Adaptation of Health Communication Material

This paper introduces some of the considerations necessary in expanding a single country programme into a regional programme, based on the experiences of Soul City Institute for Health and Development Communication (Soul City), a South African based non-governmental organisation (NGO). The Soul City regional programme involves capacity building in health and development communication in partner countries within the Southern African Development Community (SADC) and adaptation of Soul City communication materials in these countries. According to this paper, Soul City’s approach to media adaptation essentially employs an extensive process of formative research (including qualitative audience reception research), evaluating existing Soul City material which was developed in South Africa. Soul City material is then adapted appropriately based on these findings.

The paper also states that health communication is best developed in the local context. The commonalities in health and development issues across SADC make it feasible to also use communication material developed in South Africa in other countries - provided that this material goes through a very thorough process of local adaptation. For a health communication intervention to effect the desired behavioural and social change, there is a need for the communication materials to speak to the intended audience in “their own language”. This necessitates a thorough formative research process that includes coming up with a country profile regarding health issues and media environment, selection of appropriate communication material to be adapted from Soul City, stakeholder consultation and pre-testing of the material among the intended audience. In Soul City's plan, it is up to the local partner health communication teams to ensure that the research-based integrity of the adaptation process is adhered to in the media production process.

Examples of cultural adaptation are provided. For instance, Pakachere in Malawi, adapted a Soul City adult booklet entitled “Living Positively with HIV and AIDS”. In the booklet there is a section illustrating correct use of male condoms. Pre-testing findings of this page in Malawi indicated that the intended audience was not comfortable with the condom use illustration because, according to Malawian custom, the booklet would be used in a household context (despite the fact that the intended audience is adults) where they would be bound to discuss these issues with children.

The notion of adult material that must be kept away from children seemed foreign to the audience. As such they suggested that text instead of illustrations be used to explain the correct use of condoms, since they found the illustrations too explicit to be used in a context where young children would access the booklet. They were willing to discuss the use of condoms with youth and children, but thought it would be more appropriate for them to use the page without the graphics as a starting point of conversation. The findings were in contrast with the South African scenario where using the illustrations did not raise the same concerns, as there seems to be a clear demarcation between adult and children's material in South Africa.

In Zambia, Kwatu, a Soul City partner organisation, has adapted a Soul City youth booklet entitled “Choose Life”. In this booklet, there is a section illustrating a man putting on a condom. Pre-test findings in Zambia indicated that the audience was not comfortable with the condom illustration based on the social norm that it is inappropriate for youth to be exposed to sex explicitly since they are supposed to abstain, and that the condom illustration page may encourage them to have sex.

The high teenage pregnancy rate in Zambia does suggest that youth are sexually active despite this social norm, and there are therefore very good health communication reasons to include a page where the correct use of condoms is illustrated. Kwatu however expressed a concern that if the illustration was to be maintained, gatekeepers (e.g. teachers, the Department of Education) might bar the booklet from being distributed among the intended audience. As a result, a decision was made to use a wooden penis graphic illustration instead of a human penis illustration.


The paper concludes that formative evaluation research is the backbone of the whole Soul City materials adaptation process. According to Soul City, formative evaluation research ensures relevance and appropriateness of material, and enhances impact.