Vocabulary

Bulletin: A brief report or announcement, often in written form, providing information about a specific topic.

Oral: Relating to the mouth; spoken or verbally communicated, as opposed to written.

Randomized: Chosen or assigned by chance; a method where each person or thing has an equal chance of being selected.

Administered: Given or applied, especially in the context of providing a treatment, test, or service.

Disabilities: Conditions that limit a person's ability to perform certain tasks, often related to physical, cognitive, or sensory impairments.

Inaccuracy: The state of being incorrect or not precise; a mistake or lack of precision in information.

Ineffective: Not producing the intended or desired results; lacking effectiveness or efficiency.

Reproductive: Relating to the processes of reproduction, especially pertaining to the production of offspring.

Maternal: Pertaining to motherhood or related to the qualities of a mother.

Tuberculosis: A bacterial infection that primarily affects the lungs, causing symptoms such as coughing, chest pain, and difficulty breathing.

Audience Analysis 

(Chapter 3. Assessing Community Needs and Resources | Section 2. Understanding and Describing the Community | Main Section | Community Tool Box, n.d.)

Anything we do in a community requires us to be familiar with its people, its issues, and its history. Carrying out a health communication campaign is far more likely to be successful if we are informed by the culture of the community and an understanding of the relationships among individuals and groups within it.

Taking the time and effort to understand your community and define your audience well before embarking on a health campaign will pay off in the long term. A good way to accomplish that is to create a community description—a record of your exploration and findings. It's a good way to gain a comprehensive overview of the community—what it is now, what it's been in the past, and what it could be in the future. In this section, we'll discuss how you might approach examining the community in detail and setting down your findings in a community description.

WHAT IS A COMMUNITY?

While we traditionally think of a community as the people in a given geographical location, the word can really refer to any group sharing something in common—place (such as a city, neighborhood, or school district), experience (such as shared experience of racism), or interest (such as a community's concern about poverty or violence prevention).

These various communities often overlap. A Black art teacher, for example, might see herself (or be seen by others) as a member of the Black, arts, and/or education communities. Whichever community defines your work, you will want to get to know it well.

WHAT DO WE MEAN BY UNDERSTANDING AND DESCRIBING THE COMMUNITY?

Understanding the community entails understanding it in a number of ways. Whether or not the community is defined geographically, it still has a geographic context—a setting that it exists in. Getting a clear sense of this setting may be key to gaining a full understanding of it. At the same time, it's important to understand the specific community (or communities) you're serving. You have to get to know its people—their culture, their concerns, and relationships—and to develop your own relationships with them as well.

• Physical aspects. Every community has a physical presence of some sort, even if only one building. Most have a geographic area or areas they are either defined by or attached to. It's important to know the community's size and the look and feel of its buildings, topography (the lay of the land—the hills, valleys, rivers, roads, and other features you'd find on a map), and neighborhoods.

  • Understanding how various areas of the community differ from one another is also important, whether your impression is one of clean, well-maintained houses and streets; one of shabbiness, dirt, and neglect; or anything in between. 

  • If the community is one defined by its population, then its physical properties are also defined by the population: where they live, where they gather, the places that are important to them. The characteristics of those places can tell you a great deal about the people who make up the community. Their self-image, many of their attitudes, and their aspirations are often reflected in the places where they choose—or are forced by circumstance or discrimination—to live, work, gather, and play.

• Infrastructure. Roads, bridges, transportation (local public transportation, airports, train lines), electricity, landline and mobile telephone service, broadband service, and similar basics make up the infrastructure of the community, without which it couldn't function.

• Patterns of settlement, commerce, and industry. Where are those physical spaces we've been discussing? Communities reveal their character by where and how they create living and working spaces. Where there are true slums—substandard housing in areas with few or no services that are the only options for low-income people—the value the larger community places on those residents seems clear. Are heavy industries located next to residential neighborhoods? If so, who lives in those neighborhoods? Are some parts of the community dangerous, either because of high crime and violence or because of unsafe conditions in the built or natural environment?

• Demographics. It's vital to understand who makes up the community. Age, gender, race and ethnicity, marital status, education, number of people in household, first language—these and other statistics make up the demographic profile of the population. When you put them together (for example,  the education level of Black women ages 18–24), it gives you a clear picture of who community residents are.

