The Making it Real research aimed to identify best strategies in STI communication for marginalised young people and to provide an evidence base for the development of appropriately targeted STI communication strategies for these young people. The project sought:
| • | To identify the factors that facilitate or impede access to STI information and aspects of messages that engage or ‘turn off’ young people; | ||||
| • | To understand how young people seek information and evaluate the trustworthiness and relevance of sources; | ||||
| • | To identify the types of messages that young people believe will facilitate or impede their implementation of positive STI prevention practices; and | ||||
| • | To document young people's ideas for innovative and effective communication strategies. | ||||
Participants were aged between 16 and 25 years and were drawn from socially disadvantaged groups known to have an elevated risk of poor sexual health. Secondary school students were also included as a comparison ‘mainstream’ group. Young people were recruited through selected agencies. A total of 11 focus groups were held with 112 young people, including homeless young people, young mothers, Aboriginal young people, same sex attracted, transgender and intersex young people (SSATI), incarcerated youth, Horn of Africa young men and Somali young women, regional youth and secondary school students. Focus groups consisted of group discussions and evaluations of a range of sample sexual health promotion pamphlets.
The findings demonstrated important commonalities between the groups and look specifically at health seeking behaviours, messages, medium and style of sexual health communication.
Among the suggestions made… was that posters with STI messages be placed in “unavoidable locations”, but also in a range of more unusual places, including:
| • | back of Met tickets; shopping dockets; chocolate bars; inside shoe boxes; beer coasters (homeless young people) | ||||
| • | stubby holders; cards; phone boxes (incarcerated youth) | ||||
| • | taxis; skywriting; stickers; chip packets (aboriginal youth) | ||||
| • | school diaries; Club pass out stamps (SSATI) | ||||
| • | advertising in computer games' backgrounds (secondary school students) | ||||
| • | phone games (homeless young mothers). | ||||
Conclusions
The key finding was one of similarities in attitudes and preferences for STI strategies among the sub-populations we studied. Similarities were strongest in regard to preferences for medium and style of communication. There were some differences and these were primarily between males and females and between the educationally advantaged and disadvantaged rather than between particular sub-populations.
There were gender differences across groups in relation to attitudes to STIs and differences between young men and women in relation to individual health concerns. Young women were less likely to stigmatise STIs and were more concerned about their fertility.
SSATI young people and secondary school students' views tended to differ somewhat from the other groups, especially the less educated males in the homeless, Aboriginal and incarcerated groups. This was most pronounced in relation to the stigmatisation of STIs and those who may have contracted an STI, with the most educationally disadvantaged males engaging in high levels of stigmatisation.
These findings suggest that young people do not need a large-scale media campaign that targets specific sub-populations. While socially disadvantaged young people do not favour or access all of the media embraced by young people in the general population, they access enough of the same media to benefit from a general mass media campaign to raise awareness of STIs. Rather than targeting sub-populations, general campaigns need to be inclusive of all young people. They must aim to increase awareness that both males and females can contract STIs, particularly chlamydia, and de-stigmatise STIs.
Small-scale campaigns, developed with input from relevant young people, would benefit Aboriginal youth, young people from the Horn of Africa and those significantly economically/educationally disadvantaged.
Mass media campaigns must be complemented by interventions providing detailed information and health services. While reluctant to seek out STI information, young people think it is important to have access to comprehensive STI information when necessary.
Recommendations [a selection]
Communication strategies should comprise: a broad mass media awareness raising campaign; and a range of strategies to disseminate more detailed health information. Large-scale culturally and ethnically inclusive health promotion campaigns should be prioritised…
Small-scale targeted campaigns, developed with input from relevant young people, would benefit Aboriginal youth, young people from the Horn of Africa and those who are significantly economically/educationally disadvantaged… Fund an Aboriginal community group working with youth to adapt campaign materials for Aboriginal youth… Include some male-targeted advertisements, for example, set in football clubs.
Communication strategies… should utilise trusted sources of sexual health information, such as health professionals, rather than less trusted media such as the internet.
Services where young people can obtain free sexual health information, testing and treatment should be identified and widely publicised… Include Action Centre Freecall number on advertising.
Young people want to access people rather than technology when seeking more detailed information. The awareness-raising campaign should direct young people to sources such as doctors and other health workers, help lines or other trusted sources of information.
Help lines should be answered by a person not a recorded message, should be free and should have the information to refer young callers to appropriate health services. Help lines should advise people of free services where available and any potential costs related to testing or treatment should be communicated in advance.
In their own words
‘You ring up and get someone who really gives a shit.’ (Young man)
‘You look at it and you're like “Oh, I'm not going to bother reading it, it's too many words”.’ (Young man)
‘[Picking up a pamphlet about an STI]…It's like stamping it on your forehead.’ (Young man)
‘Only time I had to look up one [a sexual health website] was for a school project and even then I didn't want to.’ (Young man)
‘It's like rah, rah, rah, rah rah, do this, do that, buy this, that, that's a cool thing to do, go to that club, do this, do that, you're just kind of like okay, like I get it, and then I think, I agree with what you're saying that [if] they've got that one slow ad and you're like wow, … like it gives such a juxtaposition between the two that you're kind of like oh, okay, wow, that's intense because it's like, it's been surrounded by so much hype that you get this slow kind of really serious note and you're like, yeah, I don't want that, kind of thing’ (Young woman)
‘You can kind of go unnoticed like when you're looking at a poster.’ (Young woman)
‘I reckon just go with something funny.’
‘That's why I said like that Captain Condom thing. Because I've had that in my head for over ten years man.’ (Young men)
‘Put the message in my face but don't interrupt me.’ (Young woman)