Module 2: Mass Media as an Educational Tool to Promote Health

Mass media campaigns are used to expose high proportions of a population to health promotion messages, using the media as an educational tool. Mass media campaigns are favorable because they can efficiently communicate information to a large number of people. Mass media interventions can produce positive health changes on a grand scale by enforcing positive health behaviors among individuals.(1)    

Mass media campaigns take a variety of forms in their efforts to communicate health messages; these methods include print media, television, and radio broadcasts. In addition to digital and print media, there are a number of other creative avenues for disseminating health information. Live theater dramas and puppetry, for instance, are gaining popularity as ways to deliver health care messages to specific target audiences. Each medium offers advantages and drawbacks that must be considered in the context of program goals for improving health education.(2)

When designing an effective mass media campaign, it is important to consider how information will be interpreted by a particular audience. Adequate research is critical in avoiding cultural taboos, and ensuring that the intended meaning is conveyed. The use of analogies in material design can greatly enhance the acceptance of health messages by demonstrating cultural sensitivity.

Radio

Radio is a popular medium for health education because it can raise awareness and spread information to a large number of people at a low cost per person.(3) Radio-disseminated health messages have been found to be more cost-effective than television, as radio can reach people in their homes, cars, or at work. Brief educational radio segments can be inserted between programs during primetime hours, when the maximal number of people are tuned in. One American study demonstrated that people who listen to the radio have a surprisingly accurate ability to recall details of broadcasts from months earlier; in this way, the study findings support the potential of radio to disseminate educational messages that significantly affect listeners.(4) 

The use of radio to disseminate health education messages is particularly advantageous because of the wide range of people it can reach. In developing countries, many rural villages do not have access to reliable electricity or television, but battery operated radios are commonplace. Consequently, its ability to reach people in a diverse range of settings has made radio a prime medium for educational initiatives, and various health topics have been addressed through radio programming throughout the developing world.(5) Educational radio has been used, for instance, in India for rural development(6), in Swaziland for public health(7), in Nicaragua for health education(8), in the Philippines for nutrition education(9), in Sri Lanka for family planning and health(10), and in Trinidad and Tobago to promote awareness of proper breastfeeding practices.(11)

In Kenya, the national weekly radio program that ran in the 1970s, “Giving Birth and Caring for Your Children,” had been successful in educating audiences about modern childcare practices by using a program framework that combined entertainment, humor and instruction.(12) One survey indicated that more than 50% of listeners had listened for the educational content, while more than one-third listened for entertainment. The survey reported a general understanding of the major theme (childcare), and a high recall of topics covered during the program.

Radio can also serve as a forum to elicit listeners’ reactions and comments. One successful illustration of the power of educational radio is the Farm Radio Forum, which began in Canada in 1941 as a “radio discussion program” that has paved the way for subsequent programming in developing nations.(13) The strategies employed by Farm Radio Forum, including the use of numerous types of media to disseminate information, were later adopted in India and Ghana with the aid of UNESCO, a program of the United Nations.(14)

Like any public health campaign, radio interventions must be carefully designed and implemented. Michael Neil outlines the following components necessary for a successful radio intervention in rural settings:(15)

• Use experienced educators familiar with the local community;  

• Collaborate with community leaders;

• Model programs off of existing work that has been successful in the region;

• Use village “intermediaries” and respect “established and accepted social structures”;

• “Encourag[e] illiterate people to communicate their ideas and concerns through trusted … villagers, who can act as scribes if required.”

It is also crucial to identify the target audience in order to select appropriate production and transmission styles.(16)

Theater

Theatrical health education provides an active learning environment for audiences and encourages the exploration of social attitudes towards particular health issues.(17) Theatrical performances can be used to model positive health behaviors or demonstrate the consequences of high-risk activities. The live nature of performances brings elements of interpersonal communication that help personalize the issue for viewers. Direct interaction with audience members also enhances viewers’ reception and internalization of the message.(18) While there is great potential for the integration of theater and health education, there is also a corresponding need for trained community health educators. Effective training methods would involve skill sharing, in which health educators and theater performers exchange knowledge and ideas.