• History. The long-term history of the community can tell you about community traditions, what the community is (or has been) proud of, and what residents prefer not to talk about. Recent history can provide valuable information about conflicts and factions within the community, important issues, past and current relationships among key people and groups—many of the factors that can trip up any effort before it starts if you don't know about and address them.

• Community leaders, formal and informal. Some community leaders are elected or appointed, like mayors, city councilors, and directors of public works. Others are considered leaders because of their activities or their positions in the community, like community activists, corporate CEOs, college presidents, doctors, clergy.  Still others are recognized as leaders because they are trusted for their proven integrity, courage, and/or care for others and the good of the community.

• Community culture, formal and informal. This covers the spoken and unspoken rules and traditions by which the community lives. It can include everything from community events and slogans (such as “the blessing of the fishing fleet” and the "Artichoke Capital of the World") to norms of behavior (like turning a blind eye to alcohol abuse or domestic violence) to patterns of discrimination and exercise of power. Understanding the culture and how it developed can be crucial, especially if that's what you're attempting to change.

• Existing groups. Most communities have an array of groups and organizations of different kinds: service clubs (Lions, Rotary, and so on), faith groups, youth organizations, sports teams and clubs, groups formed around shared interests, the boards of community-wide organizations (the YMCA, the symphony, United Way), as well as groups devoted to self-help, advocacy, and activism. Knowing of the existence and importance of each of these groups can pave the way for alliances or for understanding opposition.

• Existing institutions. Every community has institutions that are important to it and have more (or less) credibility with residents. Colleges and universities, libraries, religious institutions, hospitals, and many others can occupy important places in the community. It's important to know what they are, who represents them, and what influence they wield.

• Economics. Who are the major employers in the community? What, if any, business or industry is the community's base? Who, if anyone, exercises economic power? How is wealth distributed? Would you characterize the community as poor, working class, middle class, or affluent? What are the economic prospects of the population in general and/or the population you're serving?

• Government and Politics. Understanding the structure of community government is important. Some communities may have strong mayors and weak city councils, others the opposite. Still other communities may have no mayor at all but do have a town manager, or they may have a different form of government entirely. Whatever the government structure, where does political power lie? Understanding where the real power is can be the difference between a successful effort and a vain one.

• Social structure. Many aspects of social structure are integrated into other areas—relationships, politics, economics, and so on—but there are also the questions of how people in the community relate to one another on a daily basis, how problems are (or aren't) resolved, who socializes or does business with whom, and so on. This area also includes perceptions and symbols of status and respect, and whether status carries entitlement or responsibility (or both).

• Attitudes and values. Again, much of this area may be covered by investigation into other areas, particularly culture. What does the community care about, and what does it ignore? What are residents' assumptions about the proper way to behave, dress, do business, and treat others? Is there widely accepted discrimination against one or more groups by the majority or by those in power? What are the norms for interaction among those with different opinions or different backgrounds?

Once you've explored the relevant areas of the community, you'll have the information to create a community description. Depending on your needs and information, this description might be anything from a two- or three-page outline to an in-depth portrait of the community that extends to ten pages and includes charts, graphs, photographs, and other elements. The point of doing this is to have a picture of the community at a particular point in time that you can use to provide a context for your community assessment and to see the results of whatever actions you take to bring about change.

Why Make the Effort to Understand and Describe Your Community?

You may at this point be thinking, "Can't I work effectively within this community without gathering all this information?" Perhaps if it's a community you're already familiar with and know well. If you're new to the community or an outsider, however, it's a different story. Not having the proper background information on your community may not seem like a big deal until you unintentionally find yourself on one side of a bitter divide or getting involved in an issue without knowing about its long and tangled history.

Some advantages to taking the time to understand the community and create a community description include the following:

• Gaining a general idea, even before an assessment, of the community's strengths and the challenges it faces.

• Capturing unspoken, influential rules and norms. For example, if people are divided and angry about a particular issue, your information might show you an event in the community's history that explains their strong emotions on that subject.

• Getting a feel for the attitudes and opinions of the community when you're starting work on an initiative.

