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IR 4 - ADVANCING COMMUNICATION THROUGH RESEARCH HIGHLIGHTS
At the heart of all HCP programs is a strong commitment to use research at all phases to guide program development, make midstream corrections, and evaluate impact. Research was used in 13 programs in Year 3 to test new approaches or key questions. For example, HCP conducted an analysis of gender-related factors across health behaviors using data from DHS surveys. This analysis led to a better understanding of gender norms in relation to behavior and was then used to develop research instruments for program development in both Egypt and Zambia. HCP also used research in 39 different settings to help design or adjust programs for maximum impact. A variety of formative research instruments were used when HCP pilot tested Sports for Life in Ethiopia and its materials were then refined before the program's launch. The birth spacing campaign intermediate results study was conducted in Mozambique, after which the findings were used for the HIV/AIDS programming.
Multiple Strategic Objectives (SOs) Bangladesh: HCP will complete a one-year pilot test of the ARH Life Skills Workshops through six NGOs in three different parts of the country. The pilot test will allow for any programmatic adjustment, test culturally appropriate materials for this sensitive topic, and demonstrate the program's effectiveness. Egypt: CHL research activities assess family members' knowledge, attitudes, intentions, and practices, while relating these to the development of life-stage appropriate health competency, as well as demand for and utilization of health information and services. The goal of research and monitoring efforts is to assess the reach and impact of the CHL program activities on family members' values, attitudes, intentions, and health competency leading to life-stage appropriate health behaviors, as well as on demand for and utilization of health information and services. Health behaviors will be monitored within each life stage and health competency will be measured at the individual, family and community level. At the community level, important aspects of health competency include (1) the capacity of community members, leaders, and institutions to plan and carry out decentralized participatory health communication programs, (2) collaboration among public and private sector agencies, and (3) partnerships between the community and service delivery systems. A combination of data from community members, community leaders, and service providers will be needed to assess these issues. On December 15, 2004, CHL hosted a Health Communication Roundtable to demonstrate the health competency model at the core of CHL research to a range of professionals engaged in health communication from USAID, Catalyst, Family Health International, Alam Simsim, El-Zanaty Associates, HSRP, HE2010, NAMRU, IDSR, HMHC, and the POP sector of Program Communication Research. The model describes health competence as a situation in which individuals, communities, and institutions have the knowledge, attitudes, skills, and resources needed to improve and maintain health. The Minya Village Survey results suggested that using communication to improve weak factors can raise health competence and improve health. Jordan: A baseline survey was designed and will be fielded in May 2005, with follow-up surveys in 2006 and 2008. The SEU was involved in this research, and will include segmentation by life stage. The survey will interview all the members of individual households, allowing HCP to examine the “households as producers of health” concept. Zambia: HCP has been testing community-level indicators and gender. The baseline survey was completed and the two follow-up surveys are scheduled. SO1: FP/RH Core: Africa Transformations: Building on the GEM scale, research will compare the gender perceptions, intentions to act, and actions of participants with those of non-participants. Changes in gender-equitable perceptions, intentions and actions of male participants will be compared with those of female participants. Core: Understanding the Dynamics of FP/HIV Integration at the Community Level: This research collected information on the fertility needs and desires of HIV-positive women as well as men and women of unknown status to answer key questions relating to communication around FP/HIV integration. Core: Analysis of Gender-Related Factors Across Health Behaviors: A comprehensive inventory of gender-related measures in DHS surveys was compiled, and lessons learned regarding measures of gender-based attitudes and behaviors were incorporated into new HCP research instruments in Egypt and Zambia. A rough draft of the paper including background, conceptual framework, and literature review was completed. The paper discussed the lack of clarity around the concept of gender norms and laid out a conceptual framework to understand gender norms. This conceptual framework distinguishes three aspects of gender norms: actual norms or how people actually behave such as percent of women in school; perception of descriptive norm or how people perceive the behavior of others such as beliefs that most men do not use condoms; and perception of prescriptive norm or how people perceive others ought to behave such as women should not visit clinics alone. The paper reviewed literature around nine domains of relevance for gender norms including women's mobility, financial decisions, violence, and sexual roles. The paper also reviewed some of the challenges around the measurement of gender norms. The team agreed that future research should measure the health behaviors of men and women, the attitudes, perceived norms and self-efficacy with respect to those specific behaviors, and also the three categories of gender norms described above. The paper will be further developed and completed based on the primary and secondary data analysis. HCP anticipates that an important contribution will be on disentangling the various concepts around gender norms and gender dynamics and the kinds of interventions for each of these. SO4: HIV/AIDS Uganda: An evaluation survey conducted by Straight Talk Foundation in August 2005 will serve as a baseline for YEAH, a media tracking study, and qualitative research into male gender constructs in five districts. Namibia: HCP has been testing an approach of community as a unit of analysis (CAC), and social networking studies.
