One NESB size does not fit all! What makes a health promotion campaign "culturally appropriate"?
Margo Moore, South Western Sydney Area Health Service, Di Lane, South Western Sydney Area Health Service, Anne Connolly, NSW Department of Health.
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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