• Ensuring the security of your organization's staff and participants. There may be neighborhoods where staff members or participants should be accompanied by others in order to be safe, at least at night. Knowing the character of various areas and the invisible borders that exist among various groups and neighborhoods can be extremely important for the physical safety of those working and living in the community.

• Having enough familiarity with the community to allow you to converse intelligently with residents about community issues, personalities, and geography. Knowing that you've taken the time and effort to get to know them and their environment can help you to establish trust with community members. That can make both a community assessment and any actions and activities that result from it easier to conduct.

• Being able to talk convincingly with the media about the community.

• Being able to share information with other organizations or coalitions that work in the community so that you can collaborate or so that everyone's work can benefit.

• Providing background and justification for grant proposals.

• Knowing the context of the community so that you can tailor interventions and programs to its norms and culture, and increase chances of success.

How Do You Go About Understanding and Describing the Community?

General Guidelines

To begin, let's look at some basic principles to keep in mind.:

• Be prepared to learn from the community. Assume that you have a lot to learn, and approach the process with an open mind. Listen to what people have to say. Observe carefully. Take notes; you can use them later to generate new questions or answer old ones.

• Be aware that people's speech, thoughts, and actions are not always rational. Their attitudes and behavior are often best understood in the context of their history, social relations, and culture. Race relations in the United States, for example, can't be understood without knowing some of the historical context: the history of slavery, Jim Crow laws, and the work of Martin Luther King and the Civil Rights Movement.

• Don't assume that the information people give you is completely accurate. There are a number of reasons why informants may tell you things that are inaccurate. People's perceptions don't always reflect reality, but are colored instead by what they think or what they think they know. In addition, some may intentionally exaggerate or downplay particular conditions or issues for their own purposes or for what they see as the greater good. (The Chamber of Commerce or local government officials might try to make economic conditions look better than they are in the hopes of attracting new business to the community, for instance.) Others may simply be mistaken about what they tell you—the geographical boundaries of a particular neighborhood, for example, or the year of an important event. Get information—particularly on issues, conditions, and relationships—from many sources if you can. As time goes on, you'll learn who the reliable sources are.

• Beware of activities that may change people's behavior. People (and animals as well) can change their normal behavior as a result of knowing they're being studied. Neighborhood residents may clean up their yards if they're aware that someone is taking the measure of the neighborhood. Community members may try to appear as they wish to be seen, rather than as they really are, if they know you're watching.

  • To the extent that you can, try not to do anything that will change the way people go about their daily business or express themselves. That usually means being as unobtrusive as possible—not being obvious about taking pictures or making notes, for instance. In some circumstances, it could mean trying to gain trust and insight through participant observation.

Participant observation is a technique that anthropologists use. It entails becoming part of another culture, both to keep people in it from being influenced by your presence and to understand it from the inside. Some researchers believe it addresses the problem of changing the culture by studying it, and others believe that it makes the problem worse.

• Take advantage of the information and facilities that help shape the world of those who have lived in the community for a long time. Read the local newspaper (and the alternative paper, too, if there is one), listen to local radio, watch local TV, listen to conversation in cafes and bars, in barbershops and beauty shops. You can learn a great deal about a community by immersing yourself in its internal communication.

  • The Chamber of Commerce will usually have a list of area businesses and organizations, along with their contact people, which should give you both points of contact and a sense of who the people are that you might want to get in touch with. Go to the library; local librarians are often treasure troves of information, and their professional goal is to spread it around. Check out bulletin boards at supermarkets and laundromats. Even graffiti can be a valuable source of information about community issues.

• Network, network, network. Every contact you make in the community has the potential to lead you to more contacts. Whether you're talking to official or unofficial community leaders or to people you just met on the street, always ask who else they would recommend that you talk to and whether you can use their names when you contact those people. Establishing relationships with a variety of community members is probably the most important thing you can do to ensure that you'll be able to get the information you need, and that you'll have support for working in the community when you finish your assessment and begin your effort.

Gathering Information

To find out about various aspects of the community, you'll need a number of different methods of gathering information. We've already discussed some of them, and many of the remaining sections of this chapter deal with them, because they're the same methods you'll use in doing a full community assessment. Here, we'll simply list them, with short explanations and links to sections where you can get more information about each.

