Health, Development and the Media

1. Health, Development and the Media Carlos Chirinos SOAS Radio carlos@soas.ac.uk

2. About me • Anthropologist from Venezuela • Worked in the Amazon rainforest assessing the impact of health policies on indigenous communities • Director of SOAS Radio: media outlet and media for development • Main consultant for Radio BisonaBiso, Republic of Congo • Senior teaching fellow at SOAS and lecturer at City University in community and digital media • Director’s teaching prize 2009 • Consultant and trainer for the Malaria Consortium, LIDC and LSHTM

3. OBJECTIVES • Media and international development • Media penetration in Africa • Health campaigns: methodologies and techniques • Tools for health practitioners to engage with the Media

4. Media for Development Mass media? Community Media? ICT’s? AIMS: • Raise awareness • Prompt behavioural change • Change attitudes • Disseminate specific information: media alerts BIASES: Top-down approach; prescriptive messages; ready-made solutions, etc.

5. The Communication Process Technology and The Message

6. Technology • Radio: has the largest audience penetration in Africa. Cheap to run. Promotes community participation. • TV: more expensive and laborious, limited penetration, limited participation. • Newspapers. Very important among opinion leaders, policy makers and political leaders. Fails to reach illiterate audiences • ICT’s and the Internet. Growing but still limited. Cybercafes • Mobile Phones: one to one communication. Data collection and distribution using mobile phones

7. Media Penetration in Africa

8. Media Penetration in Africa Radio and Development in Africa, A Concept Paper. Prepared for the International Development Research Centre (IDRC) of Canada by Mary Myers. August 2008 (revised March 2009). Available from http://www.idrc.ca/uploads/user-S/12581214041Radio_and_Development_in_Africa,_concept_paper.pdf

9. The Message Editorial + Production values • Editorial guidelines: what does this particular outlet talks about? • Selection of relevant topics • Development of formats • Production values: technical and journalistic skills in content production: Interviewing skills, editing skills, video/audio capturing, presenting and production skills

10. Health and the Media • Prevention of contagious diseases • Awareness of risks: contaminated water • Accident prevention: road accidents, using seatbelts • Promote vaccination to increase immunization rates • Addressing domestic violence and other social problems related to health

11. Using the Media or engaging with the Media? Approaching the media as channels for advertising placements or relaying news stories alone is problematic. Potential backfire: -Reluctance of media organisations to appear to be taking sides with government initiatives -Supporting one set of interests amidst political conflicts between officials and the press.

12. Media as a stakeholder -Media as a stakeholder to advance important public policy issues is well established in the United states -Media has been considered as a key stakeholder in international health programs such as maternal health in Zambia, domestic violence in South Africa and child and adolescent health in Brazil.

13. Media as a stakeholder Example: The Polio Eradication Initiative The PEI launched outreach initiatives that included -One-on-one interaction with editorial staff and journalists of state and local media -Ongoing tracking of media coverage of polio issues -Strengthened capacity of district information officers -Involvement of media and communication professionals in health campaigns

14. Escalated Media Impact: the audience • Influencing opinion makers: scholars, intellectuals, personalities. • Influencing niche audiences: policy makers, politicians, senior advisers. • Influencing mainstream audiences

15. Media Impact Newspapers, blogs, tweets Literate audience Opinion makers, policy makers, academics, intellectual community

16. Media Impact Radio/TV/Mobile Phones Illiterate audiences Mainstream impact: hygiene campaigns, sexually transmitted diseases. Niche impact: minority media, community focused, specific problems

17. Methodologies: Media and Health • Influencing people techniques • Fear inducing messages: The extended parallel processing model (EPPM) • Edutainment

18. Influencing Strategies Rationale • Behavioural beliefs. Attitude: Is it worth it? • Normative beliefs. Who else thinks I should do it? Subjective norm: Is it expected of me? • Control beliefs: What I am capable of? Perceived behavioural control: How easy will it be?

19. Influencing people techniques • Applying peer pressure • Making thinking easier • Building up credit • Creating scarcity or minimizing the options • Establishing a precedent • Appealing to authority

20. Influencing strategies • PUSH: External impetus, proposals, power and pressure, hierarchies and expertise, argument and reason, existing power relationship. Vertical approach: FORCING THE PROCESS • PULL: Internal impetus, invitational, involvement and envisioning, relationships and rapport, conviction and personality. New peer relationship. Horizontal approach: PROMPTING COMMITMENT FROM INDIVIDUALS AT RISK

21. Using fear to induce behavioral change • A model to assist scholars and practitioners in the development of effective risk communication messages and offer insight into how to channel an individual’s fear into motivation for effective action. • Tested in nearly 50 studies across a wide variety of topics including skin cancer; HIV/AIDS prevention, teen pregnancy, genital warts, breast cancer, radon awareness and tractor safety. Source: Muthusamy, Levine, Weber (2007)

22. The Message: Fear or Efficacy of treatment? • Using fear messages where there is already a pre-existing level of fear might prompt a defensive reaction. Example: graphic images of people dying of HIV/AIDS • Focusing on efficacy of treatment prompts a change of attitudes towards the problem: evidence of reduction of danger by using condom.