Multiple Strategic Objectives (SOs) Jordan: To shape program design, HCP conducted an organizational BCC capacity assessment to identify needs, a community participation assessment to identify the health priorities of local underserved communities, and field testing of communication materials. Egypt: CHL workplans and activities reflect strategic planning informed by scientific research. Several studies completed thus far include a baseline survey of El Minya focal villages conducted in the summer of 2004, presented by El Zanaty and Associates Research Team in December; quarterly pharmaceutical sales data from International Medical Statistics (IMS); and monthly media monitoring data and research on Egyptian media consumption via a contract signed in December with PARC Media Monitoring Services. Through ongoing analysis of these and other research data, CHL designs strategic programs that include integrated mass media, community outreach, and one-to-one counseling activities to maximize results. Zambia: With the rationale of developing a deeper understanding of the communities where HCP works, community assessments were held to profile community structures, networking between organizations, issues of collective action, and to assess the capacity development needs of community groups. The assessments also included a gender analysis which investigated the division of labor between men and women. SO1: FP/RH Secondary Analysis of Data (Core) – Used for ongoing program design in many countries:
SO4: HIV/AIDS Zambia: An analysis of HEART campaign data was used to help design new messages and communication strategies for Zambia 's HCP program. HCP studied exposure of adolescents to HIV/AIDS risk reduction messages to understand psychosocial and behavioral barriers and facilitators. In addition, the HEART Waves activities began with focus group discussions with in- and out-of-school young people in the rural areas to understand their attitudes and behavior on issues regarding their sexuality and their interaction with parents and other adults. Using the findings from these discussions, a strategy design workshop was help to develop key messages. Mozambique: Birth spacing campaign study research was conducted to assess reception of the communication program and to understand attitudes and practices toward family planning and birth spacing. Namibia : Population-based and social networking surveys and qualitative research conducted as part of the community mobilization activities were all incorporated into the design of the campaign. South Africa: User research monitoring and evaluation to measure impact was used to improve the Mindset Health Channel's offerings. Secondary Analysis of Data:
Multiple Strategic Objectives (SOs)
SO1: FP/RH
Post-Abortion Counseling Resource Package (GLP): Two rounds of global expert reviews were completed during Year 3. The reviews identified the key BCC materials that will be included in the Global PAC Resource Package. Experts also identified the changes that need to be made to each material so that it conforms to the latest research and understanding of PAC. Post-abortion Care Resource Package for Tanzania (GLP): HCP is working with EngenderHealth and the Ministry of Health to develop a Tanzania PAC Resource Package. Like the Global Resource Package, the Tanzania version will contain summaries of the latest PAC research as well as the Tanzania PAC service delivery guidelines, training curricula, and BCC materials. Most recently, HCP provided technical assistance to the MOH in using an expert review process to identify the BCC materials that will be used in their local resource package. MAQ: Lessons Learned and Tools for Success (Core): HCP will complete the final stages of revision and production of a publication and accompanying CD that documents across country programs the lessons learned and a range of approaches and tools necessary to implement MAQ activities. A Tool for Expanding FP Use among Poor, Marginalized Populations: HCP in Nepal is adapting the evidence-based Radio Health Program drama serial and materials (radio listeners' group facilitator guide and comic book) to two local cultures and languages for implementation. This will help the program reach needy populations with effective communication tools linked to improved services for maximum impact.