• Public records and archives. These include local, state, and federal government statistics and records, newspaper archives, and the records of other organizations that they're willing to share. Many of the public documents are available at public and/or university libraries and online at government websites. Most communities have their own websites, which often contain valuable information as well.

• Individual and group interviews. Interviews can range from casual conversations in a cafe to structured formal interviews in which the interviewer asks the same specific questions of a number of carefully chosen key informants. They can be conducted with individuals or groups, in all kinds of different places and circumstances. They're often the best sources of information, but they're also time-consuming and involve finding the right people and convincing them to consent to be interviewed, as well as finding (and sometimes training) good interviewers.

Enlisting people who've spent time learning about the community can be other sources of information. University researchers, staff and administrators of health and human service organizations, and activists may all have done considerable work to understand the character and inner workings of the community. Take advantage of their findings if you can. It may save you many hours of effort.

• Surveys. There are various types of surveys. They can be written or oral, conducted with a selected small group—usually a randomized sample that represents a larger population—or with as many community members as possible. They can be sent through the mail, administered over the phone or in person, or given to specific groups (school classes, faith congregations, the Rotary Club). They're often fairly short and ask for answers that are either yes or no or that rate the survey-taker's opinion of a number of possibilities (typically on a scale that represents "agree strongly" to "disagree strongly" or "very favorable" to "very unfavorable.") Surveys can, however, be much more comprehensive, with many questions, and can ask for more complex answers.

• Direct or participant observation. Often the best way to find out about the community is simply to observe it. You can observe physical features, conditions in various areas, the interactions of people in different neighborhoods and circumstances, the amount of traffic, commercial activity, how people use various facilities and spaces, or the evidence of previous events or decisions. Participant observation means becoming part of the group or scene you're observing so you can see it from the inside.

Observation can take many forms. In addition to simply going to a place and taking notes on what you see, you might use other techniques (Photovoice, video, audio, simple photographs, drawings, and so on). Don't limit the ways in which you can record your observations and impressions.

Understanding the Community

Now let's consider what you might examine to understand and describe the community. You won't necessarily look for this information in the order given here, although it's a good idea to start with the first two.

The Community's Physical Characteristics

Get a map of the community and drive and/or walk around. (If the community isn't defined by geography, still note and observe the areas where its members live, work, and gather.) Observe both the built and the natural environment. In the built environment, here are some things to pay attention to:

• The age, architecture, and condition of housing and other buildings. Some shabby or poorly maintained housing may occupy good buildings that could be fixed up, for example; that's important to know. Is there substandard housing in the community? Look for new construction and new developments. Take note of where they are, and whether they're replacing existing housing or businesses or adding to it.

  • You might want to find out more about these. Are they controversial? Was there opposition to them, and how was it resolved? Does the community offer incentives to developers, and, if so, for what?)

  • Is housing separated by income or other factors, so that all low-income residents, for instance, or all North African immigrants seem to live in one area away from others? Are buildings generally in good condition, or are they dirty and run-down? Are there buildings that look like they might have historic significance, and are they kept up? Are most buildings accessible to people with disabilities?

• Commercial areas. Are there stores and other businesses within walking distance of residential areas or of public transportation for most members of the community? Do commercial buildings present windows and displays or blank walls to pedestrians? Is there foot traffic and activity in commercial areas, or do they seem deserted? Is there a good mix of local businesses, or nothing but chain stores? Are there theaters, places to hear music, a variety of restaurants, and other types of entertainment? Do many buildings include public spaces— indoor or outdoor plazas where people can sit, for example? In general, are commercial areas and buildings attractive and well-maintained?

• The types and location of industrial facilities. What kind of industry exists in the community? Does it seem to have a lot of environmental impact (like noise, air or water pollution, smells, and/or heavy traffic)? Is it located close to residential areas, and, if so, who lives there? Is there some effort to make industrial facilities attractive—landscaping, murals or imaginative color schemes on the outside, and so on?

