Developments in the Use of the Mass Media at the National Level for HIV/AIDS Prevention in South Africa: Research and Development
The internationally recognised centre at Johns Hopkins developed a model for public healthcommunication practice called the "P" Process. In this model seven distinct steps are described.These steps are largely informed by communication experience that recognises the importanceof researching and understanding the target audience, the pre-testing of messages and imagesand the monitoring and measurement of the impact of the campaign.
Figure 2 summarises the steps of the "P" Process.
Figure 2: Johns Hopkins "P" Process
There is now widespread understanding that formative and evaluative research is essential.Johns Hopkins recommends that 10% of a campaign budget should be spent on research andevaluation.[9]
In the independent appraisal of Beyond Awareness II, commissioned by the Department of Health,it was concluded that although the campaign was found to be generally competent it was criticisedfor its application of some of these steps.[10] Only 2.5% of the Beyond Awareness II budget was spent on research and evaluation and it was felt that the campaign had failed to adequately address the following:
- The development of a theoretical model (as required by Step 2).
- To provide a clear definition and segmentation of the target audience. The precise targetaudience for the Beyond Awareness Campaign changed between various activities andpublications.
- To provide evidence of pre-testing of campaign messages, image and branding including the"red ribbon" campaign (as required by Step 3).
- To provide an impact evaluation at the end of the campaign.
Soul City has an 18 month development period for each series, during which the followingdevelopment process is adopted:
- Choosing topics and identifying the target audience.
- Build partnerships with organisations working on the relevant issues.
- Researching the topics and the target audience.
- Developing the messages and the storyline.
- Pre-testing the storyline and radio and TV scripts with the target audience and topic experts.
- The development and pre-testing of supplementary educational packages.[11]
The research and development process for the mass media is not documented by loveLife although they have a national baseline study for youth.
In government where there is some independent media advertising about AIDS separate tocommissioned campaigns, campaign messages are developed largely in isolation of research.GCIS has themselves commissioned research in the last two years, but are only now compilingthis information to inform strategy and message development.
Thus, although the value of research is understood, the ability to read and interpret the research forHIV/AIDS prevention is lacking. For example, although there is no evidence in their own researchthat South Africans are interested in abstaining from sex, GCIS promoted the "ABC" campaign of which the first message is "Abstain from sex". Interestingly, Beyond Awareness found that there is some qualitative evidence to suggest that reversal from being sexually active to being sexually inactive is an attractive option for some young people, especially women who are ambivalent aboutsexual relationships.[12] However, this nuance is not reflected in the rather crude ABC to safer sex campaign.
Branding
One of the critical decisions in the research and development phase is the identification ofappropriate branding. Government is acutely aware that the branding of government or Department of Health campaigns has been sorely inadequate. A study of sectoral perceptions on government communication campaigns on HIV/AIDS found that there was confusion aboutwhich organisations are responsible for what campaign. Many respondents in the study were unable to specifically mention government initiated campaigns such as the "Partnership againstAIDS" and "Beyond Awareness". This caused one respondent to say,
"What is government?... not clearly branded. A lot of confusion."[13]
The Beyond Awareness campaign has succeeded in popularising the red ribbon. In their sentinelsite research, they found that 74% of respondents report having seen the red ribbon before. However, recognition of having seen the red ribbon is much higher than the ability to think of a symbol that stands for AIDS without prompting. Exposure to the red ribbon was generallyfound to be high. The highest exposure was found to be 94% in a tertiary institution in Northern Province, with the lowest exposure being 40% in rural Eastern Cape.[14] Despite the high exposure, there is no documented evidence by Beyond Awareness II of what the red ribbon symbol meansto the public.
In the study of sectoral perceptions of government campaigns referred to earlier, it is clear thatcontroversies such as those around AZT or the origins of AIDS and the HIV virus are felt to be abarrier to the successful implementation of government communication campaigns of HIV/AIDS.
"The AZT debacle made it seem as though the government is not serious about HIV/AIDS."
"Controversies like AZT undermine campaigns because it keeps people off platforms where they may wantto talk about other aspects of HIV/AIDS but all the attention is on AZT."[15]
In contrast to the understated use of branding by Beyond Awareness, Soul City and loveLife place a lot of onus on the importance of branding. Soul City believe that they have developed "brand loyalty" by the consistent production of high quality media products that are popular in their target groups. In their latest evaluation of Soul City 4, they quote from an independent survey in which 47% of the national population in South Africa spontaneously mentioned Soul City as a television programme from which they feel that they have obtained useful informationabout HIV/AIDS.[16]
Figure 3: Spontaneous recall of television programmes from which respondents feel that theyhave obtained useful information on HIV/AIDS (Markdata).
In a study looking at the value associations of the Soul City brand, it was found that the brand islargely defined as educational, but with entertainment value. The value associations with SoulCity are positive. The "Soul City" brand is found to be trustworthy, healthy, experienced, reliable,knowledgeable, aspirational, reflecting values of selflessness, understanding and togetherness.[17]
In the evaluation of the first year of loveLife, one of their greatest successes is thought to be creatingbrand recognition among almost 60% of South Africans nationally. More than 90% of those who are aware of loveLife correctly identify the brand with healthy living and positive lifestyle, and 60% said that loveLife had caused them to think and talk about issues related to sex, sexuality and HIV/AIDS.[18] Describing themselves as a "brand-driven" initiative, their success in promoting their brand has been achieved through a large scale and intensive countrywide publicity campaignusing outdoor media, television, radio and print.
