|The Essential Handbook. Radio and HIV/AIDS: Making a Difference. A guide for radio practitioners, health workers and donors (UNAIDS, 2000, 128 p.)|
Assessing health needs for radio programming in Afghanistan (photograph by Gordon Adam)
What is initial research?
Initial research for radio programming means gathering, organising and analysing information of different kinds before you start planning and producing your programme. For example, you should research the incidence and impact of HIV/AIDS in your country or specific locality. Find out what the target audience currently knows and believes about HIV and AIDS, what practices they engage in that put them at risk and also what their attitudes are concerning these practices. It is also important to find out what the audiences reactions are to persons with HIV/AIDS (PWAs) and persons living with HIV/AIDS (PLWAs). They are the family and friends of the PWAs. You need to find out what information health workers think the audience needs to know and what they need to do to protect themselves against HIV and other STDs, and to support positively PLWAs. In this way you can start to identify the information gap that exists, and that the radio broadcasts will attempt to fill.
Ideally, you should gather information at different stages of your project or campaign (see Section 5 - Pretesting and Section 9 - Monitoring and evaluation). So if possible build research into the planned activities and budget of your HIV/AIDS programme (see Section 8 - Partnerships, page 83-86 for information on funding). Your audience may participate in the research and programming process by giving informal feedback (see Section 4 - Making radio interactive) as well as through the more formal methods described later in this section.
Why do initial research?
HIV/AIDS communication aims to provide information and raise awareness of issues that will bring about positive changes in attitudes and behaviour. As such it responds to the needs of the target audience. But because broadcasters dont know exactly what these are, they have to be researched. In news broadcasting you should make sure that the facts are accurate by carrying out research. Health education broadcasting imposes a special responsibility on broadcasters because you are providing information that people may act on to improve their health. If the information is incorrect the consequences could be serious or fatal.
With HIV/AIDS education the emphasis is on cause and prevention, with treatment rarely an affordable option. HIV/AIDS are subject to socially and culturally determined perceptions and unless you understand local attitudes and base your broadcasts on them, there is a danger that the audience will regard any education and advice as irrelevant.
Before designing the programme format and selecting key messages you should assess the HIV/AIDS situation so that the target audiences information needs and preferences are reflected. Radio and other media-supported initiatives are more likely to have a positive impact if they are well-informed, up-to-date and realistic.
HINT to broadcasters
Your station may be committed to devoting part of its airtime to development, social and health issues. In this case you will want to start by finding out what aspects of HIV/AIDS (and other related health problems, such as STDs) your listeners (or groups of them) face. You may not even be sure who your listeners are so you could find out this at the same time.
Theres no point in designing a programme on HIV/AIDS and sexuality for young people if your main audience is aged over 30, unless you intend to change your listenership profile too. Once you know what health problems you want to focus on and who your target audience is you can go on to the next stages of identifying and prioritising information on the issue(s), setting communications objectives and designing appropriate educational messages.
What information is needed?
· information about HIV/AIDS: facts and figures
· information about the target audience, especially their knowledge, perceptions and behaviour concerning HIV/AIDS
· information about listenership and broadcasting: who listens to what and when
· information about the target audiences preferences for programming style and treatment: this can vary substantially between women, men and youth, and will often reflect where they live (in the town or the country) and their level of education
· information about other organisations providing HIV/AIDS education and related products and services
Information about the HIV/AIDS issue
Try to get
· information on the causes, symptoms and prevention measures. It should be up-to-date and accurate but be aware of competing or contradictory views and interests
· statistical data on the incidence of HIV/AIDS by socio-economic factors. For example, geographical location, gender, age, ethnicity, occupation and language
· material on past and current local campaigns: make sure that government or donor policy does not conflict with the messages promoted by your campaign; make sure that all relevant agencies are aware of your campaign and its objectives
· information on the use of services or purchase of goods (eg attendance at STD clinics, figures for sales of condoms). This information can be used as a baseline against which to measure changes brought about by your campaign or project (impact)
GETTING INFORMATION ACROSS
In Cambodia recently, the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health ran a TV and leaflet campaign with the slogan Dont bring AIDS back home. This ran just before the launch by the World Health Organisation (WHO), the Ministry of Health and a number of NGOs of a campaign on Home and Community Care for People with HIV/AIDS'.