• Infrastructure. What condition are streets in? Do most streets, at least in residential and commercial areas, have sidewalks? Bike lanes? Are pedestrians shielded from traffic by trees, grass strips, and/or plantings? Are roads adequate for the traffic they bear? Are there footbridges across busy highways and railroad tracks, or do they separate areas of the community and pose dangers for pedestrians? Is there adequate public transportation with facilities for people with physical disabilities? Does it reach all areas of the community? Can most people gain access to the internet if they have the equipment (such as computers or properly equipped cell phones)?

This is a topic that is ripe for examination. In many rural areas, particularly in developing countries, but often in the developed world as well, there is very little infrastructure.  Roads and bridges may be impassable at certain (or most) times of year, phone service and TV reception nonexistent, internet access a distant dream. Public transportation in many places, if it exists at all, may take the form of a pickup truck or 20-year-old van that takes as many passengers as can squeeze into or onto the bed, passenger compartment, and roof. Is any of this on the government's or anyone else's radar as a situation that needs to be addressed? What is the general policy about services to rural and/or poor populations?  Answers to these and similar questions may both explain the situation (and the attitudes of the local population) and highlight a number of possible courses of action.

Community Demographics

Demographics are the facts about the population that you can find from census data and other similar statistical information. Some things you might like to know, besides the number of people in the community:

• Gender

• Racial and ethnic background

• Age and the numbers and percentages of the population in various age groups

• Marital status

• Family size

• Education

• Income

• Employment (Both the numbers of people employed full and part-time, and the numbers of people in various types of work)

• Location (Knowing which groups live in which neighborhoods or areas can help to recruit participants in a potential effort or to decide where to target activities.)

In the United States, most of this and other demographic information is available from the United States Census, from state and local government websites, or from other government agencies. Depending on what issues and countries you're concerned with, some sources of information might be the US Centers for Disease Control, the US Department of Health and Human Services, similar websites in other countries, and the various agencies of the United Nations.

On many of these websites, notably the United States Census, various categories can be combined, so that you can, for example, find out the income levels in your community for African American women aged 25–34 with a high school education. If the website won't do it for you, it's fairly easy to trace the patterns yourself, thus giving you a much clearer picture of who community residents are and what their lives might be like.

Another extremely useful resource is County Health Rankings & Roadmaps, which provides rankings for nearly every county in the nation. The County Health Rankings model includes four types of health factors: health behaviors, clinical care, social and economic, and the physical environment. The County Health Rankings illustrate what we know when it comes to what’s making people sick or healthy, and the new County Health Roadmaps show what we can do to create healthier places to live, learn, work and play. These reports can help community leaders see that our environment influences how healthy we are and how long we live, and even what parts of our environment are most influential.

Describing the Community

Once you've gathered the information you need, the next step is describing the community. This is not really separate from understanding the community: in the process of organizing and writing down your information, you'll be able to see better how it fits together and can gain greater understanding.

There are many ways you can create a description of the community. The most obvious is simply to organize, record, and comment on your information by category: physical description, government, institutions, and so on. You can comment about what has changed in the community over time, what has stayed the same, and where you think the community might be going. You might also include an analysis of how the various categories interact, and how that all comes together to form the community that exists. That will give you and anyone else interested a reasonably clear and objective description of the community, as well as a sense of how you see it.

For a fuller picture, you could add photographs of some of the locations, people, conditions, or interactions you describe (perhaps as a Photovoice project), as well as charts or graphs of demographic or statistical information. For even more detail, you might compose a portrait in words of the community, using quotes from interviews and stories of community history to bring the description to life.

Given the availability of technology, you don't have to limit yourself to any specific format. Computers allow you to easily combine various media, like photos, graphics, animation, text, and audio, for example. The description could add in or take the form of a video that includes a tour of the community, statements from and/or interviews with various community members (with their permission, of course), an audio voice-over, maps, and so on. A video or a more text-based description—or both—could then be posted to a website where it would be available to anyone interested.

Once you have a description put together, you might want to show it to some of the community members you talked to in the course of exploring the community. They can suggest other things you might include, correct errors of fact, and react to what they consider the accuracy or inaccuracy of your portrait and analysis of their community. With this feedback, you can then create a final version to use and to show to anyone interested. The point is to get as informative and accurate a picture of the community as possible that will serve as a basis for community assessment and any effort that grows out of it.

