Part III: Formulation

Chapter 6: Setting objectives

6.1 How to identify the target audience?

The target population for an educational intervention is made up of several groups. In order to adapt the approaches to each group, it is necessary to differentiate between these groups.

Vulnerable Groups and Target Groups

It is important to differentiate between the vulnerable and target groups for intervention. The vulnerable group may in fact be the same as a target group of a communication program, but this is rarely the ease. For example a vulnerable group at risk for protein-energy malnutrition consists of children under five years. The nutrition intervention for reducing this risk will not be directed at the young children but rather at all those involved in the care of children under five years.

An effective communication strategy takes into account activities at all these levels. Each target group, especially the primary one must then be divided into its "segments" a term often used in marketing.

Target Groups

Within the target audience there are primary, secondary and tertiary target groups.

The primary target group is composed of persons whose behaviour is to be modified. In the example given above, these persons could well be the mothers of children under five years. In that case the aim would be to modify the manner in which they prepare their children's meals or care for them.

The secondary target group is comprised of people who will be used as intermediaries to get the message across to the first target group. In the same example, this could be health workers, teachers, agricultural promoters or journalists. It all depends on what the communication networks are in the community.

The tertiary target group is made up of people who can facilitate the communication process and behaviour change. There include administrators and politicians but also those persons close to the mother - the father of the child and the extended family.

This implies that the approach will vary for segments differing in terms of educational level, socio-economic status, etc. In the last example, we need to differentiate between the mothers who constitute the target group and between the various segments of the target group mothers, which will each benefit from a specific strategy.

The media and support materials used to reach mothers who are functionally illiterate and living in rural areas will differ from those directed at more educated mothers living in urban areas.

Example:

We must not forget that target groups should be participants in the process of social communication and not mere receivers of information. A one-way communication system for nutrition education would defeat our aim for an effective global approach. Also, the target groups must themselves play a role in transmission of messages to other groups and to the "promoters" of the intervention.

Influential people in the community should also play an important part within the secondary and tertiary target groups. This group is a catalyst in social communication.

6.2 At what levels are the objectives to be defined?

Nutritional objectives

The primary objective of a nutrition intervention programme is the nutritional improvement of the target group. This may be measured by dietary, biochemical, clinical, anthropometric and biophysical indicators. These indicators indicate different stages of nutritional status of a population.

Nutritional status is a complex phenomenon which is influenced by many factors external to an educational intervention. The time frame within which different indicators are affected by interventions differ. The nutritional objectives should, therefore, be defined with shorterm and long-term objectives. An educational programme is basically designed to change behaviour within the long-term objective of improving nutritional status provided the other external factors that influence nutritional status are favourable; for example, improved food production, availability of food and improved health facilities. All these are conditions external to and outside the control of communication intervention.

The immediate outcome is the direct result of intervention independent of external factors. The improvement of mother's knowledge concerning the nutritional needs of their children is a perfect example.

It is important to set nutritional objectives in measurable terms, but understand that these objectives will be achieved only when factors external to communication interventions are conducive to their achievement.

Educational Objectives

The specific objective of a nutrition education program is to obtain lasting changes in the behaviours affecting nutritional status. Adoption of new behaviour depends on many factors external to the communication program.

Intermediate objectives are those concerned with changes in motivation, knowledge, self efficacy, preferences for a particular behaviour and in the "savoir faire" -the skills required. These objectives are the independent outcomes - the promoters of the intervention must attend to these, in spite of external factors.

Educational objectives must be operationalized. This is described in a later section.

Communication objectives

For the communication program to be effective and bring about lasting change, it must focus on exposing the target population to the messages, and on the retention of the messages on their part.

In the field of communication, the methods are as important as the apparent results. This is because they forge lasting attitudes among the population.

For example, two communication programs can achieve the same objective of message retention. The first program because of its top-down authoritarian approach results in a relationship of dependence while the second which is participatory, encourages the population itself, to make informed decisions to resolve their problems. The second option is to be preferred.

Summary

At what levels are the objectives to be defined?

6.3 How to define educational objectives?

Educational objectives should be operationalized as far as possible. These provide the basis for preparation of an objective evaluation of the intervention.

To be operational, an educational objective should state clearly:

• what observable behaviours will indicate that the objective has been achieved,
• who will show the various behaviours,
• what will be the results of the new behaviour,
• under what conditions will the behaviour be shown,
• what criteria determine whether the desired result has been achieved or not.