HINT to broadcasters and health workers
This is a good time to examine your own attitudes towards HIV/AIDS and Persons with HIV/AIDS (PWAs). Do your own views, knowledge and behaviour reflect the current advice given? Do you bring bias or prejudice to your interpretation of the problem? Find out what sensitive and positive language to use to avoid stigmatising. Get the best up-to-date and local information from specialists.
Information on your target audience
Research into the knowledge, attitudes and practices (KAP) of your target audience will help reveal
· gaps in knowledge which the radio programme will aim to fill including facts people themselves feel they lack or need reminding of
· positive attitudes relating to HIV/AIDS issues which programming can build on
· misconceptions, taboos, fears and prejudices associated with HIV/AIDS and sex which programming can address
· current behaviour and the extent to which it matches accepted good practice
· factors (including the opinions of others) that influence peoples decisions to take action on a particular problem
· barriers that prevent people from acting on information and health education: financial, gender, religious, cultural, practical, the availability, accessibility, acceptability of health services and the attitudes of health workers
· competing claims people have on their time, money, workload and what priority they give to solving or preventing the problem you have identified
· if non-target audience or target audience members might be disadvantaged in ways that could affect the success of the project, for example by creating social tensions between groups or isolating those who come forward and acknowledge they are HIV positive
· the objectives of the programme and indicators of change. These are selected items for measuring impact eg knowledge of causes and transmission routes of HIV infection, extent of compassion displayed towards PWA etc. They can provide a basis for assessing what changes in KAP have arisen between the beginning and the end of the campaign, as a result of the broadcasts (see Section 9 - Monitoring and evaluation for further information)
KAP STUDY ON ATTITUDES TOWARDS HIV/AIDS AMONGST CAMBODIAN WOMEN
A KAP survey of women in Kampot province, Cambodia, revealed that the more they heard about HIV/AIDS, the more afraid they became, and the less tolerant they were towards people living with the disease. For the HIV/AIDS communicators, the lesson learned was the importance of monitoring HIV/AIDS campaigns for unintended consequences and thereby identifying listeners concerns that needed to be addressed in follow up broadcasts.
Alfred, Health Unlimited (1996)
RESULTS OF KAP SURVEYS
Commercial sex workers in Cambodia (and many other countries) say they know all about using condoms to prevent AIDS, but many of their customers are soldiers who refuse to use them. Others are drunk and sometimes violent. So what can the sex worker do?
In other instances husbands know they are at risk because they have slept with commercial sex workers but they are reluctant to use condoms with their wives because this would amount to them confessing they had been unfaithful.
A third situation arises when a wife wants to use condoms for her own protection, and her husband refuses. In many societies, the woman lacks the power to insist on safer sex.
Radio listenership patterns and the media
A radio programme is only going to have impact if people are able to hear it: if possible try to devote some time, and possibly money, to collecting information on
· radio ownership including the geographical distribution of, control over and access to, radios among target audience
· listenership: collect information on the gender, age, social, ethnic and income/wealth group of listeners and non-listeners
· listening patterns: what are the target audiences preferred programmes, programme formats and times of listening
· transmission: number and type of stations on air, frequencies, time of transmission
· reception: what is the range and quality of reception, what factors influence reception
· media ownership: who owns and controls the station(s) and how are they financed
· extent of press freedom in the area/country; credibility of stations with the target audience
HINT to radio broadcasters
Be careful not to make assumptions about peoples needs. Even if you have the same cultural background as your audience (and many radio practitioners do not) there may be many differences between you and your target audience. Do you still live in the village or in the same community as your target audience, or have you moved to the city? Do they have the same level of education? Differences in knowledge, perceptions and behaviour can occur for many reasons: gender, age, or a combination of the two, status within the household (eg mother-in-law, daughter-in-law, hierarchy among wives in a polygamous marriage), social background and ethnicity, and educational background.
