Making my first TV spot at U. of Chicago as a script writer, film director and cameraman!
When I was a college student, I studied journalism thinking that it would lead me to become a writer! Back then, I loved and wrote poetry, short stories and one-act plays. I was active in the student movement of the 1970s, writing satire articles on various public affairs issues, and used one of the wall boards in the university hallways to be my “wall magazine”. Many colleagues and even some of my professors would stand in front of it to read my new weekly article.
Sitting, right, with friends and fans of my wall magazine at Cairo University
My dream to be a writer was shattered after I graduated. I soon found out that there was no chance for a recent graduate like myself to be a “writer”. Even getting a job as a reporter in one of the newspapers or magazines, almost all of which were state-controlled, proved to be virtually impossible. I felt lost!
Luckily, I
was offered a job as tenure-track junior faculty member at my department since
I graduated on top of my class! I could not refuse the offer, even though it
wasn’t my dream job as it appeared to be purely academic.
But the
creative side in me refused to give up.
I was assisting Ehab El-Azhary who was teaching a course on “writing for radio.” El-Azhary was one of the most creative persons I ever met in my life. He wrote several radio dramas and was particularly interested in science generally and in science fiction in particular. As the head of the “Youth Radio” station, he asked me to visit his station for a microphone test. On the same day I did my test, he asked me to think of an idea for a new radio program that I would write and co- present.
Ehab El-Azhary, my first employer for a creative job
I came up
with a name: “old songs and new information”.
The program’s idea was using entertainment as a vehicle for conveying
health and scientific messages. For example, a great many songs include the
words “eyes”, “hearts”, “moon”, etc. The idea of the program was to have an
interesting mix between popular songs and music and the relevant scientific
facts. Everyone loved the program, which I kept doing very happily for several
months, along with my “academic” university job.
But one day
in the summer of 1976, this dream combination had to end!
I got
accepted in the Master’s program at the University of Chicago to study
population communication.
Everything
was so cold in Chicago when I arrived there in November 1976. I was told upon
arrival that I needed to go to an off campus English language institute for one
quarter before I could start my program at the university, so I did.
After being in that institute for one month, something unique happened. The English instructor displayed a set of posters on the board, and asked us to write a sentence in the past participle tense on each one of those posters. All of them showed pictures that had to do with fish.
ELS Language Institute that rewarded my creativity rather promptly!
Instead of
doing what she asked in a literal sense, I pretended to be the fish in the
poster and wrote a story that was indeed in the past participle tense! The fish
spoke of how it was asked by her friends to go on a short trip, and how it was
caught by the fisherman, etc.
When the
teacher saw my answer sheet, she literally grabbed it and asked me to go with
her to director of the institute. I didn’t know what was going on and was in
fact a bit worried. When she told him what happened, he informed me that I
didn’t need to stay there any longer, and that my English was good enough to
start my Master’s program at the University of Chicago.
In Chicago, most of my master’s program, which was eventually extended to a PhD, was theory and research. But one summer, I had a six-week intensive workshop that had a creative component, where a CBS producer tutored us as on script writing, filming, editing, and directing.
The University of Chicago is where I learned theory, methodology, and refined my creative potential!
The challenging
assignment at the end of the program was to make a TV spot from A to Z using a
super-8 film (if anyone still knows what that is!) But the real catch was that
the spot had to be silent yet able to convey a clear message on family
planning.
I still remember
that my spot received a standing ovation.
I guess that
was the real beginning for me in learning to combine theory, methodology, and
creativity.
As a matter
of fact, what I consider to be my most advanced theoretical contribution is
indeed a creative one! It is the theoretical model of “knowledge and Social
Change”, which I invented as my doctorate dissertation, and which has
guided all of my research and creative work ever since.
There’s no theory or methodology, however that could lead to successful communication for behavior change without creativity. The paradox, however is that while the first two may fit together, the third one: creativity appears to be the odd one out and may even seem to conflict with the other two! I’m quite fortunate to have been able to do all three with equal ease throughout my career, to the extent that I sometimes don’t know, when asked, whether to describe myself as an academic, researcher, professor, script writer, film director or producer!
In 1984, I founded the Center for Development Communication (CDC) as a private, not for profit professional organization. This page will cover the “Sehettak Biddonia” project, which was CDC’s first project, and indeed the one which CDC was originally established to implement.
Why did I have to establish CDC?
When I developed the “Sehettak Biddonia” concept, there was no institution in Egypt at the time that could provide the enabling environment to implement the project, which was based on the idea of integrating communication theory, research and creative production. I decided therefore to found CDC in order to create the needed structure and enabling environment that would make it possible to develop and implement this pioneering project.
The donors of Sehettak Biddonia encouraged this step and I therefore wish to thank them because it would have been virtually impossible to bring this project to life without CDC.
Logo of the Sehettak Biddonia Project
Before going into more details on this topic, let me quickly alert the reader that CDC didn’t stop at the Sehettak Biddonia project. In fact, CDC has quickly become the major organization in Egypt and the Middle East for developing and implementing social marketing and communication for development campaigns. For more on CDC’s projects, please see:
“Sehettak Biddonia” means in Arabic (Your Health is Worth the Whole World). It’s also the name of a project that was developed by Dr. Farag Elkamel and submitted as an unsolicited proposal to Johns Hopkins University, Unicef and the Ford Foundation in a pioneer and comprehensive initiative to define and test the media potential for the prevention of various health problems in Egypt. The Canadian International Development and Research Center (IDRC) also joined as a fourth donor at a later stage.
The main justification for the need of this project was the fact that Egypt had several health challenges that could be prevented with good communication. However, whatever was being done in this respect could be classified as no more than paying lip service to the cause. Health programs on radio and TV were quite boring, and the few public service announcements that were produced by the ministry of health lacked the basic principles of effectiveness.
On the other hand, 50 percent of all Egyptians, including 70 percent of all adult women were illiterate at the time this concept was developed, while, 93 percent of them had access to television and watched it on a regular basis. TV therefore had the promise to become the “knowledge-leveler”, overcome the illiteracy hurdle and provide the badly needed health information to all citizens.
But the challenge however was the contaminated health communication scene in Egypt, where bad quality health messages were disseminated with virtually no effect. The argument then became like this: how can we develop the needed health messages and present them to those who desperately need them, and in the most effective ways.
Positive feedback and evaluation reports about the TV campaign which I developed for the Oral Rehydration Therapy (ORT) project had become available, which encouraged donors to support the concept and express their willingness to fund my proposal.
Work on the project began on April 1, 1985. As planned, the project started with extensive research on the general public and public health professionals, and invited Egyptian and expatriate health experts to attend a major conference in order to discuss the project concept, plans, as well as message selection and prioritization. The project’s stated objectives were as follows:
Upgrade Egyptian quality of life through dissemination of essential health information.
Demonstrate the force of sound social research, coupled with modern communication techniques to improve social problems such as lack of health education.
Prove the usefulness and effectiveness of television in this type of social development communication.
Project Phases
The Sehettak Biddonia project was divided into four phases: 1) research, 2) planning and message development, 3) production and pretesting of pilot messages, and 4) production of TV spots and soap opera.
Phase One: Research
The following research was conducted:
A literature review of printed media to determine the attitude of government officials, media personnel and the general public towards using public channels to disseminate health information.
A survey of 100 Egyptian physicians to determine what the public should know in order to more easily communicate with doctors. The sample included directors of MOH semi-autonomous projects and public health professors at universities in the greater Cairo metropolitan area.
A survey of 20 national and international social scientists concerning the social, anthropological, and economic aspects of Egyptian health problems.
A survey of 900 mothers in 9 different governorates to pinpoint their knowledge, attitude and understanding of specific health problems. A cluster sampling method was used in rural and urban sections of the country both in the Delta (Cairo and Alexandria) and in Upper Egypt. A questionnaire consisting of 99 questions was used to collect essential data on media and health practices.
A survey of earlier health education and communication projects in Egypt and other countries to develop guidelines from successful programs.
Compilation of recommendations from attendees at a CDC Media and Health Education Conference held in Ismailia, Egypt, January 10 and 11, 1986, concerning health education priorities in Egypt, health priorities for child survival, target audience composition, message content, and the media’s role in disseminating health information
Phase Two: Planning, Concept and Message Development
Phase Two of the Sehettak Biddonia project called
for prioritizing Egypt’s health problems and developing media concepts and
approaches. A list of 156 priority health issues was developed from the following:
“Health Profile of Egypt”, a survey conducted by the Ministry
of Health;
The “Elite Doctors’ Perspectives on Egypt’s Health Problems”,
The “Highlights of Mothers’ Knowledge, Attitudes and Practices
Survey on Basic Child Survival Communication Issues”,
The “Media and Health Education Conference Recommendations”,
Various reports obtained from the Ministry of Health concerning the
types and number of emergency service required,
A report from the Central Agency for Public Mobilization and Statistics
listing health statistics such as causes of death, types of hospital services requested
types of diseases reported and maternal-child health problems.
A script writer’s guide to these 156 issues was
created in both Arabic and English. It
breaks down major points such as nutrition into specific topics, e.g.,
nutrition for pregnant women, child nutrition during weaning and illnesses, and
recognition of malnutrition in a child, and lists the relevant socio-cultural
background information and the message that should reach the target audience.
The validity of each technical point was tested through focus group research at
the local level and personal interviews with top health professionals both from
the Ministry of Health and major faculties of medicine. As results and comments returned, they were
analyzed and revisions were made.
As health issues were being determined, CDC
developed an overall media concept and approach:
Target audience –
composed of adult men and women residing in urban and rural areas. Special attention will be paid to making
messages simple enough to be understood by rural and illiterate audiences.
Message guidelines –
regardless of content, all messages will be medically correct, culturally
relevant, actionable, based on research, and presented in a clear, simple and
interesting manner.
Language and visuals –
all messages will use the standard Egyptian dialect and words will be
comprehensible to all segments of the target audience. Visuals will reflect the
typical physical environment of the main segment of the target audience.
Tone and approach – all
messages will use a positive or neutral tone. Characters will be representative
of corresponding target audiences.
Program format – The Sehettak
Biddonia programs will have two formats, both of which rely on the elements of
drama and entertainment: short (1-2 minutes) commercial-type messages and a
long social dram consisting of 15 episodes each of which is 45 minutes long. The
episodes will also incorporates songs and folk elements.
Framework and themes –
although the spots and the drama will have essentially different formats and
themes, each will attempt to contain elements of the other to reinforce the
message.
Dissemination – all
Sehettak Biddonia messages will be aired during prime viewing time.
Pretesting – messages
will be pretested among target group members and results will feed back into
program re-planning and shortcomings will be accordingly adjusted.
Phase Three: Production and Pretesting of pilot messages.
In March 1987, the project’s third phase was
completed: production of pilot
messages. Those issues designated for
immediate coverage in the first series of spot commercials are immunization,
birth spacing concepts, early weaning, Tetanus Toxoid and bilharzias. They were
partly selected to coincide with Egypt’s 1987 Year of the Child campaign. The
remaining topics will be covered in the future as funding becomes available.
Phase Four: Final Production and Dissemination
The output of the project included a TV drama series, “The Family House” and 10 TV spots. With partial support, CDC went ahead and produced a second part of the series with the name “Bread and Salt”, which also carried health and environmental messages. All of these productions were aired free during prime time on Egyptian TV.
Before going into a detailed description of these phases, let me jump to the output of this project, and briefly present the two major outputs: the TV Spots and the Soap Opera.
TV Spots
The television spots addressed various health issues, including child spacing, immunization against measles, polio, and tetanus during pregnancy. The spots also addressed correct weaning practices, schistosomiasis prevention and treatment, in addition to female genital mutilation (FGM).
This pioneer experience has succeeded in developing the appropriate methodology for using TV in health campaigns in Egypt, and has also paved the way for getting free airtime for public service announcements in Egypt.
