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One NESB size does not fit all! What makes a health promotion campaign "culturally appropriate"?

last modified 31/05/2006 18:51

Margo Moore, South Western Sydney Area Health Service, Di Lane, South Western Sydney Area Health Service, Anne Connolly, NSW Department of Health.

This article is from the 2002 Autumn edition of MMHA's Synergy magazine.

In 1987 the Office for the Status of Women reported that one in three people thought violence against women was acceptable. By 1995 there was far greater understanding of the nature of domestic violence following a series of media campaigns.

However people from culturally and linguistically diverse backgrounds were less well informed and few preventive campaigns had targeted this group.

This paper, presented at the “Diversity in Health” Conference in 2001, describes a campaign targeted specifically at awareness raising and attitude change in multicultural communities.

 

Since the late 1980s there have been a number of media campaigns that have played a role in increasing awareness within the general population about the issue of violence against women. When the Office for the Status of Women (OSW) first surveyed community attitudes about domestic violence in 1987 it reported that one in three people believed assaulting a partner was acceptable behavior.

There followed a series of media campaigns, for example, “Domestic Violence. Break the Silence”, “Wife bashing is a crime”, “Domestic Violence… you can live without it” and “Real Men don’t Bash or Rape Women”. These raised the issue of domestic violence with the Australian public, emphasised the use of violence as a control mechanism with the family and helped shift opinion towards the view that violence against women is intolerable and should be publicly opposed.

The follow-up National survey conducted by the Office of the Status of Women in 1995 showed that there had been a considerable broadening in the understanding of the definition of domestic violence beyond its physical forms. The 1995 study investigated the current awareness and understanding of, and attitudes towards violence against women in comparison to the 1987 survey. It found that there was a far greater understanding of the nature of domestic violence, that domestic violence is a criminal offence (93% agreement) and domestic violence is not a private matter (80% agreement). There was less tolerance of excuses for domestic violence (94% agreement that alcohol is not an excuse). Some population groups were better informed than others – people from higher income households were consistently more knowledgeable than the average and those born in non-English speaking countries were generally less well informed. 1 Although a great deal of work has been done on addressing the effects of violence against women, an extensive literature review showed very little evidence of any relevant preventive campaigns around domestic violence within culturally diverse communities.

It was evident from the 1995 survey that the promotion campaigns run in the mainstream media had not been successful in reaching non-English speaking background (NESB) populations. Clearly domestic violence is a crime that occurs across all cultural groups 2-7, however, the research reflected a poor level of awareness about the issues amongst non-English speaking background communities. A number of initiatives designed and implemented by non-English speaking background groups have emphasised the need for broad, community based, multicultural preventative campaigns.8-11 The emphasis on community involvement was seen to be critical in the success of the campaign if the messages were to be culturally and linguistically relevant to the target audiences.12
Baseline research

In 1997, the South Western Sydney Area Health Service (SWSAHS) and the Central Sydney Area Heath Service (CSAHS) joined together on a community campaign to raise awareness and address attitudes about domestic violence in culturally diverse communities. Four communities were involved in the campaign – Vietnamese, Chinese, Arabic and Tongan speaking.

A random telephone survey of 425 people from the four communities was conducted. The survey was based on the 1995 National survey and examined knowledge about and attitudes towards domestic violence, its perceived causes, and the best ways to deal with it.
There were some significant differences between the National survey and the pre- campaign survey. Compared to the National survey, respondents were less well informed about domestic violence and the seriousness of its effects. Only 40% of people identified domestic violence as the main form of violence experienced by women compared to 60% in the National survey. In the pre-campaign survey more than half the respondents identified relationship problems as the main cause of domestic violence compared to only one fifth of the National survey. Respondents in the pre-campaign survey were much less inclined to strongly agree that domestic violence is a criminal offence. Fifty-eight percent of respondents agreed with the statement domestic violence is a private matter best handled in the family, compared to 18% in the National survey. These, and other differences, highlighted the contrasts in thinking between non-English speaking background groups and the general population. The contrast was even stronger within the more recently arrived groups like the Chinese. The findings showed that non-English speaking background groups - notably women (59% women compared to 41% men) - acknowledged the occurrence of domestic violence within their community, but that generally the response was to keep it private. The other important finding was that fewer people knew that domestic violence is a crime in Australia, only 63% compared to 83% in the National survey.