Though there are many examples of effective health education programs that use theater, there is still a need for further evidence of a demonstrated, consistent impact. The challenge remains to find evaluation procedures that are sensitive enough to measure the subtle shifts in viewers’ attitudes.(19) To date, health education through theater has primarily been centered on HIV/AIDS, though it is important to expand and address other personal, social, and community health issues. “Between the Seams,” for instance, is a play performed by adolescents and young adults at schools and community centers around the United States to spread awareness about HIV prevention, while emphasizing tolerance and understanding of the illness.(20) Further exploration of theater-based health programming in other areas of health would help to determine the ability of drama to examine diverse public health themes.(21)

Puppetry

Educators and health care providers are continually searching for innovative methods to promote positive health behaviors that are age-appropriate and engaging. Puppetry is one medium that meets these criteria, particularly for school-age children. Puppetry is an imaginative educational and therapeutic method that can be used by trained school counselors, nurses, health educators, and elementary school teachers. Puppetry can also be used in workshops to introduce a variety of health topics, including nutrition and hygiene.

In Cambodia, where puppetry is an important part of the local culture, puppet shows are frequently used and are considered a highly effective means of communicating and teaching critical concepts to all ages. Cambodian Shadow Theater, for example, is performed during sacred temple ceremonies, at private functions, and for the public in the villages.(22) Cambodian schools have used a puppet show to discuss diarrhea; in the performance, a young female puppet describes to students how she mixed salt, sugar and water to make a remedy for her younger brother.(23)

Analogies

Analogies are useful tools for forming mental constructs that simplify or render familiar a concept that the individual is attempting to understand.(24)(25) Analogies can be used to introduce new scientific concepts or change previously held beliefs; they can help individuals overcome barriers to education by facilitating creative connections between familiar concepts and the new ideas that are being presented.(26)(27)(28)

A study by Gazzinelli et al. was conducted to assess whether educational tools that are developed based on context-specific information are associated with comprehension and acquired knowledge among participants. Specifically, they sought to evaluate the efficacy of an educational video that integrated local analogies into its content, which was focused on vaccines in a hookworm-endemic area of Brazil. In describing the educational video, researchers explained:(29)

“The video was filmed in the communities of Jamir and Beija Flor, and was produced based on the use of analogies. In it, the daily tasks of local inhabitants, such as the farming of cassava, and the production of flour, sweets and cheese, are compared to the manufacturing of vaccines and to the experiments of researchers working in the laboratory. The production of a regional sweet is shown, starting with cultivation of the sugar cane, extraction of juice, and preparation of other ingredients. Interspersed with these images are those of FIOCRUZ researchers working in the laboratory, using machines and instruments to assist them in discovering ideal components that, when combined in the correct amounts, may produce an effective vaccine.”

An analogy was constructed in the video between familiar activities in the region (i.e. producing sweets) and the manufacturing of a hookworm vaccine. The people referred to the illness as “amarelao” or the “illness of Jeca-tatu” (after a popular cartoon character). Researchers found that the video intervention was effective in improving participants’ understanding of hookworm infection because the viewers were able to relate to the film’s messages.(30)

mHealth

As mobile phones and wireless technologies rapidly advance and become more widely available, they are increasingly applied to the achievement of health objectives.  The term “mHealth” refers to the use of mobile devices and wireless technologies to support health-centered initiatives.  In addition to being used as a method of monitoring patients and collecting data, mHealth can also be an effective medium for education and health promotion. (31)  For example, one study found that a cell phone-based messaging intervention in China increased health literacy scores.  Participants who received texts regarding health education improved their health knowledge, behavior, and skill more than those participants who were only exposed to more traditional methods of health education, like posters and lectures. (32)