In the past year, more than 27,500 sample materials were distributed. The M/MC website offers visitors a “Professional Picks” section that highlights the favorite materials of health communicators in the field, and an “In the Spotlight” feature which highlights a specific health communication campaign.
Health e-Communication (Core): Ninety-six new documents were added to the Health e-Comm site this year, a growing number of which were submitted by visitors to the Health e-Comm directly via the website. Evidence of taking community empowerment to scale (Core): This paper detailed three case studies of programs successfully brought to scale and drew upon lessons learned to enable program managers to use these lessons to plan programs that can go to scale. Two other cases were also discussed that did not successfully go to scale. A draft of the paper is being circulated for comment. Multi-level analysis of health communication program impact (Core) : The following abstract was accepted by APHA: Paul Hutchinson and Jennifer Wheeler. A Multilevel Framework for the Adoption of Modern Contraception in Tanzania: Evaluation of a Mass Media Communication Program; literature review on multi-level analyses of HC programs completed, analysis of paper on the impact of mass media on stigma and disclosure of VCT test results in South Africa completed. Summative Evaluation (Core): Two papers were presented at the Conference on Globalization, Development, and Stability in Latin America and the Middle East, held at the Payson Center, Tulane University, New Orleans, April 2, 2005 :
Two papers were presented at the Cost-Effectiveness Expert Meeting, held at the Center for Communication Programs, Baltimore, March 17, 2005 :
Five papers were submitted for presentation at the Annual Meeting of the American Public Health Association. All five papers were accepted.
Two papers on cost-effectiveness for health communication programs prepared:
These papers will become part of the special issue of the Journal of Health Communication, slated to come out in 2006, on Cost-Effectiveness Analysis. HCP Tools and Resources Available Online (Core): In Year 3, HCP produced three Health Communication Insights on the role of communication in fighting TB; one Communication Impact on Zambia 's HEART campaign, and one on FGC in Nigeria. In addition, HCP reproduced the Client-Provider Communication CD, developed a CD of all HCP Publications, and translated the P-Process brochure into French, Arabic and Spanish. HCP makes all of its guides and tools, including research instruments and publications, accessible via download from the Internet, allowing for easier access by users and more widespread, efficient sharing of information; and many of these items are also shared by regular mail. Communication Impact, Health Communication Insights, Partners in Action, Healthwise and other HCP resources are available via the HCP website. During this year, over 58,000 documents were downloaded from the HCP website and mailed out, including over 23,000 copies of the Field Guide to Designing a Health Communication Strategy, over 11,000 copies of various issues of Health Communication Insights, about 3,200 copies of the new P Process, and over 4,000 copies of Communication Impact. SO5: INFECTIOUS DISEASE Tools supporting malaria communications in Uganda : HCP developed materials to assist the National Malaria Control Program (NMCP) in providing timely, consistent, quality and clear information on malaria policies, strategies, and prevention information to the general public. These materials include fact sheets, an NMCP web page on the MOH website, a literature review on malaria KAP, and an updated final draft of the national malaria communication strategy. Two new reports: HCP's Health Communication Insights series, which explores issues related to advances in strategic health communication. One report summarizes the lessons learned from both Peru and Vietnam, based on conclusions from two more in-depth reports: The Role of Health Communication in Vietnam's Fight Against Tuberculosis and The Role of Health Communication in Peru's Fight Against Tuberculosis . |
In addition, HCP produced and disseminated 140 evidence-based tools and research products, including publications, manuals and peer-reviewed journal articles. Innovative products included Health e-Comm and Healthwise, a service that helps health communication professionals design more effective communication programs by providing them with expert medical knowledge about a variety of public health issues. And a total of 13 peer-reviewed journal articles or book chapters were published in Year 3 by HCP researchers. More detailed information on HCP's research activities follows.
