A Qualitative Assessment of Two Educational Brochures: HIV Antibody Testing: Information for Men & Safer Sex for Gay Men: HIV+ & HIV-


By John Maxwell
April, 1996



Background and Purpose


Two focus groups were conducted in April 1996 for the purpose of evaluating two of the AIDS Committee of Toronto's educational brochures, "HIV Antibody testing: Information for Men" and "Safer Sex for Gay Men: HIV+ & HIV-". Both of these brochures were written and produced in 1993 and are currently out of print. It was hoped that these groups could be used to evaluate both the messages and the format of these brochures, as well as provide input into the development of replacement brochures. To this second end, draft revised texts for both an HIV testing and a safer sex brochure were also presented at these groups, for comments and feedback.

Research Objectives:

The objectives of these focus groups were:

> to obtain reactions to the "HIV Antibody testing: Information for Men" and "Safer Sex for Gay Men: HIV+ & HIV-" brochures in terms of language (vernacular), length, content and design.

> to obtain reactions to the proposed text of a new testing brochure and a new safer sex brochure.

> to receive input into the proposed design and format of these new brochures.

> to identify the information needs of gay men in 1996.



A FEW NOTES ON QUALITATIVE METHODOLOGY:

As a research methodology, focus groups are a means of generating discussion and eliciting synergistic insights into particular questions. The purpose of a qualitative methodology such as focus groups is not to test pre-determined hypotheses, but rather to elicit the perspectives of individual participants. Generalizing from a "representative sample" of gay men to gay men in general is not possible; nor is it necessary for the purposes of this research. Rather, the reader should assume that these insights are illuminating and, therefore, directional.



Method


Sample:

A total of ten participants were recruited to participate in each of the focus groups which were held on Tuesday, April 16, 1996 at The 519 Church St. Community Centre.

A flyer, advertising a "discussion group for gay men about health issues" was distributed via the ACT Information Board system in Toronto gay bars, bath houses and other community venues. Payment for participation was $20.00. Potential participant were asked to contact John Maxwell at the AIDS Committee of Toronto and were screened out of attending the groups if they were currently, or had been in the past, either a volunteer or staff person within an AIDS Service Organization.

In total, eleven participants showed up the night of the focus groups: five in the first group and six in the second. Of these eleven, two men were Asian, one man was Latino and eight were Caucasian. The age range of participants was approximately between 20 and 45.


Procedure:

After introductions and orientation to the focus groups procedure, participants were asked to read the "HIV Antibody testing: Information for Men" brochure and then fill out a paper and pen survey. (See APPENDIX A for a copy of the brochure and the survey). Following a general discussion about this brochure (with respect to clarity of information, language, length and layout), participants were then asked to read the draft text for a replacement HIV antibody testing brochure. Participants were again asked to fill out a paper and pen survey (See APPENDIX B for a copy of the draft text and the survey) and a discussion of this draft text ensued as well as suggestions for design and format.

Participants were then asked to read the "Safer Sex for Gay men: HIV+ & HIV-" brochure and fill out a paper and pen survey. (See APPENDIX C for a copy of the brochure and the survey). Following a general discussion about this brochure (with respect to content and clarity of information, use of vernacular, length and layout), participants were asked to read the draft text for a replacement safer sex brochure for gay men. They were again instructed to fill out a paper and pen survey (See APPENDIX D for a copy of the draft text and the survey) and a discussion of this draft text ensued as well as suggestions for design and format.


Interpretive Analysis:


"HIV Antibody Testing: Information for Men" Brochure:

After reading this brochure, participants were asked to fill out a paper and pen survey to evaluate several aspects of the brochure:

1) Length of brochure: Using a Likert scale ranked from 1 (too long) to 5 (too short) the mean response to this brochure was 2.4

2) Design of brochure: Using a Likert scale ranked from 1(excellent) to 5 (boring) the mean response was 2.8

3) Overall impression of brochure: Using a Likert scale ranked from 1(excellent) to 5 (bad) the mean response was 2.6

Several people in both groups felt that this brochure was too "wordy" and long. Many participants questioned the lengthy section on "What you can do if you test positive"; while they felt it was appropriate to have some information about testing positive in this brochure, many felt that this one section seemed "out of place" in a brochure that is supposed to deal with the testing process. As one man stated:

"All this information about what I can do if I test HIV positive would scare me away from getting tested".

People generally felt that the language level was appropriate, as it avoided "technical and medical jargon". One person indicated that the terms 'pre-test' and 'post-test' could be explained as 'counselling before you test' and 'counselling after you get your test results back'.

Both groups generally felt that there should be more information about who to call/where to go to access anonymous testing. People felt this could be accomplished by having a box at the end of the brochure that directs people to a number to call (i.e. the ACT Hotline) as well as using bold type in the body of the brochure that would say "for more information contact..."

Some people felt that the design could have been stronger, and that the paragraph titles could have been made larger (so that you could easily scan the brochure for the sections that you wanted to read). People generally liked the use of the colour purple, but felt that a new brochure could be improved by having more colour, larger headings and some interesting graphics to draw people's eyes into the text.