The 10 spots mentioned above can be viewed (with English subtitles) here:
The Soap Opera
As indicated above, a major component of this project was the development and production of an entertainment-education soap opera to test the potential of this format for addressing deep-rooted health and social beliefs and practices. This innovative project consisted of conducting necessary audience research in three countries (Egypt, Jordan, and Morocco), as well as developing, producing and distributing a 12-hour television drama series consisting of 15 episodes.
In addition to addressing the issues of family planning and early marriage, the “Family House” carries essential messages on AIDS awareness and prevention, environmental protection, acute respiratory infections (ARI), home accidents, and drug addiction. The series has been aired in Egypt, Morocco, and Lebanon. It has been watched by over 90 percent of all adult television viewers in Egypt, and more than 80 percent of them liked it and learned from it. Other parts of this site address this series in more details, but here is link to the series itself:
The Mothers’ KAP Survey On Basic Child Survival Communication Issues
Highlights of Mothers’ KAP Survey On Basic Child Survival Communication Issues
By: Dr. Farag Elkamel
January 5, 1986
The Center for Development Communication (CDC) carried out a survey of 900 mothers of children who are less than three years of age in nine governorates. The survey was conducted from July through September 1985, and employed the cluster sampling technique. The survey instrument used was a questionnaire containing a total of 99 closed and open-ended questions. The nine governorates where the survey took place are: Cairo, Behera, Dakahlia, Sharkia, Gharbia, Suhag, Kena, Menya and Assuit. Unicef, Johns Hopkins University, IDRC and the Ford Foundation sponsored the study as part of the Sehettak Biddonia project. The purpose of the study was to establish a baseline and uncover the priority health issues and messages to be addressed by this pioneering project.
Major health issues covered in the survey are breastfeeding, weaning foods and practices, immunization, mother and child nutrition, diarrhea and dehydration, acute respiratory infections, child spacing and family planning, home sanitation, food and personal hygiene, and water supply and sewage.
A. Breastfeeding
Of the total sample of 900 mothers of children under three years of age, 85.6% reported breastfeeding their children. A greater percentage is expected for mothers of children less than two years old. The majority (84%) of breastfeeding mothers said that they breastfeed their babies at night, too.
For those who said that they did not breastfeed their children, the number one reason given by 8.6% of the total sample was that they did not have enough milk. Other reasons given were that the mother is sick (1.9%) and that the child is sick (1.2%). While 21 mothers gave other various reasons, only one mother reported not breastfeeding because she preferred the artificial formula, and only five mothers said that they did not breastfeed because they could not stay at home.
When mothers were asked about the substitute they gave their infants, the majority of those who did not breastfeed said that they gave powdered milk (12.7% of total sample). The remaining mothers gave cow and buffalo milk (1.8%).
The majority of mothers who artificially fed their children consulted a physician (12%). The remaining 2.8% consulted relatives and other people. The vast majority of mothers who are not breastfeeding their children use other substances while the child was very young. Half of the mothers substituted breast milk during the baby’s first month and the other half during the second and third months.
Almost all mothers who are not breastfeeding use the bottle rather than other mechanisms such as a glass and spoon. Nearly half of those giving bottled milk have only one bottle at home, and most of the remaining half have two bottles. Almost all women using the bottle said that they threw away milk remaining in the bottle after feeding their babies.
B. Weaning Practices
Half of the women in the study sample of 900 cases reported weaning their babies before the 24th month. A vast majority of the remaining 50% mothers (44%) said that they weaned their babies exactly when the babies became two years old.
Egyptian mothers practice a gradual rather than sudden weaning process. More than three-fourths (76%) of mothers in the sample said that they gave their children other foods “Talhees” while milk feeding them. Before the child is one year old, almost all mothers give supplementary feeding. In fact, more than half do so before the child is six months old. When asked about the first thing they gave their children, the most often mentioned foods were boiled potatoes, boiled rice, biscuits, beans, egg yolks, yogurt, and milk pudding (mehallabia.)
C. Immunization
When the women were asked whether they had their children vaccinated or not, 87% said that they had done so and only 13% said that they had not. However, when they were asked to list the vaccines their children got, 83% of the entire sample said that their child was vaccinated against polio, 26%vaccinated mentioned tuberculosis, 40% mentioned measles vaccines, and about 10% said their children received a DPT vaccine. Interestingly, 16% of the women interviewed named non-immunizable diseases as ones that their children were inoculated against!
The great lack of information among mothers becomes more evident in their responses to a question on the number of times children should get immunized during the first year of life. Ten people said the child should receive a total of one vaccination, 33 mothers said they should receive two vaccinations, 255 women said three, 133 women said four, 107 women said five, 88 mothers said six times, and 68 mothers said seven or more times. One hundred and ninety-six women had no idea. Other more detailed information in the study reveals the wide knowledge gap between what the public knows and what they should know.
It is clear that the television polio campaign tremendously increased awareness about polio vaccinations. Of the total sample, 99% have heard of polio, and 67% of them heard of it from television. Twelve percent heard from health units, 9% heard via loudspeakers, 6% heard of it from neighbors and relatives, and the remaining 6% heard from other sources.
While awareness of polio vaccine
was found to be extremely high, other aspects of knowledge about it were not
the same. When respondents were asked about
age at which a child should get the first polio dose, 175 mothers said two
months, 337 said 3 months, 144 said four months, 28 said five months, 84 said 6
months, 80 people said more than 6 months and 52 people said they did not know.
In contrast with polio awareness,
awareness of D.P.T. was quite low. Only 15% of the entire sample heard of
D.P.T., and only a little over half of them (9% of total sample) know that
D.P.T. is to be given three times, and almost the same number knew what the
three D.P.T. diseases are.
Of the mothers surveyed, 61.7% said that their children had measles before. This is almost the same percentage of children who did not get the measles vaccine. The main reasons mothers mentioned for not having their children immunized against measles are that the child is too young, vaccines are unavailable, or that mothers do not usually know immunization sites and schedules unless they are announced via loudspeakers.
It is significant that when asked how to protect their children from getting the measles, only 217 mothers answered ‘by vaccination’. Two hundred and thirty-one said nothing could be done, 183 said they did not know, and the rest stated different opinions.
Unfortunately, 31% of mothers said
that they would let their healthy children get near a child infected with
measles so that they would catch it too.
Ninety-seven mothers said that the reason was that they wanted to care
for all of their children at once, 54 women said that they would do this because
sooner or later the child must get the measles, 43 mothers said they wanted to
get the illness over with, and 29 mothers said that they could not practically
separate them.
D. Maternal Health
Over half the women in this sample said that they got married before they were 18 years old. Only 22% were older than 20 when they got married, and only 4% were older than 25 years old. 27% of respondents mentioned that their last child delivery was attended by a doctor. Only 16% of women surveyed said that they eat differently while they were pregnant, and, when probed, 70% of the total sample did not think that pregnant women need to eat differently.
E. Diarrhea And
Dehydration
Diarrheal morbidity average about 43% of the 900 women surveyed. Of all respondents, 98% have heard of Oral Rehydration Solution (ORS), and 85% of them heard of it from television. Fifty-four percent of all Egyptian mothers interviewed in this survey have used ORS, but the percentage would be much greater if we consider only mothers whose children have had diarrhea.
Interestingly, when asked about
causes of diarrhea, a very high percentage of women surveyed mentioned
“cold” even though it was not one of the causes given in the Media campaign
which has been underway for almost two years when the survey was conducted,
which suggests the stubbornness of some public beliefs and the need to sustain
public education programs over a relatively long period of time.
On the other hand, women have also
learned specific preventive measures from the public campaign of the Oral
Rehydration Therapy (ORT) Project. Thus,
when asked what mothers should do to prevent diarrhea, most mothers mentioned
“keeping the food clean,”
“washing hands”, and also added, “protecting the child
from catching cold!”
Women who did not use ORS were asked to state the reasons they had for not giving it to their children. Over 95% of those who did not give ORS said the reason was that diarrhea was light or that the child did not get dehydrated. A small number of mothers (5%) mentioned that the doctor did not prescribe it.
F. Subjects Which Mothers
Want Television To Inform Them On
Mothers were asked if they wanted
to get information on other health issues in the same way they got information
on ORT. Of the 900 mothers surveyed, 85%
answered the question positively. The percentages of issues which women
mentioned that they needed more information on in new TV spots are listed below:
Issue
Percent
Child care
35%
How to treat diseases
14%
General health care
8%
Contraceptives and how to
use them
7%
Appropriate foods for
infants
7%
Maternal and child care
7%
Hygiene
6%
Pregnancy problems and care
5%
Immunization schedules
2%
Mentioned a variety of
other issues
10%
G. Acute
Respiratory Infections
Almost 81% of the total sample said that they heard of bronchitis. The symptoms most recognized by respondents are: cough, vomiting, fever, diarrhea, stomach ache, and wheezing. Over 95% of mothers said they took their children to see a doctor when they got bronchitis and only 5% gave medicine or other remedies before consulting a doctor.
To protect their children from respiratory infection, mothers mentioned specific actions such as keeping the child away from air drafts, keeping the child warm, and keeping the child clean. Over 10% of those familiar with bronchitis did not know how to protect their children from it. This, of course, is in addition to 19% who did not know what bronchitis was.
Mothers were asked whether or not
their children caught cold during the two weeks preceding the interview. (Note that the study was conducted in the
summer – from July through September- where infections are normally lower than
winter time infections.) One out of four mothers said that at least one of her
children had a cold. Two-thirds of the
children with cold were seen by doctors, according to mothers’ responses.
H. Family Planning
And Child Spacing
Respondents were asked to spontaneously name up to six contraceptive methods that women could use to space child bearing or prevent pregnancy. The following are the methods mentioned and the percentage of respondents which mentioning each of them:
Contraceptive Method
Percent Knowledge
The Oral pill
82
I.U.D.
76
Injections
43
Spermicides
18
Condoms
9
Foaming Tablets
7
Sterilization
2.6
Diaphragm
1.7
Safe period
0.3
We also asked these women about their source of contraceptive information. The following lists the sources and the percents of respondents citing each of them:
Source of Information
Percent
Television
78
Other women
12
Health units
11
Radio
8
Other
6
I. Home Hygiene
And Space Allocation
Twenty percent of the women
surveyed lived in one – roomed residences and 25% lived in two rooms. Another 25% lived in three rooms and 30% of
the sample lived in residences containing four or more rooms. In terms of space allocation, 89% of the
sample had rooms that were dedicated only to sleeping, 11% had rooms that were
dedicated only to receiving guests, 10% had rooms that were dedicated only to
living and only 1.6% had rooms that were specifically dedicated to dining.
Overall household hygiene in the
homes of respondents was rated by middle class interviewers as follows:
Good
31%
Average
41%
Poor
28%
Interviewers also observed whether the households they visited had bathrooms with soap and water. The results were as follows: 55% had bathrooms with soap and water, 39% had bathrooms which did not have either soap or water, and 6% did not have bathrooms. Furthermore, interviewers observed whether a towel was in or near the bathroom: 25% of the bathrooms had clean towels, 5% of the bathrooms had dirty towels, and 70% of the bathrooms had no towels.
J. Food
Preparation And Hygiene
One-half of the women sampled said
that they cooked in their kitchens and the other half cooked in rooms used for
more than one purpose. Forty percent
used a kitchen table to prepare their vegetables, while 12% used the low-round
table called “Tablya” and 43% used the floor. The remaining 5% used other
places.
