from Peter Labouchere

November 2001

One underlying dimension which is key to the effectiveness of behavioural impact communication programmes concerns the extent to which these programmes either:

• get people to focus on the problem and ways of stopping, solving or getting away from the problem (Problem Focus); or
• enable people to focus on what they want in life and to develop ways of staying safe and healthy so that they can move towards these desired goals and dreams. (Positive Outcome Focus)

The sort of questions we ask, as listed below, lead to either a problem or outcome focus. These impact differently on the feelings people have about an issue and their motivation to resolve it. The problem-focused questions often elicit some interesting and useful information, but leave people feeling de-motivated and stuck in the problem. The outcome-focused questions generally produce less analysis and more creativity, resulting in feelings of empowerment and enthusiasm to do something about an issue, and a sense of progress towards resolving it.

If you wish to test and experience this for yourself:

1. Think of any issue or problem you are currently facing.

2. Answer the problem focussed questions with regard to this issue. When you have finished, notice how you are feeling.

3. Answer the outcome focussed questions with regard to the same issue. When you have finished, notice how your feelings have changed.

Problem-focused questions

• What is the problem?
• Who or what caused it?
• Where did it come from?
• Why have you got this problem?
• What other implications does this problem have?
• How can you get away from this problem?

Outcome-focused questions

• What do you want?
• How many different ways are there to get there?
• What else will you have when you get there?
• What support do you need?
• What is the first thing you need to do now?

The problem focused approach to HIV/AIDS has contributed greatly to awareness raising and to the analysis and understanding of the current situation. This is vital to any planning process. The issues surrounding the pandemic are huge and complex and these need to be explored and their realities acknowledged. However, focusing just on the risk, consequences and prevalence of HIV/AIDS often produces a 'Fear Response', which ignores, rationalises, or denies the reality of the problem (see "The Use of 'Fear Appeals' in Public Health Campaigns and in Patient/Provider Encounters", Dr Kim Witte). In some circumstances this focus may even reinforce a fatalistic belief about the inevitability of HIV infection, with corresponding high risk behaviour.

We naturally move towards whatever we focus on most, and how we imagine our future to be. Hence the best way to solve the problem is not to focus on the problem, but on the outcomes that we really want in our individual lives, families, communities and programmes. To effect sustainable change, we must enable people to make their own well-informed choices about what they do, linking these choices to achieving what is really important to them in life (i.e. their own values-based desired future outcomes.)

The rationale for these assertions derives from studies of best practice in personal and organisational effectiveness, some basic human neurology, and experiences of applying these ideas in participatory HIV/AIDS training tools in various African countries.

In the literature on personal development and personal effectiveness, a strong positive outcome focus consistently emerges a key characteristic of effective people, though phrased in different ways. Stephen Covey's empirically based book 'The 7 habits of highly effective people' identifies 'start with the end in mind' as one of them; Ron Holland's most fundamental prescription for personal achievement is 'Relax and visualise the future as you desire it'. The degree to which communities and organisations have collective commitment to a clear vision and desired outcomes also correlates closely with their success in achieving them.

Human neurology offers an understanding of why this is so, most simply explained by relating computing terminology to our incredible bio-computer, the human mind. We each 'programme' our mind's information filter, the reticular activating system (RAS) with our self-image, beliefs, values, what we focus on and think about most, and how we imagine our future to be. The RAS then filters and uploads to our conscious mind those elements of our experience which are consistent with and help us realise the mental programs we have set up. Hence it is vital that we program the RAS with what we want, not what we want to avoid. I have emphasised that our outcome focus must be positive; if we have a negative outcome focus, our RAS will act just as effectively to ensure that we achieve this. The danger of a problem-focused approach is that we risk the problem becoming a negative outcome focus.

The contrasting responses of people who discover they are living with HIV and AIDS provides one example of how these ideas apply in practice: The problems facing PLWHAs are complex and multi-faceted, and in many ways a problem focussed response is natural. An HIV positive test result can be interpreted as demolishing life dreams, leaving no future, leading variably to depression, ambivalence about re-infection / infecting others, a rapidly depressed immune system and earlier onset of AIDS. Other PLWHAs in apparently similar or worse situations have responded in a way which enables them to live many healthy and fulfilling positive years. What makes the difference? One key factor is the extent to which we are able to establish and focus on desired outcomes commensurate with our HIV status.

This was clearly evident during sessions I facilitated at the Hope House support group for PLWHAs in Lusaka. After discussion around a range of issues facing the group, we ran a creative visualisation exercise enabling members of the group to formulate and represent on paper or physically how they wanted their personal situation to be at some point in their future. Some shared their visions and drawings. One women, whose husband had recently died of AIDS and had been stigmatised in her community, portrayed herself two years hence still looking healthy and with a big smile on her face. She enthusiastically described her illustrated vision, as if she was already there: "These are my two children, both now at school, happily telling me about all they have learnt. Those are cloths for a small sewing business I have started, which earns me enough money. I have sorted out with an uncle that, if I become ill and die, he will look after my children and their education. My neighbours are there too, greeting me warmly. I have been working with local community and youth groups to educate people about HIV and AIDS. Because I am living with HIV, people listen to me seriously and they now really respect me for doing this. I feel happy and proud of myself." She keeps her picture with her or at her home. Whether or not she actually realises every aspect of the vision, the motivating focus it provides helps her live positively and pick up on every opportunity that presents itself to progress towards these desired outcomes.

For more information, contact:

Peter Labouchere

HIV/AIDS Training, Consultant

Bridges of Hope
Box 13
Victoria Falls

Zimbabwe.

Tel/Fax: +263 13 43254

peterl@mweb.co.zw

Bridges of Hope website