Communication

Goals for communication articulate the desired change, e.g. increasing uptake of CBVCT services or increasing health knowledge. Clear and achievable goals for communication are the reference points for planning, carrying out and evaluating communication activities, e.g. fliers, online or social media campaigns.

Overall communication goals for CBVCTs include:

As many MSM as possible are aware of and accessing the CBVCT facility
Those who are most likely to benefit from testing take it up
Service providers in the region are aware that the CBVCT exists and know about it in detail
Communicating successes (and areas for improvement) to increase awareness and understanding of funders and supporters
Attracting potential volunteers
Strengthening the community (empowerment)
Enhancing general knowledge about HIV/STI and risk
Increasing knowledge of PrEP, PEP, TASP etc.

When formulating specific objectives for communication interventions, SMART criteria are useful to ensure the objectives can guide implementation as well as lead to meaningful evaluation. The SMART criteria vary from source to source. This is one version:

SMART criteria

S mall
M eaningful
A ppropriate
R ealistic
T imebound

Communication topics that are based on epidemiology, e.g. low testing rates among gay men with multiple sexual partners, may not match the subjective priority needs of the key population. Any communication intervention needs to take both into account. Participatory methods can assist in discovering the current needs of the key population and adjusting communication goals accordingly.

The PQD (Participatory Quality Development) toolkit (available at www.quality-action.eu) includes SMART criteria for goal setting. A range of participatory methods from the toolkit can be used to improve the goals set for communication.

Action plan

This Action Plan helps you to work directly on the items identified as priorities (yellow and/or red fields in the Checklist). Please list actions that are as specific as possible. You can download your finished Action Plans for each section as an xlsx.-document and print it afterwards. The Action Plans form the basis for your further planning, implementation and evaluation.

The Action Plan shows a sequence of steps to be taken, or activities to be performed for a strategy to succeed. The Action Plan has four major elements: (1) what will be done (specific tasks), (2) by whom (responsibility), (3) by when (timeframe), and (4) how the implementation of the task will be monitored.

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Defining audiences

Audiences are groups of people who are the intended recipients of communication. To tailor communication content, channels and style to their needs, it is useful to define them clearly during planning.

The central audience for CBVCT communications is the key population (MSM). Use the most detailed epidemiological analysis available for defining and selecting audiences for communications. MSM are not a homogenous population, and some are more vulnerable than others. Analysing CBVCT statistics can also show gaps in reaching sections of the key population. Here is a list of MSM subgroups that may be defined as audiences:

First time testers (MSM never tested for HIV)
MSM participating in chemsex
MSM in a relationship/MSM not in a relationship
MSM that have recently joined an online or app-based dating service
MSM with a migration background
MSM who follow the recommendations to get tested (one, twice) a year
HIV positive MSM who want to check their STI status.

Any demographic information available about the chosen key population helps in selecting the most promising methodology for communication:

Which MSM are most affected/most at risk?
What are the known characteristics of MSM who are at risk?
What is their age, education and socio-economic status?
What is their first, what is their second language?
What is their migrant or ethnic minority status?

Involving members of the key population at this early stage provides valuable insights, especially since social research about the demographic characteristics of MSM is not always available.

Sometimes, an audience cannot easily be reached directly. Those who are in close contact with them (e.g. owners of gay businesses, general practitioners) may instead become the defined audience.

Defined key populations can also include volunteers, the community, funders, partners and other stakeholders.

Planning effective communications requires knowledge of the lifestyles, social networks, social and sexual subcultures of the men to be reached:

How do local MSM socialise, find sexual partners?
How do they access information?
Who else has access to local gay men and other MSM?

Local surveys and focus groups of members of the key population provide access to this knowledge.

Quality improvement tools for prevention and health promotion projects such as the self-assessment questionnaire Succeed and the reviewer-assessed QIP, both available at www.quality-action.eu, include sections on defining key populations based on evidence. They ask questions such as:

What key population(s) does the project reach or aim to reach?
Do/did you have specific reasons for selecting this group or groups?
Did you use any data or other information to make your selection?
Are you reaching or planning to reach this key population directly with your project?

These can be used to see if any improvements can be made to defining audiences for the communication activities of the CBVCT.

The PQD (Participatory Quality Development) toolkit (available at www.quality-action.eu) includes step-by-step guides to participatory methods for learning more about and from the key population, e.g. Rapid Assessment and Focus Groups.

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Key messages

Key messages contain the information that you want the audience to receive, understand and act on.

Key messages that CBVCTs communicate to MSM are about:

Access to the CBVCT: location, opening hours
How the CBVCT operates: e.g. peer counselling concept, transparency, confidentiality
Why getting tested is beneficial
Fighting HIV stigma
That clients can talk about risky behaviour, including chemsex, drug use etc.
That prevention today includes several strategies, e.g. condoms, TasP, PrEP, PEP
What living with HIV means today, e.g. “People with HIV live everyday lives”
Being part of the community, including becoming volunteers with the CBVCT.

