Best Laid Plans: Cultural Entropy and the Unraveling of AIDS Media Campaigns

Best Laid Plans: Cultural Entropy and the Unraveling of AIDS Media Campaigns

by Terence E. McDonnell

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McDonnell here offers some startling new ways to think about propaganda, specifically about health campaigns. He uses HIV/AIDS media campaigns in Ghana as his case, laying out efforts to control and organize how local communities make sense of the disease. Using media to change people’s sexual practices involves evidence-based design, opinion leaders in the design process, and getting all organizations behind a single message. But these campaigns hardly ever work. Why? They are subject to cultural misfires: they are disrupted by misinterpretation and misuse. Enter “cultural entropy”—this concept identifies a process through which intended meanings and uses of propaganda (and other cultural objects) fracture into alternative meanings, new practices, failed interactions, and blatant disregard. The book shows with exquisite ethnographic details how the AIDS media campaigns succumb to cultural entropy: e.g., how people turn female condoms into bracelets, AIDS posters go missing from public postings and become home décor, and red ribbons fade into pink ribbons under the sun. Cultural entropy is a disruption process that affects things as well as symbols. Cultural entropy offers a new explanation for the failure of AIDS campaigns specifically and modern interventions broadly.

Product Details

ISBN-13: 9780226382159
Publisher: University of Chicago Press
Publication date: 08/18/2016
Edition description: New Edition
Pages: 264
Product dimensions: 6.00(w) x 8.90(h) x 0.60(d)

About the Author

Terence E. McDonnell is the Kellogg Assistant Professor of Sociology at the University of Notre Dame.

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Best Laid Plans

Cultural Entropy and the Unraveling of AIDS Media Campaigns

By Terence E. McDonnell

The University of Chicago Press

Copyright © 2016 The University of Chicago
All rights reserved.
ISBN: 978-0-226-38229-6


Cultural Entropy

Organizations see objects as solutions to a number of problems. Organizations extend their agency and interests through objects, diffusing messages beyond what is possible through face-to-face communication. Objects also appear to stabilize meaning better than trained peer-educators, who might go "off script" when spreading the message. Objects are never off the clock, extending messages through time, even after communications staff have gone home. Using objects, organizations can carefully craft messages they believe will communicate their intended meaning.

Organizations miss how objects are "unruly" (Domínguez Rubio 2014). Although objects stabilize meaning to some degree, objects are inherently open to disruption. Organizations put too much faith in their capacity to craft campaigns that communicate clearly, consistently, and persuasively. Despite organizations' meticulous planning, campaigns misbehave: campaigns communicate unintended meanings, people appropriate campaigns for alternative purposes, objects fall apart or go missing. To successfully impact beliefs and behavior, campaign objects must communicate the intended message to the intended audience, but I find that campaign intentions are systematically disrupted. To explain how this disruption happens, I introduce the concept of cultural entropy. Before defining and elaborating this idea, let's examine a few examples that will serve as a foundation for building the framework.

Miscommunication in a Muslim Neighborhood

Family Health International (FHI) staff in Ghana took great care to create a billboard that promoted an HIV prevention strategy that Muslims would support — faithfulness. Working in collaboration with the Muslim Relief Association of Ghana (MURAG), FHI staff identified images and messages relevant to the experiences and needs of the Muslim community. FHI tailored the billboard for this community by translating a common slogan ("AIDS Is Real") into Hausa ("AIDS Gaskia Ne"), the predominant language among local Muslims (see fig. 1). The billboard also presents the faithfulness message in a way that is inclusive of local sexual practices: the parenthetical "(s)" recognizes that Ghanaian Muslims accept polygamous marriages. In addition, FHI aligned this image with Muslim culture, photographing people in appropriate Muslim dress with a well-known mosque in the background. FHI was careful not to cause offense. While other campaigns depict condoms or flirtatious behavior, sexual content is noticeably absent from this image because depicting sexual activity is taboo in the Muslim community.

