THE DEVELOPMENT AND EVALUATION OF A HEALTH-RELATED FOTONOVELA ABOUT TIK USE IN THE W-CAPE AND N-CAPE Burt Davis Africa Centre for HIV/AIDS Management Stellenbosch University 24 April 2018 1
What is a fotonovela? 2
Why fotonovelas? 3
Fotonovelas in health communication - Effective as health communication tool (e.g. Boyte et al., 2014; Unger et al., 2013) -Growing interest among allied fields medical education & public health (Kings et al., 2017) - Potential remains under-explored (Lee et al., 2013) Opportunity for sustainable research outputs?
Fotonovelas in health communication 5
Why fotonovelas may work 1. E-E narratives proven to work in a health context, also in SA (James et al., 2005) 2. Successful among low-literate, disadvantaged groups 3. TB fotonovela perceived as effective in Cape Town (Dick et al, 1996) 6
Health-related type documentation I could find at public health settings 1. Traditional type brochures/pamphlets 2. Posters 3. Flip charts facts and figures about the dangers of tik 7
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Effectiveness of health-related documentation Often an open question Fotonovelas possible alternative strategy? 11
Research question 1 To what extent does reading a fotonovela about tik by Coloured people influence their: a) knowledge levels b) behavioural attitudes, and c) behavioural intentions compared to reading a more traditional brochure about this topic? 12
Possible explanations for effects a) narrative engagement b) fear appeal based explanations, and c) emotions 13
Research question 2 To what extent do Coloured people prefer a fotonovela about tik to a more traditional brochure about this topic? 14
Development short overview (1) - Pre-production study Determine level of awareness Increase fear appeal perceptions - Post-production study appreciation? effectiveness? realistic (story and characters)? credible (story and characters)? familiar (story and characters)? any recommendations 15
Development short overview (2) - E-E approach + 6-step production process - linguistic + culturally adapted - participatory approach - subject-filed experts - fear appeal characteristics added 16
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FOTONOVELA EVALUATION STUDY (N = 303) 18
Experiment set-up - Three-armed Randomized Controlled Trial - Fotonovela - Traditional brochure (self-developed) - Control condition 19
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Results: RQ1: Do people prefer a photonovel about tik or a more traditional type brochure about this topic? 21
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Main findings (1) - Knowledge level fotonovela group and traditional brochure group vs control group: significant differences to the advantage of the fotonovela and brochure fotonovela group and traditional brochure no significant differences 24
Main findings (2) - Attitudes and intentions tik use Fotonovela group and traditional brochure group vs control group: no significant differences - Intentions towards speaking to a family member or friend who is involved with tik about their drug habit Significant difference between fotonovela and traditional brochure, to the advantage of the fotonovela No significant differences between fotonovela group and traditional brochure group vs control group 25
Main findings (3) - Message Preference Compared to the traditional brochure about twice as many respondents preferred reading about tik in fotonovela format Clear preference for fotonovela in the age groups 19 years and 35 years 26
Main findings (4) Explanations for the effects found (1) Limited support found for narrative engagement variables (EORM) (2) Fear appeal elements threat and self-efficacy showed promise for possibly affecting attitudes related to personal health behaviour (3) Emotions sadness and compassion were significant and positive predictors of intentions and attitudes related to interpersonal discussions of tik health messages, 27 respectively
WAITING ROOM INTERVENTION STUDY 28
Waiting room intervention study Fotonovela and traditional brochure placed in waiting room of clinic Done to provide additional clarity to RQ2 measuring message preference Explorative in nature 29
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Main findings 1 Patients preferred to take home the fotonovela over the traditional health brochure Answer to RQ2? Main motivating factor for deciding to read the fotonovela: Appearance of the fotonovela Main motivating factor for deciding to read the traditional brochure: Wanted to learn more about tik/health subject matter 31
Main findings 2 Participants who read the fotonovela remembered aspects of the storyline best Participants who read the traditional brochure mainly remembered health information about tik 32
Overall practical implications 1 Based on the preference found for the fotonovela in both studies, and on the comparable knowledge and behavioural intentions = document designers should consider using fotonovelas as health communication tool Adding fear appeal characteristics and elements to try and arouse sadness and compassion to improve effectiveness should be considered. 33
Overall practical implications 2 Is combining a narrative with a traditional type format the way to go? e.g. by adding an explicit persuasive appeal such as a Q&A section at the end of a fotonovela (and announcing health topic on the cover) Proven successful in previous studies Can address additional information about a health issue not covered in a fotonovela Health information can be repeated/presented in a more direct fashion 34
From: Harold Arends [mailto:harold.arends2@westerncape.gov.za] Sent: 07 July 2015 08:42 To: Davis, HD, Mnr <burt@sun.ac.za> Subject: Navorsing studie Goeie dag Burt Davis. Jammer ek was langer af as beplan,maar nou gesond.die kontak persoon by die munisipaliteit is Sylbert Meyer by e-pos sylbert@swellenmun.co.za Indien moontlik sal ek ook graag wil weet wat die uitkoms van die dag se studie was. Ek het baie navrae gekry oor die boekie. Mense wil dit graag in hul diens organisasies gebruik,bv:kerk en jeug.dit sal ons leke beraders ook baie help met hul intervensies met pasiente. Indien moontlik kan u vir my van die boekies stuur. Groete. Haroldine Arendse Department of Health HAST Clinical Program Coordinator Swellendam Sub-district Tel nr: 028 5148400 Email Address:Harold.Arends2@westerncape.gov.za 35
Of course, more intensive interventions than merely reading a fotonovela are probably necessary to convince people to seek treatment or make long-term behavior changes. However, fotonovelas may be useful as a first step to raise awareness of important health issues, reduce stigma, and motivate people to seek help. Fotonovelas may act as a door opener for attitudinal and behavioral change. (Unger et al., 2013) 36
THANK YOU! ANY QUESTIONS OR COMMENTS? 37