The last word here is that this shouldn't be the last community description you'll ever do. Communities reinvent themselves constantly, as new buildings and developments are put up and old ones torn down, as businesses move in and out, as populations shift—both within the community and as people and groups move in and out—and as economic, social, and political conditions change. You have to keep up with those changes, and that means updating your community description regularly. As with most of the rest of the community building work described in the Community Tool Box, the work of understanding and describing the community is ongoing, for as long as you remain committed to the community itself.

Audience

Once you’ve got a sound understanding of the community in which you will be working, it is important to begin narrowing down your audience by performing audience research.

(Centers for Disease Control and Prevention, 2014)

The process of gathering information about the audience’s beliefs, motivations, and media use is often called audience research. Doing this research before starting a campaign helps the communications team identify influential messages and select effective communications channels (see an example from Illinois below). Spending some time and resources on audience research before the campaign begins guards against wasting program funds on ineffective strategies. Even the most experienced communications staff can benefit from audience research to stay up to date on changes in media preferences or social norms about tobacco use. Audience research is most useful when the communications team gathers as much information as possible about the audience. For example, programs may want to know about the following: 

• Demographic information, such as age, race, ethnicity, education, and income 

• Current and past cigarette smoking and other tobacco product use

• Knowledge and attitudes toward tobacco use and tobacco control

• Hobbies, interests, and other lifestyle preferences

• Preferred media channels (such as TV, newspapers, radio, or internet) 

• Media use patterns (such as frequency or time of day)

• Literacy level and language preferences

Much of this information is available at little or no cost. Large-scale surveys like the Census or the Behavioral Risk Factor Surveillance System report data on population demographics and tobacco-related behaviors. State and local health departments and coalitions often collect detailed information about the populations they serve through community assessments. The team can also talk with TV, radio, and print representatives. 

Learning about the people who view and listen to their content can help select channels that will reach audience members. Market research firms also maintain databases with information about audience media use and lifestyle preferences. Although firms charge for access to this information, it is generally more cost effective for programs to use this data than to collect the data themselves. 

Nonprofit and government reports and newspaper coverage of tobacco use among the intended audience can also have useful information. CDC staff and communications staff in other states can often offer advice from their experiences with campaigns focused on similar audiences. Social media monitoring complements more traditional forms of audience research. It can reveal individuals’ current feelings and any misunderstandings about tobacco control issues. Many social media sites offer their own free monitoring tools (such as Twitter Analytics and Facebook Insights). Paid monitoring services are also available and may offer additional features.

Communications campaigns can be jeopardized if they try to reach too many people at once. Focusing on a smaller, more specific audience increases the chance of delivering a message that actually reaches and resonates with the audience. Dividing a large audience into smaller groups is sometimes called audience segmentation. A single audience may be broken into many different segments, but focusing on at most one or two priority segments will keep from straining existing resources.

To choose priority segments, the communications team can focus on groups that fit the following criteria:

• Most affected by the problem

• Most likely to change their behavior

• Easiest to reach with available campaign resources

• Large enough to justify a campaign

• Not already reached by existing campaigns 
  

Communications team members can use the information collected to create a detailed profile for each priority segment. One strategy is to imagine a single member of the audience and describe that person in detail. This method uses a story of a day in the life of the audience member, describing the person’s family life, community, routines, and media habits. By telling this story, the communications team can begin to understand what will work to change the audience’s behavior. Once the audience profile is complete, the team can use it to refine strategies. 

The primary audience for a communication strategy will usually be the people who are at risk of or who are suffering from a particular health problem. One exception to this is children, in which case their caregivers are usually addressed as the key influencing audience. To help identify potential audiences, review the available research about the extent of the condition or disease. Sources of this information include the Ministry of Health (MOH), local health centers, and national health surveys. Medical and public health personnel can explain how the problem spreads and can identify those at risk or affected by it. There may well be gaps in available information that will require formative research or baseline studies before you can understand enough about potential audiences to clearly articulate and describe who they are.

