C-CHANGE
C-Channel:
Issue 30 | MAY 2011
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Novel approaches to communicating on HIV

Of Interest…

AIDSTAR-One highlights the novel approach of the Fataki radio campaign in Tanzania, which uses humor and familiar stories to foster dialogue around the dangers of intergenerational sex and encourage community members to intervene. Access the case study at the AIDSTAR-One website.

C-Channel-30 presents eight articles about HIV communication materials that go beyond traditional formats. The first two articles concern a theory-based audio presentation for women unable to read in rural Ethiopia: the format they preferred and intervention outcomes. The third article outlines an evaluation tool used with low-literate audiences in Haiti, and the fourth details the process used to develop visual images to communicate side effects of antiretroviral treatment. The fifth article references the need to communicate about HIV in Braille, sign language, and other disability-friendly formats, and the last three articles address the contributions of videos, instant messaging, and a script-writing contest to effective communications on HIV.

C-Change has developed a unique, interactive toolkit to foster community dialogue around HIV and mobilize communities to take action to prevent the virus from spreading. The Community Conversation Toolkit is now available in seven African languages on C-Hub. Each version is based on extensive field-testing and adapted to the specific context. This is reflected in the artwork of the different tools, which include finger puppets, “throw” boxes, playing cards, and dialogue buttons.

 

In this issue

Communicating with low-literate populations and persons with disabilities

1. Effects of an audio-based HIV/AIDS intervention for an illiterate population - Ethiopia

2. Reaching illiterate women in the Ethiopian highlands with oral HIV/AIDS prevention messages
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3. Evaluating HIV/AIDS education programs for low literacy populations in Haiti

4. Communicating information about antiretroviral side effects using visual images

5. Different formats for communicating HIV/AIDS information for persons with disabilities - Kenya
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Use of videos, instant messaging, and a script-writing contest to communicate about HIV

6. A video-based HIV risk-reduction intervention for female military personnel - Nigeria
FREE FULL TEXT

7. Using instant messages and the Internet to facilitate HIV/STD education and prevention

8. Youths' social representations of condoms in HIV-related narratives from six African countries


Communicating with low-literate populations on HIV

1. Effects of a theory-based audio HIV/AIDS intervention for illiterate rural females in Amhara, Ethiopia

Authors: Bogale GW 1,2; Boer H 2; Seydel ER 2
Institutions: 1 Educational Media Agency, Ethiopia; 2 University of Twente, The Netherlands
Source: AIDS Education and Prevention Feb 2011; 23(1): 25-37.

ABSTRACT

In Ethiopia the level of illiteracy in rural areas is very high. In this study, we investigated the effects of an audio HIV/AIDS prevention intervention targeted at rural illiterate females. In the intervention we used social-oriented presentation formats, such as discussion between similar females and role-play. In a pretest and posttest experimental study with an intervention group (n = 210) and control group (n = 210), we investigated the effects on HIV/AIDS knowledge and social cognitions. The intervention led to significant and relevant increases in HIV/AIDS knowledge, self-efficacy, perceived vulnerability to HIV/AIDS infection, response efficacy of condoms and condom use intention. In the intervention group, self-efficacy at posttest was the main determinant of condom use intention, with also a significant contribution of vulnerability. We conclude that audio HIV/AIDS prevention interventions can play an important role in empowering rural illiterate females in the prevention of HIV/AIDS.

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2. Reaching the hearts and minds of illiterate women in the Amhara highland of Ethiopia: Development and pre-testing of oral HIV/AIDS prevention messages

Authors: Bogale GW 1,2; Boer H 2; Seydel ER 2
Institutions: 1 Educational Media Agency, Ethiopia; 2 University of Twente, The Netherlands
Source: Sahara Journal Jul 2010; 7(1): 2-9. [Open Access]

ABSTRACT

In the style of radio programmes, we developed three episodes of audio HIV prevention education for illiterate women in Ethiopia. We used social-oriented presentation formats, such as discussion between women on HIV prevention, and expert-oriented presentation formats, such as an interview with a male doctor. The aim of this study was to assess the relation between evaluation of presentation formats and overall liking of episodes, which is important for persuasive effects. Thirty women from rural Amhara listened to the episodes and, after listening, female data collectors interviewed the women on evaluation of presentation formats, overall liking of episodes, identification with the characters and convincingness. Evaluation of social-oriented presentation formats was strongly related to overall liking of episodes, but evaluation of expert-oriented presentation formats was not. This relation was mediated through convincingness and not through identification. We conclude that social-oriented presentation formats make messages more convincing and, consequently, improve overall liking and persuasive impact.

