensures that their presentation is appropriate and relevant for the various target audiences.

• Developing a complete dissemination strategy at the time that the project is planned. This strategy should include dissemination of some key findings as soon as possible after data collection is completed to sustain interest and speed the implementation of prevention activities.

• Preparing target audiences to understand the meaning, limitations, and interpretation of results well in advance of their actual release to these audiences.

• Developing separate dissemination materials for each target audience that explain the findings in clear and simple language they can understand and that avoid discipline-specific language that has no meaning to that specific target audience.

• Actively following up with target audiences to answer questions, clarify meanings and interpretations, and make informed recommendations on appropriate policies, programs, or actions as suggested by the data.

Audiences For Survey Results

The persons to whom the results should be disseminated will vary from country to country depending upon local conditions, influential groups, and social and political structures. Possible recipients might include:

• policymakers, including senior officials in the office of the President, the Ministry of Health, other Ministries and Parliamentarians;
• program managers in government agencies, non-governmental organizations (NGOs), and community-based organizations (CBOs);
• members and leaders of the communities surveyed;
• mass media;
• donors and other funding agencies;
• the general public;
• universities and research institutions;
• private employers;
• labor unions;
• religious organizations;
• military;
• professional organizations; and
• provincial and district officials.

All other things being equal, the broadest dissemination of results is preferred. Each of the potential target audiences listed above has a role in reducing HIV transmission and can take action based on the findings. However, it must also be remembered that there are often local concerns and sensitivities about the open discussion of the behaviors that transmit HIV. These sensitivities are often strongest among key government officials or high-ranking religious leaders, whose alienation might seriously impede prevention efforts. In designing dissemination activities and materials, careful attention should be paid to these concerns, especially those of key gatekeepers. Whenever possible, the data should be disseminated in forms that respect the concerns of the target audience, involve them in the dissemination process, and present the results in language that will not be found objectionable. Indirect avenues for dissemination, such as explaining the significance of the findings to those closest to influential policymakers and religious leaders in hopes that they may assist in reaching their colleagues, can also be explored.

Because members of the communities under evaluation are actively involved in data collection and have the ability to respond to the findings by changing behavior, those who carry out surveys have a special obligation to ensure that the leaders and other members of these communities are informed of the findings. Their active participation throughout the entire process of design, implementation, and dissemination will strengthen the system and help to ensure its reliability and validity. The remainder of this chapter provides concrete suggestions for implementers on how to effectively disseminate the results of their surveys so as to ensure that key stakeholders are involved and informed.

Possible Forms Of Dissemination

Those implementing surveys or any evaluation project cannot assume that they have finished their work when they produce a final report with detailed statistical analysis. Though a technical report is necessary, most people do not know the meaning of "p-value" or "confidence interval" and such language is likely to confuse the issues in their minds rather than clarify them. To reach all potential target audiences with the appropriate messages, a number of forms of dissemination will usually be required, including:

• A detailed report with complete statistical analysis–This report serves as the technical foundation for preparing other dissemination materials and may be appropriate for distribution to program managers and staff of organizations actively working with the communities surveyed. Even within such a report, project staff should highlight and summarize significant results in clear, non-technical language at regular intervals.

• Briefing materials for the press or other mass media–These materials should avoid all technical language. Each press release or briefing should focus on only one or two key findings and their implications so as not to confuse the reader. Whenever possible, staff should provide a written summary of remarks when discussing findings with broadcast media. This will help to reduce misquoting and misinterpretation. It is important to remember that the press is also an indirect way of reaching policymakers and the public, and staff should plan the content accordingly.

• Short one- and two-page policy briefs– Because policymakers and leaders of the surveyed communities are positioned to have a major impact on prevention measures, materials specifically targeted at them are essential. Each policy brief should focus on one or two key aspects of the findings, discuss implications for their own activities, and provide recommendations regarding actions they might take to influence prevention activities positively. Separate briefs will often be necessary for different groups of policymakers or community leaders so the materials can be made directly relevant to them.

• Group dissemination meetings or presentations–Larger meetings or presentations can offer an opportunity to present the findings to members of the surveyed communities, large groups of policymakers or program managers, or the general public. The full process of dissemination may involve such meetings before, during, and after the release of the data. Meetings before can be used to explain the data that are being collected, discuss issues of its interpretation, and prepare people to accept it. Meetings during and after offer an opportunity to present the findings, answer questions, clarify any misunderstandings, and discuss the implications for people in light of their respective responsibilities and the activities they can influence.