At the end of the training an overwhelming majority of participants indicated that their expectations regarding the program were met. One of the goals of the training was to revisit prevailing attitudes on campus. It was found that attitudes regarding people living with HIV or AIDS has improved. One of the most exciting findings was that 81% of participants indicated that they have changed, or are intending to change some aspects of their behavior as a result of the workshops. Some of the reported behavior changes include being more aware of high risk behaviors and situations and to lead a healthy lifestyle. 
South Africa : Analysis of Tsha Tsha data regarding effectiveness of message strategy (character identification, message comprehension, and behavior response) was used to refine message strategies for Phase II and to justify continued funding by the Mission for this program activity. Use of character mapping analysis techniques was refined (including development of better exposure measures), which improves the technology for use in other countries and program evaluations. 
Egypt: CHL used a multitude of evidence-based tools and products to advance health communication knowledge, including television and radio programs, orientations, trainings, materials, and community events. CHL has been actively working to disseminate evidence-based tools to the public. Based on evidence, more than 100 television and radio programs on topics featuring messages on general health, overpopulation, and in support of gender equity aired. TV and radio spots on family planning and reproductive health aired at a high frequency with an estimated reach of 25 million. Over 2,000 press items related to campaign messages were published in national and party newspapers and magazines. Two press inserts were produced and distributed, one on HIV/AIDS and another on the man's role in family planning. A variety of provider and client education materials were produced through a collaborative effort of message development involving all project partners. The Mabrouk! Booklet for Newlywed couples is being distributed to newlywed couples throughout the country by health outreach workers, maazouns (marriage registrars), and priests. Other materials include a flipchart for health outreach workers, an optimal birth spacing poster, and a poster for the newlywed contest. Many of the materials are for dissemination by the over 4,000 MOHP clinics. CHL has been planning with Tahseen a quality-improvement and service marketing campaign for the 4,000 MOHP clinics. On a local level, the CDA-led focal village programs began a number of family health interventions. Female leadership trained in the AWSO program proved highly motivated and competent, and more than 100 women attended biweekly AWSO meetings organized over a six-month period in several villages where they participated as active agents in the community to assist community members to access needed services and solve problems. Graduates of the AWSO training are preparing to conduct a series of home visits with women. Primapera classes are underway in El Minya, with over 50 women attending structured learning sessions to prepare for the first birth. Parallel to this activity, local health units and staff were prepared, equipped, and trained to follow MOHP antenatal care protocol. Dawar meetings for male village leaders continued. 
Media Advocacy Toolkit: Eighty-seven representatives from a variety of sectors from Bangladesh, Indonesia, Nepal, Pakistan, and the Philippines convened in Penang, Malaysia, in 2003 to determine how the media could be used to build a constituency for contraceptive security in every participant country. As a response to that meeting, HCP worked with partners to design a tool for developing media relations strategies. The Media Advocacy Tool was designed in a modular way to be used as part of a larger health communication strategy or as a stand-alone guide to action. With this tool, the user can simplify the more complex conceptual issues related to contraceptive security and then design and convey effective messages to audiences unfamiliar with the topic. The tool covers fundamental aspects such as defining contraceptive security for those not familiar with the concept, explaining when a media advocacy campaign makes sense within a larger communication strategy, and guiding how to set realistic media advocacy goals. HCP will also set up a sub site on the Implementing Best Practices (IBP) website to cover issues related to media advocacy for contraceptive security. The site will provide access to the existing tool and to other relevant CS documents and will also facilitate a continuous dialogue within the Media Advocacy for Contraceptive Security (MACS) community. 
Media/Materials Clearinghouse (M/MC): The M/MC continues to serve the health communication community as the single largest resource of sample materials on the subject. During this year, the M/MC website ( 
Healthwise: A weekly service for health communication professionals provided expert medical knowledge about a variety of public health issues to help them design more effective communication programs.