Post-broadcast Evaluation of the Brothers for Life Medical Male Circumcision "Salon" Campaign

This report discusses the findings of an evaluation that sought to explore the reception impact of a medical male circumcision (MMC) campaign implemented in South Africa as part of the Brothers for Life programme. The “Salon” MMC campaign included television, radio, billboards, and posters; it used women in a hair salon setting to promote the benefits of MMC. The findings of the evaluation are meant to be used to develop a set of recommendations for the MMC campaign going forward.

Brothers for Life (B4L) is implemented by the Centre for Communication Impact (CCI, previously JHHESA) and seeks to promote the health and wellbeing of South African men with a specific focus on HIV prevention and treatment, MMC, and sexual and gender-based violence (SGBV)(see Related Summaries below for more information). The “Salon” media campaign (which ran from February 2015 to July 2016) seeks to promote partner dialogue and discussion around MMC and the use of condoms by men once they have been circumcised. Using females as key communicators of MMC and its benefits, the primary slogan was “Get the upgrade that counts”, referring to the benefits of MMC. Key phrases were “Zing” (a euphemistic term used to express sexual pleasure) and “circumcise and condomise”. In all mediums (television, radio, billboards and posters), an SMS number (*120*662#) was provided for obtaining information about the nearest clinic as well as links to Facebook and Twitter (#MMCZING), and the B4L website. The primary intended audience was young men aged 18 to 34 years, single or in a relationship, unemployed, uncircumcised, and/or engaging in high-risk sexual activities. A secondary audience was young, unemployed, out-of-school women aged 18 to 34, single or in relationship.

The post-broadcast evaluation of “Salon” advertisements was conducted in three provinces (Gauteng, Mpumalanga, and KwaZulu-Natal) in July 2016, and included focus group discussions in 9 sites including urban, peri-urban, and rural localities. The evaluation looked at each medium used in the campaign, and included questions to assess reach, recall, views about characters and language, messages and information received, interpersonal communication stimulated, and participants' recommendations.

The findings are discussed in detail in the report, including excerpts from the focus group discussions. The following are just a selection of some of the findings and recommendations for the way forward:

For example, the research findings show that the campaign succeeded in contributing significantly towards a shift in social norms regarding men and women discussing MMC. As stated in the report, “[A] notable theme throughout all focus group discussions regarded the impact of seeing and listening to women openly discussing intimate details of their sexual experiences, connected to their partner being medically circumcised. The women in the focus groups expressed a range of positive attitudes and emotions revolving around the empowerment that this campaign had provided to women, by opening a discussion to women that had previously been restricted to men. Although some men expressed discomfort in this shift in social norms, there was no doubt expressed by men that this was effective in providing motivation to men to get circumcised, either directly through the messaging regarding the benefits of MMC, or indirectly via female partners (and potential partners) expressing their preference for a circumcised man, via discussions between partners regarding MMC, and also broader social pressure from friends and family regarding MMC improving a man’s sexual performance and sexual health. It is therefore recommended that the general approach of using female characters advocating MMC in future campaigns is maintained.”

Overall, the characters and dialogue of the “Salon” advertisements were viewed as realistic, and effective in promoting MMC in audiences. However, the impact was not as notable with specifically rural audiences (male and female), older men, and more traditional men. Related to this, the research also highlighted the need for male-only scenarios, or scenarios that involved discussions between men, particularly dialogues between older men and younger men.

A prominent theme through all groups was that the ‘Zing’ catch-phrase was a key factor in making the “Salon” advertisement memorable, and it also provided the main entry point to conversations with family, friends, and partners. In comparison, the slogan ‘get the upgrade that counts’ was less remembered, understood, and used.

Although the majority of participants had cell phones with internet access, and there was a high level of usage of social media and internet, a notable finding was that the printed information – the clinic locator SMS number, social media hashtag, and the B4L website address – was poorly received, with very few participants stating that they had noticed or used this information. The report recommends a survey to determine why this was the case. The radio advertisements were generally well received, and the fact that they were both male and female voices was stated to be a good approach to engage men who were both comfortable and uncomfortable with MMC being discussed publicly. Findings showed that billboards were seen by few participants, but participants expressed the view that there should be more billboards, not only on main roads, but also within communities.

The report also recommends that future campaigns should address the concerns that many uncircumcised men have regarding the pain of MMC (procedural and post-procedure), such as how it is managed, for example with testimonies of men that the pain is tolerable. It is also recommended that greater prominence is given to older men accessing MMC in future campaigns, such as assigning specific days at MMC services for these men, and that this is advertised widely. The findings also pointed to the need for community activities – specifically, engaging the community in events and meetings - particularly in rural areas and peri-urban areas with populations holding traditional views.