Presentation and treatment
Try to collect information that will guide the content and construction of the drama, spot or other programme format. Build on what is familiar and acceptable and locate health problems and health-seeking behaviour within their social context. This is particularly important for drama programming because you want listeners to identify with the situation and empathise with characters if they are to absorb and act on the messages or issues raised. Find out about
· people in the community who are role models or opinion formers and are liked and trusted. This might include religious leaders, traditional birth attendants (TBAs), chiefs, community leaders (male and female), traders, teachers etc. Also find out who they dislike or mistrust
· sources of information commonly used such as community meetings, marketplaces, mosques, churches, newspapers etc. The kind of stories and characters people like
· the target audiences opinion of radio as a source of health information
· local views on the subject to be broadcast as well as vocabulary and idiom used to describe/talk about it, and appropriate anecdotes for inclusion in the programme
· popular recreation activities, meeting places, events and opportunities that could be included or replicated in programming
· music listening preferences to guide choice of signature or theme tune and incidental music
· non-local figures (footballers, film stars, etc) who are popular with the target audience; either for reference within the programme to make characters conversations topical or to enlist in support of the HIV/AIDS campaign
Assessing knowledge, attitudes and practices relating to HIV/AIDS would require the following questions to be asked
What do you think are the causes of HIV/AIDS? In some places people believe that HIV/AIDS is spread by mosquitoes, or by eating certain foods, or that it mainly spreads from women to men. Advice given to prevent HIV/AIDS by using condoms or staying faithful to one partner known to be uninfected.
How do you know if you have HIV? Are there any signs or symptoms that would enable you to identify a person with HIV? One aim of health education is to teach people there are no signs or symptoms and that a person with HIV may look healthy and attractive.
How do you/can you prevent HIV? Are the transmission routes understood? Are condoms available? Are disposable syringes and needles available? Can poor people afford them? Do women have the right to insist on condom use?
How would you relate to a person with HIV? How would you feel if a friend or relative told you he/she had HIV? How could you help them? What problems might they face?
HINT for aid organisations
Examine the audiences perception of radio, and of the station you plan to use in particular. For example it may be associated with one or other ethnic group or political party and be unacceptable to some, or all, of your target audience.
How do you do research?
There are no hard and fast rules governing research for educational radio: instead a number of different disciplines and techniques can be drawn on, depending on your requirements and constraints of time and money. Health professionals and social scientists have developed numerous approaches and tools for collecting information on peoples ideas, beliefs, knowledge and actions concerning health issues. Some of these are outlined below with case studies showing how they have been used in the field.
HINT for radio stations or health organisations
By documenting how important radio is in peoples lives you may strengthen your proposal in the eyes of potential donors.
HINT to donor organisations
Weigh up carefully the need for a quantitative survey. They do not always provide the information you need to establish needs and impact. If you go ahead and commission a market research firm to carry out a survey make sure the radio producers are closely involved in writing the terms of reference.
Methods and tools
The KAP survey is based on a questionnaire in which only multiple choice or Yes/No answers are possible. It is administered to a statistically representative sample of the target audience. Often it is repeated during and after a health project to measure changes in the target audiences KAP. Target group KAP surveys are a standard tool in designing health education interventions, and with minimal adaptation (to include research into listenership, media, presentation and treatment) can be used in the context of radio programming.
