Making Condoms More Acceptable: Harnessing the Power of Mass Media to Turn Audiences into Participants

This 56-slide PowerPoint presentation highlights research conducted to assess the relevance and impact of a yearlong multimedia behaviour change communication (BCC) campaign launched in December 2007 to promote condom use among young men in India.

The integrative BCC model used to structure the British Broadcasting Corporation (BBC) World Service Trust (WST)'s "Condom, Condom!" campaign is outlined in slides early in the presentation, such as one drawn from The Role of Theory in Developing Effective Health Communications, by Martin Fishbein and Joseph N. Cappella. Also explored here is SPARK - a strategic planning tool that involves: immersion (consider the various aspects of the issue), ignition (arrive at the key barrier and trigger and then evolve a SPARK statement, or a key insight that will catalyse change), strategic options (what is the main thought to be expressed), and brief (crystallise this process into a piece of paper whose content is "inspiringly expressed").

Other slides highlight how other research - such as that conducted among men in project towns who had had commercial sex in the last 12 months - shaped the development of the campaign. BBC WST's own formative research revealed that key barriers to consistent condom use among high-risk men included: behavioural beliefs and attitudes towards behaviour (product-led, situation-led, and attitude-led) and normative beliefs and subjective norms (embarrassment/shame in purchase and use; fear of being judged by others/stigma). Endline research for BBC WST's HIV/AIDS awareness programme highlighted the importance of interpersonal discussion as a key mediating variable in effecting behaviour change (Chatterjee et al 2007).

Statistics provided here help convey how BBC WST strategically selected the campaign's communication vehicles. India is reportedly the "world's fastest growing mobile telephone market with 400 million users". In this context, it is a tool of empowerment that can ensure equity by helping secure the right to information. BBC WST also observes the "huge growth" of cable and satellite (C&S) television and vernacular channels (news and general entertainment channels, or GEC). There is "far greater exposure to mainstream, slicker entertainment" and reality shows that are "very popular, inviting participation from audience".

Within this context, "Condom, Condom!"'s communication framework was developed, and is outlined on slides 9 and 10 of the presentation. In short, the primary objective was to address the following barrier to condom normalisation: sex and condoms are private/personal matters. A look at the stages of condom normalisation led organisers here to focus on making people feel free to discuss condoms with peers, with the communication objective of getting men talking about condoms with their peers. The secondary objective was to address barriers to condom normalisation including negative judgment and increased association with disease. The stage of condom normalisation at issue here is freedom from judgment among community, with the objective of associating condoms with smart and responsible behaviour.

In the end, the key message to emerge: a condom is just another (personal) product.

That said, BBC WST's creative strategy looked beyond the message, providing stimuli to turn audiences into participants - making the campaign as interactive as possible. Organisers adopted a 360-degree approach that combined mass media with new media and on-the-ground activation for greater interactivity. They sought to create a sustainable, relevant, memorable approach to undoing stereotypes.

The media strategy is outlined next. Television was the lead medium selected because it could provide wide coverage and mass reach in a cost-efficient way that would not eliminate illiterate people and that would allow nuanced depiction of a complex issue like normalisation. In addition to using local satellite and terrestrial channels, BBC WST combined radio, print, and outdoor media as well as new media (telephony was envisioned as the link for mass interactivity, with the internet sparking "buzz"). In addition, "below-the-line activation" was used as a stimulus for direct interaction, generating interest, and evoking a response. For instance, in Phase I of the campaign a contest was envisioned as a "high-decibel start to the campaign", which revolved around participation to necessitate discussion among peers. Reward oriented-prizes were offered.

The second phase of the campaign, which launched in March 2008, also linked the confidence and the smartness required to talk freely about condoms to being a "real man". The ad used a socio-cultural event as a backdrop to show acceptance of the message: it showed a kabaddi match - kabaddi is a team sport originally from the Indian subcontinent where chanting the word "kabaddi" during play is a crucial aspect of game. In the ad, the protagonist wins the match against a "macho" team by chanting "condom" instead of "kabaddi". The strategy involved making "condoms" a part of the vocabulary, associating condoms with "winning". The TV ad was used to start debate/discussion in other media (e.g., radio), and a short messaging service (SMS) poll brought interactivity to this phase. For instance, a print ad that appears like a news story with the headline "Kabbadi Match Win Stirs Up Controversy" carries the subtitle "winner chants 'condom, condom'...outsmarts opponents". An image carries the caption: "the winner showed what real men are all about, when he said, 'If we men don't talk about condoms, who will!'". Part of text reads: "...condoms signify smart and responsible behaviour, the hallmark of any winner" and concludes with the instruction "please SMS to tell us whether you agree or disagree with the above statement" ["smart men talk about condoms"].

Phase III revolved around a condom ring tone. BBC WST sought to engage audiences on a taboo topic through a direct-response device. This strategy was based on the insight that mobile ring tones as personal statements have become very popular. A 'Condom a Cappella' ring tone was created and made available through SMS short code and from the campaign website advertised through the aforementioned TV spot aims to get the word out in the public domain. Organisers received nearly 550,000 requests for the ring tone download through the SMS short code, and saw over 200,000 website downloads (not counting Bluetooth transfers). The website received 3.5 million hits, and mobile tagging over 3 days reached out to 1 million exclusive users further boosting ring tone downloads.

BBC WST notes that there was great "buzz" around the ring tone, with "massive media coverage in India and abroad". The ring tone was the page 1 story in The Times of India, most national dailies, and on Indian TV. It was played and discussed on National Public Radio (NPR) and on radio stations from Canada to Colombia. Organisers note that, "Besides comments on the website, blogs on sites like 'you tube', demonstrate how the medium was leveraged in starting a dialogue on a taboo topic. Over 200 portals have written about the condom ring tone..."

Phase IV of the campaign was called "Champions for Condoms". It was characterised by what BBC WST describes as an organic progression in messaging within the campaign from protagonists to other champions. (For instance, incorporating a puppy named "Condom" was a strategy for undoing gender and age stereotypes, helping make condoms more acceptable, and making condom users look smart).

BBC WST carried out an impact evaluation in order to assess campaign reach and to measure changes in the knowledge, attitudes, and behaviour of the intended audience from the baseline with specific reference to condom discussions, attitudes towards condoms, and image of a condom user. The sample size involved a total of 7,357 men in the reproductive age group (15-49 years) who are aware of condoms. Data were weighted within each of the 4 project states for Avahan and non-Avahan districts [Avahan is an initiative launched in 2003 by the Bill & Melinda Gates Foundation to reduce the spread of HIV in India. It focuses on Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Nagaland, and Manipur] and for rural and urban populations, as well as across states for relative populations of different states in the study group.

Several slides detail campaign reach and recall - for example, it is estimated that 50.1 million male TV viewers (aged 15-49) in the 4 project states were reached - as well as its effectiveness in reducing stigma and embarrassment related to condom use.

Here are some additional data:

BBC WST notes that the National AIDS Control Organisation (NACO)'s Social Marketing and Normalization support enabled the campaign (TV and radio ads) to go national from Phase II onwards. This resulted in the campaign reaching 139 million adult men nationally (as compared to the original goal of 48 million men in 4 states). BBC WST stresses that this "underscores government's need for quality mass media outputs that are part of a well designed and researched campaign."

In the concluding slide, lessons learned are outlined. For example, use strategic planning to look beyond the message: trends, insights, and change points. An intervention needs to be experiential for greater engagement. BBC WST encourages scientific and cost-effective media planning, buying, and monitoring. Finally, use communication "to act as a compass, pointing to positive values and principles."

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