FHI directed this message at residents of Nima, one of the poorest slums in Accra and a neighborhood with one of the largest concentrations of Muslims. To ensure that the design was clear and culturally sensitive, designers pretested images with Nima residents and vetted the proposed billboard with the local imam, whose group (initially) approved the image. After assessing the needs of the local community, partnering with a civil society organization to develop an appropriate campaign, pretesting campaign ideas with target audiences, refining ideas to avoid misinterpretation, and getting approval from powerful stakeholders, FHI placed the billboard adjacent to the Nimamarket, the hub of the neighborhood. By all accounts, FHI met or exceeded international standards of health campaign design. Surprisingly, despite every effort to eliminate misinterpretation by following the best practices of campaign design, the imam and Nima residents ultimately rejected the billboard.

Although the imam had supported the effort when he first approved the image, after the billboard went up he objected to how the image undermined traditional gender norms:

After the pictures were taken, and everyone had done the pretest, we realized we hadn't done pretests with the highest authority within the Muslim community — the Imam. So we had to send the materials to his group to look at. Initially he said the pictures are ok, but then he realized the woman in the picture is telling the man something, which is not normally the case for them and their community. So he would prefer if the man is rather showing or depicting "I am telling you, the woman, something and you should listen."

Contrary to local Muslim mores, FHI's representation of gender dynamics encoded a Western ideal of gender equality held by FHI and other international health nongovernmental organizations (NGOs). In the image, the woman is active and the man is passive. She faces the audience, drawing the attention of both those viewing the billboard and the man in the image, thus giving her authority. Taken with the billboard's text, she appears to instruct her husband about the relationship between faithfulness and AIDS. A woman daring to educate her husband about faithfulness — in public space and under the shadow of a mosque — challenges traditional Muslim gender relations of this community. The billboard's imperfect fit to the local culture disrupts communication of FHI's intended meaning.

Moreover, when I engaged Nima residents walking past this billboard, many indicated that they believed the billboard's message was not intended for them. One woman explained, "Sharia law came first, then AIDS laws ... I follow Sharia law, I don't go around with lots of men." Another man concurred, saying, "Already I am faithful to my wives." These residents admitted that others may need to hear the message, but the billboard was redundant for good Muslims like themselves. Local residents did not accept FHI's "definition of the situation" (Thomas 1927; Goffman 1959). The reason to practice faithfulness was not to prevent AIDS, but rather to follow God's will. Sharia law had greater authority to define reality than AIDS organizations. In order to validate their identity as pious Muslims, they had to reject FHI's message.

Another source of unintended interpretations was the material decay of the billboard. FHI installed this billboard before 2003, and it remained in place until my last visit in March 2008. Over five or more years, harsh environmental conditions weathered this billboard: the image and letters faded, words peeled off the backing, the billboard was caked in dirt, and the left half of the billboard was crumpled, partially obscuring the man's image. By 2004, the funding for FHI's Impact program ended, and the billboard was forgotten. When I asked one resident about the billboard, he remarked, "If they care about it, they will maintain it — clean it, straighten it out, then repaint it. But they don't care about it." The lack of maintenance made visible FHI's disappearance, confirming community members' beliefs that government agencies and NGOs had forgotten them. Material evidence of organizational neglect detracted from the message about faithfulness.

Why did this billboard fail to communicate its intended message? Health communicators would attribute these unexpected disruptions to insufficiently customizing campaigns for the target audience (Backer, Rogers, and Sopory 1992; Nowak and Siska 1995): if only they had pretested the campaign with more community members, worked more closely with the imam, then they would have identified these problems and changed the image and text to preclude misinterpretations. Another explanation might be that while designers relied on community involvement, they still imposed their own views (about gender or polygamy) on the community. Perhaps involving the community earlier in the process could improve the effectiveness of communication (Myrick et al. 2005; Wilson and Miller 2003). By allowing communities to identify their own messages, instead of screening AIDS organization–devised slogans, NGOs could both improve communication and secure the community's support for the campaign. Before you blame these failures on FHI, let me tell you another story.