Water
Sources of
drinking water in the homes visited are followed:
Water Source
Percent of Respondents
Piped Water
57
Hand Pumps
22
Public Taps
11
Tap in building or at Neighbor’s
6.5
Other
3.5
Sewage
Types of sewage system in
respondents’ homes:
Sewage System
Percent of Respondents
Sewage well
42
Connected to Public Sewage System
36
Cesspools
9
Other means
8
Do not know
5
Finally, the following household
items were surveyed and their presence was identified as follows:
Household Item
Percent Of Respondents
Electricity
94
Total Television
91
Black & white TV
65
Color TV
26
Radio
82
Washing machine
68
Tape Recorder
66
Fan
51
Stove
49
Refrigerator
47
VCR
4
The Health Experts’ Survey
Doctors’ Perspectives on Egypt’s Health Problems
By: Farag Elkamel, December, 1985
(This study was conducted as part of the Sehettak
Biddonia project, sponsored by the Ford Foundation, UNICEF, and the Johns
Hopkins University)[1]
STUDY OBJECTIVES
This study has two main objectives: 1) to
identify Egypt’s most important national health problems from the Egypt’s top
doctors’ point of view; and 2) to identify the best methods through which mass
media might deliver relevant health information to the public, also from the
doctors’ point of view.
METHODOLOGY
One hundred top health professionals from several
universities, the Ministry of Health (MOH), and other projects were selected to
participate in this survey (see list of respondents). Participants were chosen on the basis of
lists and suggestions acquired from university officials and the MOH. Each respondent
was asked to complete a questionnaire of seventeen questions regarding pressing
health problems and methods of disseminating information about them. The study
was conducted by the Center for Development Communication between July and
November 1985.
Seventy-six of the 100 respondents were connected
to universities, 15 with the MOH, eight with health projects, and 12 with other
institutions. (Some were connected with more than one category of the above.)
Respondents represented a variety of professional
experience. Thirty-six respondents were professors, 10 assistant professors, 30
lecturers and assistant lecturers, 15 MOH administrators, 8 project officials
and 1 that could not be classified in any of these categories.
Most respondents (54) specialized in pediatrics.
Of the rest, 17 specialized in public health, 5 in pharmaceutics and 24 in
other assorted fields.
STUDY DIFFICULTIES
Certain problems were encountered during field
work:
Many selected participants from the university were on vacation during
summer field work, which delayed their responses.
Some selected respondents did not return surveys promptly for other
reasons.
The application procedure for the necessary official permits for the
project is lengthy. First, the Central Agency for Public Mobilization and
Statistics (CAPMAS) required three weeks to process the application. Second,
the Ministry of Health and its security needed at least another week to issue
the subsequent permit.
Open-ended survey questions needed complex and lengthy analyses
requiring extra time, though the information gathered was worthwhile.
FINDINGS
1. Important National Health Problems
IN YOUR OPINION, WHAT DO YOU THINK ARE THE TEN
MOST IMPORTANT HEALTH PROBLEMS IN EGYPT?
COULD YOU ARRANGE THEM IN ORDER OF IMPORTANCE?
The first question concerns the ten most
important health problems in Egypt. Respondents
were asked to arrange these problems in order of importance. While all of the participants answered the
question, not all gave ten answers.
Respondents indicated the most important health problem as being malnutrition, followed by diarrheal and gastroenteritis diseases, endemic parasitic diseases, infectious diseases, chest & respiratory diseases. They also mentioned pollution and bad sanitation as causes for many of these health problems. The category “infectious” encompasses general problems, mainly focusing on those requiring immunization. Tuberculosis, polio and measles, which also require vaccinations, are listed as separate categories being mentioned specifically by respondents.
2. Ideal Methods for Disseminating Information
WHAT DO YOU THINK IS THE BEST METHOD(S) TO DISSEMINATE INFORMATION TO THE PUBLIC ABOUT THE PROBLEMS YOU MENTIONED?
WHAT DO YOU THINK IS THE BEST METHOD(S) TO DISSEMINATE INFORMATION TO THE HEALTH PROFESSIONALS TO KEEP THEM INFORMED OF UP-TO-DATE DEVELOPMENTS?
In order to best disseminate information both to
the public and to health professionals of up-to-date developments, respondents
were asked to chart the value of various channels, including personal
counseling, lectures and talks, radio, television, press, films, pamphlets,
booklets, posters, community organizations and other suggestions.
Reaching the Public. To reach the public, most respondents (91%) chose television as selected method, followed 66% choosing by radio, 50% personal counseling and 40% community organizations. Films were less desirable, chosen by 29%, as were lectures (20%), press and posters (18%). Of the remaining choices, 8% chose booklets and 4% gave other answers. Only 1% failed to answer the question.
Reaching the Health Professionals. To reach the health professionals, the highest percentage of respondents, 67%, chose lectures and talks. Pamphlets seemed useful to almost half of the group, or 43%, as did booklets, which were chosen by 41%. 28% selected personal counseling and 15% press and films. Each of the other categories received less than 12%. 5% of the respondents did not answer this question.
3. Formats for Health Information
WHICH FORMATS WOULD YOU PREFER HEALTH INFORMATION
TO BE PROVIDED TO THE PUBLIC IN? PLEASE ARRANGE
IN ORDER OF PREFERENCE.
Respondents were asked to arrange the following
format choices in order of preference. These formats represent preferred
methods of providing health information to the public. Only 1 % of the respondents did not answer
the question, but several checked boxes without ranking their choices.
As the number one choice, out of 86 answers 20 of
them said interviews with mothers, 19 said drama, and the same number said
songs. Interviews with health
professionals and commercials were chosen by 13 each and prize competition and
others by 1 each. As the second
preference, out of 81 answers, 22 said interviews with health professionals; 18
said interviews with mothers; 17 said drama; 12 said commercials; 7 said songs;
3 said prize competitions. Combining all
of the rankings, 75% chose drama and interviews with mothers and health
professionals as a preferred format, closely followed by commercials receiving
72% of the total response, songs 65% and prize competitions 48%. Thus it appears that generally, interviews
with mothers and health officials and drama are the popularly recommended
formats by the respondents.
4. Key Interventions to Reduce Child Morbidity and Mortality
THE FOLLOWING MEASURES WERE IDENTIFIED AS KEY INTERVENTIONS TO REDUCE CHILD MORBIDITY AND MORTALITY IN EGYPT. FOR EACH INTERVENTION, PLEASE SPECIFY WHETHER YOU THINK IT WILL BE VERY EFFECTIVE, SOMEWHAT EFFECTIVE, OR NOT EFFECTIVE.
THEN, FOR EACH OF THESE INTERVENTIONS, PLEASE SPECIFY WHAT THE PUBLIC SHOULD KNOW AND/OR DO.
The next question identifies key interventions to reducing child morbidity and mortality in Egypt: Oral Rehydration Therapy, Immunizations, Breast Feeding, Water Supply and Sanitation, Personal and Domestic Hygiene, Weaning Practices, Food Hygiene and Protecting Pregnant Mothers against Tetanus. Respondents were also asked about the effectiveness of intervention and what the public should know and do.
1. Oral Rehydration Therapy.
For the use of oral rehydration, 74 responded
that it is very effective, 21 somewhat effective, and 1 person said that it was
not effective. 4 did not respond. 68 of the respondents gave explanations. Most
of these explanations (23) said ORT was effective because it was able to
decrease diarrhea and dehydration. 17 others said that it was easy to use, 16
people mentioned that it was easy to prepare, 13 liked its low cost, 10 that it
was easy to obtain, 9 that it was useful in severe cases and 3 that it was
safe.
What the Public Should Know and Do
Respondents were also asked to identify what the public should know and do. Most (37) said that the public should know exactly how to prepare and use the solution, while 10 respondents noted that the public should know when to administer the therapy, its effectiveness and to be sure to consult a doctor or hospital. Other suggestions include warning mothers to continue breast feeding, telling parents where to obtain the fluid and when it’s useful, and of complications and benefits.
2. Immunization: the Triple Vaccine
For the triple vaccine immunization, 41 persons
found this intervention to be very effective.
9 respondents explained that its efficiency was effective while others
noted that it is a good prevention of serious diseases, that there is currently
a low incidence of these diseases, and that the routine practice is familiar to
all.
What the Public Should Know and Do?
On the other hand, respondents identified what
they thought the public should know and do regarding this vaccine. 7 people said hazards of the disease should
be known. 5 others said timing of
vaccinations should be stressed, as well as its importance. The public should also know the importance of
spacing between doses, complications after vaccination, where to get
vaccination, and about contraindication.
3. Vaccination for Measles
Out of the 24 respondents who believed this
vaccination to be very effective, half gave some explanations. 5 respondents thought this particular
immunization to be able to prevent scars, others noted the widespread waves of
the disease, and that there are high cases fatality. One person mentioned that two doses are
needed, as are booster shots.
What
the Public Should Know and Do
When asked what the public should know and do, respondents
believed that people should be told about booster doses, how the vaccination
prevents diseases, about timing, and the proper site of injection to avoid
nerve paralysis.
4. Vaccination against Polio
Of the 47 who believed this vaccination to be
very effective, 10 explained that it was effective in abolishing or decreasing
the incidence of polio, while 2 said that it was successful in that it was easy
to take.
What Public Should Know and Do
When asked what the public should know and do,
the respondents suggested that people should know of polio’s complications,
about timing, its method of administration and about booster doses.
5. Immunization in General
Among the respondents who answered that
immunization as a whole was effective, 24 responded that it was very
effective. If given as a prophylactic,
immunization can reduce morbidity.
Compulsory programs were recommended, put into effect with mass media
campaigns. Also, due to the aggregation
of the population, health units, primary health care and private clinics could
be used to help the mass media spread information.
What Public Should Know and Do for Vaccinations
In reference to what the public should know and
do for the three vaccinations together, 34 respondents replied that proper
timing should be stressed. 17 said that
the public should know of the value of the vaccination and its
effectiveness. The dangers of disease
and difficulty in treatment were mentioned by 13 others. Other recurrent answers were to inform where
to obtain the vaccinations, possible precautions and side effects, and about
the timing of booster doses and age to be administered. Some mentioned that the public needs more
information, which may be served by mass media and personal contact.
6. Promotion of Breast Feeding
70 of the respondents believed the promotion of
breast feeding to be very effective. 11 respondents reasoned that it was a
cheap supply of nutrition, while 10 noted that it decreases diarrhea and gastroenteritis,
which artificial milk can stimulate. 7
people remarked that it was easily available, clean, and contains
antibodies which gain immunities for the child.
Others noted the psychological benefits to mother and child, and its use
in preventing malnutrition and most infectious diseases. It is also culturally acceptable, and a
natural form of child spacing. Also, bottle feeding can be expensive. Even for working mothers, in rural and urban
low socioeconomic brackets, breast feeding is well practiced and high
biological value. There were also
suggestions to introduce informative health units in clinics, television and
radio and to form a health nucleus for the community.
What the Public Should Know and Do
In the next question, respondents were asked what
the public should know and do. Most persons (48) emphasized that the public
should know advantages to mother and baby and the disadvantages of artificial
milk. Also, the public should know the role of breast feeding in prevention of
infection and in increasing immunities to protect the child’s health. Also, perhaps the public should be informed
of proper timing and how to prepare for it.
7. Adequate Water Supply and Sanitation
Of all the respondents, 65 said this would be
very effective. 38 found that as a prophylactic, it would prevent or reduce
water and food borne infections, as well as diarrheal diseases. As a hygienic environment, a sanitary water
supply would promote general health if readily available.
What the Public Should Know and Do
When asked what the public should know and do,
most stressed its importance in preventing diseases and its advantages. Also, the public should know how to use and
obtain sanitary water. A few mentioned
the need to work closely with the government.
8. Promotion of Personal and Domestic Hygiene
48 of the respondents believed this to be very
effective. Of these, 26 said that as a prophylactic against microbes and
infectious diseases it would be very useful.
Also, personal hygiene would be good for general health practices.