23. Edutainment Edutainment has been used successfully in various settings to educate people and create the conditions for social change through the use of entertaining media carefully crafted to have the desired effect. • Mainstream media • Folk Media

24. Edutainment: Soul City series in SA • 13-part prime-time television drama • 45-part radio drama • Transmitted in nine languages through the SABC sta- tions • Full colour booklets distributed through 10 newspapers nationally. • The health messages are integrated into the drama through a process of research, development, testing and partnership development in order to ensure the optimal messaging and advocacy (Galavotti et al., 2001) • Funded by DFID

25. Aims of Soul City • Change attitudes against HIV/AIDS and living with HIV/AIDS patients • Domestic Violence: highlights the power inequalities between men and woman • OneLove campaign promoting “one partner at a time” Sample

26. Folk Media Any form of endogenous communication system which by virtue of its origin from, and integration into a specific culture, serves as a channel for messages in a way and manner that requires the utilization of values, symbols, institutions, and ethos of the host culture through its unique qualities and attributes. -Personal and group information sharing -Entertainment nature

27. Forms of Folk Media • Storytelling • Puppetry • Proverbs • Visual art • Drama • Music Example: Use of condom in Latinamerica Ponte el Sombrero Ponte el Sombrero - Lyrics

28. Examples of work with Mobile Phones • Southern Africa Center for Infectious disease surveillance (SACIDS) project in Ngorongoro Use of mobile phones to capture data about animal and human diseases at point of outbreak/care, working with community based health reporters. www.sacids.org • D-TREE development and use of treatment protocols for common diagnosed illnesses based on best field practices. The protocols are programmed into inexpensive mobile phones for use by frontline health workers in both clinical and community settings. www.d-tree.org

29. Health practitioners and the Media • The social role of the health professional • Intervention of health professionals in the media: key influential role • Appealing to authority: even if the researcher’s output or practitioners activities’ do not directly affect policies or hygiene practices, quoting them adds weight to the message.

30. Practical tools for Health Practitioners and Researchers • Identifying the key message • Focus of the message on its impact on the population or changes needed in public policy • Narrowing the information down to data and plan of action

31. Preparation for Media Interventions • Change mindset: focus on the message, detach personal input • Request briefing and questions in advance if possible • Assess the media outlet to understand its potential impact and adapt answers accordingly Example: what to say on national TV, regional radio or specialist science reporter for a national newspaper?

32. Practical considerations • Check use of appropriate language according to media • Avoid acronyms and provide specific dates • Quote data and precedents • Appeal to authority including funding or other information

33. Strategic Media Plan • Engagement with editors of national and local media in the design of health messages • Elaboration of a glossary and appropriate documentation for local journalists • Provide capacity building workshops with the media, training them in the use of terms and language, clarify doubts and demystify health-related information • Production of timely sensitive press releases with specific information. One message at a time

34. Bibliography MASS MEDIA, STIGMA, AND DISCLOSURE OF HIV TEST RESULTS: MULTILEVEL ANALYSIS IN THE EASTERN CAPE, SOUTH AFRICA. By: Hutchinson, P. L.; Mahlalela, X.; Yukich, Josh. AIDS Education & Prevention, Dec 2007, Vol. 19 Issue 6, p489-510, 22p Scaring the Already Scared: Some Problems With HIV/AIDS Fear Appeals in Namibia. By: Muthusamy, Nithya; Levine, Timothy R.; Weber, Rene. Journal of Communication, Jun 2009, Vol. 59 Issue 2, p317-344, 28p The Complexity of Social Mobilization in Health Communication: Top-Down and Bottom-Up Experiences in Polio Eradication. By: Obregon, Rafael; Waisbord, Silvio. Journal of Health Communication, Jan 2010 Supplement, Vol. 15, p25-47, 23p, 1 Chart; DOI: 10.1080/1081073100369536 Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. By: Hogan, Daniel R.; Baltussen, Rob; Hayashi, Chika; Lauer, Jeremy A.; Salomon, Joshua A.. BMJ: British Medical Journal (International Edition), 12/17/2005, Vol. 331 Issue 7530, p1431-1435 Communicating HIV and AIDS, What Works? A Report on the Impact Evaluation of Soul City's Fourth Series.Full Text Available By: Goldstein, Susan; Usdin, Shereen; Scheepers, Esca; Japhet, Garth. Journal of Health Communication, Jul/Aug2005, Vol. 10 Issue 5, p465-483, 19p Assorted bibliography: skin cancer (Stephenson & Witte, 1998), HIV/AIDS prevention (Murray- Johnson, Witte, Liu, & Hubbel, 2001; Witte, 1992a, 1994; Witte, Cameron, Lapinski, & Nzyuko, 1998; Witte & Morrison, 1995), teen pregnancy (Witte, 1997), genital warts (Witte, Berkowitz, Cameron, & McKeon, 1998; Witte, Cameron, McKeon, & Berkowitz, 1996), breast cancer (Kline, 1995), radon awareness (Witte et al., 1998), and tractor safety (Witte et al., 1993). Source: Muthusamy, Levine, Weber (2007)