Following are several illustrative examples.

How to define educational objectives?

Specific objective: The mother will introduce between the 6th and 9th month of the child's life, a cooked meal of maize legumes and oil, these being foods which are available and affordable to her. Criteria: This meal is to be consumed by children of that age group at least three times a week and not more than once a day

Intermediate objectives also can be operationalized, as shown in the following examples

In terms of skills considerable effort must be made to define the behaviour to be adopted by the population.

Cornflour, legumes, oil

The programme team for HEALTHCOM listed 38 behaviours in the curative domain and 69 in the preventive domain for diarrheal diseases.

An analysis is given below of the required practices for oral rehydration, more specifically those concerned with mixing the contents of a packet of rehydration salts with one litre of boiled water.

• Select a container which holds one litre of liquid.
• State clearly that the container must be washed and cleaned.
• Fill the container to the brim with boiled water.
• Open the packet taking care not to spill any of the contents.
• Add the contents of the packet, again being careful not to spill any liquid or salt.
• Add nothing more.
• Stir or shake the container.
• Label the container
• Emphasize that the mixture must not be boiled.

The planning team will be able to define the messages for communication on the basis of this analysis.

Chapter 7: Designing the messages

7.1 Messages, media and support materials

To distinguish between messages, media and support materials:

• "message" is the formulation of an idea or concept to be transmitted to a specific population (e.g., "fish is a healthy food for the child");
• "media" is the channel of communication through which the message is transmitted (e.g. talks at a health centre, school lessons by radio, etc.);
• "supports" are the materials on which the message is transmitted (e.g., poster, radio program, flannelgraph).

In developing the message the first questions to be asked are: What words should be used and in what order?. In the choice of media: What type of media? What is the optimal media-mix, for this situation?. In the development of support material: Which material? What images to use? Which colours? Which type of sound systems?).

These questions are closely linked. The contents of the messages influence the choice of media and support materials. These, in turn, influence how the message is formulated. The results of the pretest, however, may indicate that another choice of media has to be made. This is significant as the selection of support material is dependent on the choice of media.

Messages, media and support materials

7.2 How to ensure that messages are coherent?

Coherence with objectives

First, all the messages should be consistent with the objectives for behaviour change. In practice, the specific objective of a communication intervention should determine the messages to be developed.

The message must also be in keeping with the intermediate objectives.

On what basis is behaviour to be modified? Should there be focus on improvement in knowledge, in motivation or self confidence, or should there be emphasis on the values of the target group?

Depending on the nature of the intermediate objective, messages will be designed accordingly. These differences may be reflected in the message content. For example, a message for giving information will vary from one designed to raise self confidence.

This example illustrates that messages have to be designed in accordance with objectives set during the conceptualization phase of the strategy.

The results of the surveys which were carried out in that phase will also be useful in designing the message. The following example of an experience in Nigeria illustrates this point (25, p. 32).

The messages should be coherent. Quite often, it is not the only one but a number of messages are conveyed to the audience at the same time. Several messages which mutually reinforce each other may be used to achieve a common objective.

Here is an example of three complementary messages:

• "Measles kills,"
• "When your child is eight months old, have him vaccinated against measles,"
• "Protect your child from measles with the ROUVAX vaccine."

Coherence with of her interventions:

All nutrition education interventions in the same community must be coherent. This is often difficult because many institutions are involved, including those at the national level (school, health services, social services, agricultural extension, non-governmental organizations), and at the international level (United Nation Agencies,

These three messages are coherent. They aim to achieve one objective: the immunization of children eight months and older against measles, organizations for bilateral cooperation, (non-governmental organizations). How can coherence of efforts be ensured? One way of doing this is to associate all concern in the planning committee during the planning phase. Representatives from all development sectors actively involved in nutrition education in the area should meet for this purpose.

If there is no unity of effort between institutions the public may be confronted with contradictory messages. They will not know which message should be followed. If this situation does not change, there can be no expectations for any behaviour changes.

7.3 How to design persuasive messages

Well-designed messages reach their target audience. Although there is no one formula for message design, there are several useful guidelines. A selected guideline is given below.

How to design persuasive messages

7.4 How to maximize the potential for effective messages

The potential effectiveness of a message is certainly enhanced by format. This concept has been widely used by commercial advertisers so much so that advertisements today are rarely a mere description of the qualities of the product.