What the Public Should Know and Do
In response to what the public should know and do, 18 noted the advantages in prevention and eradication of infectious diseases as prominent. 26 stressed the public’s need to know how, and 20 others why. A few respondents mentioned that a religious approach might be effective.
9. Improved Weaning Practices
Out of all 100 respondents, 40 believed improving
weaning practices to be very effective. 25 of these 40 said that it would
improve health and prevent serious nutritional disorders, diarrhea and
gastroenteritis. Others mentioned that
it decreases psychological problems, and provides a nutritional supplement to
breast milk. Also, MOH centers should
improve facilities.
What the Public Should Know and Do
When asked what the public should know and do in
reference to weaning practices, 23 emphasized how, or the ideal weaning details
of food for each month, and 20 others stressed what kind of food to give the
baby. 16 mentioned timing, and 26 others
wanted the advantages of good weaning practices to be known. Others noted the need to provide
well-trained, adequate facilities and education.
10. Improved Food Hygiene
44 of the respondents replied that improving
food hygiene would be very effective. 29 felt that it
would prevent diseases, such as diarrhea, gastroenteritis, and food poisoning,
as well as nutrition disorders. 2 people
noted that communities also need sanitary water and general sanitary
conditions, in addition to education on community and personal levels.
What the Public Should Know and Do
The respondents were then asked what the public
should know and do about food hygiene.
Most people stressed how, or what sanitary means were available for
preparing and keeping food. Others
stressed its importance, in preventing diseases transmitted through flies and
other insects. Others mentioned the
responsibility of government to inspect milk shops, meat shops and restaurants.
11. Immunization of Pregnant Mothers against Tetanus
42 of the respondents believed that immunizing
pregnant mothers against tetanus would be very effective. 22 said that it prevents tetanus which is
common and serious, and neonatal tetanus, since many babies are delivered by
midwives in unsanitary conditions.
Others noted that it was easily organized and implemented, and
thoroughly advantageous.
What the Public Should Know and Do
Numerous and varied answers were given to the
question of what the public should know and do. 24 stressed the need to inform
the public of its advantages and importance, while 19 wanted to emphasize
proper timing. Others noted that the
public should know of possible dangers of tetanus on physical and mental
development of children and the importance of personal hygiene and sterile
conditions during birth. Also, a program
should tell the public how and where to obtain the vaccine, and make sure
facilities are indeed available.
5. Other Measures to Reduce Mortality and Morbidity
WHAT OTHER MEASURES DO YOU THINK COULD BE
EFFECTIVE IN REDUCING CHILD MORBIDITY AND MORTALITY IN EGYPT?
The following question asks respondents what
other measures might be effective in reducing child mortality and morbidity in
Egypt. The subsequent paragraphs summarize the responses of the 79 who answered
this question.
Family planning and Birth spacing. 16 of the respondents maintained that family planning and spacing was important to children’s’ health.
Education. 35 mentioned education as an effective measure, while some specified health education and others education to mothers. Some believed illiteracy to be the factor needing to be eliminated. Some respondents stressed the need to introduce health topics in schools for children, others the need to educate in rural areas, perhaps using students during summer holidays. Many mentioned the role of television in health education. Finally, some responded that medical and paramedical professionals need to continually be educated.
Health Services. 22 of the respondents answered that improving health services would be an effective measure in reducing child mortality and morbidity in Egypt. Some places that were specified include maternal child health facilities, general street clinics, hospitals, health delivery systems, places outside big cities, institutes for handicapped children, specialized centers for children and pediatric hospitals. Specific practices to be watched carefully and improved include diagnosing diseased children, caring for newborn and genetically determined diseases, C.N.S. injection, overuse of instrumentation during birth resulting in brain damage, obstetric care, neonatal services, and antenatal care. Information is needed about the effect of drugs and nutritional problems, and more medical care is needed.
Economic and Social Development. 16 of the respondents said that raising the socioeconomic level of people and improving jobs and wages for workers would be an effective measure in improving children’s’ health.
Others. Other varied responses include proper psychological care for children; community participation; prevent leading causes of morbidity and mortality; use mass communication; improve health awareness; recognize early manifestation of common problems; use day care centers; reduce traffic accidents; fight bilharzias; leave mothers free to handle children during first 3 years; hazards of drugs, especially stimulants in secondary schools and addictions. Some respondents repeated measures all ready discussed within the questionnaire. These include sanitary environment (10), immunizations and vaccinations (7), nutrition (7), hygienic conditions, ORT and breast feeding (3).
6. Current ORT Mass Media Campaign
PLEASE COMMENT ON WHETHER THE FOLLOWING ASPECTS
OF THE CURRENT ORT MASS MEDIA CAMPAIGN ARE GOOD OR NOT GOOD AND WHY: CONTENT,
FORMAT, DURATION AND TIME OF BROADCAST.
To help decide whether or not to adopt the same
technique for other health problems, respondents are asked whether the
following aspects: content, format, duration and time of broadcast, of the ORT
mass media campaign are good or not, and why.
Content. Most respondents (76) considered the content to be a favorable aspect. Twenty-two explained that the content was good because it was simple and easy for the public to understand. Others replied that the content was well studied and covered important information, while seven offered no explanation. Most of the explanations given by the 13 who said that the content was not good focused on the incompleteness of the information offered, which may lead to misunderstanding. Some feared that mothers would stop seeking medical advice, misuse the treatment and assume it’s the only and proper solution for each case.
Format. Of all the respondents, 78 said the format was good. Sixteen respondents liked the format because it was attractive and interesting, two noting the popularity of the actress. Twelve explained that the short, simple, and concise format style was good, and five expressed that television was an excellent medium for reaching the target audience. The 10 respondents not liking the format explained that the songs were not serious, the appeal was not scientific, and perhaps required more explanation.
Duration. Of the 100 persons surveyed, 73 liked the length of the messages. Twenty-four respondents explained that the length of commercials were good not being time-consuming, requiring much attention and able to be repeated. Four explained that the frequency was appropriate and they believed the conciseness kept the message interesting. Three people thought the duration of the message to be too short, one too long; one believed the message to be too frequent, another two, not frequent enough. Thirteen people offered no explanations at all for their opinions.
Time of Broadcast. Seventy-nine respondents liked the time of the broadcast. Eighteen respondents explained that the time of broadcast was good in that the families were usually gathered at that time to watch television. Five others noted the good position in the broadcasting schedule, being before popular dramas. Eighteen believed it to be good but offered no explanation. Four of the eight respondents who believed the time to be not good offered some of the following explanations: other evening times might be better; could also be before comedies, films and football matches.
7. Child Immunization Coverage
WHAT DO YOU THINK ARE THE REASONS UNDERLYING THE
OBSERVED LOW CHILD IMMUNIZATION COVERAGE WITH THE TRIPLE VACCINE AND MEASLES
VACCINE?
Recently, child immunization coverage with triple
and measles vaccines has been observed to be low. Respondents were asked what they thought to
be the underlying reasons for this. 22
felt that ignorance, negligence, carelessness of mother or parents were the
main reasons, while 16 others found faults that there were not enough publicity
campaigns or general education. Again,
bad storage techniques, especially in villages were mentioned by 9
persons. Others noted the high level of
poverty, illiteracy and unacceptability in rural remote areas. Also, the vaccine was unavailable in many
markets.
Triple Vaccine. In reference to
the triple vaccine, again ignorance of mother or parents was given as the cause
for low coverage by 26 persons. 12
people said that repeated doses are needed, which should be added to currently
deficient health education and mass media campaigns. The bad behavior and
attitudes of health personnel were also a problem. A few noted the expense of vaccine and
poverty of people may contribute to this low coverage.
Measles Vaccine. As to the measles vaccine, again culture and tradition
(the disease is considered a gift from god and not harmful) was mentioned as
the root cause for low use by 12 persons.
9 others pointed to a failure of the vaccine itself. Again, a lack of health education, facilities
expense and availability were mentioned as problems.
8. The Polio Campaign
PLEASE COMMENT ON WHETHER EACH OF THE FOLLOWING
ASPECTS OF THE PAST POLIO CAMPAIGN IS GOOD OR NOT, AND WHY: CONTENT, FORMAT, DURATION AND TIME OF
BROADCAST.
In the following question, people were asked to
comment on the content, format, duration and time of broadcast of the polio
campaign.
Content. 68 respondents believed the content to be good. Most of the respondents explained that the content was well-done (8) and effective (7). Also, they said that the message was simple and easily understood (5) and polio in fact was decreasing (2). Others believed that the content could be livelier and include more details. 8 people did not like the content, explaining that it emphasizes paralytic polio, is not attractive, not completely scientific and there is no mention that vaccinations should not take place on street roads, but in health centers.
Format. 66 people thought the format was a good one. Their reasons include that the format is well-done (5), easily understood (3), short (2), attractive (3) and accepted (2). One person thought it should be more often, another not enough. 11 respondents replied that the format was not good for these reasons: more stress needed on morbidity and mortality; use songs and films; too short (2); more drama and interviews with mothers and doctors; too authoritative.
Duration. 58 of the respondents were pleased with the duration. Most believed the duration to be suitable (8), while some specified the short length as being good in not consuming much time (4). Others remarked that it was effective (3) and that the evening time (1) and frequencies (1) were working well. 17 people did not like the duration. Of these, 7 respondents though the duration to be too short, and the other 2, too long.
Time of Broadcast. 62 respondents liked the time of broadcast. Most responded that it was suitable (8), others that the evening time was good (4), summer time preferable (1) and that positioning should be before drama, films and sports matches. 10 people gave no explanation but believed it to be good, and two people said it was not good without explanation. Of the 8 that explained it to be not good, some believed it to be not suitable for all women (2) and not to be shown at the right time (1).
9. Strengths of Existing Health Programs
WHAT ARE THE STRENGTHES OF THE EXISTING HEALTH
PROGRAMMES ON RADIO AND TV? PLEASE COMMENT ON CONTENT, FORMAT, DURATION AND
TIME OF BROADCAST.
The next question asks respondents to comment on
the strengths of existing health programs on radio and television. 40 people
answered this question.
Content. 29 respondents commented upon the content of the programs. 14 of the respondents thought the content to be good; 4 said it to be clear and easily understood and 4 others comprehensive but 3 others found that the content was a mixture of good and not good.
Format. 32 respondents discussed the strengths of the formats, while 8 people did not answer. 15 liked the formats, and 5 thought it easily understood, 4 said fair, and 1 effective. Two people did think the format could be revised.
Consistency. 22 people responded to the question of consistency. 12 People specifically said that they liked the consistency, but 4 thought it should be strengthened. Others recommended that it be simple, effective and attractive, while one responded only for the ORT campaign. 18 people did not answer.
Language. As to the language, 32 people provided answers, while 8 did not. 22 preferred use of native, slang language, while 4 others thought Arabic should be used to target educated persons. 19 the 28 respondents thought scheduling was well-done. Others recommended evening and afternoon hours, weekly times, and before news and movies. 12 people did not answer this section.
10. Weaknesses of Existing Health Programs
WHAT ARE THE EXISTING HEALTH PROGRAMMES ON RADIO
AND TV? PLEASE COMMENT ON CONTENT, FORMAT, CONSISTENCY, LANGUAGE AND
SCHEDULING.
Respondents were then asked to comment on the
weaknesses of existing health programs on radio and television. 40 people did
not answer at all.
Content. 23 of the 37 people answering found fault with the content, as being not detailed enough or providing wrong information. 7 others said the content was not well understood or interesting and 2 said it was ineffective. Only 2 thought it to be adequate. 7 did not answer this question.
Format. 27 responded to the format section. The format is also found by 8 to be lacking in adequate information, 7 said it was not well organized, 6 that it was unattractive, 4 not easily understood and 2 replied that it varied. 17 people did not answer this section.