Implementing a “culturally appropriate” campaign
A partnership approach was developed with community representatives participating in designing and developing culturally and linguistically accurate campaign materials. Community members of the Tongan working party spoke to church congregations about the issue of domestic violence and the Vietnamese working party became key decision-makers in how the campaign was run. Members of the working parties and the steering committee provided the expertise on panels at community information forums. Key community and religious leaders also had a high profile, giving interviews to ethnic media, being on panels at information sessions with the public, speaking at the launch of the campaign and promoting it through their own networks.

Some of the issues raised in the working parties included: the gender imbalance between men and women; the role of women in their community; the role of religion in challenging or upholding ways of thinking; the power dynamics within communities, and the difference between the cultural mores and laws of their country of origin and Australia. Given the challenging topic, community cooperation was outstanding.

Developing Culturally Appropriate Media Messages - one size doesn’t fit all
Separate focus groups with men and women followed the initial research to extend the understanding of issues raised in the baseline survey. Results of the focus groups highlighted the need for a different approach in non-English speaking background campaigns. In contrast to the images frequently used in English speaking campaigns, the communities clearly did not want to see images of battered women and distressed children. They wanted to build on the positives – strong family unit, strong community, strong social ownership of the issue. Peace and harmony in the family were developed as challenges to domestic violence. Images of happy families were chosen to highlight the importance of the children’s future and the desire to maintain domestic harmony.

In addition to highlighting the difference in attitudes that exist between the general population and non-English speaking background populations, the research also showed the differences between each of the four communities. The research findings proved to be a vital tool in assisting the working parties in understanding their community’s attitudes and perceptions to domestic violence. The research offered working party members an insight into their communities’ current attitudes about domestic violence and became a valuable resource to draw on to ensure slogans and messages were pitched at a realistic level. It was important to meet with community and religious leaders early on in the process in order to brief them and keep them informed, so that they were prepared for the campaign.

The project management team decided from the outset that the campaign material would not be based on a “translation model” where material is written in English first then translated. Instead, a “first language first” model was adopted, which allowed the working parties to develop messages in their first language using the vernacular and culturally specific expressions unique to each group. The time that would have been spent in translations and back-translation was instead invested in community consultation which resulted in the creation of specific messages that had substance and meaning within each cultural context.

One of the techniques we used in developing the campaign messages was borrowed directly from advertising. It built up a picture or “profile” of the person we were addressing. Each “person” had a name and a set of personal characteristics and experiences based on what we found out from our earlier research and on cultural input from bilingual workers. Rather than asking what messages we wanted to convey we asked each “person” what messages they wanted to hear about domestic violence. The profile was a very useful tool when it came to writing the radio ads – we developed eight characters, a husband and a wife’s story for each of the language groups and incorporated specific messages that these characters would be open to hearing.

The Media Campaign
The campaign ran over a period of two months from November 1997. The intention was to draw attention to the issue of domestic violence prior to and during the Christmas period as this is traditionally the time when the incidence of domestic violence rises.
The multi-media campaign consisted of radio (SBS and community radio), ads and articles in ethnic newspapers, community forums and billboards at four railway stations. The artwork for the billboard was matched in posters and bookmarks.

The ethnic press strongly supported the issue, particularly the Tongan, Chinese and Arabic press. In addition to the paid advertisements placed in newspapers, the campaign received coverage of the community events and accompanying articles about domestic violence, which exceeded initial expectations. For example, the Chinese “Independent Daily” reproduced the entire Domestic Violence Workers Directory in a four-page supplement it produced in a weekend edition newspaper. The Tongan newspaper carried an article about one aspect of domestic violence in every edition throughout the campaign period. The Arabic newspaper “An Nahar” carried a piece about domestic violence in its look back over the year of 1997 signifying that the issue had a prominent position in the the Arabic speaking community.

Tailoring the messages, images and community events to be culturally appropriate
The survey results were integral in informing the way the messages were devised and the “look” of the campaign. A principle of working with the communities was that survey results would not be used to single out or stigmatise any of the four communities. Under the direction of the working parties and the bilingual workers, images were created which appealed to the target audience and which could be seen and understood regardless of literacy.