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3. An effective, low-cost approach to implementing HIV/AIDS education programs in low literacy populations: An example from rural Haiti

Authors: Preidis G; Shapiro C; Inobert P; Dyer M; Kozinetz C; Grimes R
Source: Journal of Health Care for the Poor and Underserved May 2010; 21(2): 430-437.

ABSTRACT

The HIV/AIDS pandemic disproportionately afflicts regions of the world that have minimal access to formal schooling and low literacy rates. Health educational interventions are difficult to evaluate efficiently in these settings because standard approaches such as written questionnaires cannot easily be employed. Here, we describe a novel method of rapidly assessing health interventions among large groups that does not require the ability to read or write. We tested this evaluation tool within the context of a community-based HIV/AIDS drama education program in a low-literate region of rural Haiti. The evaluation was simple, easy to use, and confirmed substantial improvements in knowledge after the intervention. The tool also provided information that helped alter the intervention to improve educational outcomes in subsequent productions of the drama. This evaluation method can be utilized for very little cost, and may be replicated in resource-poor, non-literate settings throughout the developing world.

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4. Developing visual images for communicating information about antiretroviral side effects to a low-literate population

Authors: Dowse R 1; Ramela T 1; Barford K 1; Browne S 2
Institutions: 1 Rhodes University, South Africa; 2 University of California at San Diego, USA
Source: African Journal of AIDS Research Sep 2010; 9(3): 213-224.

ABSTRACT

The side effects of antiretroviral (ARV) therapy are linked to altered quality of life and adherence. Poor adherence has also been associated with low health-literacy skills, with an uninformed patient more likely to make ARV-related decisions that compromise the efficacy of the treatment. Low literacy skills disempower patients in interactions with healthcare providers and preclude the use of existing written patient information materials, which are generally written at a high reading level. Visual images or pictograms used as a counselling tool or included in patient information leaflets have been shown to improve patients' knowledge, particularly in low-literate groups. The objective of this study was to design visuals or pictograms illustrating various ARV side effects and to evaluate them in a low-literate South African Xhosa population. Core images were generated either from a design workshop or from posed photos or images from textbooks. The research team worked closely with a graphic artist. Initial versions of the images were discussed and assessed in group discussions, and then modified and eventually evaluated quantitatively in individual interviews with 40 participants who each had a maximum of 10 years of schooling. The familiarity of the human body, its facial expressions, postures and actions contextualised the information and contributed to the participants' understanding. Visuals that were simple, had a clear central focus and reflected familiar body experiences (e.g. vomiting) were highly successful. The introduction of abstract elements (e.g. fever) and metaphorical images (e.g. nightmares) presented problems for interpretation, particularly to those with the lowest educational levels. We recommend that such visual images should be designed in collaboration with the target population and a graphic artist, taking cognisance of the audience's literacy skills and culture, and should employ a multistage iterative process of modification and evaluation.

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5. Implication of communication formats on HIV and AIDS information for persons with disabilities in Kenya

Authors: Kochung E; Were C
Institution: Maseno University, Kenya
Source: Educational Research Jan 2011; 2(1): 752-56. [Open Access]

ABSTRACT

Provision of information is one of the strongest tools for fighting HIV/AIDS, and various organizations in Kenya have put tremendous efforts to provide information on HIV and AIDS prevention. However, despite these efforts, the people with disability particularly those who are blind or deaf are still being excluded from accessing information due to communication formats used by HIV/AIDS service providers. The audio-visual channels such as radio, television, newspapers, large bill boards, internet, lectures or brochures being used to provide information on HIV/AIDS to the general population are discriminative since they require the use of sight and hearing. This study examines implication of communication formats on HIV and AIDS information to persons with disability in Kenya. Data for this study was collected specifically from blind and deaf students through interview and focus group discussion. Results indicate that people who are blind or deaf do not access HIV and AIDS information given to the general population and that language used is complicated and technical. HIV and AIDS information should be provide through accessible disability-friendly communication formats such as talking computers, Braille, sign language and symbols.