Consistency. 21 people responded to the consistency. 8 believed not enough was said about various problems, 4 others that it was too complex, 3 that it was not attractive and 2 that generally not very good). 23 people chose not to answer this question.
Language. 20 people did not respond as to their opinions on language, but of the 24 who did 18 preferred simple, native languages that would be easily understood. Only a few offered differing responses: language should be more scientific (2); less vulgar (1); in English (1).
Scheduling. 9 of the 16 respondents answering the next section believed the scheduling to be disorganized, 5 said it was not working well and another 5 said not frequent enough.
All Aspects. When asked to respond as to those aspects all together, 16 People gave the following answers: too complex, not simple and direct enough (4); unorganized (4); boring (2); needs more promotion (1); no weaknesses at all (2).
11. Guidelines for Health Planners
WHAT DO YOU THINK ARE THE MOST IMPORTANT 5
PRECAUTIONS PLANNERS OF HEALTH EDUCATION PROGRAMMES SHOULD BE AWARE OF?
In the last question, respondents are asked what
five most important precautions planners of health education programs could be
aware of (12 % did not answer this question).
Baseline Study. In reference to a primary study, several varied answers include: should know culture, tradition and habits of Egyptians (26); know health needs of population (14); the age group of target population and how to reach them (11); their level of education (13); their socio-economic level (4); literacy and intelligence level (8); religious beliefs and how to deal with them (6); and more about the population, such as how they live, number of children in each family, where mothers live, free time of mothers, and more about parents in general.
Health Programs. Planners of health programs should also be careful to make campaigns attractive (4), not too scientific or frightening (4), valid, correct and clear (9), thorough (5), not too frequent (2) but frequent enough (7), reasonable, suitable time of broadcasting to audience and prominence of disease (10), to consult with health professionals and experts, to avoid abuse or overdose of knowledge (2), utilize message harmony with programs, show public dangers of problem (2), and choose the right person for this message (some prefer popular personalities and others desire prestigious health personnel with high education.
Language. 19 respondents mentioned language as one of the important precautions after knowing the target population. The language chosen should be easily understood, simple, and common.
Health Education. In reference to health education, respondents desired more health education facilities; more health education to mothers (3), medical students and doctors; health education in nursery and schools; use of audio visual means, films and television (2); importance of basic scientific message; right method to reach professionals; maternal education in nutrition, weaning and hygiene of infants.
Other Precautions. Other precautions mentioned include being aware or availability and feasibility, to plan for an independent evaluation, to note the existing gap between the community and government, to not forget non-traditional approaches of informing the public and to study problems in the field before advising the public.
[1] It should be noted
that a parallel study was conducted with a sample of the general public. It
should be interesting to compare the findings of the two studies, which are
published in this site.
Participants in the health experts’ survey, by alphabetical order:
Dr Abdel Rahman Ahmady, Pediatrics, Al Azhar University
Dr Abdel Moniem Youssef, School Health Administrator in H M , M O H
Dr Ahmed Nagaty, SRHD Project
Dr Ahmed Yehia Darwish, Abu El Rish Hospital, Cairo University
Prof Ahmed Mohamed Abou Hassan, Pediatrics, Cairo University
Dr Ahmed Saad El-Din El-Beleidy, Pediatrics, Cairo University
Dr Ahmed Swedan, Pediatrics, Cairo University
Dr Ahmed Hashem Abd el Aziz, Director General of Urban P H C , M O H
Prof Ahmed Hanafi Mahmoud, Community Medicine, Cairo University
Aisha El Marsafy, Pediatrics, Cairo University
Prof Amal El-Beshlawy, Pediatrics, Cairo University
Dr Amin Kamel Said, Head Clinical Nutrition Dept , Nutrition Institute
Prof Amina Hendawy, Pediatrics and Neurology, Cairo University
Prof Amira Salem, Pediatrics, Cairo University
Prof Anissa M El Hefny, Pediatrics and Clinical Immunology, Cairo University
Prof Awatef El Mazni, Pediatrics, Cairo University
Prof Baheia Mostafa, Pediatrics and Nephrology, Cairo University
Professor Bayoumi El Sibaie, Pediatrics, Cairo University
Prof Bothina M El Naggar, Pediatrics, Al Azhar University
Mr Effat Ramadan, N P C and Executive Director of F O F
Ms Effat Ibrahim Kamel, Director of the General Nursing Department, M O H
Dr Entissar M El Sabbar, General Director of M O H
Dr F A Saleh, Epidemiologist, M O H
Prof Fadia Mohamed Ali, Pediatrics, Cairo University
Prof Farida Faried, Pediatrics, Ain Shams University
Dr Farouk Shaheen, Nutrition Institute
Dr Fawzan Shaltout, Pediatrics, Cairo University
Prof Fawzi Gadalla, Community Medicine, Al Azhar University
Prof Fouad El Behairy, Pediatrics, Al Azhar University
Dr Gamal El Din Abdel Aziz, NCDDP
Prof Gilane Abd El Hamid Osman, Pediatrics, Ain Shams University
Dr Hala Fouad, Pediatrics, Cairo University
Dr Hassan Belal, Head of Communication Department, M O H
Dr Hamida Mohamed El Gohary, Faculty of Pharmacy, Cairo University
Professor Hekmat El Ghadban, Pediatrics, Cairo University
Dr Hoda Ibrahim Fahim, Public Health, Ain Shams University
Dr Hoda Seoud, Pediatrics, Al Azhar University
Dr Hosni Mohamed Mahrous, Marketing Coordinator, NCDDP
Prof Hussein El Nahal, Bilharzias Institute
Dr Ibrahim Fouad, Public Health, Cairo University
Dr Ibrahim Farrag, Director General of Fever Hospital Dept , M O H
Dr Ibrahim S Hegazy, Public Health, Cairo University
Dr Iman Abd el Salam Seoud, Pediatrics, Cairo University
Dr Jerry Russell, Public Health, NCDDP
Dr Kadry Wishahy, Pediatrics, Cairo University
Prof Karima El Zawahri, Pediatrics, Cairo University
Prof Laila Mahmoud Kamel, Public Health, Cairo University
Dr Lamis Ragab, Pediatrics, Cairo University
Dr Madiha Said Mohamed, Public Health, Cairo University
Dr Magda Mohamed Fathy, Faculty of Pharmacy, Cairo University
Prof Magdy El Barbari, Pediatrics, Cairo University
Dr Maha Moustafa Kamel Mourad, Pediatrics, Cairo University
Prof Maher Mahran, Secretary General of NPC and OBGYN at Ain Shams University
Dr Mahi Mahmoud Fahim, Public Health, Ain Shams University
Dr Mahmoud Radwan Mohamed, Public Health, Ain Shams University
Prof Mahmoud Essawi, Pediatrics, Ain Shams University
Prof Mahmoud Taher El Mougi, Pediatrics, Al Azhar University
Prof Mamdouh Kamel Gabr, Chairman of Pediatrics, Cairo University
Dr Mansour M Al Okka, National Control of Diarrheal Disease Project
Prof Mervat El Rafie, Public Health, Cairo University
Dr Mogedda Mohammed El Ayoubi, Pediatrics, Cairo University
Dr Mohamed Naur Abd el Wahab, General Director of M C H , M O H
Dr Mohamed Said Ibrahim El Sayed, Pediatrics, Cairo University
Dr Mohamed Atteya, General Director of Health Education and Information
Prof Mohamed Khayyal, Faculty of Pharmacy, Cairo University
Prof Mohamed Fouad El Badrawy, Pediatrics, Ain Shams University
Dr Mohamed El Mosalamy, Public Health, Al Azhar University
Dr Mohamed Amr Hussein, Nutrition Institute
Dr Mohamed Galal Mahmoud, Department of Curative Medicine, M O H
Dr Mohamed Fahmy Ameen, Al Azhar University
Dr Mohsen Gadallah, Public Health, Ain Shams University
Dr Mona Hassan El Tagy, Pediatrics, Cairo University
Dr Mona Soliman Mohamed, Public Health, Cairo University
Dr Mona Zahran, Bilharzias Institute
Dr Mostafa Hamami, Vice Minister of M O H for Primary Health Care and Family Health
Dr Nadia Mostafa, Pediatrics, Cairo University
Dr Nahed Amer, Pediatrics, Cairo University
Dr Nahed Fahmy Helal, Mounira Children’s Hospital
Dr Naira El Akkad, Pediatrics, Al Azhar University
Dr Narges Albert Labeeb, Public Health, Cairo University
Dr Norman Kaddah, Pediatrics, Cairo University
Dr Osman Galal, Director of the Nutrition Institute
Prof Rabah Shawky, Pediatrics, Ain Shams University
Dr Rabha El Shenawy, El Mounira Pediatric Hospital
Prof Ramzi El Baroudy, Pediatrics, Cairo University
Prof Saadia Abdel Fattah, Pediatrics, Ain Shams University
Dr Said Madkour, MCH Specialist, M O H
Prof Salah Kamel Nassar, Pediatrics, Cairo University
Dr Salah Madkour, General Director for Communicable Disease Control Dept, M O H
Dr Salwa Abdel Aziz, Public Health, Cairo University
Prof Susan Amin El Sokkary, Pediatrics, Ain Shams University
Dr Samia Nour, Pediatrics, Cairo University
Prof Samiha Samuel Wissa Doss, Pediatrics, Cairo University
Dr Sanaa Ahmed Aly, Pediatrics, Cairo University
Dr Sowsan Abd El Hady Hassan, Pediatrics, Cairo University
Prof Sayed Hilal, Dean of Faculty of Pharmacy, Cairo University
Prof Shafika Saleh Nasser, Community Medicine, Cairo University
Prof Soad Ishaac Wahba, Pediatrics, Cairo University
Prof Taha S El Alfy, Faculty of Pharmacy, Cairo University
Dr Wafaa Moussa, The Nutrition Institute
Media and Health Education Conference, Etap Hotel, Ismailia, Egypt
January 10 and 11, 1986
Summary of Conference Recommendations
Participants of the “Mass Media and Health Education Conference” that was held in Ismailia on January 10 and 11, 1986, reviewed and discussed the “Sehettak Biddonia Project.” They examined the Project’s components and focused on baseline studies[i] which were conducted by the Center for Development Communication (CDC). Participants held extensive discussions and formulated specific remarks about and recommendations for the project.
Participants strongly support the Sehettak Biddonia Project’s scientific and systematic approach of using communications and social marketing techniques to improve the public’s health standards and quality of life through this health education program. They also assert that the Project significantly contributes to national development as it addresses a real need for public information on health issues. The participants emphasize that the project would lead to improved health whcich benefits every citizen whether (s)he be a woman, man, or child.
This is a summary of the recommendations for the Sehettak Biddonia Project, as outlined by the participants in this “Media and Health Education Conference.” organized by CDC and the donors of the project.
A. Pool of Health Issues and
Problems
The conference participants pointed out a
valuable source of health issues for the Sehettak Biddonia Program to focus on
which is the extensive “Health Profile Survey”, conducted by
the Ministry of Health. Other sources are
the results of the 100 health experts and 900 mothers surveyed by CDC as well
as the Mass Media and Health Education Conference itself.
B. Criteria for Establishing Health
Priorities
The workshop participants maintain that criteria for establishing health priorities include the following:
Prevalence
Severity (causing death / disability)
Community concern
Social impact
Can be affected by information
Preventability (health problems that can be prevented by behavioral
change)
Existing Infrastructure (issues which have an existing health services
infrastructure takes higher priority over those that require creating new
services.)
Health problems and issues should be given scores
on each of the above criterion and prioritized according to the order of those
scores. The issue with the highest score takes highest priority.
C. Scoring
Participants recommend that CDC evaluate and
prioritize health problems and issues in the way described above. They further
recommend that the draft be evaluated by judges comprised of experts identified
by CDC and the Ismailia Workshop participants.
