Action Media: Consultation, Collaboration and Empowerment in Health Promotion

This paper presents "action media" as a methodology for the development of media products that integrates the interests of both the communicator and representatives of intended audiences within a health promotion context. This methodology has its roots in participatory action research (PAR) approaches and incorporates qualitative contextual research with a media development process. Warren Parker describes the methodology in detail, illustrating it with a range of examples of activities and media products developed for the promotion of socially marketed condoms in the Soweto township near Johannesburg, South Africa.

In the paper's first section, Parker explores linear models of communication in the communication for health promotion context. These models, often referred to as communicator-message-receiver (CMR) models, incorporate the communicator as a primary agent in determining the nature of information and the mechanisms for information flow. Conventional CMR approaches emphasise how meaning is made, rather than how messages are understood by ordinary people. As Parker explains, these conventional communication models are sometimes supplemented with semiotics and semiology (per Wikipedia, the study of sign processes or signification and communication signs and symbols). However, from Parker's perspective, neither CMR models nor semiotics and semiology provides for sufficient collaboration, or a balance of interests, between communicators and receiver/readers.

According to the author, typical methodologies for the development of health promotion communication are professionalised and tend to be based on CMR theories, with the addition of feedback and research elements to facilitate the refinement of communication messages. For example, analysis of research data may show low levels of child immunisation. The initial communication requirement would be raising awareness and promoting services. Health and communications professionals would work together to assess potential audiences, develop key messages and concepts, pre-test these with representatives of the intended audience, and then go on to develop finalised media products. Parker explains that there are a number of shortcomings to this approach. For example, health and communications professionals tend to occupy somewhat different socioeconomic contexts relative to broader intended audiences. Also, participants in pre-testing sessions "are limited in terms of choices, and responses to words and images tend to be over-elaborated within analysis that is divorced from context."

The action media approach, on the other hand, involves a process that allows for integration of perspectives of representatives of intended audiences - a process that Parker says "allows for deep reflection around issues that affect their lives" and that "allows for the incorporation of linguistic and cultural perspectives relevant to the target audience....The methodology is such that it engenders action amongst the participants and this impetus can be harnessed in subsequent activities at the individual, group, or local community level." In summary, action media as it pertains to health promotion has the following elements:

• Identification of significant health challenges;
• Identification of sufficiently homogeneous groups within defined geographic areas - for example, youth formations in townships;
• Collaboration with individuals within each context to co-facilitate workshops;
• Recruitment of a core group of 15-20 participants on a voluntary basis for participation in a series of four 3-hour workshops that incorporate highly participatory educative focus group sessions. Other elements include activities such as games, role-plays, songs, distribution and demonstration of condoms and media development. There is also an opportunity for evaluation.

"The media products that emerge typically reveal deep insights into perspectives of the target group, are immediately relevant to the participant's peer communities, and may be relevant nationally as health promotion products....In the case of reproductive health, participants in the process became strongly committed to safer sexual behaviour and promotion of peer awareness. In the case of one group of participants who were tracked longitudinally, there is evidence of committed behaviour change. The methodology differs considerably from producer-centric approaches in that it sees contexts of media utility as dynamic, and furthermore, sets out to generate media products that are supportive of action, rather than simply as vehicles for information."

In the discussion section of the paper, Parker reflects further on the methodology and some of its challenges and characteristics. The health promotion products that emerge through action media tend to be discursive, to raise questions, and to stimulate debate. They do not always fit into conventions of political correctness, Parker claims. For example, the "Viva Condoms" image was viewed by some as an appalling degradation of the new national flag. He notes that: "The power of media products lies not in the direct intention of their messaging, but rather in the contexts within which they are viewed and used. If a media product generates discussion and debate, its relevance within a societal context is multiplied several fold, and is far better than products that seek simply the transfer of specific concepts from communicator to receiver."

Finally, Parker explores the significance of context in the action media methodology. He explains that, even at the level of the individual, subjective responses can be framed by contextual factors, and meaning and interpretation may shift over time. Thus, "it is important that the Action Media methodology is perceived as malleable within the principles that frame it. Researchers, facilitators, resources and contexts frame the application of the methodology and colour the products that emerge. If communication and meaning are framed as dynamic and subjective, then processes that seek to generate meaning should be seen dynamically too."