How can we increase the persuasiveness of a message transmitted through images (symbolic message). Various procedures have been used in commercial advertising and to a lesser extent in public service communication. The reader may consult relevant manuals on communication, marketing and advertising for more information on the subject (10).

Some well known suggestions regarding style which can be helpful in designing more attractive messages are presented in Technical Files 6 and 7.

How to maximize the potential for effective messages

TECHNICAL FILE N°6: Seven elements of style for symbolic messages

TECHNICAL FILE N°7: Family trials

Chapter 8: Choice of media and multimedia combination

8.1 What are the media?

The media are the channels of communication through which messages are transmitted. It is necessary to distinguish between two channels of communication, namely, the face-to-face and the mass media.

Face to face communication

Oral communication in the form of a face-to-face encounter may take place in two kinds of circumstances. The interpersonal face-to-face situation (e.g., an agricultural extension worker speaking to a farmer) and the "face-to-face in a group" situation (e.g., a health officer leading a discussion with a group of mothers).

The voice is the main organ of face-to-face communication but the use of other support materials is highly recommended. These support materials can be printed, visual, and audio-visual. They reinforce the oral communication between the "educator" and his target audience.

Interpersonal Communication, in which two people are brought together in a face-to-face situation, is of considerable importance in any strategy for public education. In fact, the most successful attempts to change nutritional habits have been based mainly on interpersonal communication used in conjunction with other methods.

Face to face communication

It was stated earlier that the aim of the intervention is to modify social communication with regard to nutrition in order to change what people say about nutrition. The result of an intervention in nutrition education must therefore encourage interpersonal communication. For the most part this effort has to be voluntary. There is no real compensation for the mother who speaks to her neighbour about the necessity of vaccinating her child. However, professionals who are trained and paid for their interventions (health officers, agricultural adviser, social assistants, teachers, etc...) must support these efforts.

Interpersonal Communication

In what context can such an intervention take place?

The most obvious time is during consultation in a health centre. The Health Officer takes time out to speak to his patient (or the parent of the patient if the latter is a child), listen and help him to find a solution to his problem. This message must complement those transmitted via other channels of communication. Most people working in development programs are involved in interpersonal communication. They can reinforce the messages relevant to the public. The planning committee for the nutrition intervention has to identify these channels and include them in their multimedia strategy.

Communication in a group situation has been the principal means of nutrition education for a long time. It was referred to as "discussion" but was often the monologue of a Health Officer before a group of mothers of young children. Since that time, other means of education have evolved. In particular, communication in a group situation has improved as a result of field experience and scientific research.

Communication in a group situation

There is a significant amount of material available on training for group discussion which deals with methods, group participation and material, and visual or audio-visual supports.

The emergence of special supports has led to the development of innovative training methods. This will be described in Chapter 11. Technical files will be presented for slide-language, Video-animation and Popular theatre.

The mass media

With mass-media communication, the transmitter and receiver are never in direct contact. The interaction is mediated through the visual image, print, or by a combination of these elements.

Radio diffusions use sound (music and words). The programmes come in many formats, talks, debates, soap operas, advertisements. Regretably, for a long time health education programmes were limited to debates between journalists and medical experts. Since then a more effective advertising campaign has been developed which makes use of other formats. Radio is a very popular media throughout the world. All countries listed in the "Report on Communication in the World" (38) have at least one public or private radio station. In some of the poorest countries access to radio is estimated at between 2 and 4% of the population, but in most of the developing countries, including Africa, the proportion of radios in use exceeds one in ten. If the population pyramid, as well as collective listening, is considered, it may be inferred that in almost every country, the majority of adults have direct access to this medium. However, there is a need to determine the expected media coverage of the population in the country or region chosen for a nutrition education intervention.

Radio diffusions

The radio may be looked at from two different perspectives: interactive and non-interactive. The more common way of using radio is non-interactive. Messages are transmitted in one direction, from the transmitter to the audience. Here the transmitter has no direct feedback on the impact of his programmes except through opinion polls.

The radio

Conversely, experiences with rural radio have demonstrated the possibility of having lively interactions with the people in these communities. With this medium, there is a combination of radio diffusion and direct oral communication with a group.

Television uses sound, moving images and sometimes the written text. Therein lies its strength. However, it is less accessible than radio. In 1990, 38 countries or territories did not have a television service (38). In many countries no televised programmes could be received in any parts of the country. Moreover the number of receptors per 1000 people remains quite low in most developing countries.