D. Health Issues of Highest Priority
Participants ranked health issues according to the priority in which issues should be covered by the Sehettak Biddonia Program. It was agreed that the following four issues take highest priority:
Immunization: campaigns should aim to fortify the present immunization schedule and program
Malnutrition of children and adults
Personal hygiene
Reproductive health
Additional priorities will be established through
the process described in A, B, and C, above.
E. Supportive Infrastructure
Participants
believe several factors , which are beyond the control of the project, can
reinforce the “Sehettak Biddonia” project impact:
1. Continuing improvement of the
health delivery system in these areas:
Management
Nursing
Service quality
Equipment
Health professionals’
continuous in – service training
2. Communication messages should
be synchronized with service availability.
F. The Socioeconomic Environment
The following socioeconomic factors positively or
negatively affect the four health issues in `D’ above should be considered when
designing messages:
income
economic constraints
traditional modes of
production
beliefs
level of health information
already possessed
status of women
child labor exploitation
level of formal
education
Interrelations between the
four health issues
G. Target Audience
Illiterates and low-income
level groups will be especially targeted.
Some messages will mainly
address women
Some messages will target
men
Some messages will be aimed
at all family members
The detailed report also includes comments that
have been given throughout the conference and elaborated upon during group
discussions and presentations.
[i] The baseline
studies reviewed by conference participants were: 1) “Highlights of the
Health Experts Survey on Basic Health Issues in Egypt; and 2) “Highlights
of Mothers’ Knowledge, Attitude, and Practice Survey on Basic Child Survival
Communication Issues.”
List of People Invited to Attend the Conference According to Alphabetical Order of First Names:
Dr. Ahmed Nagaty, Strengthening
the Rural Delivery System, MOH
Mr. Ahmed Bahaa el Din, Writer,
Al Ahram Newspaper
Dr. Ahmed Foad el Sherbini, Professor
and Dean of Public Health Institute, Alexandria
Dr. Ahmed Khasab, Professor
of Pediatrics, Benha University
Dr. Ali Agwa, Vice Dean,
Faculty of Communications, Cairo University
Ms. Amal Mikawy, Director of
Channel One, Television
Ms. Ann Crowly, Catholic
Relief Services
Mrs. Aziza Hussein, Cairo
Family Planning Association
Dr. Barbara Ibrahim, Ford
Foundation
Ms. Connie Collins, Child Diarrheal Disease Control, United States
Agency for International Development
Mr. Edward Lannert, Country Representative, UNICEF
Mr. Effat Ramadan, National Population Council and Director of F.O.F.
Mrs. Elham Fateem, F.O.F. Research Department Director
Dr. Ez el Din Osman, Professor and Head of Gynecology and Director of
Fertility Care
Mr. Fahmy Omar, President of Egypt Radio
Dr. Fahyma Mohamed Hassan, Menoufia University, Pediatrics
Dr. Farouk Abou Zeid, Cairo University
Dr. Farouk Shaheen, Nutrition Education Project
Dr. Fawzy Gadallah, Prof. of Community Medicine, Al Azhar Univ.
Dr. Reginald Gibson, Oral Rehydration Therapy
Dr. Gihan Rashty, Vice Dean of Communications & Head of Radio
Dept., Cairo Univ.
Dr. Gilane Abd el Hamid Osman, Professor of Pediatrics, Ain Shams
University
Dr. Hassan Belal. Head of Communications, M.O.H.
Mrs. Hind Khattab, American University in Cairo
Dr. Hosein Amer, Head of Epidemic Control, M.O.H.
Dr. Ibrahim el Kerdany, UNICEF
Dr. Jerry Russell, John Snow, Inc./ NCDDP
Dr. Judy Barslow,Ford Foundation
Dr. Kamal Ismail, Security Department, M.O.H.
Dr. Laftaya el Sabaa, Egypt Television
Dr. Laila Mahmoud Kamel, Professor of Public Health, Cairo University
Dr. Lee Travers, Ford Foundation
Ms. Liz Taylor, National Population Council
Dr. Maher Mahran, National Population Council
Mr. Khashab Matheme, UNICEF
Dr. Mahmoud Essawi, Professor of Pediatrics, Ain Shams University
Dr. Mahmoud Taher el Mougi, Professor of Pediatrics, Al Azhar
University
Dr. Mahmoud Hafez, Professor of Pediatrics, Zagazig University
Dr. Mamdouh Gabr, Director of Pediatrics, Abou Elrish Hospital, Cairo
Univ.
Dr. Mansour el Okka, Oral Rehydration Therapy
Ms. Marlene Kanawati, Oxfam
Dr. Martin Ochs, Chairperson, Mass Communications Unit, American
University in Cairo
Dr. Mervat el Rafie, Professor of Public Health, Cairo University
Dr. Moukhtar el Tohamy, Dean of Communications, Cairo University
Mr. Moustafa el Anany, Director of Health Programs, Television
Dr. Moustafa Hamami, Vice Minister of M.O.H. for Primary Health Care
and Family Health
Dr. Nabil Younis, Gynecologist, Al Azhar
Dr. Nadia Farah, Coordinator of Woman’s Health Book Project
Ms. Nagwa Farag, UNICEF
Dr. Naira el Akkad, Professor of Pediatrics, Al Azhar University
Dr. Olfat Kamel, Professor of Public Health, Mansoura University
Dr. Refeit Kamal, El Akhbar Newspaper
Dr. Saadia Abd el Fatah, Prof. of Pediatrics, Ain Shams Univ.
Dr. Said Ewaase, MOHP
Dr. Salah Madkour, Director General for Communicable Diseases Control
Department
Ms. Samia Sadek, President of Egypt Television
Dr. Samiha Gabriel, Director of Censorship, Television
Dr. Samiha El Katsha, American University in Cairo
Dr. Sarah Loza, SPAAC Research
Dr. Shafika Salh Nasser, Professor of Public Health, Cairo University
Dr. Sayed Hilal, Dean of Pharmacy, Cairo University
Dr. Soad Hussein, Professor and Director of Nursing Institute, Assyut
University
Dr. Sobhy Moharram, UNICEF
Ms. Susan Kline, John Snow, Inc. / NCDDP
Dr. Youssef Adrees, Writer, Al Ahram Newspaper
CDC Staff
Dr. Farag Elkamel, Founder
& President
Abdel Fattah Abdel Bary
Dr. Fayka Bakr
Nerman El-Hiny
Walaa Amer
Nadia Kamal
Faten Hassouna
Shaker Elkamel
Tanya Kangas
Ghada Sleem
Impact of the Sehettak Biddonia Project
Several pulications document the impact of this pioneering project. These are included elsewhere in this site:
This article is an extensive review of the evaluation studies that were conducted to evaluate The Family House television series. It was published in Health Education Research, 10, No. 2, Oxford University Press. June 1995.
Abstract
This paper reviews evidence of the impact which television
generally, and drama series in particular, can have on health beliefs,
attitudes and behaviours, it describes how a television series, TheFamily
House, was planned in Egypt to disseminate key health messages in an entertaining
context. As only a very small number of television series were specifically
developed to address health issues, and even fewer were evaluated, this paper
presents important new data derived from focus group discussions and survey
interviews which help in understanding the potential television series can have
for health education, Finally, the paper presents data on the
cost-effectiveness of TheFamily House series.
Introduction
The family is the true primary health care provider. Almost all
health care actions begin at home and, even when a doctor has been consulted,
it is the family which must continue providing the appropriate care. For the family
to do so, however, it has to be empowered with the necessary information,
skills, beliefs and attitudes. In this day and age, television is proving to be
one of the most effective vehicles for achieving such an objective. The success
of televised health programmes has been well documented in Egypt. A 7 year
campaign of televised public service announcements advocating oral rehydration
therapy for children suffering from diarrhea (1983 — 1991) apparently achieved
remarkable success. As early in the campaign as November 1985, only 2 years
after it started, The British Medical Journal (1985) concluded that “the
lives of more than 100 000 Egyptian children have been saved as a result of
what may be the world’s most successful health education campaign”. Egypt’s
infant mortality rate due to diarrhoea declined from 29.1in 1983 to 12.3 in
1987, while non-diarrhoeal mortality rate declined during the same period from
35.6 to 32.8. This is a decline of 57.7% of diarrhoeal mortality compared with
7.9% of non-diarrhoeal mortality. For children 1 —4 years of age, the rates of
diarrhoeal mortality were 4.0 in 1983 and 2.3 in 1987, while the rates were 6.0
and 5.5, respectively, for non-diarrhoeal mortality. This means a decline of
42.5% in comparison with 8.3% during this period (El-Rafie et al., 1990). More
recent statistics show a 65.4% reduction in diarrhoea-related infant mortality
between 1983 and 1989, and a 72.9% reduction in diarrhoea-related child
mortality during the same period.
A second campaign aired on television between 1987 and 1991
consisted of short, 1-3 min dramas aimed at persuading women to plan their
families and to use contraceptives to space births. These dramas proved very
popular: more than 95 % of those interviewed knew of the main characters and
correctly described the family planning methods addressed.
Egypt’s birth rate took a downward turn after this campaign and
the rate of population increase subsequently declined from 3% in 1985 to 1.8%
in 1992(Al-Ahram Newspaper, 1994). The television messages used in these two
campaigns were based on drama, where short commercials of 1 or 2 min were
episodes of a series, some featuring popular soap opera stars, and always
ending with “cliff-hangers”, just like longer drama episodes.
In both campaigns described above, television was the main medium
in a multi-media public education campaign. The data on infant mortality and
birth rates are based on national vital statistics and show strong evidence of
behaviour change. However, neither television nor other means of health
education could have caused this change without the support of other
socio-cultural and structural factors, such as improved services and more
affordable costs. The exact contribution of each factor to the overall outcome
is of course difficult to measure and discussion is beyond the scope of this
paper.
Television series, on the other hand, are among the most popular
television material. However, a series is more like the media itself, in the
sense that its impact is neither positive nor negative in absolute terms, as
this depends, for example, on how a series is designed and for which purposes.
A striking case of the possible negative Impact of television series is
documented by Phillips (1982), who presented systematic evidence that violent
fictional television stories trigger imitative deaths and near fatal accidents
In the US. He analyzed data compiled by the National Center for Health
Statistics for 1979, and concluded that the incidence of suicides, motor
vehicle deaths and accidents rose immediately following ‘soap opera’ suicide
stories.
While this type of impact may be an extreme case, unplanned
television series and other entertainment material can cause different
unintended effects, some of which may be harmful. On the other hand, planned
series and entertainment materials have been shown to achieve impressive
results in health education. The Ugandan film, It’s not Easy, which the use of
condoms for AIDS prevention, has been described as so effective that those who
had seen it were more than twice as likely to have used condoms in the 2 months
prior to the interview, as were those who had not seen the film (Piotrow e!
al., 1992). In the Philippines, a popular music video intended to encourage
youth to postpone sex and avoid unwanted pregnancy resulted in enhancing youth
communication with their parents. It also motivated over 150 000 Filipino
youths to call a sexual responsibility hotline promoted in the television
videos featuring musical stars (Turner, 1992). In Turkey, 240 000 women are
estimated to have adopted modern family planning methods as a result of
television dramas and humorous spots (Church and Coller, 1989). In India, a
study on the Hum Log soap opera, a planned television series with
educational messages, found that 47% of those who wrote letters to the
producers reported that their beliefs concerning a social issue had changed due
to Hum Log and 7% indicated that their bchaviours had changed due to the
programme (Rogers and Singhal, 1991).
In the US, and as a result of a planned media campaign which
utilized short spots and messages embedded within soap opera dialogue, the
concept of the ‘designated driver’ became sufficiently well known that 52% of
Americans under the age of 30 had actually acted as designated drivers. Among
all alcohol drinkers; 28% had been driven home by a designated driver, as had
43% of “frequent drinkers” (Winsten, 1993).