The messages are best kept as clear and simple as possible. They must be factually accurate, reliable and current. Providing information about a health problem or risk should always be combined with a ‘call to action’, e.g. “make an appointment today by calling 1 234 56 78”:

What are the facts to be communicated? Are they accurate and current?
What is the message to be communicated?
What is the call to action?

How a message is expressed is as important as its content. The language, images and design should match that of the context in which the message will be received. Hitting the right tone depends to a large extent on an intimate knowledge of the audience, their lived experience and preferences for communication. Involving members of the key population in wording and designing messages helps maximise authenticity, legitimacy, reach and effect:

Who is the sender of the message?

What is the language to be used? What is the style to be used?
What is the role of images?

What is the desired response?

In some instances, the use of humour (also cartoon images) in communications can help overcome taboos and embarrassment, in others it may come across as patronising.

How often a message is communicated also needs to be adapted to the content and audience. Repeating messages can be useful as people might absorb it over time. This can be effective for new information (e.g. ‘Undetectable = Not infectious’) or to decrease stigma by presenting positive images of life with HIV. Other communications, e.g. calls to action or appeals for behaviour change, work better when they are not repeated too often and presented in a different form from time to time.

It is best to use a participatory process to develop key messages and also some form of pre-test before launching or mass-printing materials:

How is the message understood?

How could the language be changed to make it more attractive?

Do the images and design lead to the desired response? Could they be improved?

Are there any undesired effects? How can the overall message be improved?

How well does the message reach MSM?

How well is the message understood?

The PQD (Participatory Quality Development) toolkit (available at www.quality-action.eu) includes a step-by-step guide on running Focus Groups.

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Communication channels

Communication channels are what you use to reach your identified audiences with the selected key messages.

CBVCTs use a range of reach communication channels to reach MSM:

Online communication and social media: websites, Facebook, twitter

Websites with or without interactive components such as self-assessment tools, discussion boards and personal advice functions can be knowledge hubs for self-directed reference, reinforcement and referral.

Communications using the internet and mobile networks can take place in virtual spaces MSM use to find sexual partners. There are several options for online communication: paid advertising on commercial websites, free content on own or other non-profit sites, and interactive methods such as online advice in chatrooms or on discussion boards.

Messages can also be communicated through social media, but not all social media are equally suited to a given key population, objective and message (e.g. maintaining a facebook page may be an effective and efficient interactive component of a prevention campaign but a twitter account is less likely to be worthwhile): Why do we want to use social media? Which men do not have access to the technology? How much time and money will be needed to maintain an interactive presence?

Advertisements on dating websites (Gay Romeo, Grindr etc.) and in the gay press

Paid advertising on commercial websites and dating apps can target a broad range of users (banner advertisements) or users with particular customer profiles (pop-up advertisements). The formats, targeting techniques and prices are subject to rapidly changing market conditions, as are the user preferences of MSM. Many CBVCTs also maintain their own profiles on dating apps, and some are negotiating support from the owners in the form of free advertising and ensuring profiles are not suspended.

Articles, press releases (e.g. World AIDS Day), conferences
Mass communication and peer education campaigns using role models, (e.g. ‘’I got tested, how about you?”)

Including MSM as role models in mass communication campaigns aims to make the message relevant to their lived experience. It means recruiting role models to provide personal stories, testimonials and images.

Opinion leaders who have the respect of the key population and can command their attention are important collaborators for mass communications.

Face-to-face communications and outreach work

Outreach can be conducted where MSM meet, such as public places and venues used for social connection and for finding sexual partners, or in virtual spaces on the Internet and in mobile networks.

Tool 3 in the toolkit of the CDC’s HIVTestingImplementationGuide_Final, (available at http://www.cdc.gov/hiv/testing/nonclinical/) offers a detailed planning guide for outreach testing projects.

Face-to-face counselling, support and advice in combination with testing is an opportunity for communicating more complex health information and rationales for behaviour change, and for addressing personal barriers.

Printed information materials

Printed information materials come in a range of formats (condom/lubricant packs, pamphlets, brochures, booklets); many of them are designed in smaller formats so they can be picked up and carried discreetly. They can also be used as communication tools in outreach work and other personal interactions, such as clinic consultations and counselling sessions.

To adapt communications to local conditions, it is important to know which communication channels MSM use locally and to work in close collaboration with local gay associations:

Which sources of information, sites and apps do local MSM use?
How can we reach them most effectively and efficiently?
How complex are the messages we want to transmit?
Which channels and methods can transmit them?
What are the financial and human resources we have available and what is our timeframe?
Which channels and methods fit into our limits?

It is useful to select channels and methods based on their suitability for reaching the key population and on the available resources. Equally important considerations are the level of complexity of the information in the message, and the capacity of communication channels and methods to convey that information.