Advantages (if carried out properly)
· confidence in the findings because they are statistically representative
· the same questions are asked irrespective of who is doing the questioning so the results are unbiased and comparable over time and place
· establishes a baseline for future comparison
· little contextual information is obtained
· difficult to gauge perceptions with closed answer questions
· the audience has little opportunity to guide the agenda
· often time-consuming
· expensive if designed and implemented from scratch
· requires statistical analysis and associated skills
· difficult to obtain statistically representative samples in areas of conflict where there is little baseline information
Ways of overcoming the disadvantages and doing it more cheaply and/or more quickly
· use existing research and secondary documentation where possible
· add questions to an existing household survey
· call in specialist advice to design questionnaires and perform analysis
· design short questionnaires to generate information on, say, listenership, using simple calculations
· combine with qualitative methods
Whilst carrying out a KAP survey it should be possible to add some questions about listenership and reception to the questionnaire used, so avoiding the need for separate research. Factual information about the media and transmission can be obtained from the broadcasters, but remember what they say is happening may not actually be happening on the air so cross-check with listeners.
Partly due to the disadvantages of quantitative methods, research to guide health interventions often uses qualitative methods. Qualitative research gathers information about feelings and impressions from a small sample of respondents who tend to be purposively, rather than randomly, selected. Cross-checking (triangulation) of information through using a variety of methods, sources and researchers can help ensure that the data is trustworthy. The data gathered cannot usually be quantified in numerical terms and manipulated statistically: caution should be exercised in making generalisations from the results.
· can be used in a rapid assessment exercise
· can tell you what people really feel rather than simply give a structured reaction to questions
· many qualitative methods combine the double function of generating both data and dialogue with participants
· can feed information on specific topics into the design of quantitative surveys and make them more effective
MIXING METHODS: THE CASE OF NDINGA NACIO
In Kenya, the Agricultural Information Centre carried out needs assessments in seven villages in Meru and Tharaka Nithi Districts prior to developing an agricultural soap opera (later named Ndinga Nacio). A mixture of qualitative and quantitative methods were used. The exercise took nearly three months and included a fortnights training for local agricultural technical assistants in data collection techniques and listening skills (they were not specialised researchers but knew the area they worked in and were accustomed to communicating with the target audience).
Firstly they devised a short listenership questionnaire which they asked 20 people, randomly sampled, in each village to answer. The results were added up to find out, for example, how many people owned radios according to gender, age and wealth. The teams also used qualitative methods to gain greater insight into peoples preferences for programme content, presentation and style. These included techniques such as seasonal calendars, resource mapping and ranking (some of which are explained below) to explore the context and priority concerns of the target audience and focus group discussions. The latter were held with different groups (men, women, young, old and poor) using a checklist of questions.
The mix of methods ensured that crucial information relating to listenership, programming format and content was revealed causing the production team to seriously rethink some of their initial assumptions
· the quantitative survey showed that poor farmers in the area were unlikely to benefit from the planned programmes since only 35% had a radio in their house, and 30% had no access to any radio. Reaching women was a project priority but because in 80% of households men controlled the radio it was recommended that men were targeted as the secondary audience
K Lloyd-Morgan (1995)
· requires strong interpersonal skills and good teamwork
· can be lengthy to prepare, carry out and analyse
· interpreting qualitative information can be difficult
· can be harder to convince others of the results than with quantitative findings
Below are listed five categories of qualitative methods and tools to use in gathering information: they are by no means exhaustive but are intended to guide the reader to some of the more accessible research techniques that have been or could be used in the context of radio programming. They include consultation; secondary source review; direct observation; case histories; and focus group discussions.
Consultation with interested parties (stakeholders)
Discussions or workshops with relevant organisations
· information providers (government, NGO, United Nations (UN) media etc)
· campaigning organisations
· providers of goods and services (NGOs, government, commercial interests)
· potential funders (donor agencies, NGOs, commercial companies)
Consultation and dialogue with potential or actual partners in health education can be a good starting point and in this way you can build on the knowledge and experience of others. One aim of doing this is to ensure consistency of message or information. Also, by reviewing other initiatives dealing the with same topic or target audience, you can build links, create synergy and reinforce impact. This kind of interaction should be structured with clear aims and objectives.