Television series have been considered effective vehicles for
educational messages since 1976, when Mexican national television aired a
popular 1 year-long soap opera, Ven Commigo, advocating literacy During
that year 839 943 people registered for literacy classes in the Open Education
System, nine times the number of registrants in 1975 and twice the number of
those registered in 1977 (Rogers et al., 1989). A subsequent soap opera
addressing family planning concerns, Accompaname, has been credited with
being “the determining factor in the drop of Mexico’s population growth
rate from 3.1 to 2.5%” during the period it was aired from 1977 to 1978
(Galindo and Poindexter, 1986).
These results should not be interpreted as necessarily indicating
causal relationships between television series, or television generally, and
the reported behavioural change. In almost all of these cases, specific
services, legislation and other structural adjustments, as well as other
multi-media programmes, were synchronized with such television campaigns. It
is, however, difficult to ascertain the relative contribution of each of these
elements in causing the reported behavioural change. Nonetheless, it is
reasonable to assume that the mass media component made a significant
contribution.
The potential for educational series in Egypt
The potential of television series to promote literacy, family
planning, and other health and social beliefs, attitudes and behaviours has
encouraged a few countries, including Brazil, India, Kenya, Nigeria and Egypt,
to produce their own educational series,
Egypt’s experience, however, has the potential to add an important
dimension, because of her position as an exporter of series to other countries
in the Middle East. This experience is also important because The Family
House, the educational series Egypt produced, does not address only one
issue, like most series discussed above, but a number of inter-related health
and social problems.
In Egypt, over 90% of nightly viewers tune in to television series
(Union of Radio and TV, 1987). This is quite significant, considering that over
95 % of the populace is reported to have regular access to television (AED,
1988). The need to use television for health education is made more salient by
the relatively high illiteracy rate in the country, where 65% of women and 35%
of men are reported to be illiterate (UNESCO, 1991). Illiteracy rates are
higher among rural and low-income segments of the population, which deprives
them of educational opportunities via the print media, leaving television as
one of only a few other alternatives to deliver health messages to these
segments of the population. This becomes even more important when we realize that
most health problems are also disproportionately distributed with the rural and
illiterate populations tending to suffer more from preventable childhood
diseases and higher maternal mortality largely due to inadequate family
planning and child spacing (CAPMAS, 1988).
Method
Intervention: The Family House – objectives, development
and airing
The Family House, which was intended to address a
number of inter-related health and social problems, was developed in Egypt as
the first systematic effort to use television series for health education. The
main objective of this intervention was to test its potential for attracting
the attention and interest of the typical soap opera audience. The series was
conceived, developed, written and produced by the Center for Development
Communication (CDC) between 1990 and 1992, and was broadcast in Egypt and
Morocco in 1993, and in Lebanon in early 1994.
The Family House television series was planned to
consist of an indefinite number of parts, each consisting of 15 episodes. Each
episode lasts approximately 45 min. The series reflects Egyptian culture in
terms of clothing, life styles, environment, moral standards, common values,
social norms and rituals. Events take place in different urban and rural
settings, and the main characters represent different socio-economic and
regional backgrounds. All characters speak colloquial Egyptian, with variations
corresponding to their areas of origin. All medical information is presented in
simplified terms and the content of each episode was certified medically correct
by a review panel of medical experts. Well known actors and actresses star, not
only to attract a large audience, but also to lend credibility to the
information presented. The main characters are an artisan named Amena, her
husband, Hashem, who had mysteriously disappeared 15 years earlier; their
children, Khaled and Hanaa (in their 20s), and Yasmeen (teenagers); Dr Omar, a
kind physician who becomes attracted to Amina; and his daughter, Wesam.
Television series thrive on problems of a wide variety – such as
kidnapping, infidelity, deaths, jealousy, accidents, murders, etc. While The
Family House draws on a wide pool of these ‘typical’ problems depicted in
soaps, health and social problems are emphasized. These include acute
respiratory infections (ARI), drug addiction, home accidents, child spacing,
child brides and AIDS. Such (and information about coping with them) are woven
into the story, providing some of the dramatic problematic elements required.
Once introduced, the problems are dealt with over the course of several
episodes as in the standard soap opera format. Information and issues are
explicitly presented, but never in a formally didactic way. Characters do not
address the audience directly nor is the information presented outside the
dramatic story line.
Evaluation of The Family House
Two studies were conducted to evaluate the impact of The Family
House. The first study utilized focus group discussions and the second consisted
of a national survey of 600 adults. Seven focus group sessions were held during
the week of 9 — 15 August 1992. Each group comprised approximately six
people. Of the seven groups, four were all men and three were all women. The
groups were shown the first episode of TheFamily House and were
then asked to evaluate it as well as discuss other daily series they had seen
on television recently (Diase, 1992). Four of these seven sessions were held
with semi-literate and literate men or women in Cairo, while three sessions
were held with illiterate and semi-literate men or women in neighboring rural areas
of ‘Wadi Natroun’ and ‘Kafr Ghatati’.
After all the episodes of the series had been broadcast on
Egyptian television in December 1993, 630 adult television viewers were
interviewed in a national cluster-sample survey. Only 30 viewers were found to
have not watched it and they were, therefore, not included in the analysis. The
sample was distributed among the three main regions: Metropolitan Cairo, the
Delta and Upper Egypt as per the population distribution, according to the 1986
Census. Of the total sample of 600 viewers who watched TheFamily
House, 256 cases were in rural areas and 344 were in urban areas. The
sample was divided equally between men and women viewers, and consisted of
clusters of 16-20 randomly selected interviewees.
Results
Focus group discussions
The objective of this study was to assess viewers’ potential
interest in health messages and to pre-test their reaction to the main entertainment
elements, such as music, plots, stars, pace, sound effects, etc, in order to
give immediate guidance for programme production.
The study revealed that viewers of television series in Egypt not
only did not mind watching a series which contained educational messages, but
they also stated clearly that “a good series entertains as it addresses
problems of ordinary viewers”. In fact, the potential to learn something
from a series was found to be a factor which affected whether viewers would
like it or not. Furthermore, participants consistently stated that they
believed that all series had goals and that this was a positive thing. “All series
have goals, that’s why we watch them. They attract us because they teach us a
lot of things.” Before focus group moderators brought up the topic of learning
from television series, participants repeatedly stated that they preferred
series that they learned from. They provided moderators with numerous examples
of things that they felt they had learned and/or were currently learning from
television series.
The health messages in TheFamily House came mostly
from Dr Omar, the positive role model physician in the series. The study found that
he was a unanimously popular character. On the other hand, participants
disliked Amina and Yasmeen, both intended to be negative role models. When
participants were asked to remember what the health messages in the episode
were, the majority of women correctly stated them. Men, however, were less
likely than women to remember these messages. Since the health messages in
question had to do with child care and prevention of ARI, one possible
interpretation for this difference is that it may be a reflection of the
division of labor in many Egyptian families, where women hold primary
responsibility for the health care of their children.
The majority of female participants in the focus group discussions
were so enthusiastic about The Family House that they ranked it as
possibly better than other series. While men were slightly less enthusiastic,
they still ranked it as either better than or as good as other series. This is
impressive for a series which is intended to be educational as well. The reason
for this, according to participants, is that TheFamily House has
most of the criteria which characterize a ‘good’ series, which participants
identified as being based on (1) a realistic, and (2) a well-acted story, that
is: (3) entertaining, (4) educational, (5) set in modern Egypt, (6) including events
in the countryside, (7) depicting characters who are “people like us” (8) involved
in a variety of problems, which are (9) eventually solved (10) to the benefit
of the good characters in the story (Diase, 1992).
National survey
This survey aimed at evaluating (1) viewers’ understanding of and liking
for the series as a whole, and (2) their reaction to specific health themes and
entertainment elements.
Table I presents data on viewers’ evaluations of the entertainment
value; learning from the series; evaluation of the educational value; and
desire to see a second part, which is an indirect measure of overall attitude
towards the first part. The data are broken down in Cairo by socio-economic
level of neighborhood, and in Lower and Upper Egypt by urban/rural residence.
As shown in Table I, 83 % of viewers liked the series, 79% reported learning
from it and 75% stated that they would like to watch the second part of the
series. However, viewers in Lower and Upper Egypt clearly liked the series and
learned more from it than Cairene viewers.
The contrast is even sharper between those who liked the series in
rural Lower Egypt (88%) or rural Upper Egypt (91 %), and viewers from high
income Cairene neighborhoods (only 59%). The same pattern applies to the other
two measurements in Table I, i.e. learning from the series and desire to watch
its second part.
Table II, on the other hand, shows the differences between males
and females in the three regions. Here too, a clear pattern exists, where women
in the sample reacted much more positively to the series than men. A closer
look at the data reveals that women who lived outside Cairo were much more
positive towards the series than Cairene women. In the Delta (Lower Egypt)
region, nine out of every 10 respondents liked the series, learned from it and
indicated a desire to watch a second part; very similar responses were provided
by women from Upper Egypt. On the other hand, Cairene women were not only less
positive than non-Cairene women, but also less positive than Cairene men.
However, when Cairene women are classified into the two categories of low and
high socio-economic residential areas, we find a possible explanation in that
81 % of low income women liked the series compared with only 55% of high income
women.
The same explanation applies to the unexpected distribution of
Cairene men and women in respect of their desire to watch the series’ second
part. Further analysis of the data reveals that
Cairene women who live in high-income neighborhoods were the least
positive. Only 42% of them indicated any desire to watch, compared with 67% of
Cairene women coming from lower-income neighborhoods. Table Ill presents data
on liking the series among low- and high-income women viewers, and Table IV
shows the desire to watch part II among low- and high-income Cairene men and
women viewers.
The most frequent reasons given by participants for liking the
series were that it dealt with family and social problems; it treated health
issues, particularly AIDS and drug addiction; the story was interesting. Most
of those who did not like the series criticized the acting, film directing or
felt that some of the events were unrealistic.
As indicated earlier, most of these criticisms came from more
sophisticated urban viewers. Viewers who said that they learned from the series
were asked to state examples. Among the most frequently mentioned examples
were: causes and prevention of AIDS, importance of belonging, roots, importance
of giving sufficient care to one’s children, seriousness of drug addiction,
importance of good parent-child communication, benefits of child spacing and
family planning, disadvantages of early marriages, as well as general good
values such as patience, respecting other people’s opinions and not giving up
hope.
Discussion
It should be emphasized that the two studies conducted to evaluate
The Family House series focused on measuring viewers’ attitude towards
the series itself, and on assessing the acceptability and suitability of this
form of communication for disseminating health messages. The intention of this
intervention was not to change behaviour per se, as the first 15 episodes were
intended to establish rapport with, and gain the acceptability of, soap opera
viewers, which would make it easier for the following episodes to include
specific themes and messages aimed at behavioural change. The series would then
need to be coordinated with other communication efforts, and with other
interventions including other relevant socio-cultural and structural factors.
For this reason, the evaluation studies reported above have relied on the
interviewees’ evaluation of their own reactions and attitudes towards the
series, its characters, and the health themes it contained.
The single most important behavioural criterion was, however, watching the series itself.
Evaluation of subsequent episodes, on the other hand, must utilize revised
methodologies more appropriate for measuring the impact of the series, if any,
on specific health behaviours. This could include, for example, pre-post
designs and the inclusion of relevant health behaviour outcomes. In the
meantime, the following conclusions appear to be important in the context of
the present study.
(1) One of the encouraging aspects of these results is that the
series was liked more by rural than by urban viewers and more by women than
men. It is indeed these segments of the population which need an enhanced access
to health information, and the challenge has always been how to reach them more
effectively through national campaigns which have tended to reach men and urban
audiences better (Elkamel, 1983).
