The Use of Videos in the Prevention of Chagas Disease in Ecuador
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The Use of Videos in the Prevention of Chagas Disease in Ecuador A thesis presented to the faculty of the Center for International Studies of Ohio University In partial fulfillment of the requirements for the degree Master of Arts Julia C. Nogueira August 2008 2 This thesis titled The Use of Videos in the Prevention of Chagas Disease in Ecuador by JULIA C. NOGUEIRA has been approved for the Center for International Studies by Rafael Obregon Associate Professor of Telecommunications Betsy J. Partyka Director, Latin American Studies Daniel Weiner Executive Director, Center for International Studies 3 ABSTRACT NOGUEIRA, JULIA C., M.A., August 2008, Latin American Studies The Use of Videos in the Prevention of Chagas Disease in Ecuador (148 pp.) Director of Thesis: Rafael Obregon More than 20 million people in the world are infected with Chagas disease in 18 Latin American countries, and 50,000 people die a year from the illness. Since there is no vaccine for Chagas and the cure is only effective in rare cases, prevention is fundamental to combat the disease. Different health communication theories present ways to achieve behavior change, but little has been done regarding Chagas. And the existent educational materials and videos were not produced following health communication theories. Due to the lack of awareness and proper educational materials dedicated to Chagas, this thesis created a series of preventative public service announcements and an educational video. To guarantee they were adequate to the target audience’s needs and capability of action, the videos were pre-tested with 129 community members from Ecuador. The research concludes that presenting adequate information and using an appropriate language to the target audience’s comprehension is fundamental to the effectiveness of video materials. Pre-testing video materials and making indicated changes before implementation is also fundamental. This research also created and suggests the implementation of a complete Communication Strategy for Chagas disease prevention in Ecuador. Approved: _____________________________________________________________ Rafael Obregon Associate Professor of Telecommunications 4 To my dearest godmother Heloisa Conrado (in memoriam) 5 ACKNOWLEDGMENTS A special thank you to my parents Ralfe and Diva, my sister Paula, my beloved Gustavo and my family for supporting me in this academic journey outside of Brazil. To my advisors Dr. Rafael Obregón, Dr. Mario Grijalva, and Eric Williams for believing in me, supporting and helping me during this research. To the Ohio University Tropical Disease Institute and the Centro de Investigación en Enfermedades Infecciosas/Pontificia Universidad Católica del Ecuador (CIEI/PUCE) for financing my thesis research and believing in my capacity to produce the videos they will be using in their future activities. To all the Ohio University students who kindly worked with me in the production of the videos done by this project, performing fantastic works of camera, sound, editing, animation and narration. To Dr. Grijalva and the personnel from CIEI/PUCE for their help, support and friendship during this research and to the people in the communities in Loja and Manabí provinces in Ecuador that participated in the shooting and pre-testing of the videos. To the many friends that patiently revised my scripts in Spanish and English. To the Brazilian friends that are waiting for me in my home country and the new ones I had the chance to meet during this research in Athens, and also to the new friends from the United States and other different parts of the world who gave me important advices and were there for me when I needed help and support. 6 TABLE OF CONTENTS Page Abstract............................................................................................................................... 3 Dedication........................................................................................................................... 4 Acknowledgments............................................................................................................... 5 List of Tables .................................................................................................................... 10 List of Figures................................................................................................................... 11 1. Introduction............................................................................................................... 12 2. Background and Theoretical Framework...................................................................... 16 2.1. Chagas Disease ...................................................................................................... 16 2.1.1. Chagas Around the World .............................................................................. 18 2.1.2. The Fight against Chagas Disease ................................................................. 20 2.1.3. TDI and the Community Based Chagas Disease Research Project................ 21 2.2. The Role of Communication in Chagas Control ................................................... 22 2.2.1. Previously Produced Printed Materials ......................................................... 22 2.2.1.1. Educational Booklet................................................................................. 22 2.2.1.2. Calendar ................................................................................................... 24 2.2.1.3. Pamphlet .................................................................................................. 25 2.2.1.4. Brochure................................................................................................... 26 2.2.1.5. Chagas Disease CD Insert........................................................................ 26 2.2.2. Previously Produced Videos ........................................................................... 27 2.2.2.1. Chagas Disease Prevention Campaign in Manabí ................................... 27 7 2.2.2.2. Chagas Disease Prevention Campaign in Loja ........................................ 29 2.2.2.3. Community Based Chagas Disease Research Project – Loja .................. 31 2.2.2.4. Chagas: A Hidden Affliction ................................................................... 32 2.2.2.5. Video and Song about Chagas Disease.................................................... 33 2.2.2.6. Kids without Chagas................................................................................ 34 2.2.3. The Gap in Chagas Related Communication Materials ................................. 35 2.3. Health Communication Theoretical Framework ................................................... 36 3. Message Design and Pre-testing Methodology............................................................. 55 3.1. Message Design ..................................................................................................... 55 3.1.1. Script Writing – Educational video................................................................. 57 3.1.2. Script Writing – PSAs ..................................................................................... 59 3.1.3. Video Editing .................................................................................................. 62 3.2. Research / Pre-Testing Design............................................................................... 63 3.2.1. Pre-Testing of Pre-Scripts .............................................................................. 64 3.2.2. Participants in the Pre-Testing....................................................................... 66 3.2.3. Pre-testing Procedures ................................................................................... 67 3.3. Findings and Discussion of Pre-Testing ................................................................ 70 3.3.1. Findings of Pre-Testing of Educational Video ............................................... 72 3.3.2. Findings of Pre-Testing of PSAs..................................................................... 76 4. Recommendations – A Communication Strategy..................................................... 78 4.1. Goals and Objectives ............................................................................................. 81 4.2. Materials of Communication Strategy................................................................... 83 8 4.2.1. Educational Video........................................................................................... 86 4.2.2. Public Service Announcements ....................................................................... 86 4.2.3. Radio Spots ..................................................................................................... 87 4.2.4. Promotional Video .......................................................................................... 87 4.2.5. Educational Booklet........................................................................................ 88 4.2.6. Calendar ......................................................................................................... 88 4.2.7. Pamphlet ......................................................................................................... 89 4.2.8. Brochure ......................................................................................................... 89 4.2.9. Website............................................................................................................ 90 4.3. Implementation