Soul City Institute for Health and Development Communication, South Africa, Gender and Health Unit, Medical Research Council, South Africa, School of Public Health, University of Witwatersand, South Africa, Population Services International, Washington D.C., USA.

2004

Published in the Health Promotion Journal of Australia in 2004, this study evaluates Soul City, a South African non-governmental organisation (NGO), specifically focusing on the impacts of the mass media campaigns on community and health practice changes at the individual, interpersonal and community levels. According to this study, conceptually, the project was built around the idea of health literacy - a set of skills combining knowledge in health issues, understanding of socio-cultural constraints surrounding health practices, and individual and community agency to bring about positive changes in health conditions. By combining both quantitative and qualitative methods, and by measuring communication strategies' impacts at various scales in the South African society, this evaluation study was designed to reflect the Soul City project's comprehensive socio-ecological perspectives on health.


Evaluation/Research Methodologies:

The project employed television and radio entertainment-education programmes that were broadcast nationwide, which were supplemented by printed materials distributed nationwide through newspapers and a national advocacy strategy involving lobbying of government and decision makers. The television programme consisted of 13-part drama, broadcast weekly on prime-time national television for 13 weeks. The radio programme was a 45-part drama broadcast daily nationwide. The media and media advocacy strategies as a whole addressed issues in HIV/AIDS and youth sexuality, domestic violence and sexual harassment, hypertension, and small business development and personal finance.

Data were collected in five different ways:

1. A nationwide survey was conducted in 1999 (baseline) and 2000 (evaluation) targeting the intended audience of the entertainment-education programmes to measure the health and social impacts of the project. This component gathered responses from 2000 individuals in 16-65 years of age.
2. A separate survey was conducted in two specific sites, one urban and one rural, on a panel (cohort sample) of respondents (n=1000) and a control group (n=100) in order to take repeated measurements of the impacts throughout the duration of the television and radio drama broadcast.
3. A qualitative assessment of the impacts was attempted through a series of focus groups and individual interviews administered in the two cohort sample sites as well as four additional sites. The survey was designed to delineate themes related to health and community life identified by the study participants.
4. The media advocacy aspect of the project was evaluated through interviews and focus group discussions with representatives of national and provincial government, service providers, NGOs, journalists, training institutions, community members, and project stakeholders. In addition, the study analysed the telephone call records at the Stop Women Abuse Helpline.
5. Finally, the study compiled a database of organisations and institutions reached by Soul City.

Key Findings/Impact:

Soul City entertainment-education broadcasts were received by more than 80% of the target audience, perceived as credible source of health-related messages, and effective in increasing health literacy, especially with reference to domestic violence and HIV/AIDS. Specific findings are the follows.

Reach

The television and radio programmes reached diverse audience segments in terms of education, age, sex, and geographical location. Forty-two percent of the television audience and 54% of the radio audience lived in rural areas; 66% of the television audience and 67% of the radio audience were women; 38% of both audiences were youth aged 16-24; and 22% of the television audience and 26 % of the radio audience had no formal schooling or some level of primary-level education only. Soul City also reached a total of 4,300 institutional audiences in diverse fields, such as schools (47%), adult education and training centers (34%), and clinics (10%).

Audience Reception

A qualitative assessment of focus group and interview responses in six sites revealed that the entertainment-education was perceived as a relevant, credible, and entertaining educational vehicle. The audience members reported that the broadcasts conveyed constructive and pro-social modeling of attitudes and behaviours, and showed plausible alternatives or coping strategies in realistic and familiar settings.

Impact on Creating a Supportive Environment

The findings provided evidence that Soul City contributed to creating a supportive environment for facilitating behaviour change, particularly in the areas of domestic violence and HIV/AIDS. Soul City had impacts on lobbying, media advocacy, and community mobilisation (e.g., public marches) that lead to the successful legislation of the Domestic Violence Act in 1999. Five percent of the people who had high exposure to the Soul City television drama reported that they had made contact with an organisation working in violence against women, comparing positively to 4% (those with low and medium exposure to the drama) and 1% (those with no exposure). The findings also pointed to synergetic effects of Soul City, such as the television and radio dramas' positive impacts on the usage level of the Stop Women Abuse Helpline and the AIDS helpline, and the enhanced communication between community leadership and their constituencies who used the television and radio dramas as common reference points.

Impact on Social and Interpersonal Environment

The findings suggested that the Soul City entertainment-education contributed to the empowerment of local communities. It raised collective health consciousness, facilitated a sense of collective empowerment to effect change, facilitated collective action and the formalisation of community structures, reinforced social networks, and provided positive vision and hope for a better future. One striking evidence of the impact on community and collective empowerment was the case of a rural township suffering from severe poverty, violence against women, and lack of social and health services. The entertainment-education, which used a setting similar to this township's socio-economic circumstance, inspired the community members to marshal a successful community mobilisation against an exploitative local economic practice. Further, the township changed its name to "Soul City" in recognition of the entertainment-education.

Impact on Individual Change

The exposure to the Soul City entertainment-education was associated with the greatest improvement in knowledge and awareness of the Domestic Violence Act, condom use, community action against domestic violence, knowledge and awareness of where to find support regarding violence against women, and intention to do something to stop violence against women. There were not quantitative evidence of an impact on personal attitudes pertaining to sexual behaviour, sexual behaviour itself, and attitudes and subjective social norms around sexual harassment.

The study concludes by discussing the factors that contributed to the positive outcomes of Soul City including: the multimedia format, the drama edutainment format, the synergy of multiple, mutually reinforcing intervention components, historical dealing with multiple issues, an understanding of the importance of collectivism, and a theory-based intervention strategy.

Scheepers, E., Christofides, N. J., Goldstein, Usdin, S., Patel, D. S., & Japhet, G. (2004). Evaluating health communication - a holistic overview of the impact of Soul City IV. Health Promotion Journal of Australia, 15 (2). 121-133; and email from Sue Goldstein to The Communication Initiative on February 15 2008.