Rpiort No. 5 South Asia Human Development Sector 37836 Final Report: Study to Assess Attitudes Towards Sensitive Messages Public Disclosure Authorized in Pakistan December 29, 2003 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Discussion Paper Series Table of Contents Executive Summary .................................................... 1 Abbreviations and Acronyms .................................................... 4 Background of the Study .................................................... 5 AIDS in Pakistan - The Global Context ................................ 5 Purpose and Objectives of the Study .................................................... 5 Methodology of the Study .................................................... 7 Literature Review Findings ........................................... 9 Development Communication ....................................... 9 Evidence from Other Regions & Countries ................................................. 10 Africa ...................................................... 10 India ....................................................... 11 Nepal ...................................................... 11 China and Malaysia ............................................ 12 Philippines .................................................. 12 North America & Western Europe ................................................... 13 Summary ................................................... 14 Media in Pakistan ............................................... 14 Availability of TV and Radio .................................................... 14 Viewer and Listenership Patterns .................................................... 15 Evolution of Pakistan's Family Planning and HIV/AIDS Campaigns ......................... 16 Responses to Sensitive Message Campaigns .................................................. 17 Attitudes Towards Sensitive Messages on Radio and TV in Pakistan ..................... 17 Attitudes of Males Towards Sensitive Messages ........................ 20 Attitudes of Females Towards Sensitive Messages ................................................. 20 Suggestions for Changes in Spots .................................. 21 Key Findings and Conclusions from Literature Review ..................... 21 Focus Group Research Findings ....................................... 23 Message Review Process in Media Organizations ................................................. 23 Ministry of Health ............................................. 23 Ministry of Population Welfare .................................................... 25 Population Welfare Departmnent .................................................... 25 Pakistan Television Corporation ................................... 27 Pakistan Broadcasting Corporation ................................. 28 Private TV Channels ........................................... 29 Attitudes of Media Decision Makers .................................................. 29 Government Ministry Personnel (MoH, MoPW, and PWD) ................ 30 Pakistan Television Corporation Personnel ............................ 33 Pakistan Broadcasting Personnel .................................................... 37 Private TV Channels ........................................... 37 Decision Maker Survey Results .................................... 38 Key Findings about Decision-Makers ......................... I......................... 40 Attitudes of the General Population .................................. 42 Responses to Health Messages: Recall and Action .................................................. 42 Attitudes Towards Messages on Mass Media .......................... 43 Knowledge and Beliefs about Family Planning and AIDS ...................................... 55 Attitudes toward Explicit Family Planning and AIDS Messages ............. 57 Family Planning and AIDS Information Sources ........................ 59 Condom Advertising Ballot Results ........................................................ 60 Key Findings about the General Population ........................... 62 Recommendations ................................................ 65 Suggested Changes in Process ...................................... 65 Suggested Changes in Message Content and Format ................................................... 66 GLOSSARY .................................................... 67 References ...................................................... 68 Appendix I: List of Participants ................ ......................................... i Core Team ........................................................ i FGD Facilitators and Note Takers ......................................................... i Appendix II: Detail of Study Methodology ..................................... i Elements of the Study ......................................................... i Participant Demographics ....................................... vi Appendix III: Detail on Findings of Literature Review ............................. i Sources of information about AIDS and Family Planning in Pakistan ....................... i Social Marketing and Advertising Firms Positions on Sensitive Messages ..............iii Appendix IV: Detail on Spots Used in Focus Group Discussions .................... i Spot I ........ ................................................ 1i Spot2 .......................................................... i Spot 3 ........................................................ ii Spot 4 ........................................................ iii Spot 5 ........................................................ iv Appendix V: Survey Tools ........................................................ 1i Tool 1: Assessing Attitudes of the Decision Makers About Sensitive ............................ i Messages on Media ................................................... i A. DISCUSSION FOCUSSED ON BANNED SPOTS ........................ i B. DISCUSSION ON OTHER ISSUES .............................. i Tool 2: Level of Acceptance by Decision Makers About Sensitive ............................... v Messages on Media ............................................... v A. FOR FAMILY PLANNING ................................... v B. FOR HIV/AIDS ........................................... vi Tool 3: Guidelines for Arranging the Focus Group Discussions ............... viii 1. Proposed Approach for Selecting the Group ................................................... viii 2. Criteria for selection of the participants .......................... viii 3. Selection of venue ......................................... viii Instructions for the Facilitator and the Note Taker ....................... ix Tool 4: Conducting Focus Group Discussions ..................................................... xi Acknowledgment The study team would like to express its appreciation to several individuals who contributed in different ways and helped us in accomplishing the assignment. We are grateful to decision makers in Ministry of Health and NACP, Ministry of Population Welfare and Population Welfare Departments, PTV Headquarters and Karachi and Peshawar Stations, PTV Censor Board Members, Pakistan Broad Costing Corporation and Karachi and Peshawar Station, GEO, Indus TV, Greenstar Social Marketing, Key Social Marketing, Midas and Spectrum. Their names have not been included in the report for the sake of confidentiality as agreed with them. We are also especially thankful to Key Social Marketing, Midas and Spectrum for providing us spots on family planning and HIV/AIDS. Those were extensively used in the study. Appreciation is also due to several National Experts who contributed in the study as member of the Technical Advisory Group. We are indebted to several hundred community people in the three provinces who willing gave time and frankly participated in the discussions. Our gratitude is also due to the World Bank for reposing confidence in our group and we look forward to working for the Bank in future. Dr. Aijumand Faisel Project Director Final Report Study to Assess Affitudes Towards Sensitive Messages in Pakistan The World Bank Executive Summary The objective of this study is to comprehend decision making processes and attitudes related to discussion on television and other mass media of condoms and other sensitive issues, by performing comprehensive research including (i) a review of available literature; (ii) focus group meetings with decision-makers involved in behavior change communications in Pakistan (staff of MoH, National and Provincial AIDS Control Programmes, Ministry of Population Welfare; officials working in television and radio, and censor board members); and (iii) focus group meetings with a sample of the general population in urban and rural areas of Pakistan. The environment for utilizing the mass media to convey sensitive messages on such topics as family planning and HIV/AIDS in Pakistan is dynamic. Of special interest to policy makers and donor agencies, this study finds that television audiences in Pakistan are eager to receive accurate and up-to-date information about HIV/AIDS and, to a lesser degree, about family planning. In addition, the study indicates that television should be a principal vehicle for BCC campaigns, although the approval process for both campaigns and individual spots is cumbersome and in need of reform. This reform will require political will, organization, education and consensus building. This study also