The planning behind loveLife's brand awareness has been extensive. Their aim has been to position the loveLife brand as part of youth culture. The key to loveLife's approach is to get young South Africans to talk about sex, sexuality and gender relations or "talk about it". The loveLife media campaign has concentrated on brand awareness and promotion through an initial teaser campaigndesigned to create intrigue to a clearer focus on sex and HIV. The three objectives for the campaignin the first year were to:
- Initiate a national conversation about the loveLife brand and excite the popular imaginationabout loveLife.
- Guide this dialogue towards sex and specifically adolescent sexuality with an emphasis oninter-generational communication about sexuality.
- Make explicit the link between sexual behaviour and HIV.
The start to the whole the campaign was a series of billboard teasers titled "Foreplay". In Phase 2of the campaign, the payoff line "Talk about it" was introduced and the youth sex talk show loveLife "JikaJika" launched, as well as the toll-free telephone help line. In Phase 3, the second television series "S'camto" was flighted and billboard messages designed to shock complemented the series. The publication "The Impending Catastrophe" was widely distributed in the printmedia aiming to inform the broader South African public of the ramifications of the epidemic. In the final phase of this first year's campaign, the link between behaviour and HIV was made more explicit by using the theme "The future ain't what it used to be". The print media was moretargeted in this phase, challenging parents to talk to their children about sex. During this finalphase the LoveTrain made stops in Cape Town, Durban and other smaller towns.
One of the striking features of the loveLife's description of their media campaign is how branding and messages are used interchangeably. At the start of this phased campaign, loveLife talks about creating brand awareness. By the end of the campaign, the effectiveness of their messages is being evaluated without any clear differentiation of the two. However, in discussion[19], it wasmade clear that the product being sold is a "healthy lifestyle", the brand is loveLife and the payoff line is "talk about it."
Messages
It is widely accepted that messages for a public health campaign should be researched. Usdinidentified nine important elements to the development of health messages.[20] These are:
- Messages must be meaningful to the target audiences in the context of their own lives andtherefore target audience research is essential. What does the target audience understandabout the issues? What are their beliefs and attitudes and what are the barriers to them takingup the healthy behaviour?
- Health expert input – What do the experts believe the target audience should know? Expertscan help identify key issues and can ensure that the messages are accurate.
- Is the message appropriate to the medium? Can the messages be conveyed effectively throughthe medium? For example, detailed information is not good for television, but would be moreappropriate for written material, as people can keep it and absorb it at their own pace.
- Positive messages work better – Often health promoters use fear and alarm as a means of gettingtheir audience's attention. But research shows that people respond to fear with feelings ofhelplessness, denial and even public hysteria.
- Avoid victim blaming. Health educators have often used victim blaming to shame people intotaking action.
- More immediate messages that tell the target audience the immediate benefits of a health behaviour have been shown to be more effective.
- Appropriate to the target audience – The language and style must suit the target audience.
- Kept simple – Messages must avoid technical or scientific jargon.
- Kept short – A few words are better than many.
The critical step is ensuring that health messages (including images used in support of a campaign, and otherprint materials) are pre-tested. Pre-testing is usually conducted through focus group research.
Soul City is meticulous in their development process. They estimate that the development phase for an edutainment product amounts to 50% of the project time. The Soul City AIDS messages have included a full range of prevention and care support messages. Their prevention messagesin series 2, 3 and 4 are listed below. Soul City does not have a sustained media presence as their messages are primarily woven into TV and radio series. The TV series, when flighted, runs over a period of thirteen weeks.
| Soul City HIV/AIDS prevention messages Series 2, 3 and 4
|
Beyond Awareness did not document any pre-testing of their messages neither did they specificallyevaluate recall of messages in their sentinel site research. The mass media component of theBeyond Awareness campaign that promoted specific messages spent approximately 34% of thetotal budget over two years.
Figure 4: Beyond Awareness II media advertising
I
loveLife report conducting focus group discussions and using theatre techniques to explore theperceptions and responses to specific media productions on television, radio, outdoor advertising,booklets and newsprint. From the documentation, this would appear to be evaluative ratherthan formative research. Their evaluation of the first year does include an evaluation of theeffectiveness and likeability of the messages. The positive attributes of the messages werethought to be:
- The message provides important information on how to avoid HIV/AIDS (42.7%).
- The message caught my attention and made me think about issues of sex (35.2%).
- The message caused me to talk about sex and HIV/AIDS to others (19%).
There is some evidence in the evaluation of the first year of loveLife that their pre-testing is inadequate. In Phase 3 of the mass media campaign, the results show that the message was seen as hard hitting and relevant, but that the impetus of the message was lost because of thecontradictory images that accompanied the information. As their billboard campaign has unfolded, loveLife has come under increasing criticism.