Mass Media Campaigns Against HIV/AIDS

At the United Nations General Assembly Special Session on HIV/AIDS in June 2001, signatories of the Declaration of Commitment on HIV/AIDS agreed that, “[b]y 2005 […] at least 90%, and by 2010 at least 95% of young men and women aged 15 to 24 [will] have access to the information, education, including peer education and youth-specific HIV education, and services necessary to develop the life skills required to reduce their vulnerability to HIV infection”.(33) Education has been deemed the “vaccine against HIV”, since awareness of the disease is the best way to prevent transmission.(34) Unfortunately, many potentially successful HIV/AIDS interventions that focus on educating people about the biological and social aspects of the illness are ultimately unable to reach the public on a large scale. 

Social media strategies are innovative tools that can strengthen HIV/AIDS awareness campaigns by increasing the coverage of people receiving health promotion messages. UNAIDS advocates for the use of media to promote HIV/AIDS awareness, since disseminating educational messages through the television or radio has successfully reached large audiences.(35) The media can help to de-stigmatize the disease, which is especially important in regions where there is tremendous discrimination towards people living with HIV/AIDS. Mass media approaches have already been effective in improving people’s knowledge about HIV/AIDS and reducing associated stigma throughout sub-Saharan Africa.(36)(37)(38)(39)(40)

Footnotes

(1) Wakefield, M.A., Laken, B., Hornik, R.C. (2010). Use of mass media campaigns to change health behavior. The Lancet, 376, 1261-1271. 

(2) Austin, L. S. & Husted, K. (1998). Cost-effectiveness of television, radio, and print media programs for public mental health education. Psychiatric Services, 49, 808–811.

(3) Ibid.

(4) Ibid

(5) Nwaerondu, N., Thompson, G. The Use of Educational Radio in Developing Countries: Lessons from the Past. The Journal of Distance Education /Revue de l'Éducation à Distance, North America, 2, August 2007.

(6) Long, T. (1984, March). Broadcasting for rural development. Media in Education and Development, 17(1), 17-19.

(7) Byram, M., & Kidd, R. (1983). A hands-on-approach to popularizing radio learning group campaigns. Convergence, 16(4), 14-22.

(8) Cooke, T., & Romweber, G. (1977). Radio nutrition education - Using the advertising techniques to reach rural families: Philippines and Nicaragua. (Final Report). Washington, D.C.: Manoff International.

(9) Ibid.

(10) Academy for Educational Development (1979). Paraguay using radio for formal education in rural areas. Academy News, 2(2), 4. Washington, D.C.: Clearinghouse on Development Communication.

(11) Gueri, M., Jutsun, P., & White, A. (1978). Evaluation of a breastfeeding campaign in Trinidad. Bulletin of the Pan American Health Organization, 12 (2).

(12) Hostetler, S. (1976, July). Health messages through humor. ICIT Report No. 15. Washington, D.C.: Clearinghouse on Development Communications.

(13) Nwaerondu, N., Thompson, G. The Use of Educational Radio in Developing Countries: Lessons from the Past. The Journal of Distance Education /Revue de l'Éducation à Distance, North America, 2, August 2007.

(14) Ibid.

(15) Nwaerondu, Ndubuisi Goodluck, and Gordon Thompson. 1987. "The Use of Educational Radio in Developing Countries: Lessons from the Past." Journal of Distance Education. 2(2): 43-54.

(16) Bates, T. (1982, September). The impact of educational radio. Media in education and development, 15(3), 144-149.

(17) Ball S: Theatre in health education. In Learning through Theatre. New Perspectives on Theatre in Education. 2nd edition. Edited by: Jackson T. London: Routledge; 1993:227-238.

(18) Glik, D., G. Nowak, T. Valente, K. Sapsis, and C. Martin. 2002. "Youth performing arts entertainment-education for HIV/AIDS prevention and health promotion: Practice and research." Journal of Health Communication 7(1):39-57.