Discussions or interviews with key informants
Key informants are people who know the audience and/or aspects of the health problems well and are in a position to give often unique insights and an historical perspective. They might include community leaders, medical anthropologists, health workers, other community level workers and alternative medical practitioners in the community (including TBAs, witchdoctors, faith healers, religious leaders, pharmacists). In addition it is often worth investigating the interaction between certain categories of key informant (eg traditional healers and modern doctors). And finally informing them: their approval of the campaign or project activities may be critical to its success (eg religious leaders).
If you are planning a nationwide campaign it will be necessary to hold consultations with national level organisations, and selected regional or district level agencies. For a small-scale project covering say, a district only, many of your contacts will operate within the target area. In all cases consultation should be ongoing throughout the programmes lifetime.
The ways of establishing dialogue with your listeners are explored in greater depth elsewhere in this handbook but it is ultimately part of the consultation process.
The BBCs educational soap opera for Afghanistan New Home, New Life, holds monthly consultative committee meetings with funders and aid organisations with specialist knowledge of specific educational themes. These storylines have been outlined by the writing team in Script Development Notes and circulated in advance to those attending the meeting. A typical agenda (from a meeting in February 1997) discussed: inappropriate remedies for malaria, immunisation campaigns, de-worming of livestock, rehabilitation of the disabled, hygiene in everyday life, and circumcision. Following the discussion, the drama scripts are written in detail. A recent improvement has been to select one or two of the forthcoming storylines, ask members of the target audience about these issues in focus group discussions, and have a report on their comments circulated to those attending the meeting. That way, the audiences perceptions are taken into account before the soap scripts are written.
Secondary sources review
This involves collecting, reviewing and analysing written, visual, audio and audiovisual materials. Often NGOs, UN, research institutions or government bodies have produced very useful reports on attitudes to HIV/AIDS and related issues, as well as factual and statistical evidence of the incidence and trends. You can probably borrow them or get them free of charge. Secondary sources could include
· national programme policy guidelines
· household survey results
· Health Centre survey reports
· KAP survey results
· qualitative or ethnographic study reports on HIV/AIDS and sexuality, drug use or on the target audience
· radio listenership surveys
· broadcast schedules
· audio-visual materials from previous campaigns
· observation (visual, aural): observation consists of watching and recording what people do. For HIV/AIDS it can help establish the general context in which unsafe sexual practices occur. It can help inform the presentation and treatment of the subject rather than providing a record of specific practices as would be the case with other health issues. The use of certain tools, such as a checklist, and procedures can help systematise the process of observation
Minimise the impact of the presence of researchers by walking into a village or neighbourhood rather than driving. Vehicles tend to pull crowds and may give the impression that you have come to give money or tangible resources. Dress respectfully but not flashily. Researchers need to be sensitive and unobtrusive.
You will need to build up rapport with the respondent to elicit meaningful narrative. Also respect the confidentiality and desire for anonymity of interviewees; provide privacy for interviewing especially people with HIV where social stigma is attached to the condition.
Health workers, stringers and reporters can carry these out as part of the process of gathering information. It involves writing down or recording conversations that they hear in their places of work or on a field trip, with the aim of discovering which issues concern villagers on a day-to-day level and what they talk about. Also, how they talk about it can feed into programme production. It is particularly important when the language of the broadcast is not one in common usage by the staff of the media and health organisations involved. This might involve eavesdropping at the well, market place, bus stop, workplaces etc.
Case studies, stories, life histories, oral or written, told by key informants or members of the target audience, can provide in-depth information on issues and attitude-changing, thought-provoking material for inclusion in programming. Illness narratives are similar to oral testimonies (see Section 3 - Programme formats) but can guide research if generalisations are made carefully.
These are where you invite a member of the target audience to explain in his or her own words and language his or her own experience of the issues in question (eg someone who is HIV positive, someone caring for a relative who has AIDS). They can give insights into attitudes and reasons for certain harmful practices.