Yes, but Not on My T-Shirt

Known for working closely with Ghanaian communities, Planned Parenthood Association of Ghana (PPAG) placed the community at the center of the design process. PPAG sought to design an HIV prevention campaign that encouraged condom use among youth. Through discussions with Ghanaian youth, PPAG realized that many of them were timid about buying condoms. If someone saw them purchase a condom, they would be implicated in premarital sex, suggesting a lack of moral character. In collaboration with PPAG, youth devised several potential messages, including "Don't Be Shy, Use a Condom." After pretesting these messages, PPAG found that this community strongly supported the "Don't Be Shy" slogan.

PPAG produced a series of posters and T-shirts with the slogan. When PPAG returned to the community to distribute the materials, many young people refused to accept the T-shirts. According to a PPAG staffer:

I got this message, "oh, we're getting the t-shirts back." Young people said there was no way they were going to wear those t-shirts in the communities because people would know they were using condoms and stuff. If you're saying don't be shy, that means they use condoms. There were probably about 1,500 t-shirts that all came back.

This is surprising for two reasons. First, the community created this message, so why would they reject the T-shirts featuring it? Second, Ghanaians who depend on the used clothing market usually clamor for new, free T-shirts. In theory, abstracted from the public context where the message would eventually be deployed, focus group participants supported condom promotion by PPAG. While Ghanaian youth may agree with the philosophy of the message, and may even use condoms regularly, displaying that message on their chests said more about them than it did about promoting condoms. In practice, wearing the T-shirts was tantamount to Hester Prynne wearing a scarlet letter A. If Ghanaian youth advocate condom use, it might "spoil" their identity (Goffman 1963). Wearing the shirt in support of condoms implied commitment to personal condom use and therefore promiscuity. More than other channels of health communication such as billboards or radio ads, T-shirts intimately linked the message to an individual's identity. Even though PPAG used design practices that improved its cultural sensitivity, PPAG missed the social consequences of the T-shirt campaign for local youth.

As it did with FHI's billboard in Nima, the field of health communication would attribute the failure of these T-shirts to a careless design process. Whereas in hindsight it is easy to attribute these moments of miscommunication to designers' negligence, my sense is that FHI and PPAG acted in good faith. They diligently followed the steps of good campaign design as laid out by the field of health communication and best-practice documents. They conducted formative research and worked hand in hand with targeted communities to develop what seemed to be culturally sensitive and resonant campaigns. They pretested these campaigns, refining them to ensure that audiences wouldn't misconstrue their message. One must acknowledge that organizations have limits — they lack the resources, time, and people to test all possible iterations in advance. Designers did not find these alternative interpretations during pretesting, so they did not expect to see this variation after the launch. It might still seem like PPAG and FHI could have done more to prevent these disruptions. But before you blame PPAG for not conducting enough focus groups or for not asking the right questions, let's examine one more story.

Getting Creative with Condoms

Public-health organizations in Accra (and globally) promote female condoms as a way for women to control fertility and prevent sexually transmitted infections (STIs) such as HIV/AIDS (Kaler 2001; 2004). More often than not, female condoms are promoted through peer education and instructive pamphlets at health clinics and community meetings. During an interview, Grace, the head nurse at an Accra clinic, recounted an unexpected consequence of promoting the female condom. According to Grace, clinic staff noticed a dramatic spike in female condom sales. At the time, clinic staff concluded that their efforts at promoting female condoms had finally paid off. Soon after, a girl came to the clinic asking for a large box of female condoms. Concerned that the girl was too young to be having sex, Grace asked her, "What are you planning to do with these condoms?" The girl replied, "They are not for me, but for my sister." The girl admitted to Grace that her sister turned the condoms into bracelets by removing the latex lining, boiling the plastic rings to stretch them to size, and then dyeing them in bright colors to sell at the market. Later, an older girl came by the clinic with her arm full of these bracelets. Grace reported asking the girl, "How many boyfriends do you have?" The girl answered, "Two." Grace asked if she used protection with these men, to which the girl replied, "Sometimes." Grace became concerned that these girls "would buy the condoms at the clinic in the morning, make bracelets in the afternoon, and then have unprotected sex with boyfriends at night."

