“Spyt kom te laat” The development and evaluation of a health-related fotonovela about methamphetamine (“tik”) use in the Western Cape and Northern Cape provinces of South Africa

Davis, Herbert Douglas (2017-12)

Thesis (PhD Document analysis and design)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: The aim of this research project was to establish if and why fotonovelas can be an effective messaging tool to communicate the dangers associated with using methamphetamine (“tik”) to Coloured communities in the Western Cape and Northern Cape provinces of South Africa and persuade them to avoid this drug. A health-related fotonovela about tik, “Spyt kom te laat” (Regret comes too late), was developed for this purpose using an entertainment-education approach involving a six-step production process, incorporating inputs from the target audience and subject field experts. Fear appeal characteristics were added to help improve the fotonovela’s effectiveness. Two related studies were performed to evaluate the impact of the fotonovela. One study (N = 303) was a randomized controlled trial that compared the effects of three message conditions (a group who read the fotonovela, a group who read a traditional brochure, and a no message control group) in a between-groups experimental design. The results did not show knowledge gain in the fotonovela group to be significantly higher compared to the traditional brochure group. When compared to the control condition, both health documents did have a positive and significant effect, however, on knowledge level for those questions that did not show ceiling effects. The effects of the two health documents did not differ in terms of respondents’ attitudes. Nonetheless, intention related to interpersonal discussions of tik health messages was found to be significantly higher for those respondents in the fotonovela condition compared to those respondents in the traditional brochure condition. The results did not show attitudes and intentions in the fotonovela and traditional brochure group to be significantly higher compared to the control group. The Extended Parallel Process Model (Witte, 1992, 1998), the Entertainment Overcoming Resistance Model (Moyer-Gusé, 2008), as well as theoretical assumptions about the arousal of emotions (fear, surprise, anger, sadness and compassion) from reading the fotonovela were applied to come up with explanations for differences in participants’ attitudes and intentions. The fear appeal elements threat and self-efficacy showed promise for possibly affecting attitudes related to personal health behaviour, while the emotions sadness and compassion were significant and positive predictors of intentions and attitudes related to interpersonal discussions of tik health messages, respectively. In terms of message preference, about twice as many respondents said that they preferred reading health information about tik in fotonovela format over the traditional brochure, with a clear preference for the fotonovela in the 19 years and younger and in the 35 years and older age groups. The other study was explorative in nature. In this study, the fotonovela and traditional brochure were placed in the waiting room of a primary health care clinic to measure actual preference for either document as health communication tool. In performing this study – the first of this type ever – some instructive practical problems were experienced that could not all be solved. Nevertheless, there seem to be sufficient grounds to conclude that patients preferred to take home the fotonovela over the traditional health brochure. However, this preference will have to be put to the test again in follow-up studies. The appearance of the fotonovela was highlighted as the main motivating factor as to why patients decided to read the fotonovela, while patients who chose to read the traditional brochure did so mainly because they wanted to learn more about the health subject matter. Participants who read the fotonovela remembered aspects of the storyline best, whereas readers of the traditional brochure mainly recalled health information associated with tik. Based on the preference for the fotonovela over the traditional brochure found in both studies, and on the comparable knowledge and behavioural intentions that were identified after people had actually read the information in one of these formats, it is recommended that document designers consider using fotonovelas as a health communication tool dealing with tik or similar subjects. In order to help enhance the persuasiveness of such a fotonovela, adding fear appeal characteristics to such a health document and incorporating elements to try to arouse the emotions sadness and compassion can also be considered. Furthermore, it appears that combining fotonovelas with elements from traditional brochures may increase the chances of the included health messages reaching audiences. Therefore, further research is warranted into the efficacy of, and preferences for fotonovelas that incorporate features of traditional health brochures – or the other way around.