Identify Common Audience Characteristics

As you identify potential audiences, group them according to common characteristics, such as age range, gender, occupation, residence, or number of children, as well as by lifestyle and access to print, radio, and television media. Look for characteristics that differentiate the potential audience from persons who are not at risk or do not have the health problem. Make sure that your analysis is gender-sensitive by considering the different gender roles and relationships among potential audience members. How are the potential audiences currently behaving in relation to the concepts of gender equity and gender equality? Also look at whether members of potential audience groups have a high degree of perceived social support, which can play an important role in an individual’s ability to change.

Identify Behavior Change Stage

For each audience, look for information that identifies current health behaviors compared with desired or recommended health behaviors. How close or far away are they from adopting the behaviors? 

To develop estimates of the stage of behavior change of the potential audiences, review existing quantitative data, such as Demographic and Health Surveys (DHS) and census data. Both sources may provide relevant information about the stage of behavior change of various groups of people within a country’s population. DHS generally asks about knowledge, attitudes, and practices relative to reproductive, maternal, and child health. The latest DHS is generally available from your local MOH or from the USAID office. If not, Macro International, Inc., can provide copies of DHS reports for various countries. (Macro International, Inc., 11785 Beltsville Drive, Calverton MD 20705, USA, organizations working in health phone: (301) 572-0200, fax: (301) 572-0999, email: reports@macroint.com) 

Often the existing audience data are insufficient for making decisions related to a communication strategy. You may need to work with research experts to design and implement a quantitative baseline survey that generates reliable information about audience characteristics, behavioral issues, barriers to behavior change, and so on. Similarly, it is often useful to conduct qualitative research, such as focus groups, with potential audience members to yield rich, descriptive information about the audience. Sometimes this is coupled with one-on-one interviews with key stakeholders to get additional insights. 

You and your team members will need to make judgments about what preliminary research, if any, is required, and you should also consider timing and budget issues when addressing this issue. In addition to reviewing formal studies, interview local experts to get their opinions on the stage of behavior of the group in question. Also, to gain additional insight, talk with program personnel who work with the potential audience on a daily basis.

Identify Known Barriers to Behavior Change 

As you interview program workers, health experts, community representatives, and members of the potential audience, ask why they think the audiences are not adopting the desired health behaviors. Often one of the main barriers to adopting behaviors is the fact that the audience is “preknowledgeable,” meaning they do not know enough about the behavior or how to adopt it in order to do so. 

In Bangladesh, for example, a situation analysis for the National Tuberculosis Control Strategy revealed that most people, especially in rural areas, did not know that treatment is provided free of cost from government health facilities. However, you and your team must also consider barriers that go beyond awareness and knowledge. 

Look for barriers in the following categories to give you a more complete picture of the situation: 

• Availability: Are the services or products needed to adopt the desired behavior available in the area where the proposed audience lives and works? 

• Accessibility: Is the audience able to obtain and use the services or products needed to adopt the desired behavior? 

• Affordability: Can the audience afford the services and products needed to adopt the desired behavior? Think in terms of time and inconvenience costs as well as money. 

• Acceptability: Is it socially acceptable for the audience to get and use the services or products? Is it acceptable for them to practice the desired behavior? 

Understanding the barriers to change—even those that may be beyond the ability of communication to change—is important for making strategic communication decisions. This knowledge will help you estimate the degree of change that can be achieved within a given timeframe.

Identify Key Influencers

After you have identified your potential audiences, find out who influences their health behaviors. Talk with program managers who work in the community as well as community workers who visit the audience regularly. Review relevant research findings. Make informal visits to communities and homes. 

References

Centers for Disease Control and Prevention. (2014). Best Practices User Guides: Health Communications in Tobacco Prevention and Control. https://www.cdc.gov/tobacco/stateandcommunity/guides/pdfs/health-communications-508.pdf

Chapter 3. Assessing Community Needs and Resources | Section 2. Understanding and Describing the Community | Main Section | Community Tool Box. (n.d.). Retrieved September 27, 2023, from https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/describe-the-community/main

O’ Sullivan, G. A., Yonkler, J. A., Morgan, W., & Merritt, A. P. (2003). A Field Guide to Designing A Health Communication Strategy. John Hopkins Bloomberg School of Public Health/Center for Communication Programs. http://ccp.jhu.edu/documents/A%20Field%20Guide%20to%20Designing%20Health%20Comm%20Strategy.pdf