The television

While television is still not easily accessible to most people in rural areas, it continues to exert enormous influence in urban areas, as was the case in the Ivory Coast program "Télé pour Tous."

The printed press has its shortcomings. These are linked to illiteracy on one hand and limited circulation on the other.

The printed press

The circulation of newspapers is quite low in most developing countries. The fact remains that the printed press cannot be seen as a popular media but rather as an elitist one. Newspapers can be used in communication projects if the aim is to mobilize a social class comprising opinion leaders and their social networks.

Posters can serve as a means of communication. It is advisable, however, to use them in conjunction with other media. This channel associates fixed images with written text, and thus limits the target audience to the literate population. Posters can be used without any text. The procedure is complex and demands a particular kind of literacy skill which most people do not have.

Posters

The support material for a poster is the poster itself, but may also be in the form of a T shirt.

8.2 How to select media and support materials

The selection of media and support is done through diagnostic research undertaken in the phase of conceptualization of the programme, where the channels and the active communication networks in the community are identified.

The planning committee should draw up a table with two axes, one for the different media, the other for supports in accordance with the criteria given below.

What are the criteria for the choice of media and supports?

1. Cost: Can the use of this media be accommodated financially? (cost of using the media, training people for the relay, buying and producing the support).

2. Accessibility: to what extent does the target audience have access to the media?

3. "Ease of Use" of media (taking into account the competence already acquired by the people responsible for the intervention) Is this media easy to use?

4. Credibility of each media type: Is this media credible?

5. Community participation: Does this media encourage participation?

6. Dissemination of the message with time: Does this media allow for extended, long-term dissemination of the message?

7. Relation to objectives of the intervention: Can this media tee used to achieve the objectives?

For each criterion, each type of media is graded (good, satisfactory, bad). Once complete, the table helps the reader to consider the best choice depending on the importance attributed to each criterion.

In each situation, the criteria must be set in order of importance. The choice is then made with regard to the most important criteria.

For example, in a situation where finance is limited, the criterion for cost appears at the top of the table.

In another situation where the problem of financial means is less acute, but where more importance is given to the long-term effects of the programme, the duration for diffusion of the method would be one of the main criteria.

The planning committee has to consider which media are best suited for achieving the intermediary objectives of the intervention.

The Table 2 summarizes the relative strengths and weaknesses of the various media in relation to changing improving the various parameters of nutrition education and Table 3 provides a list of media and their effectiveness in reaching the various target groups. Both of these tables will help in the selection of a suitable media for reaching a target group.

Table No. 2 - Relative strength of the media in changing various parameters of nutrition education

0 = little effect * = moderate effect ** = good effect

Below is a list of target publics that you may wish to reach and the different means of communication.

Lets take the example of rural women. In order to reach them one can make personal contacts, use radio, organize cooking demonstrations, show flipcharts in the market, health centres and in other meeting places.

Lets now take another example of the Government authorities. The best way to raise their interest are circulation of information notes, meetings and debates, television, written publications and may be also through radio programmes.

Table 3 - Comparative effectiveness of means of communication in reaching various target groups

+ = less effective

++ = very effective

8.3 How to determine the best multimedia combination

An essential element of many successful public education program has been to use of a multimedia combination.

This media mix involves an organized concomitant use of several channels of communication. One may speak of synergy if the overall impact of the intervention is increased through the use of several types of media, each reinforcing the other, so that their collective impact is greater than the sum of their influences taken separately. The basis of a media mix is the association of interpersonal communication with mass-media communication.

Each channel of communication is specific in its own way. The challenge is to find the best combination which can result in the realization of the objectives for each target group.

To achieve this, the credibility of the message must be assured. In this regard, health workers are often the first choice because nutrition is considered a priority in their field. All the same, if nutrition education aims at promoting food production, other categories of worker may better suited to the task (e.g., agricultural extension officers). It is often through communication on a person-to-person level with members from the target community that the best source for the message can be determined. These sources should be identified during the diagnostic research phase.

The other channels of communication can play an additional role in the communication strategy. Radio, for example, can spread the message to a much larger audience than that could be covered by the development agents. Posters can ensure long-term exposure to the message. Today, in many countries, T-shirts are still being worn years after they were distributed to advertise the merits of oral rehydration.

It can therefore be seen that the ideal approach is to select not one, but several complementary media to maximize the potential for a successful intervention.

This also explains why intersectoral collaboration is necessary. No one sector can control all the media-related elements of the intervention.