AFRIKAANS OPSOMMING: Hierdie navorsingsprojek was daarop gemik om vas te stel of en waarom fotonovelles as ’n doeltreffende boodskap-medium gebruik kan word om aan bruin gemeenskappe in die Wes-Kaap- en Noord-Kaapprovinsies van Suid-Afrika die gevare rondom metamfetamien (“tik”) se gebruik te kommunikeer en hulle te oorreed om dié dwelm te vermy. Deur ’n vermaaklikheid-opvoedkundige benadering te gebruik wat ʼn sesstap-produksieproses behels het, én met insette van die teikengehoor en onderwerpsveld-kenners, is “Spyt kom te laat” (Regret comes too late), ’n gesondheidverwante fotonovelle oor tik, vir dié doel ontwikkel. Eienskappe van vreestrefkrag is bygewerk om die fotonovelle se doeltreffendheid te verbeter. Om die trefkrag van die fotonovelle te beoordeel, is twee verwante studies uitgevoer. Een studie (N = 303) was ʼn ewekansige, beheerde proefneming wat die invloed van drie boodskap-toestande (’n groep wat die fotonovelle gelees het, een wat ’n tradisionele brosjure gelees het en ’n boodskaplose kontrolegroep) in ’n tussengroep- eksperimentele ontwerp vergelyk het. Resultate het nie getoon dat kennistoename in die fotonovellegroep beduidend hoër in vergelyking met die tradisionele brosjuregroep was nie. Wanneer enige een van die twee gesondheidsdokumente egter met die kontroletoestand vergelyk is, het albei dokumente ’n positiewe en beduidende effek op kennisvlak vir dié vrae gehad wat geen plafoneffek getoon het nie. Vergelykings in terme van respondente se houdings het nie afdoende bewys gelewer dat die fotonovelle, of tradisionele brosjure, beter as die ander een was nie. Intensies met betrekking tot interpersoonlike besprekings oor tik-verwante gesondheidsboodskappe was egter beduidend hoër vir deelnemers in die fotonovellegroep in vergelyking met deelnemers in die tradisionele brosjuregroep. Houdings en intensies was nie beduidend hoër wanneer enige een van die twee gesondheidsdokumente met die kontrolegroep vergelyk is nie. Die Extended Parallel Process Model (Witte, 1992, 1998) en Entertainment Overcoming Resistance Model (Moyer-Gusé, 2008) asook teoretiese aannames oor die opwek van emosies (vrees, verbasing, woede, hartseer en deernis) weens die lees van die fotonovelle is aangewend om verduidelikings vir die deelnemers se uiteenlopende houdings en intensies te vind. Die vreestrefkrag-elemente bedreiging en selfgelding beloof om dalk ’n invloed te hê op houdings wat verband hou met persoonlike gesondheidsgedrag, terwyl die emosies hartseer en deernis onderskeidelik beduidende en positiewe voorspellers was vir intensies en houdings wat verband hou met interpersoonlike besprekings oor tik-verwante gesondheidsboodskappe. Rakende boodskap-voorkeur het bykans twee keer soveel respondente gesê dat hulle gesondheidsinligting oor tik in fotonovelleformaat, eerder as in die tradisionele brosjure, verkies het, met ’n duidelike voorkeur vir die fotonovelle by die 19 jaar en jonger- en by die 35 jaar en ouer-ouderdomsgroepe. Die ander studie was ondersoekend van aard. In hierdie studie is die fotonovelle en tradisionele brosjure in ’n primêre gesondheidsorgkliniek se wagkamer geplaas om werklike voorkeur vir elke dokument as kommunikasie-instrument te meet. Met die uitvoer van hierdie studie – die eerste nog in sy soort – is enkele leersame praktiese probleme ondervind wat nie almal opgelos kon word nie. Nietemin wil dit blyk asof daar genoegsame redes bestaan om af te lei dat pasiënte verkies het om eerder die fotonovelle as die tradisionele brosjure saam met hulle huis toe te neem. Dié voorkeur sal egter in opvolgstudies weer op die proef gestel moet word. Die fotonovelle se voorkoms het uitgestaan as vernaamste motiveringsfaktor waarom pasiënte dít wou lees, terwyl dié wat die tradisionele brosjure verkies het veral meer wou uitvind oor die gesondheidsorg-materiaal. Deelnemers wat die fotonovelle gelees het, het aspekte van die storielyn die beste onthou, terwyl lesers van die tradisionele brosjure hoofsaaklik inligting oor tik kon onthou. Gebaseer op die voorkeur vir die fotonovelle bo die tradisionele brosjure, wat in albei studies gevind is, en gebaseer op die vergelykbare kennis en gedragsintensies wat gevind is nadat mense werklik die inligting in een van dié formate gelees het, word aanbeveel dat dokumentontwerpers die gebruik van fotonovelles oorweeg as instrument vir gesondheidsorg-kommunikasie oor tik of soortgelyke onderwerpe. Om die oorredingskrag van so ’n fotonovelle te help versterk, kan ook oorweeg word om vreestrefkrag-eienskappe by te voeg, en ook elemente in te werk wat hartseer en deernis as emosies probeer opwek. Voorts blyk dit dat die kombinasie van fotonovelles met elemente van tradisionele brosjures die kanse sal verbeter dat die ingeslote gesondheidsboodskappe gehore sal bereik. Derhalwe is nog navorsing geregverdig oor die doeltreffendheid van en voorkeur vir fotonovelles wat kenmerke van tradisionele gesondheidsbrosjures inkorporeer – of andersom.

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