Key findings from the postbroadcast reception analysis
of We Beat TB television
adverts
4 April 2012
Helen Hajiyiannis, Alice Clarfelt, Tselisehang Motuba
Centre for AIDS Development, Research and Evaluation
www.cadre.org.za
USAID TB Project
• The USAID TB Project, coordinated through the
University Research Corporation, is a 5-year
programme (2009-2014) aimed at strengthening
tuberculosis control & prevention initiatives in SA.
 One of the key pillars of the USAID TB Project, the
Advocacy, Communication and Social Mobilisation
Strategy (ACSM), has been developed by Johns
Hopkins Health and Education in South Africa
(JHHESA).
 Objectives of the ACSM strategy are to: (1) reduce
number of new TB cases; (2) improve quality of TB
services; (3) increase availability of TB treatment;
(4) increase demand for TB services; (5) improve
management of TB support systems.
USAID TB Project
 Part of the ACSM strategy entails a mass
media campaign called We Beat TB!
 Three television personal service
announcements (PSAs) were produced in
several languages and broadcast on the
national TV broadcaster. Radio PSAs were
also produced.
 The television PSAs were field tested prior
to broadcast and findings were used to
revise adverts and scripts.
USAID TB Project
 The campaign has had four media bursts
on national TV and radio stations:
 November 2009 to January 2010
 March 2010 to April 2010
 October 2010 to December 2010
 July 2011 to September 2011
 A post-broadcast reception analysis was
conducted in March 2012 focused on the
television adverts. This was five months
since adverts were last broadcast on TV.
Target audiences
 Mass media component of strategy is
implemented at national level, whereas
community mobilisation activities are
implemented at provincial and district
levels.
 Target audiences of TV adverts are urban,
peri-urban and rural South Africans of all
ages and particularly those between the
ages of 16 to 64, from low to middle
income households.
Description of three TV adverts
and messages
 Infection control: Open your windows and
cover your cough. Messages: Open the
window, cover your cough, and wash
hands after coughing or sneezing to
prevent the spread of TB.
 Treatment adherence: Take 180 doses to
be number one okay. Messages: Complete
the full course of treatment to be cured of
TB; “180 to be number one okay”.
Description of three TV adverts
and messages cont.
 TB/HIV co-infection: TB is curable even if
you have HIV. Messages: TB is curable
even if a person is living with HIV; get
tested for HIV and TB.
Objectives of post-broadcast
reception analysis cont.
 Objective 1: Explore reception environment
of the adverts.
 Objective 2: Explore personal responses.
 Objective 3: Explore contexts of
interpersonal communication.
 Objective 4: Explore relationship between
educational objectives and actual reception
 Objective 5: Identify gaps in TB knowledge
& develop recommendations for
development of new adverts.
Study design
 Six focus groups were conducted with
representatives of the target audience.
 Focus groups were conducted in three
South African provinces (Gauteng, Eastern
Cape, KwaZulu Natal).
 Focus groups were conducted to include
three localities: urban, peri-urban and rural.
 Focus groups included males and females
and were representative of two age ranges:
18-30 years and 30 years plus.
Study design cont.
 39 people participated in the focus groups.
16 males and 23 females.
 28% of urban participants had tertiary
education, 33% from peri-urban areas had
matric or less and 80% of those from rural
areas did not have matric.
 Minimum criteria for inclusion: seen at least
two TV adverts; willingness to talk openly.
 Groups were conducted in language of
participants’ choice, discussions audio
recorded & audio files translated to English
and transcribed verbatim.
Data analysis
 Team of researchers involved in this project
were tasked to each read through all of the
transcripts and become familiar with the
data.
 A coding structure was developed that
allowed for data from each advert to be
coded separately, as well as for the coding
of data that was general about the adverts.
 Though an inductive approach was taken
to the development of codes, care was
taken to ensure that coding was done in
relation to the key research questions.
Take 180 to be number 1 okay
 Advert was well remembered and seen
across the various localities.
 Commonly was seen on SABC 1 or SABC
2 in English. Only participants from rural
KZN had heard the advert on radio in Zulu.
 Advert was generally described as “the
advert with the dancing cartoons”,
perceived as attractive, appealing and
attention-grabbing.
 Dancing was perceived as “local”, “South
African” and appealed to youth culture.
