The Straight Talk Campaign in Uganda: Impact of Mass Media Initiatives

This 121-page report presents findings from an evaluation of the Straight Talk Foundation's (STF) mass media communication programmes, which have been implemented in Uganda since 1993. Produced by Horizons and Straight Talk Foundation, the community-based survey of adolescents was designed to answer several questions related to STF campaigns, as outlined below.

• What proportion of youth is reached by each Straight Talk mass media, community, and school activities?
• Do adolescents who are exposed to STF materials have higher knowledge and more positive attitudes toward safe behaviours than those who are not exposed to these media activities?

Do adolescents who are exposed to STF materials practice more safe behaviours than those who are not exposed?

The STF programmes comprise three synergistic materials:

1. Straight Talk (ST) radio programmes broadcast to various districts in English and 11 other Ugandan languages, aimed at in- and out-of-school youth;
2. ST newspapers in English and six other Ugandan languages, primarily aimed at secondary school students; and
3. an English language Young Talk (YT) newspaper geared toward primary school students. STF also implements a complementary array of school-based activities to engender a supportive school environment. It has invested in many community activities such as health fairs, and has worked to support youth-friendly health care services.

The adolescent household survey was conducted with 2,040 males and females between the ages of 10 and 19 years in 6 districts in Uganda: Apac, Arua, Ntungamo, Soroti, Kisoro, and Kamuli. While ST has been active in all six districts, it has been particularly active in the first four. The study aimed to provide an assessment of the impact of STF in four high intensity and two low intensity districts and an assessment of dose response, i.e. the impact of incremental exposure to ST activities on specific outcomes. Data were gathered using face-to-face interviews after obtaining informed consent from the adolescent's parent or guardian, and from the adolescents themselves.

The evaluation suggests that exposure to STF materials has improved adolescents' knowledge and attitudes about sexual and reproductive health and helped them to adopt safer behaviours.

• Nearly all secondary school students, two-thirds of primary school students, and more than half of out-of-school youth have been exposed to at least one Straight Talk product.
• For both male and female adolescents, exposure to STF materials was associated with increased knowledge of sexual and reproductive health, a greater likelihood of communicating with parents about these issues, and better attitudes toward condoms.
• STF materials promote empowerment among female adolescents: females exposed to the materials were twice as likely to report high self-confidence, twice as likely to possess more equitable attitudes about gender, and four times more likely to abstain from sex if they had a boyfriend, compared to their unexposed counterparts.
• STF materials have been particularly beneficial in promoting abstinence among male adolescents: males exposed to the materials were less than half as likely to engage in sexual activity and three times more likely to resume abstinence if they had previously had sex, compared to those not exposed. They were also 20 times more likely to consider their current relationship "serious".
• Exposure to STF activities was associated with getting tested for HIV. Female adolescents were three-and-a-half times more likely to have been tested than those not exposed, and male adolescents were nearly four times more likely to have been tested.

The evaluation also revealed some disturbing attitudes among parents, many of whom are unable or unwilling to talk with their adolescent children about sexual and reproductive health. One-quarter of parents feel that males should be favoured when financial resources are scarce; about the same percentage feel that girls are intellectually inferior to boys; two-thirds agree that women should tolerate abuse from their husbands to keep a family together; and one-third report that there are times when women deserve to be beaten by their husbands. Perpetuation of such inequitable gender norms in families can undermine the ability of their daughters and sons to negotiate safer sex practices.

According to the authors, the study presents a rich source of information for programmers who are involved in adolescent sexual and reproductive health (ASRH). Though there is a wide variety of findings from the evaluation, the following highlight just a few issues.

• Sources of Information - When compared to other individuals such as teachers and health workers, parents emerge as the most important, and frequently the most preferred, source of information among young people, even while youth simultaneously question their ability to provide accurate information. The finding that fathers are rather distantly involved in communication with their children, even though their sons and daughters (especially their sons) consider them a most important source of information in the family, suggests that fathers As exposure to STF materials increases, higher proportions of young people mention teachers as important information sources.
• Most Important Among Sources of Information - The study explored three main sources of ASRH information for adolescents: individuals (such as parents and teachers), any radio programmes, or any print materials. Respondents were asked to rank which one they considered most significant of the three sources. The results show that individuals were most preferred, followed by radio, then newspapers. Girls of all ages preferred individuals far more than males, who cite individuals, print media, and radio in nearly equal shares.
• ASRH Knowledge - Greater exposure to STF activities is significantly associated with higher ASRH knowledge, and each incremental exposure is associated with increased knowledge; this relationship holds for both males and females. Despite years of intense media coverage and community dialogue about HIV/AIDS in Uganda, there remains room for improvement in AIDS and reproductive health knowledge among young people. A large proportion of adolescents remain uninformed about HIV. More so than informing youth about the risks of HIV/AIDS, discussed in multiple media and venues across the country by any number of respected sources, there is a need to alert young people to basic sexual risks.
• Knowledge of STIs - The STF products seem to have been particularly effective on the topic of STIs, this topic, as a higher proportion of those living in high media intensity districts, and those exposed to higher numbers of STF materials, are more likely than their counterparts to know about other STIs. Males, urban residents, and those in school (all associated with higher exposure to ST) are most likely to know that other diseases besides HIV/AIDS are transmitted through sexual intercourse.
• Support if Child Sexual Abuse Attempted - Most young people say they have someone to tell if they were pressured to have sex. Living in high media intensity districts and exposure to more STF materials is associated with higher proportions reporting someone to tell, indicating that messages about turning to a trusted adult, in most cases identified by the adolescents as a parent, are being heard and accepted. Girls seem to feel more confident that they can tell someone about abuse, and those exposed to STF products were more confident than those not exposed.