From the point of view of clinic staff, they had subsidized, promoted, and distributed female condoms for a singular purpose: so that young women (and men) could avoid contracting HIV and other sexually transmitted diseases. From Grace's perspective, young women who were turning female condoms into jelly bracelets perverted that intention. For enterprising young women, female condoms meant something altogether different: female condoms were raw materials for bracelets, not prophylactic devices.

How could this happen? Why didn't AIDS organizations predict that women would turn condoms into bracelets? Wasn't it obvious? Let's be honest, these questions seem absurd. You might be thinking, "Of course they couldn't predict condom bracelets!" I completely agree. Although this example might seem extreme, I don't see it as any different than blaming FHI and PPAG for their failures. When campaigns don't work according to plan, the field of health communication considers this failure a problem to solve by being more proactive before the campaign's launch. They work to make best practices better. Following this instrumental-rational logic, organizations should gather even more data about their audience to develop even better campaigns that speak with even greater cultural sensitivity. Then, they would expand the pretesting of their campaign ideas with additional focus groups to refine and clarify their message (How about five? No, ten! No, twenty!). Organizations could purchase higher-quality marketing data to choose sites for campaigns that reach target audiences more effectively. However, there are rapidly diminishing returns on these investments. The commitment to evidence-based design that informs each of these solutions requires organizations to spend increasing time and money to wipe out the possibility of misinterpretation. As easy as it might be to blame campaign designers for not doing enough, a more fundamental problem exists. Campaigns are disrupted in spite of these efforts to align their messages with the audience.

The problem is not with AIDS campaign designers in the field but rather with the instrumental model of culture that undergirds the field of health communication. This model, based in social science research, assumes that AIDS organizations can predictably control how people interpret their campaigns and change their behavior by aligning their message with the culture of the audiences they target through a systematic process of campaign design. This book calls into question this instrumental, audience-focused model. To begin to elaborate the deficiencies of this model, let's unpack the process that led to "condom bracelets."

From Condom to Bracelet

The story starts with a young woman visiting a clinic seeking care for an STD or speaking with a nurse during one of the clinic's community interventions. During such a meeting, a nurse discusses the risks of unprotected sex, distributes handfuls of female condoms, and explains how to use the condom effectively. As a female-controlled contraceptive device, the female condom is viewed by public-health organizations around the world and in Ghana as a way to undermine gender inequalities, offering an implicit lesson in feminism. In essence, clinic staff members share a new system of meanings and practices regarding sex and women's empowerment with this young woman.

Opportunities for disruption manifest even at this early stage of the condom promotion process. Women at community meetings who have not experienced an STD may reject the need for condoms outright. Some women may see contraceptive decisions as the responsibility of their partners and reject the empowerment message. Or, the presentation itself might undermine the goal of condom promotion. Many nurses and peer educators have never used a female condom themselves, and their lack of familiarity has been shown to negatively influence clients' likelihood of trying condoms and incorporating them into their sexual practices (Mantell, Scheepers, and Karim 2000).


Excerpted from Best Laid Plans by Terence E. McDonnell. Copyright © 2016 The University of Chicago. Excerpted by permission of The University of Chicago Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents

1 Cultural Entropy
2 The Cultural Topography of Accra
3 “Best” Practices
4 Imagined Audiences and Cultural Ombudsmen
5 Displacement and Decay: Materiality, Space, and Interpretation
6 Scare Tactics: Interpreting Images of Death, Illness, and Life
     Methodological Appendix: Social Iconography

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