The report describes and evaluates an approach utilised by C-Change, which is funded by the United States Agency for International Development (USAID), during a series of Action Media workshops in The Bahamas in September 2011 with most-at-risk populations (MARP): men who have sex with men (MSM), individuals engaged in sex work (SW) contexts, and people living with HIV (PLHIV). The goal was to inform the development of social and behaviour change communication (SBCC) resources in an effort to support and strengthen HIV prevention interventions with or by these populations.
As detailed here, Action Media is a participatory research methodology that integrates the perspectives of focal audiences in the development of health communication resources and tools. It was developed in the mid-1990s in South Africa in response to approaches to health promotion that perceive communities as "target audiences", towards whom messages and imperatives about health should be directed. In contrast, "Action Media workshop sessions involve a sequence of participatory interactions that involve developing trust between communication practitioners and participants. Channels for dialogue are informal. Participants are encouraged to engage with community problems critically through participant-led discussion groups. Role-plays, games, and other participatory activities enhance thinking and reflection while exploring the relation between contextual factors and health-beneficial action. As the series of workshops progresses, communication concepts are drawn out, extending to the point where communication resource requirement, mediums, and content are determined."
A review by C-Change notes that The Bahamas is at a "definitive moment" in their response to HIV and addressing HIV among vulnerable groups is a central concern. Recommendations include:
- Developing a national SBCC strategy that addresses the prevention and support needs of individuals who work in a SW context, MSM, and PLHIV;
- Strengthening the capacity of civil society and Ministry of Health partners implementing SBCC-related prevention programmes for individuals who work in a SW context, PLHIV, and MSM;
- Comprehensively addressing the deep levels of stigma that these groups experience;
- Undertaking advocacy toward the decriminalisation of sex work: moving beyond addressing individual knowledge and behaviours to creating an enabling environment for change;
- Engaging MSM, individuals who work in a SW context, and PLHIV in the development of programming and messages;
- Addressing the psychosocial needs of people who are part of these MARPs; and
- Exploring how communication channels such as the internet and other social media can play a role in programming for MARPs.
To that end, as described in this report, Action Media workshops were conducted in Nassau, Bahamas, September 11-23 2011, with a separate series for each different group of participants: MSM, individuals who work in a SW context, and PLHIV. The overall goals of the activity were to develop concepts for communication resources that contribute to reducing HIV incidence among MSM and individuals who work in a SW context, as well as reducing HIV transmission to partners of PLHIV, and to improve sexual and psychosocial health of all groups. By way of introduction, participants worked in teams of two to learn about each other, drew sketches of each other, and introduced each other to the group as a whole. Then, a discussion was held about participants' general sources of health information. Next, participants were asked to illustrate "a day in the life" of MSM/individuals who work in a SW context in The Bahamas and to draw a map of various elements, including safe and risky spaces. Participants worked together in three discussion groups without direct facilitation; they then reported back to the larger group. (Editor's note: findings from all of these discussions are outlined in the report.)
A range of print materials were made available for participants to review to elicit information on communication material preferences. These included booklets, leaflets, posters, and flipcharts produced by various agencies outside The Bahamas, a few local Bahamian poster examples, and participatory materials developed by C-Change (e.g. discussion cubes, role play guides, playing cards). For example, findings from the MSM workshops include: "Bright colors were well liked and there was a strong affinity for the C-Change 'community conversation' Toolkit materials. MSM expressed enthusiasm for cartoon images....Playing cards were also well liked - in particular, the range of slogans and phrases that were used....It was suggested that messages could be put on dominoes, as this was a popular game among gay and straight men. The discussion cube was also liked because the phrases were thought provoking, the colors were bright, and it could be used on a desk or coffee table....HIV-only messages were considered problematic, since STI [sexually-transmitted infection] prevention should also be included....Communication gaps as reported by MSM included HIV prevention among MSM, and unity among MSM and the non-MSM community. Participants worked in three groups to conceptualize slogans and then selected their preferred slogan for poster illustration."
Concept testing sessions were held with each group from the workshop sessions. The graphic artist's prototypes, which were developed during the preceding workshops, were presented on a video projector and participants were able to comment on the visual treatment, choice of colors, typeface, and wording. The full set of prototypes was shown to all groups. The graphic artist led a discussion on the emerging prototypes. Participants then discussed each critically. (Editor's note: details from these discussions are included in the report.) The slogans developed by each group were reviewed by the relevant participants, with some slogans being rejected based on further review. During the final concept testing sessions with MSM and individuals working in a SW context, a consultant delivered a presentation on the risks of HIV transmission through sexual networks, including high partner turnover and having concurrent sexual partners. The increased efficiency of HIV transmission during acute infection was presented and discussed by the group.
At the end of the concept review sessions, participants were asked to provide individual written comments on their experiences during the workshop. Most participants mentioned that they had found the workshops timely and informative, with much appreciation for the group interaction, with one noting "It showed that if a person gets together for a common goal, we can make a change". According to C-Change: "The methodology worked consistently well with all groups, achieving high levels of participation and generating a range of creative concepts in a short space of time. Participants appreciated the opportunity for open discussion and interaction on issues that directly affect them. The process was beneficial to many individual participants, who improved their confidence and self-esteem through group interaction, and many expressed appreciation for improving their knowledge and understanding of HIV."
Concepts and information from workshops in The Bahamas have been shared with stakeholders so they can use them to inform their development of communication materials.
Email from Sandra Kalscheur to The Communication Initiative on January 6 2012.