(19) Ball S: Theatre in health education. In Learning through Theatre. New Perspectives on Theatre in Education. 2nd edition. Edited by: Jackson T. London: Routledge; 1993:227-238.

(20) Gallagher, Dan. "Between The Seams." Between The Seams. AIDS Theater Project New York, Inc.

(21) Ball S: Theatre in health education. In Learning through Theatre. New Perspectives on Theatre in Education. 2nd edition. Edited by: Jackson T. London: Routledge; 1993:227-238.

(22) Ewart, F. G. (1998). Let the Shadows Speak: Developing Children's Language Through Shadow Puppetry. Stylus Publishing, LLC..

(23) Ibid.

(24) Lynoe N, Hoeyer K (2005). Quantitative aspects of informed consent: considering the dose response curve when estimating quantity of information. J Med Ethics. 31: 736–738.

(25) Cook SH, Frances Gordon M. (2004). Teaching qualitative research: a metaphorical approach. J Adv Nurs. 47: 649–655.

(26) Limo´n M, Carretero, M. (2000). [Previously-held ideas of students: how does this impact the teaching of science?]. In: Carretero M, ed. [Constructing and Teaching the Experimental Sciences], 2 ed Buenos Aires: Impreciones Sud Ame´rica. pp 19–43.

(27) Cook SH, Frances Gordon M (2004) Teaching qualitative research: a metaphorical approach. J Adv Nurs. 47: 649–655.

(28) Gazzinelli MF, Lobato L, Matoso L, Avila R, and de Cassia Marques R, et al. (2010). Health Education through Analogies: Preparation of a Community for Clinical Trials of a Vaccine against Hookworm in an Endemic Area of Brazil. PLoS Negl Trop Dis 4(7): e749.

(29) Ibid.

(30) Ibid.

(31) World Health Organization (2011). "mHealth: New horizons for health through mobile technologies." https://www.who.int/goe/publications/goe_mhealth_web.pdf.

(32) Zhuang, R., Xiang, Y., Han, T., Yang, G., & Zhang, Y. (2016). Cell phone-based health education messaging improves health literacy. African Health Sciences,16(1), 311-318.

(33) UNAIDS (2016). Snapshot: HIV prevention. https://www.unaids.org/sites/default/files/media_asset/Prevention_Snapshot_en.pdf.

(34) UNAIDS (2004). The media and HIV/AIDS: making a difference.https://www.unaids.org/en/resources/documents/2004/20041022_jc1000-media_en.pdf.

(35) UNAIDS (2016). Snapshot: HIV prevention. https://www.unaids.org/sites/default/files/media_asset/Prevention_Snapshot_en.pdf.

(36) UNAIDS (2004). The media and HIV/AIDS: making a difference. https://www.unaids.org/en/resources/documents/2004/20041022_jc1000-media_en.pdf.

(37) Fakolade, R., Adebayo, S.B., Anyanti, J., & Ankomah, A. (2009). The impact of exposure to mass media campaigns and social support on levels and trends of HIV-related stigma and discrimination in Nigeria: tools for enhancing effective HIV prevention programmes. Journal of Biosocial Science, 42, 395-407. 

(38) Solomon, P., Nyaney, M.O., Amoah, S.O., & Aidoo, N.G. (2001). Using folk media in HIV/AIDS prevention in rural Ghana. American Journal of Public Health, 91(10), 1559-1562.

(39) Hutchinson, P., Mahlalela, X., & Yukich, J. (2007). Mass media, stigma, and disclosure of HIV test results: Multilevel analysis in the eastern cape, South Africa. AIDS Education and Prevention, 19(6), 489-510.

(40) Kuhlmann, A. K. S., Kraft, J. M., Galavotti, C., Creek, T. L., Mooki, M., & Ntumy, R. (2008). Radio role models for the prevention of mother-to-child transmission of HIV and HIV testing among pregnant women in Botswana. Health Promotion International, 23(3), 260-268.