"The fun loving, partying and carefree young people seemed to suggest that such a lifestyle places one atrisk of acquiring HIV, directly contradicting the overall strategy of the loveLife campaign. It was also seen to imply that people who are HIV positive couldn't have a good time. As with previous phases, the imagery that was of black people and suggested that HIV is a black disease. The characters portrayed in the advert were also seen to suggest promiscuity and prostitution."[21]
This type of criticism should normally be picked up during the pre-testing phase. Overall, black respondents were more receptive to the campaign than whites, and over 60% of blacks rated the campaign "very effective" while almost 60% of whites rated it "fairly effective". This wasthought to be because whites do not identify with the predominantly black images used in the loveLife campaign, as well as because of racist and class perspectives on HIV/AIDS as a disease of poor blacks, a view that exists mainly among whites, but also among upwardly mobile middleclass young blacks.
Nokwedi, loveLife's media director, describes the billboard advertising campaign in its second year as,
"… deliberately obtuse so that young people will constantly come back to that same billboard or othermedia they see time and again and talk about it."[22]
Unfortunately for loveLife, so obtuse is their campaign with the jigsaw puzzle pieces and disjointedstatements that there is further criticism. Halperin and Williams [23], writing for the Washington Post, report that youth with whom they spoke informally in Mogwase in North West Province found the billboards "confusingly vague" and were outraged by the misallocation of resources. In their criticism of loveLife, they contrast the cryptic messages such as "climax/anticlimax" and "drop dead gorgeous/the drop" written in English with the use of outdoor media in Uganda.There, a community-designed AIDS billboard shows cattle tethered to a post symbolizing, in imagery familiar to local people and predominantly rural communities, the country's "Zero Grazing" prevention approach. Although such imagery would not be appropriate for loveLifethe point is clear.
In reply to such criticisms, Nokwedi insists,
"No billboard campaign ever created behaviour change because we know that media alone cannot bringabout behaviour change."[24]
The general sentiment of this is true, because historically the individualistic behaviour changeapproaches that isolated the individual from their physical and social environments did fail. However, this response to the criticisms leveled at loveLife fails to appreciate the potential of billboards within the integrated loveLife strategy where the media is not a stand-alone component, and therefore has the potential to be used strategically and to great effect.
What loveLife has shown is that outdoor media does provide effective exposure. In general, they found that television and billboards accounted for greater brand recognition than radio and taxis.
The loveLife experience illustrates the value of sustained media advertising. The irony of the present situation is that although South Africa is now in the fifteenth or sixteenth year of the HIV/AIDS epidemic, there has yet to be one sustained HIV/AIDS media campaign that promotespre-tested messages and images.
9 Piotrow, P.T., Kincaid, D.L., Rimon II, J.G., Reinhart, W. Health Communication: Lessons form Family Planning and Reproductive Health, Praeger, USA, 1997.
10 Coulson, N., Goldstein, S. A strategic appraisal of Beyond Awareness II and HIV/AIDS communication 2001-2003, Department of Health, September 2000.
11 Japhet, G. Edutainment: How to make edutainment work for you - a step by step guide to designing and managing an edutainment project for social development, Soul City, 1999.
12 Kelly, K.J. Communicating for Action: A contextual evaluation of youth responses to HIV/AIDS, Beyond Awareness Campaign, Department of Health, 2000.
13 Christofides, N. Government Communication Campaigns on HIV/AIDS: Sectoral Perceptions for GCIS, Women's Health Project, 2000, p.6 .
14 Kelly, K.J. Communicating for Action: A contextual evaluation of youth responses to HIV/AIDS, Beyond Awareness Campaign, Department of Health, 2000, p.21.
15 Christofides, N. Government Communication Campaigns on HIV/AIDS: Sectoral Perceptions for GCIS, Women's Health Project, 2000, p.10.
16 Markdata (Pty) Ltd Strategic Research Solutions. HIV/AIDS Popular Perceptions and Dangerous Delusions, Markdata, February 2000, p.1.
17 Crowther, H. A Look into Value Associationsof Soul City Brand, O'Brian Marketing Research International, September 2000.
18 Stadler, J. Looking at loveLife the first year - Preliminary monitoring and evaluation findings of the first year of loveLifeactivity: September 1999 - September 2000, Reproductive Health Research Unit, 2001.
19 Harrison, D. CEO loveLife, personal communication.
20 Usdin, S. Media and health promotion in Coulson, N., Goldstein, S., Ntuli, A. Promoting Health in South Africa: An Action Manual, Heinemann, Cape Town, 1998, p.119.
21 Stadler, J. Looking at loveLife the first year - Preliminary monitoring and evaluation findings of the first year of loveLifeactivity: September 1999-September 2000, Reproductive Health Research Unit, 2001.
22 Nokwedi, J. What's going on with loveLife? 19 September 2001, available by clicking here
23 Halperin, D., Williams, B. This is no way to fight AIDS in Africa, Washington Post, 25 August, 2001.
24 Nokwedi, J. What's going on with loveLife? 19 September 2001, available by clicking here.
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