Tessa Dooms and Chris Vick argue for more effective communication by everyone involved in the struggle against the spread of the Covid-19 pandemic
South Africans who are in their 30s and 40s now were teenagers and young adults 20 years ago at the height of the HIV/AIDS crisis. Young people were at the centre of the HIV pandemic and behaviour change was determined to be the best weapon against HIV prevalence in the long run.
Although youth were not thought of to be the primary population of concern for COVID-19 at the start, the second wave is showing that COVID-19 messaging must reach everyone as more and more young people are succumbing to this deadly virus.
Whether it's about responsibility for the health of others or our own, the messaging about COVID-19 needs to provide clear and firm cues on what we all need to do to effectively manage the spread of the virus.
In the 1990s, HIV messaging was about fear and shame. However, the result of attempting to cast shame on people only led to stigma. Stigma was called an additional epidemic because instead of discouraging risky sexual behaviour it produced hostility in healthcare facilities, patients who would not test for fear of judgment for their "poor" behaviour and more risky behaviour due to what labelling theory calls a "self-fulfilling prophecy" of risky behaviour by people who are already being labelled as deviants in their society.
What is clear, if we look back with honesty, is that we cannot shame each other into better health behaviours.
Inform not blame
What the 2000s brought to the HIV messaging strategies, especially for young people, were campaigns like loveLife and Soul City. These were messages that sought to inform not blame, inspire not shame and promote agency not inaction. These campaigns explained what HIV was and how it affects the body, but more importantly it explained how HIV could negatively affect the social lives and futures of the youth.
In doing so, it focused their attention on the long-term benefits of seemingly small inconveniences and changes in behaviour today. Most importantly it gave young people an active role in reducing HIV and improving the future for themselves and others.
In a time of COVID19, what can we learn about health behaviour change messaging from successful HIV messaging?
- Educate: people respond to information about the disease, how it spreads and need to be able to make sense of the potential harm the virus can cause.
- Engage: people need safe and constructive opportunities to ask questions about the virus and how the health behaviour change translates to their context.
- Enable: we have to make sure that all the things needed to enact the health behaviour changes are widely available and provide step by step guidance on how to conduct social interactions like funerals and family visits safely. This means setting people up for success, not failure.
- Empower: people have to be positioned as potential contributors to the solution, providing them with clear goals they can set or interventions they can make at very local levels to affect change.
- Enlist: we need to create calls to action that build individual and collective buy-in to behaviour change. This means building new actions and new desired goals into our communities.
- Accessible: information needs to be available in home languages, in formats that are easy to access and at locations (be them digital or in the real world) in which the audience, be it young people or otherwise are likely to consume it.
At COVID Comms – a volunteer network of professional communicators that was galvanised into action in March by the need to develop accessible, easy-to-understand public health messaging – we have adopted an approach that aims to speak to people about what COVID-19 means for their daily lives.
Since COVID Comms' formation, we have realised that we cannot expect instructions alone to effect behaviour change. South Africans do not respond well to being told “do this, do that” – there needs to be encouragement alongside enforcement.
For this reason, we have combined basic information – wash your hands, keep your distance, wear a face-mask – with motivational messages that explain why this is important. As the festive season approached, bringing with it greater risk, we combined shock tactics (“don’t make this your last summer”, for example) with practical tips for travelers, stay-at-homers, victims of gender-based violence, and those in need of psychological support.
Government, however, sometimes seems to be missing in action when it comes to health information that people can use and/or information products that will result in behavioural change. For a start, most available government material – whether on www.stateofthenation.gov.za, the Department of Health website and the Presidency’s website – is almost exclusively in English.
There are also gaps in the state information chain. Up until last night’s new lockdown announcement, government’s own news service – the @GCISMedia account, with over 140 000 followers, many of them journalists and valuable societal influencers – hadn’t tweeted a word on anything, never mind COVID-19, since 18 December. To compound this, there appears to be a complete absence of GCIS material in anything other than English – which is unthinkable in a society with such language multiplicity.
And then there’s the new ad agency-driven campaign launched by the Solidarity Fund, which seems to be based on the premise that urging people not to be a “mampara”, a “moemish” or a “chop” will change the way we live our lives.
The campaign has barely stuttered along on social media platforms, despite clearly significant resources and sponsored posts, and it’s not hard to see why. Take a look at this example:
A new approach
The level of disruption caused by the pandemic requires a robust response to creating a new normal, and raises particular challenges for anyone in the communications environment.
People do not only need to know what to do but why and how to do it. The message must be targeted to them and be easily translated to their lives and contexts. This means plain language, accessible information products and messaging that will drive fundamental behavioural change. And, as is the case with COVID Comms, it should ideally be produced in all South African languages and distributed in easy-to-access formats such as WhatsApp groups and social media, to ensure information reaches the people who need it most.
Most importantly, in a time of uncertainty and hopelessness we need messages that provide a positive path out of the confusion and destruction that has come with COVID-19.
There is no silver bullet – just ask anyone involved in trying to get South Africans to stop driving drunk, or to stop driving recklessly.
The challenge facing all those involved in communicating behavioural change is massive. It requires a collective approach involving health practitioners, youth activists, public health NGOs, communicators and decision-makers – not to mention funders.
We need to put the emphasis on information products that will make people change the way they treat themselves, and the way they interact with other members of society, rather than thinking tighter lockdowns on their own will save us.
We need to put our heads together and combine our efforts, perhaps in a national summit of government, private sector and civil society experts that results in more focused behavioural change campaigns with meaning.
The truth is that we’re all learning. And we will probably be more effective if we share learning and learn together. There will not be a one-size-fits-all solution. But at least we can compare notes, get a sense of what is working (and how this is being measured, apart from anecdotally) and build on these successes.
Reposting videos of young people celebrating in the street is easy. Stopping them from doing it is the real challenge, and it’s a challenge we need to respond to urgently, using new mobilisation techniques and the new digital communication tools at our disposal, to bring about fundamental behavioural change – before it’s too late.
Dooms and Vick are on the secretariats of COVID Comms, a non-profit volunteer group producing public health education material. Their free public health information products are available at www.covidcomms.org.za