One participant felt that the brochure would have been improved by including a paragraph at the beginning of the brochure encouraging people to get tested.


New HIV Antibody Testing draft text:

Again, participants were asked do read the draft text for this brochure and then fill out a paper and pen survey to evaluate aspects of the text:

NOTE: It had been hoped that there would have been a draft design for the brochure available at the focus groups. Unfortunately, this was not yet available.



1) Length of new brochure: Using a Likert scale ranked from 1 (too long) to 5 (too short) the mean response to this draft text was 2.9.

2) Overall impressions of content: Using a Likert scale ranked from 1 (excellent) to 5 (bad) the mean response was 2.2.

3) Comparison between new text and old brochure's text: Using a Likert scale ranked from 1 (much better) to 5 (much worse) the mean response was 2.0.

Participants generally preferred this text to the old brochure. Many noted the inclusion of mother/child transmission as an important piece and preferred the shortened section on "what you can do if you test positive" over the old brochure.
The only suggestion regarding the text, was a suggestion to clarify what 'pre-test' and 'post-test' counselling means.

As far as suggestions about design, people reinforced the idea of creating a box at the end of the brochure that would indicate where people could call for more information about testing, and for information about access to anonymous testing sites.

Some people felt that the inclusion of photographs in the brochure would make it more "personal" while others challenged this belief and felt that photographs might in fact alienate some people:

"Somebody might look at the faces in the brochure and say 'hey, these people don't look like me, so why should I get tested?".




"Safer Sex for Gay Men: HIV+ & HIV- " Brochure:

After reading this brochure, participants were asked to fill out a pen and paper survey to evaluate several aspects of this brochure:

1) Length of brochure: Using a Likert scale ranked from 1 (too long) to 5 (too short) the mean response was 3.0.

2) Design of brochure: Using a Likert scale ranked from 1 (excellent) to 5 (boring)
the mean response was 1.4.

3) Overall impression of the brochure: Using a Likert scale ranked from 1 (excellent) to 5 (bad) the mean response was 1.5.

All participants spoke very highly of this brochure, both in terms of content and design. As one participant noted :

"There is a lot of information in here about how to make different sexual activities safer. This is really good for someone who may not have seen any information about safer sex for gay people".

When asked about the use of the vernacular when referring to sexual activities and body parts, the vast majority of people in both groups felt that this was important and necessary. As one person commented "not everyone may understand the 'proper' terms."

A few people felt that the title of the brochure may limit its distribution and make it less likely for non-gay identified men to pick it up. One person noted that the piece at the end of the brochure encouraging people with questions to call ACT could be made more prominent.

People liked the use of photographs in this particular brochure, because of the design process which caused the images to be slightly blurred. This blurring process avoided the problem of the reader not identifying with the people in the pictures (because they didn't look exactly like the models). The blurring caused facial/body features to become less detailed, thus suggesting intimacy and sexual activity without alienating the reader. Many people suggested that a similar graphics treatment could be used in a new brochure.

People felt that the text was very clear, and no one was confused by any of the terms used in the text.



New Safer Sex for Gay Men draft text:

Again, participants were asked to read the draft text for this brochure and then fill out a paper and pen survey to evaluate aspects of the text:

NOTE: It had been hoped that there would have been a draft design for the brochure available at the focus groups. Unfortunately, this was not yet available.


1) Length of new brochure: Using a Likert scale ranked from 1 (too long) to 5 (too short) the mean response to this draft text was 2.9.

2) Overall impressions of content: Using a Likert scale ranked from 1 (excellent) to 5 (bad) the mean response was 2.3.

3) Comparison between new text and old brochure's text: Using a Likert scale ranked from 1 (much better) to 5 (much worse) the mean response was 2.1.

Several participants commented on the inclusion of a section titled "Safer Sex Basics" in the revised text. They felt that this was a good addition to an already good text. Several other participants liked the inclusion of alcohol/drug use at the end of the brochure. In general, participants felt that the text of this draft brochure was better than the old brochure. One participant suggested that the discussion about cuts/sores in the mouth and oral sex be expanded to include chancres.

Again, there were some comments about the proposed title of the brochure "Safer Sex Guide for gay men" as this may reduce the potential distribution for the brochure. While some men felt it would be better to avoid the term "gay" others felt it was important for gay-identified men to see a brochure that spoke directly to them.

None of the participants found any of the terms confusing and all of them agreed that it was important to use direct language when talking about sexual activities.



Information needs of Gay Men in Toronto:

A discussion took place at the end of both of the focus groups regarding HIV prevention information needs for gay men.

When questioned as to whether there was still a need for "basic" prevention information in 1996, all participants felt very strongly that this was needed. Many participants mentioned that there are always new gay people "coming out into the community" and that they needed to see and read "straightforward" information about safer sex.

Participants felt that efforts should be targeted to younger gay and bisexual men who likely have not received relevant sexual health education in the school system or at home. Many in the two focus groups were surprised to find out that ACT's materials are not distributed in the schools.

Both groups also indicated the importance of educational outreach initiatives in bars (particularly back rooms) bath houses and parks.



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