A checklist can be the basic tool for guiding discussion: use What? How? When? Who? and Where? questions to get full and detailed responses - use Why? sparingly to probe as it can be intrusive.
Focus group discussions
A moderator or facilitator guides a number of small groups (six-ten people) who each share similar characteristics (age, sex, level of education, rural, urban etc) through a discussion of a selected topic allowing them to talk freely and spontaneously. The groups may be members of the target audience or different types of key informants such as health workers. This method is frequently used in social marketing campaigns and provides in-depth qualitative information.
Good facilitation is essential to making focus group discussions work: you will need to consider whether to employ the services of trained facilitators or if you can afford to invest in training for inexperienced staff. The pay off is that you can build up in-house capacity to do this kind of research at different times during the project.
Ranking (or prioritising)
This is an activity in which people identify main problems. For instance, what do village women perceive as being the main reason for their husbands having sex outside marriage. The groups suggests problems (eg working away from home, drunkenness, peer pressure etc) and then list them in order of priority. This process can help reveal underlying factors affecting peoples behaviour and attitudes.
Who does the initial research?
· radio personnel: reporters, producers and script-writers
· professional researchers or evaluators: academic and research organisations or market research firms
· health workers and communications personnel in health organisations
· community and extension workers
But what if there is insufficient time or money to carry out research?
Funders may need persuading to pay for initial research. Although they are usually interested in the results of end of project evaluation, you do need to write it into your project proposal and include research and monitoring and evaluation budget lines. A ballpark figure might be in the region of 10-15% of the total budget.
Even though research should not be thought of as an add-on, not every project will have the resources to carry out lengthy preliminary research. Depending on the scale of the project or campaign and the importance of the radio programme, research can be tailored to your budget and need not be very expensive. Some tips on how to decide carrying out research relatively quickly and cheaply are given below
· scale of the project: is yours a small-scale low budget project or a nationwide campaign? Will there be sustained programming over a long period of time or is it a short-term series?
· target audience: how close is it to the radio station, how large and diverse is it, how sophisticated and complex is its sources of information?
· type of radio: local, independent, community, commercial, state-sponsored, national, international?
· resources available: how much money, time, staff, transport can you make available?
A minimum basic research process
· read secondary sources (reports produced on the HIV/AIDS profile of the target audience)
With more time and money you could then add a short sample survey on listenership patterns and KAP on HIV/AIDS issues.
Additions could be made to the basic research until you have a needs assessment covering all aspects mentioned at the beginning of the section.
Research procedure and practice
However basic your intended research there are certain steps to follow
· designing the research: this includes defining the purpose of the research, the target audience and the methods to use
· employing and training or briefing researchers as necessary
· pretesting (trying out) data collection tool(s) especially if you are investing a lot of time and money in a questionnaire survey or you have not used the methods before
· planning the data collection: when and where it will take place, who needs to be informed in advance and how you will travel
· conducting the research, remembering that ideally this is only the beginning of a continuous process
Allow sufficient time for the whole exercise in case of unexpected delays, and for each survey site, so that interviews are not rushed
· processing and interpreting or analysing the findings
· starting the production process
References and Further Reading
Alfred, C (1996) Workshop Report: using radio and TV for HIV/AIDS awareness, Health Unlimited, Phnom Penh
Almedom, A et al (1997) Hygiene Evaluation Procedures: methods and tools for assessing water/sanitation-related hygiene practices, London: London
School of Hygiene and Tropical Medicine
Chambers, R (1997) Whose Reality Counts? London: IT Publications
Mikkelsen, B (1995) Methods for Development and Research, London, Delhi: Sage Publications
Mody, B (1991) Designing Messages for Development Communication: An Audience Participation-based Approach, Delhi, London: Sage Publications
Nichols, P (1991) Social Survey Methods: A Fieldguide for Development Workers, Development Guidelines No.6. Oxford: Oxfam