• Individualized meetings–Individual personalized meetings with influential policymakers, community leaders from the surveyed groups, or interested NGOs and government program managers offer them an opportunity to obtain and process the results and explore the implications for their own work in a non-threatening environment. Because such meetings are time and preparation intensive, staff should pay careful attention to who can act effectively on the information when they are identifying the recipients of such individualized attention.

In preparing materials for each target audience, the basic goal of dissemination to each possible audience is to give them the information they need to encourage, target, or carry out meaningful prevention activities. Phrase the results presented in action-oriented or policy-oriented terms. In the materials explain the relevance and importance of this information to the target audience in their specific context.

Tailoring Dissemination To Specific Audiences

When material is presented to the mass media, policymakers, and the public, it must be understandable to the target audience and presented in a form that allows them to interpret figures accurately. A number of suggestions can be made for improving dissemination materials:

• Avoid use of discipline-specific language, such as statistical terms ("chi-squared" or "statistically significant") or social science terminology ("non-regular partner" or "anogenital intercourse"). These terms are not well understood by the target audience or are likely to be misinterpreted.

• In material prepared for policymakers and community leaders, include recommendations for action in their spheres of influence. For example, materials for the Ministry of Education might emphasize the need for school-based sexual health education at early secondary level based on the number of young people reporting an early age at first intercourse. To maintain maximum credibility, any recommendations given in policy briefs should follow from the data findings themselves.

• In material prepared for other audiences, discuss the implications of the findings in the recipients' own situations. For example, a presentation about high levels of risk among factory workers might emphasize the need to increase condom use, or a presentation on high levels of male premarital sex might discuss implications for HIV exposure of young women about to marry.

• Always present data with appropriate age, gender, and other breakdowns to help people understand the meaning of the results. Because levels of risk behavior change from one population to the next, vary between men and women, or change as people go through life, it is important that presentations take these factors into account in displaying the findings. Far too often, such results have been presented with no sub-population, gender, or age breakdowns. This makes it difficult for people to see important patterns, such as high levels of risk among adolescents.

• Highlight items on which the target audience can act in the presentations of the data. Because surveys often look for trends, some people mistakenly assume the lack of any clear trend is not interesting, but this is frequently not the case. For example, a low but stable level of condom use among casual sexual partners can be a catalyst for mobilizing efforts at condom promotion in the surveyed community.

• Present data regarding marginalized communities, such as sex worker or men who have sex with men, carefully and with sensitivity to the concerns of these communities. Plan carefully and present the data in a way that does not increase stigmatization or discrimination.

• Present information that shows the audience why they should care about AIDS. A presentation for the Ministry of Finance or Planning should show that it will be very difficult to achieve economic development goals without addressing AIDS. For health specialists, the presentation should show how AIDS affects the achievement of goals for child survival and life expectancy. For labor unions, the presentation should show how union members and their families are affected by AIDS. Relating AIDS to the issues of most concern to the audiences is an important component of an effective presentation.

• Show audiences that something can be done to improve the situation. Otherwise, a powerful presentation can create a feeling of hopelessness. The last part of a presentation or document should describe effective actions that can be taken now. These may be actions that those in the audience can implement themselves, or actions by others that they should support.

• Use projections to illustrate how past trends may be changed and how AIDS affects the ability to achieve future goals. It can be useful to include epidemiological projections of the number of people infected, number of AIDS cases and AIDS deaths, and projections of the social and economic impacts of AIDS, such as effects on health care costs, the number of orphans, economic growth, women's lives, and rural development. Such projections can be used to show the full range of impacts that AIDS can have on families, communities, and nations.

Conclusion

The importance of dissemination should not be underestimated. With effective dissemination, survey and other evaluation data can become an important component of advocating for expanded action and motivating a broader societal response to HIV prevention. In summary:

• Dissemination is a process that begins when an evaluation is first conceptualized and designed and continues through the life of the project. The objectives of this process are not only to disseminate the findings widely, but to see that they are understood and acted upon.

• In general, results should be disseminated as broadly as possible, but in ways that respect the concerns and sensitivities of the target audiences and key stakeholders. Possible target audiences include policymakers, leaders and members of the communities under surveillance, program managers in government, NGOs and CBOs, mass media, and the general public.

• Many forms of dissemination, including technical reports, policy briefs, mass media briefings, and group and individual meetings, will typically be required to reach all target audiences who can act upon the findings.

• Materials should be prepared in simple language that can be understood by the target audiences. Targeted materials should discuss the implications of the findings for the specific audience and present ideas for appropriate action by them.

• Staff should pay careful attention to the way information regarding stigmatized communities is disseminated so as to not contribute to their further marginalization.

• An effective strategy for disseminating findings to key stakeholders is an important factor in expanding the societal response to HIV prevention.