Quest: Supporting the local design of appropriate health learning materials

Links
Healthlink Worldwide

HIF-Net at WHO

International Institute for Communication and development (IICD)

Department for International Development (DFID)

Full Report: Exchange lunchtime discussion 16 July 2002

Introduction

David Curtis, Regional Link Coordinator South East Asia & Western Pacific, Healthlink Worldwide, set the scene by highlighting the current international debate on the importance of appropriate local content and materials. This has been an enduring concern in the work of Healthlink Worldwide, and was a strand of discussion on the Health Information Forum in 2002. The issue has become important for the G8 Digital Opportunities Taskforce (DOT force), the International Institute for Communication and development (IICD), and the Department for International Development (DFID), among others.

Producing locally appropriate information begs questions such as: where can information be retrieved from (what sources are available locally); what goes on when information is ‘filtered’; how can one create, adapt and produce relevant information; and what kind of approaches will encourage action for improved health and well-being?

David use an 'egg timer' illustration to highlight the two-way nature of the process of ‘filtering’ information: relevant information is obtained from a community, filtered into a final ‘product’, this is relayed back to the community, and may then become one of the sources of information for a new cycle of developing materials.

The Quest approach

‘Quest’ is a methodology for designing effective health learning materials. A flexible interactive framework supports the production of locally appropriate information. Questions guide uesrs through various stages of resource development, and there is an element of reflection at every step.

The Quest methodology aims to:

• increase effectiveness of materials produced
• share good practice based on lessons learned
• avoid duplication of efforts
• build on existing skills and local strengths and knowledge
• encourage collaboration, participation and ownership
• provide a tool for distance learning.

Seven stages form the core of QUEST:

• assessing needs
• planning
• researching content
• developing content
• pre-testing
• production and distribution
• post-production evaluation.

David briefly noted some lessons from a pre-testing workshop in Zimbabwe in April and May 2002. Several important lessons emerged:

• Conduct good background research.
• Set realistic objectives.
• Get the target audience to participate.
• Advocate for change.
• Recognise the social context of communication.
• Build on existing relationships and practices.
• Enlist the support of community leaders.
• Monitor and evaluate your work effectively.
• Ensure sustainibility.

Discussion

Asked how Quest differed from many similar approaches developed over the last decades, David noted that there were many useful resources covering different aspects of the process. However it was the lack of an exhaustive, one-stop resource for information on producing health materials that provided the impetus for developing Quest. Quest is different because it brings all the stages of materials development together, provides a range of guidelines and resources for that particular stage in the process, and includes a component of reflection at every step.

Andrew Chetley, Director of the Exchange programme, added that Quest's proactive approach and focus on process and relevance rather than ‘products’, helps to improve the quality of the outcome. The space for reflection is key, as evaluation is not left until the end of the process, or simply used for assessing materials after they have been developed and used. Quest’s use of extensive pre-testing ensures the relevance and success of health learning materials and bias or ill-conceived assumptions are carefully filtered out. In situations where lack of literacy is an issue, the Quest process should identify this early on and raise questions about the appropriate approach to the design of relevant materials.

Salim Sohani of the Aga Khan Health Services Foundation in Kenya commented on the pivotal role of two-way communication in Quest, mentioning how face-to-face communication is valued and sought out by communities. By being open and beginning from where people were, Quest helps facilitate the crucial two-way dialogue that is often hard to get started.

Group discussions - designing materials exercise

Following the discussion session, participants broke into small groups for a small exercise. The groups discussed key challenges when producing health learning materials for sexual and reproductive health for young people, particularly issues of HIV and AIDS, in a rural area. A range of issues emerged from the group discussions:

Power issues: the power relations at community level; the role of consensus in the community and adults as gatekeepers; the different perspectives and needs of different groups, in this case youth; the national political context; competition among NGOs; reaching those who were marginalised or outside common institutions.

Community participation: sensitivity or community denial when talking about sex or the body, and differences between publicly accepted morality and what people actually do; access to the youth in the community; getting access to girls and not just the boys’ opinions and needs.

Beliefs and perceptions: beliefs and religious morality about disease including that it is to do with witchcraft; young people’s educational level and interests – materials and campaigns should be exciting and engage their interest; rapid change of youth culture and reference points; differences between urban and rural settings in terms of willingness to discuss issues and strength of ‘community’ that may ‘own’ campaigns or materials to good effect.

Approaches/messages: differential access to technology and information for different community members, such as youth; literacy and educational level; role of oral culture and literacy; interactiveness of messages, their frequency and repetition, how well they are understood; is HIV the main concern for youth there?

Conclusion

David closed the meeting with a brief account of the training workshop with Family Aids Caring Trust, one of Healthlink Worlwide's partner organisations, in Zimbabwe in May 2002. At this workshop participants had focused on the same issue that we discussed in the small groups at this lunchtime discussion.

In Zimbabwe, the same challenge in a real life situation had lead to some unexpected results. In this setting, young people expressed a need to talk to their parents about issues relating to sex. The Quest process lead them to redesign their materials to target parents and encourage them to talk with young people about sex. In addition, dialogue with young people at a local college revealed that many students were led into sex work by economic pressures. This new knowledge resulted in an advocacy campaign involving local media in order to highlight poverty on the local campus.

Evaluation of the Discussion

Participants liked the relatively high proportion of participants from the South. Many felt the Quest methodology could be personally and organisationally useful and enjoyed the "great presentation". The general ‘interactivity’ of discussion was commented on by a number of people and the small group work was valued as a space to open up a wide range of issues (though more time would have been valued by some). A number of participants appreciated the background material that was circulated in advance, but at the same time, a number of the visiting students had not had this material. (It was available at the meeting, it is obviously difficult for people to digest in time). Participants appreciated the details of the Zimbabwe case study and one participant felt it could have been used more to highlight what was different about Quest.

Suggestions included: more involvement of students on relevant courses from countries in the south; circulation of the attendance list emails.

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