Take 180 to be number 1 okay
 Inclusion of dance was said to
communicate a positive message about
TB:
“I think the energy and the fact that the
cartoons are dancing, it kind of clears the
thought that if you have TB you are at death’s
bed or something. So the fact that there is
energy around it, it kind of improves the
positivity” (Female, 18-30, urban, Eastern
Cape).
Take 180 to be number 1 okay
 There was some cross-over between
adverts, with this advert including
descriptions of when the animated
characters go to the clinic to get tested (the
HIV and TB co-infection advert). This can
be attributed to having the ‘180’ visual
message appear in both adverts.
Take 180 to be number 1 okay
 Four aspects were identified and referred
to as the distinguishing features of this
advert:
 (1) four dancing characters or cartoons;
 (2) one of the animated characters begins
to cough and changes colour;
 (3) the animation showing pills being
swallowed; and
 (4) the inclusion of ‘180’ at a visual and
audio level.
Take 180 to be number 1 okay
Unaided recall: message takeout
 Focus group participants reported four
messages from this advert. Overall, the
common message or lesson and the one
most often reported as taken from this
advert was the importance of completing
the full course of TB treatment.
“What I saw as very important is that you
must take your treatment in full because you
default you will have a problem. You must
persevere to the end” (Male, 18-30, periurban, KwaZulu Natal).
Take 180 to be number 1 okay
Unaided recall: message takeout
 The second most common message
among focus group participants was that
TB treatment needed to be taken for 180
days.
 This message was often linked to the
message about the importance of
completing the full course of treatment:
“If you are a TB patient take your treatment
for one hundred and eighty days” (Male, 30+,
rural, KwaZulu Natal).
Take 180 to be number 1 okay
Unaided recall: message takeout
 Third message identified by participants
emphasised the need for community and
individual support in order to assist people
to complete their TB treatment.
“There was an idea of community and not
separating people with TB, because when
the one character started breaking down, the
others were like helping him or her up. There
was an idea of community and not
stigmatising TB, like separating TB people,
but rather supporting them” (Female, 18-30,
urban, Gauteng).
Take 180 to be number 1 okay
Unaided recall: message takeout
 Fourth message identified by participants,
focused on debates around whether the
‘180’ referred to in the advert is referring to
number of days of treatment or number of
pills.
“Is it 180 days or 180 tablets, or is it the
same?” (Female, 18-30, urban, Eastern
Cape), while others, spoke about 180 doses
of medication.
Take 180 to be number 1 okay
Unaided recall: message takeout
 There were clearly instances where
participants had understood the message
to be about the 180 pills: “It emphasises
that a person has to take one hundred and
eighty pills to cure TB” (Female, 18-30,
peri-urban, KwaZulu Natal).
 Another aspect identified as unclear,
related to the visual representation of the
animated character taking his pills, shown
as a continuous flow of pills. This resulted
in some thinking the advert was saying all
180 pills are taken at the same time.
Take 180 to be number 1 okay
Unaided recall: message takeout
“M3: I have an issue with the animation. It’s
like they take all their medication all at once.
They should show properly how they take
their medication. …
F4: I agree with M3. It’s like he is taking the
whole medicine, so what does that say, that
we must take the whole medicine?” (Male
and female, 30+, peri-urban, Gauteng)
Take 180 to be number 1 okay
Unaided recall: narration
 Some participants in one of the groups
commented on the narration of the advert,
stating that there was a mismatch between
the narrator’s voice and the actions of the
cartoons.
 The fact that the narrator’s voice begins
about 15 seconds into the advert, seemed
to make these participants only begin
listening to the advert then.
Take 180 to be number 1 okay
Unaided recall: narration
“M2: The narration is not relevant to the
cartoons. You can hear there is someone
speaking on the side and there are cartoons
playing… There are two different things
happening at the same time. This has made it to
lose meaning.
M1: The picture depicted by the narration at the
end does not relate with the actions that already
took place.
F1: The narration is at the end. The cartoons are
already played. By the time you listen the advert
is over” (Male and female, 30+, rural, KwaZulu
Natal).
Take 180 to be number 1 okay
Interpersonal communication
 There were examples of participants
talking to others about the advert: (1)
aspect that triggered discussion was the
dancing cartoons; (2) a female participant
described how she had discussed the
advert with her roommates, discussing the
topic of defaulting on treatment and the
resultant consequences; (3) a male
participant encouraged his wife, who had
once had TB, to watch the advert on TB
treatment; (4) a female participant talked
with her children about the importance of
treatment adherence.
