Health Literacy Lessons from a HIV/AIDS Prevention Project in Zambia, Africa

By Elisheba Muturi
Canadian-based Kenyan National

The importance of health literacy first dawned on me while studying international development, when I encountered Zambia’s Copperbelt Health Educational Project (CHEP). Established in 1988, CHEP created educational programs to promote awareness about HIV/AIDS and encourage safe practices among the public.

Because CHEP staff saw the value of visual materials, one of their early productions was a flipchart explaining HIV/AIDS transmission. To illustrate how HIV can be transmitted from mother to baby in the womb, they created a drawing of the cross-section of a pregnant woman’s abdomen. During a workshop with a group of women leaders, they discovered that this drawing made no sense to these women even though it was perfectly understandable to doctors. The women found the drawing confusing because it used technical words, had too many details, and showed familiar objects from an unusual view.

From this experience, CHES staff understood the importance of involving the audience in developing health education materials. They incorporated this approach when developing the booklet What Everyone Should Know About STDs. Before writing the booklet, they held focus group discussions with the three main target groups for the booklet: white-collar workers, manual workers, and college students. These discussions helped identify the most common beliefs, knowledge gaps, and misconceptions among these groups. The researchers used this information to prepare a list of issues that the booklet should cover.

The second step was to develop sets of short clear statements about each of the issues. CHEP staff then gave an artist these statements along with suggestions for drawings that would best illustrate the messages. CHEP staff used the artist’s rough drawings for pre-testing and revision. For pre-testing, they invited two members from each of the three target groups, none of whom had participated in the original focus group discussions. CHEP staff showed each participant a picture and asked what he/she saw. They then presented the accompanying text and asked the following questions:

What do the words mean to you?
How do you feel about the picture and the words?
What would you change?

Initially, CHEP staff did the pre-testing as a formality. However, they received such perceptive and insightful comments that they significantly revised both the drawings and the text. It took two more rounds of pre-testing and revision before the booklet was printed.

A serious barrier to health literacy arises when material developers do not tailor their message to account for the needs and limitations of their audience. CHEP staff realized that their initial approach had been basically "we tell, you listen," and that they had devoted very little time to understanding the intended audience. As their realization of the critical need to promote health literacy grew, they increasingly involved their audience in all the stages of designing new materials. As a result, their materials were more effective as their messages made sense to their audience. Disseminating clear messages had the desired effect of increasing awareness and potentially motivating their audience to action.

Elisheba Muturi is a Canadian-based Kenyan national. She now works as a Program Analyst for Canada's BC Ministry of Health. You can email Muturi directly at en_muturi@yahoo.ca. To learn more, go to her "Social Health Matters" blog at http://shebamuturi.wordpress.com

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