Channel/Method	Message Complexity	Reach	Advantages	Disadvantages	Resources
Printed information Materials	Simple to complex messages	Relies on existing distribution networks	Detailed discussion of the topic possible	Need expert consensus and input, requires time and professional skills	High goods and services costs, time intensive
Online and mobile networks	All levels of complexity	Large and targeted	Flexible, fast	High level of technical skill and marketing knowledge needed, volatile and short-lived	Medium costs, active maintenance needed
Mass Communications	Simple messages	Large but not targeted	Reaching large numbers quickly	Targeting is difficult, short-term impact, expensive	High goods and services costs, specialist marketing skills required
Face-to-face communications	Simple to complex messages	Small but targeted	Flexible, targeted, high individual impact	High level of structural support needed	Low goods and services costs, need trained staff or peers, supervision and support
Outreach work	Simple messages	Small but targeted	Targeted effort, potential for participation of gay men and other MSM	Needs high level of ongoing support	Low goods and services costs, time-intensive, local knowledge required

Adapting communication also means responding to local timetables and events. Adaptation responds to the nature of collaboration and resource sharing among organisations working for and with MSM. Some examples that influence the timing of communication activities are:

Local gay pride events
European testing week
Holidays and seasonal activities (e.g. outdoor cruising on beaches etc.)
Other health promotion campaigns.

Some examples that influence who takes responsibility for communication activities are:

MSM community groups/organisations and their activities
Existence of businesses (bars, clubs, saunas, newspapers and magazines) for and by MSM
Locally used websites and cruising apps
National campaigns and other communication activities targeting MSM.

Options for reducing costs:

Well-targeted communication interventions using very simple means, e.g. a message printed on a paper bag used as a safer sex pack to distribute condoms and lubricant, can have a large impact and can be achieved on a small budget.

Sharing designs and translating content from CBVCTs in other locations.

QIP, available at www.quality-action.eu, is a comprehensive quality improvement tool for prevention and health promotion projects. It includes a section on the communication channels used and the reasons for selecting them.

The PQD (Participatory Quality Development) toolkit (also available at www.quality-action.eu) includes step-by-step guides to participatory methods, e.g. Rapid Assessment and Focus Group, for learning more about and from the key population.

→ Copy to action plan

Evaluating communications

Evaluating communications means assessing the communication process and results: to what extend the key messages have reached the audience and have been accepted and understood. Longer-term impact evaluation can also investigate to what extent and in what ways the audience has acted on the messages.

Questions that can guide the evaluation of communications can include:

Process:

How has the CBVCT communicated so far?
Who has been involved?
To what extent have the timelines in the communication plan been kept?
What is the feedback received from partners and collaborators?

Output:

How many visits does the website get?
How many advertisements/articles have been published and where?
How many interacted on social media with you?

Outcome:

Has the communication reached the MSM it was directed at?
Which proportion of them has been reached?
How well does the audience recognise or recall the message?
What proportion of the audience recalls the messages?
To what extent have recipients understood the messages as intended?
To what extent have recipients integrated the messages into their decision-making process?
What is the feedback received from the audience?

Impact:

Did the number of people using the CBVCT rise?
Are those using the service those with the highest need?

Relevant and feasible indicators for communication interventions include the proportion of the key population the intervention has reached, how well the key population recognises and recalls the messages and to what extent the key population has understood the messages and integrated them into their decision-making processes. To assess the reach of a communication intervention, a baseline measurement or estimation of the population size to be reached is necessary. Existing secondary surveillance and social research reports may also provide a baseline of the key population’s level of knowledge, attitudes and behaviour.

The quantitative and qualitative data required for the chosen indicators may be available from existing sources (e.g. number of visits to a website, number of safer sex packs distributed, suggestion box) or specific instruments designed to collect them (e.g. rapid assessment surveys, questionnaires, interviews).

Sometimes, questions about a communication intervention can be integrated into data collection instruments such as client feedback forms.

Basic statistical analysis of quantitative data can provide insights into the process and output of communication. Comparing results with the baseline is often sufficient to illustrate levels of success or progress towards a target. If the amount of qualitative data from feedback and comments is manageable, one or more people can perform a straightforward thematic analysis by simply reading and re-reading the data while noting and refining themes.

Key questions for analysis and reporting are:

How much of what we set out to do did we achieve?
How well did our messages, channels and methods work?
What do responses from the key population tell us?
What can we do differently next time?

Given the need for constant change and innovation in developing communication interventions, it is useful to feed evaluation results directly into the planning process for the next interventions.

Evaluating communication can be done separately (e.g. to ensure the evaluation can inform the next round of communications) or in conjunction with an overall evaluation of CBVCT activities. In any case, evaluation should be based on agreed indicators and include data collection, analysis and reporting.

The effort required to carry out the evaluation should be in proportion with the effort going into the communication activities themselves. For example, simple questions like “Where did you get the information about testing at this Checkpoint?” and “Where would you prefer to get information about testing and sexual health” can be incorporated into feedback collected from clients as part of the testing process.

When designing the evaluation, it is important to consider not just the rigorousness of the research methodology but also its feasibility and ethical implications. For example, asking every client to fill in a questionnaire may provide rich data, but may be far too confronting and raise barriers to access. Collecting anonymous personal stories posted in an online discussion forum may provide interesting data, but using them for evaluation without the consent of the participants would not be ethical.