Managing Fear, Giving Hope: HIV/AIDS and Family Planning Behavior Change Communication Guidelines for Urban Youth

"Many call for empirically-grounded, theoretically-based behavior change communications. Yet, time after time empirical research goes unused as message designers abandon the often difficult task of translating data into usable information, relying instead on inspiration, brainstorming, or intuition for designing health communications. The problem with this approach, of course, is that mistakes are made and miscommunication occurs despite having 'research' to back up one's interventions."

The purpose of this 62-page Urban Youth Supplemental Report is to provide "a systematic, easy method for developing effective health risk messages using data gathered according to a well-tested behavior change communication theory. In other words, our goal is to demonstrate how to translate theory and empirical research into practice. By using theory-based research in our health risk messages, we more efficiently and effectively develop communications that work. Cost is reduced as well because the use of data and a proven theory cuts trial-and-error time as well as expensive mistakes."

The paper describes, in particular, the Ethiopian Reproductive Health Communication Project (RHCP/E), a 4-year information, education, and communication (IEC) initiative in family planning and HIV/AIDS services which is part of the United States Agency for International Development (USAID)-supported Essential Services for Health in Ethiopia (ESHE). The Ethiopia National Office of Population implements the project with technical assistance from Johns Hopkins University Population Communication Services (JHU/PCS). The purpose of the ESHE programme (and the RHCP/E project) is to improve the health status of Ethiopians and to help reduce population growth rate. The ultimate goal of RHCP/E project is to increase demand and use of reproductive health services.

As detailed here, a baseline survey including both qualitative and quantitative components was conducted between May and September 2000 with participants aged 15-30 in 5 regions of Ethiopia. The work was grounded in the Extended Parallel Process Model (EPPM), a model of health risk behaviour change integrating 40 years of health communication research. The purpose of the research was to better understand the motivations, barriers, benefits, and risks perceived by urban youth in terms of family planning use and HIV/AIDS prevention. "The goal of the EPPM is to provide guidance on how to manage fear generated from threatening health risks like HIV infection or having more children than desired. Fear is a powerful motivator, and the key to a successful health campaign is to channel this fear into a direction that promotes adaptive, self-protective action, and prevents maladaptive, inhibiting, or self-defeating actions."

An excerpt from the Summary section follows:
"Overall, the EPPM is a model that details how to create communications in order to 'manage fear.' If a population is already frightened from a serious threat, they are motivated to act (according to the theory). Our job as practitioners, then, is to make sure that the population feels able to do a recommended response and believes that the recommended response works in averting the threat (i.e., promote high self-efficacy and response efficacy perceptions to accompany the already existing high threat perceptions). In short, when health practitioners frighten people with serious threats or when people are already frightened, we also must give them hope....[T]he EPPM offers specific guidance about how to manage fear and give hope in order to promote life-saving protective actions and prevent maladaptive responses like fatalism or denial. This supplemental report outlined the step-by-step procedures for developing effective health risk messages, offered specific message guidelines for family planning and HIV/AIDS prevention campaigns targeted toward urban youth, and offered specific tabular information regarding urban youth by region. Similar strategies can be used for other focal populations."