(2) It is interesting to note that results based on only seven
focus group discussions with a total of less than 40 people and based on
watching only the first episode of the series are in full agreement with the
findings of a national survey of 600 persons who watched the full 15 episodes.
This emphasizes the value of both qualitative and quantitative research methods
in evaluating the potential impact of communication material. It is generally
believed that entertainment material, such as television series, are among the
most difficult to evaluate.
(3) Television series as a vehicle for health education can be a
cost-effective approach. The Family House has been watched by almost 95%
of the Egyptian adult population and about 80% of them reported learning health
messages as a result. Egypt’s population in 1993 is estimated to be 56,060,000,
of whom 61 % are older than 14 years (UN, 1992). It can be estimated,
therefore, that more than 27 million adults in Egypt alone learned some health
messages. As the production cost for all 15 episodes was approximately $360,000,
the per capita cost for each adult who saw the series is about 1 US cent, and
the cost for each adult who saw and learned at least one message from the
series is less than 1.4 US cents. This per capita cost is further reduced when
we include the numbers of viewers in Morocco and Lebanon, who have already seen
the series, as well as those who have yet to see it. Furthermore, marketing of
the series may generate resources which would further reduce the per capita
cost and help towards the production of new episodes.
Acknowledgements
The author wishes to acknowledge the support and encouragement of
Dr David Nyggard, Dr Sitoo Mukerji, Dr Jocelyn Dejong, Dr Phyllis Piotrow, Dr
Fawzy Kishk, Dr Sandra Lane, Mr. Patrick Coleman, Mr. Moncef Bouhafa, Mr. Jose
Rimon, II, Ms Bushra Jabre, Dr David Nostbakken, Dr Tomas Neumann and Dr Nawal
Fouad. The Family House Project has been supported by grants from the
Ford Foundation, The International Development Research Centre (IDRC) and The
Johns Hopkins University.
References
Academy for Educacational Development (AED) (1988) Communication Makes a Difference. Final report on the Egyptian Population Project. AED, Washington, DC.
Al-Ahram Newspaper (1984) President Mubarak receives United
Nations population prize. Al-Ahram Newspaper, February 26.
British Medical Journal (1985) Egypt’s Triumph with Oral
Rehydration. British Medical Journal, 291, 1249.
Central Agency for Public Mobilization and Statistic (CAPMAS) and
UNICEF (1988), The State of Egyptian Children. Cairo,
Egypt.
Church, C.A. and Coller, J. (1989) Lights, camera, action:
promoting family planning with T. V. , video and film.
Population Reports, Series J, December (38), 1-31.
Diase, M. (1992) Focus Group Discussions of Episode 1 of the
Egyptian Public Health Serial ‘TheFamily House‘. The Center for
Development Communication, Cairo, Egypt.
El-Rafie, M., Hassouna, W.A., Hirshhorn, N., L.oza, S., Miller, P.,
Nagaty, A., Nasser, S. and Riad, S. (1990) Effects of diarrhoeal disease
control on infant and childhood mortality in Egypt. Lancet, 335, 334-338.
Elkamel, F. (1983) Knowledge and practice gaps resulting from
development communication. Paper presented at the Conference on Communication,
Mass Media, and Development, North- western University, IL, October 13—15.
Galido,C. and Poindexter,D. (1986) Using soap operas to promote
family planning. Populi, 13, 30-38.
Middle East Marketing and Research Bureau (MEMRB) (1991) Eight
Case Histories. Amman, Jordan.
Phillips, D. (1982) The impact of fictional television stories on
U.S. adult fatalities. American Journal of Sociology, 87, 1340-1359.
Piotrow, P., Meyer, R.C. and Zulu,.A. (1992) AIDS and mass persuasion.
In Mann, J., TarantoIa, D. and Netter, T. (eds), AIDS
in the World. Harvard University Press, Cambridge, MA, pp. 733-747.
RadaResearch (1991) Formative Research Study. RadaResearch, Cairo,
Egypt.
Rogers, E.M., Aikat, S., Chang, S., Poppe, P. and Sopory, P.
(1989) Proceedings of the Conference on Entertainment-Education for Social
Change. The Annenberg School of Communication, University of Southern
California, March 29-April 1.
Rogers, E.M. and Singhal, A. (1991) The ‘Log’ story: from concept to
after effects. In Communication 2000 AD. Silver Jubilee
Commemorative Communication, pp. 17-25.
Ross, J.A., Rich, M., Molzan, J.P. and Pensak, M. (1988) Family
Planning and Child Survival: 100 Developing Countries. Columbia University
Press, New York.
Turner, R. (1992) Musical message reaches youth in the
Philippines. International Family Planning Perspectives, 18, 29-40.
UN Population Division (1992) Estimate for 1993. UN, New York
UNESCO (1991) Statistical Yearbook. UNESCO, Paris.
Union of Radio and TV (1987) Moshahadat al Television al Masri, Cairo,
Egypt.
Winsten ,J. A. (1993) Overview: The First Seven Years. Center for
Health Communication, Harvard School published).
The following is an image of the same paper as Published in Health Education Research Journal
In addition to the article that was was published the Health Education Research journal, another article with new data was published in the Eastern Mediterranean Health Journal المجلة الصحية لشرق المتوسط, Volume 4, (1), 1998, World Health Organization (WHO) . The article is presented below:
Soap Operas May be Good for Health: Impact Evaluation of the Egyptian Soap Opera, The Family House
Farag M. Elkamel
Introduction
Family House is an Egyptian soap opera consisting
of 15 episodes, each lasting about 45 minutes. This series was devised in order
to use the entertainment approach and format of a soap opera to convey health messages
designed to create awareness, give knowledge and change attitudes and behaviour
with regard to several health problems, including acquired immunodeficiency
syndrome (AIDS), acute respiratory infections (ARI), home accidents, drug addiction,
child marriages and child-spacing.
The Family house was created in 1992-1993 by the
Center for Development Communication (CDC), Egypt, and was supported by grants
from the Ford Foundation, the International Development Research Center (IDRC)
and United States Agency for International Development (USAID). It was broadcast
in Morocco in 1993 and in Egypt and Lebanon in 1994. The Family House will
eventually air in other countries of the Region.
The objective of this project was to test the potential impact of
television material, particularly a drama series, on the knowledge, attitudes
and behaviour of the general public, particularly women. The rationale for the
project is that such material captures the attention of the majority of
viewers, more so than any other type of television programme, and this provides
an excellent opportunity to reach the general public. The project also aimed to
establish which socioeconomic and demographic categories of public were likely
to benefit most from such an approach.
After Family house was aired in Egypt in January 1994, a survey of
600 viewers was carried out to assess audience feedback. The cluster sample was
randomly selected from Upper Egypt, Cairo and the Delta; it reflected the
urban-rural distribution of the population and males and females were equally
represented (Table l).
Findings
One of the evaluation criteria was the perceived entertainment
value of Family house. Respondents were, therefore, asked whether or not they
had liked it. As an indirect measurement, they were also asked whether or not
they would like to see a sequel. A second evaluation criterion was the educational
value of the serial. Participants were asked a number of questions which aimed
at assessing what, if anything, they had learned from watching The Family
house.
The findings were encouraging on both counts. The majori1Y of
respondents (82.5%) liked the serial, 74.0% said that they had learned from it
and 79.0% expressed a positive attitude towards a sequel.
The findings also revealed that women audiences in rural areas and
semi-literate viewers particularly liked the serial and learned more from it
than other segments of the audience (Table 2). Table 3 shows the relationship between
the educational level and appreciation of the Family House.
Most soap operas and other entertainment material usually appeal
to the middle classes and often to urban viewers. The fact that rural and
illiterate viewers particularly liked the Family House is consistent
with the educational objectives of the serial; it is those segments of the
audience who are most in need of the educational 111tssages it contained.
Those who said that they had liked the serial were asked to state what
they liked most. Of those, 18% mentioned a particular actor or actress as what
they liked most, 17% liked particular scene or events, 12% mentioned AIDS, 10%
liked the educational messages generally, 8% mentioned the theme of caring for
one’s children, 8% liked the songs, 7% liked the story on addiction and the
rest mentioned various other things.
Those who said that they had learned from the serial were also
asked to give examples of what they had learned. The most frequent answer was
related 10 the causes and prevention of AIDS. Table 4 shows what the
participants considered the most important things they had learned from watching
the Family House.
Knowledge of how AIDS is transmitted was quite high among
respondents; 85% mentioned that AIDS is transmitted through contact and about
90% mentioned blood transfusion, contaminated needles of injecting drugs. Of
those who knew how AIDS is transmitted, 9% stated that they had acquired this information
for the first lime from the Family house. However, this figure increased
15% among those with less than high school education, to 12% among female
viewers and to 14% among rural viewers.
Conclusion
The potential of entertainment as a communications approach for
health education is once again emphasized by this data. Some of the promising
features are:
The overall
liking of this “educational” television serial was high and compares well
with serials which are produced solely for entertainment purposes.
A large
percentage of the audience did indeed learn from the serial and mentioned
specific information they had acquired.
Nine per cent
(9%) of viewers learned of the causes and prevention of AIDS for the first time
from the serial; this is a major gain, given the initially high levels of
knowledge of the subject among the audience.
Perhaps the
most promising finding is that the traditionally information-deprived segments
of the population, namely women, rural residents, semi- literates and youth,
clearly liked the serial and learned more from it than other segments of the population.
This may be a breakthrough as it has always been difficult to deliver
development messages through mass media to these segments of the population,
when they are the ones most in need of them.
Below is the article as published in the Eastern Mediterranean Health Journal المجلة الصحية لشرق المتوسط, Volume 4, (1), 1998, World Health Organization (WHO)
Farag Elkamel is a YouTube channel dedicated to featuring media campaigns that have been planned, written, directed and produced by Dr. Farag Elkamel. Numerous evaluation studies indicate that these campaigns have been instrumental in saving a million lives.
(All videos have English subtitles.)
هذه القناة https://www.youtube.com/faragelkamel مخصصة لعرض الحملات الإعلامية التى قام د. فرج الكامل بتخطيطها وكتابتها وإخراجها وإنتاجها. وتشير نتائج الدراسات التقييمية العديدة إلى أن هذه الحملات قد ساهمت فى إنقاذ مليون إنسان فى مصر من خطر الموت.
1. Hepatitis C Prevention & Treatment, Egypt 2015-2016 الحملة الإعلامية لمكافحة فيروس سى، مصر
2. The Family Planning Campaign, Egypt, 1987-1992 الحملة الإعلامية لتنظيم الأسرة، مصر
3. The Oral Rehydration Campaign, Egypt, 1983-1989 الحملة الإعلامية لمكافحة الجفاف، مصر
4. Polio Eradication Campaign, 1984-1993 الحملة الإعلامية للقضاء على شلل الأطفال، مصر
5. Environmental Protection and Water Conservation Campaign, Egypt, 1987-1995 الحملة الإعلامية للحفاظ على البيئة ومياه الشرب، مصر
6. Using Video to Change an Egyptian Village, 1995 استخدام الفيديو لتغيير قرية مصرية
7. HIV/AIDS Awareness Campaign, Saudi Arabia, 1991-1992 الحملة الإعلامية للتوعية بالإيدز، السعودية
8. Family Planning Campaign, Jordan 1986-2000 الحملة الإعلامية لتنظيم الأسرة، الأردن
9. Entertainment-Education TV Soap Operas, 1989-1997 استخدام المسلسلات الدرامية فى رفع الوعى الصحى والاجتماعى
10. “Your Health is Worth the Whole World” Project, 1984-1985 مشروع “صحتك بالدنيا”
Some suggested references on the impact of these campaignsبعض المراحع عن تأثير هذه الحملات:
Farag Elkamel 