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Use of videos, instant messaging, and a script-writing contest to communicate about HIV

6. Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel

Authors: Essien EJ 1,2; Mgbere O 1,3; Monjok E 1; Ekong E 4; Holstad M 5; Kalichman S 6
Institutions: 1 University of Houston, USA; 2 University of Texas School of Public Health, USA; 3 Houston Department of Health and Human Services, USA; 4 Institute for Health Research and Development, Nigeria; 5 Emory University, USA; 6 University of Connecticut, USA
Source: Social Science & Medicine Jan 2011; 72(1): 63-71. [Epub before print; PubMed Central]

ABSTRACT

Anecdotal evidence suggests that the HIV/AIDS prevalence rates in several African armed forces are high, with gender inequality rendering female military personnel more vulnerable to the disease. The objective of this study was to replicate a successful videotape-based HIV prevention intervention among Nigerian female military personnel in an effort to establish the cross-cultural stability, feasibility and cost-effectiveness of this approach in resource-limited countries. Enlisted women (N346) were recruited from two cantonments in Southwestern Nigeria and randomly assigned to either (a) a 5-session video-based, small group, cognitive-behavioral, HIV prevention intervention, or (b) a 5-session, video-based, contact-matched, HIV education control condition. Participants provided self-report of their HIV/AIDS-related knowledge and sexual behaviors at baseline, 3 and 6 months after completing the intervention. The results indicate that the motivational skills-building intervention did not improve participants' knowledge of HIV/AIDS any better than did the HIV education control condition at each assessment period, but it significantly increased condom use among women in this group by 53.6% at 3-month follow-up. HIV preventive behaviors among women in the motivational skills-building intervention group improved significantly, being 2 and 3 times more, compared to women in the HIV education control group at 3-month and 6-month follow-up assessments. The intervention also significantly improved behavioral intentions of participants as well as reduced alcohol use before sex by 25%, after 3 months; and number of sexual partners by 12% after 6 months. Women in the intervention group were five times more likely than women in HIV education control group to suggest that their new male partners use condom. These findings indicate that a videotape-based, HIV prevention intervention is a feasible and effective approach to HIV prevention among female military personnel from sub-Saharan Africa.

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7. PowerON: The use of instant message counseling and the Internet to facilitate HIV/STD education and prevention

Authors: Moskowitz D 1; Melton D 2; Owczarzak J 1
Institutions: 1 Medical College of Wisconsin, USA; 2 Npt Labs, LLC, USA
Source: Patient Education and Counseling Oct 2009; 77(1): 20-6. [Epub before print]

ABSTRACT

OBJECTIVE: In recent years, Internet-based or online counseling has emerged as an effective way to assess psychological disorders and discuss destructive behaviors with individuals or groups of individuals. This study explores the application of online counseling to HIV/STD risk-taking behavior among men who have sex with men (MSM).
METHODS: PowerON, an organization that provides sexual health information to MSM exclusively online, used instant message technology to counsel MSM in real time through computer-mediated means. A sample of 279 transcripts of instant message exchanges between PowerON counselors and Gay.com users were recorded and qualitatively analyzed.
RESULTS: Approximately 43% of the instant message sessions discussed information about HIV/STD testing. Risk-taking behaviors were addressed in 39% of the sessions. Information about HIV/STDs and general counseling were given in 23% and 18% of the counseling sessions, respectively.
CONCLUSION: The data showed these instant message sessions to be a potentially feasible forum for HIV/STD counseling.
PRACTICE IMPLICATIONS: Information ordinarily disseminated at health clinics could be successfully distributed through the Internet to MSM.

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8. Making sense of condoms: Social representations in young people's HIV-related narratives from six African countries

Authors: Winskell K; Obyerodhyambo O; Stephenson R
Institution: Emory University, USA
Source: Social Science and Medicine Mar 2011; 72(6): 953-61. [Epub before print]

ABSTRACT

Condoms are an essential component of comprehensive efforts to control the HIV epidemic, both for those who know their status and for those who do not. Although young people account for almost half of all new HIV infections, reported condom use among them remains low in many sub-Saharan African countries. In order to inform education and communication efforts to increase condom use, we examined social representations of condoms among young people aged 10-24 in six African countries/regions with diverse HIV prevalence rates: Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso, and Senegal. We used a unique data source, namely 11,354 creative ideas contributed from these countries to a continent-wide scriptwriting contest, held from 1(st) February to 15(th) April 2005, on the theme of HIV/AIDS. We stratified each country sample by the sex, age (10-14, 15-19, 20-24), and urban/rural location of the author and randomly selected up to 10 narratives for each of the 12 resulting strata, netting a total sample of 586 texts for the six countries. We analyzed the narratives qualitatively using thematic data analysis and narrative-based methodologies. Differences were observed across settings in the prominence accorded to condoms, the assessment of their effectiveness, and certain barriers to and facilitators of their use. Moralization emerged as a key impediment to positive representations of condoms, while humour was an appealing means to normalize them. The social representations in the narratives identify communication needs in and across settings and provide youth-focused ideas and perspectives to inform future intervention efforts.

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This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of C-Change, and do not necessarily reflect the views of USAID or the United States Government.

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