The resultant billboard covered the four language groups and English. The overall English slogan says “Domestic Violence hurts everyone in the family… and it’s a crime”. The billboard was divided vertically into four panels, representing the four communities. Each panel depicts a family scene portraying the importance of the family unit and the extended family. To show family conflict each panel has symbolic representations of unease and trouble. For example, under the family portrait in the Vietnamese panel a vase has been tipped over and the flower snapped. As the rose represents woman in Vietnamese culture a Vietnamese person could read that all is not well in this family. The individually devised slogan is written as a poem and says, “Love builds harmony. Violence destroys everything.” The Tongan panel has the portrait hanging over the “tapa”, the traditional ceremonial cloth worn by women. The tapa is highly regarded as an heirloom and is often displayed on the wall. In this case the tapa has a corner pulled down off the wall, signifying to a Tongan reader that the family is in trouble. The Tongan slogan on the panel is “ Domestic violence against women affects the whole family”. The Chinese panel has the portrait reflected in a cracked mirror (very bad “feng shui”) and the Arabic photo itself has been smashed and is falling off the wall. The Chinese slogan is “Build up family respect and harmony. Speak out against domestic violence” and the Arabic slogan is “Domestic violence causes family destruction”.

Similarly, the radio ads were designed to target each audience. There was a gender-specific radio ad for men and one for women for each of the four language groups. An innovative approach to writing the ads was trialed in the project. A “profile” was worked up which gave the working parties a method of synthesising all the information they had into one female and one male character. The method developed a profile of a person with a name, a suburb, relationship to family, whether working or not and a description of the conflict situation.

Specific messages were designed for the four groups. The Chinese community was most worried about bag snatching and attacks on the street as the main form of violence against women, so this perception was addressed in the radio ads. The last line is “Physical assault is a crime, whether it happens in the home or on the street.” In the Arabic focus groups, there was a prevailing attitude that a woman should stay with her abusive husband “for the sake of the children”. These and other negative perceptions were challenged in the script writing. The phrase was turned around and the woman says “now when I look back on it, I can see that I should have sought safety and protection earlier – “for the sake of the children”.

Three of the working parties held community events – the Chinese held a “Information day”, the Arabic an “Awareness Day” and the Tongan a “Song Festival”. Even these differed from each other in the format and delivery of information. The community events became a major vehicle for directly reaching people, capturing the spirit of the campaign and providing a forum for community members to talk about the issue in their first language. The working party members and community and religious leaders provided the expertise on discussion panels at each of the forums.

Each event had its own cultural perspective. For example, the Tongan Song Festival tapped into a culturally appropriate way of talking about sensitive subjects in a non- threatening setting. The Tongan community was asked to write and compose original songs promoting the message of peace and harmony in the family and opposition to domestic violence. The songs were performed before a panel of judges and prize monies awarded. On the night of the song festival, there were sixteen contestants and over five hundred in the audience. All the songs created for the night are now part of the oral history of the Tongan community. The songs were recorded live by SBS and continue to be played on community radio. The sacred songs will also add to the repertoire of songs that are sung in Tongan churches across the State. The Tongan Song Festival is an example of how community members can participate in defining the shape and feel of a project and how culturally specific campaign messages can add value to the culture rather than take something away.

The Vietnamese working party worked differently again by choosing not to hold a community event and instead concentrated on making resources. They made a TV ad, a fridge magnet and a pamphlet. All the resources produced by the campaign have been highly utilised by the communities.

Results: Post campaign survey
Following the media campaign and community development events there were significant changes in knowledge about and attitudes towards domestic violence across all communities. The post campaign random telephone survey (of 412 people from the four language groups) showed that people were more likely to identify domestic violence as the main form of violence experienced by women (51% compared to 40% pre campaign). There were significant differences between the proportion of people identifying different forms of violence as domestic violence and also in the numbers of people reporting the various forms of domestic violence to be very serious. Seventy-five percent of respondents in the post survey strongly agreed that domestic violence is a criminal offence compared to 63% of respondents in the pre-campaign survey (a 20% increase from the baseline), and 46% of respondents disagreed with the statement domestic violence is a private matter best handled in the family compared with 39% in the pre-campaign survey.

Conclusion
The success of this campaign has highlighted the importance of “cultural tailoring” to ensure campaign messages have resonance with the target audience. The cultural and linguistic skills of the four working parties were an invaluable resource to draw on and maximised the potential of the campaign. Utilising community knowledge and involvement at every stage of the project development ensured community ownership of the issue and built sustainability. The cultural specificity of the message and images meant that they were well accepted and recalled. The model has since been adopted by other communities wanting to work around this sensitive issue.


Acknowledgements
This project was supported by grants from the Department for Women, the South Western Sydney and the Central Sydney Area Health Services. It was a joint collaboration between SWSAHS, CSAHS and the University of NSW (Department of Community Medicine). We gratefully acknowledge the support and work of the Steering Committee and Working Parties. The project has been awarded a prize and Certificate of Merit from the Australian Violence Prevention Awards, and a Certificate of Commendation from the 1999 NSW Premier’s Public Sector Awards.

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