Take 180 to be number 1 okay
Influence on behaviour
 There were two instances reported by
focus group participants of knowing
someone who had been influenced to
continue to take their TB treatment after
watching the advert. Both were from rural
localities.
“My relative was on treatment and wanted to
default thinking he was cured. By watching
this advert he was encouraged to take the
pills for 180 days because he does not want
the disease to come back” (Male, 30+, rural,
KwaZulu Natal).
Take 180 to be number 1 okay
Influence on behaviour
“F2: I have a friend of mine who was helped by this
advert. She stopped taking her pills and drank
(liquor). She thought she was alright, about three
months she was healthy, but after then she fell sick
again. She had to start all over again to take the
treatment.
Facilitator: She had stopped taking treatment…
F2: She had stopped yes. She thought she was
healed. When watching the advert, she saw the
character cough and collapse, we joked about it and
said she will be like that” (Female, 30+, rural,
KwaZulu Natal).
Take 180 to be number 1 okay
Aided recall: message take-out
 Participants identified the same messages
as during unaided recall. The debates
around ‘180’ continued and within the
context of aided recall, participants noted
that even though they had paid close
attention to this aspect of the advert, it was
still not clear to them what was meant by
180 doses: is it 180 doses of pills i.e., pills
taken once a day, or does it mean that pills
are taken over a period of 180 days, but
that there can be more than one daily dose
and or, more than one pill.
Take 180 to be number 1 okay
Aided recall: message take-out
 Commonly, among participants that were
unclear what ‘180’ referred to, there were
also remarks about the advert being “too
busy” and that the narration around ‘180’
took place as the same time as when
music played, contributing to a lack of
clarity.
“I think the part that says you have to take
180 days of medicine, 180 days, so we
thought it was 180 tablets” (Female, 18-30,
urban, Eastern Cape).
Take 180 to be number 1 okay
Aided recall: message take-out
 Three participants identified the message after
watching the advert, as being that TB treatment
takes 52 days to complete.
 This may have been as a result of seeing this
figure during aided recall, whereas previously had
not noticed them, or had understood that when the
numbers are flashing by and stop briefly at ‘52’,
that this meant the end of treatment.
 Unclear if this is as a result of aided recall context
and focusing closely on the advert, or due to the
existence of the potential for misunderstanding the
message.
Take 180 to be number 1 okay
Aided recall: recommendations
 Reduce number of messages and make
advert less busy.
 Voiceover or narration be clear and match
the actions in the advert.
 Drop references to 180 doses of
medication, rather focus on a sentence that
says something like, “you should take your
tablets within 180 days” (Female, 18-30,
urban, Eastern Cape).
Take 180 to be number 1 okay
Aided recall: recommendations
 Have calendar appear close to person
taking the pills rather than elsewhere in the
frame, so when watching person taking
pills, the calendar is linked to this person.
 Have narrator clearly articulate the
consequences of defaulting on treatment,
noting aspects such as person will get sick
again (or importantly, infect others), may
develop treatment resistance.
 Common question was whether
antiretrovirals (ARVs) can be taken at the
same time as TB medication.
TB/HIV co-infection: Overall
views
 This advert generated a strong response,
and critical engagement with and debate
over features of the animation.
 Multiple messages were derived, including:
o How TB impacts the immune system
destroying your “balance”.
o Everyone is vulnerable to TB infection.
o You can be cured of TB if you are HIV
positive.
TB/HIV co-infection: Overall
views cont.
 Overall participants liked the ad and found
positive meaning in it.
 Some participants struggled to remember
the advert during unaided recall.
 After aided recall additional meanings were
found.
 The target audience was said to be
younger people living in more urban areas,
as older rural people would not understand
the animation.
Unaided recall: Message takeout
 Everyone is vulnerable to TB infection: One
must test for TB.
 TB does not discriminate according to HIV
status.
 One must maintain a hygienic lifestyle,
washing hands and eating healthy food.
 Your treatment is the same if HIV positive
or negative (need for clarification).
Unaided recall: Message take-out
 Positive knowledge acquisition – TB can be cured even
if you are HIV positive:
o Inspires hope
o Helps de-stigmatize TB
o One must take one’s family to the clinic, knowing they can be
cured
 Symbolism around the pots and pans on people’s heads:
o The “story of the kettle and the pot” (idiom) – do not judge
someone else when you are in the same situation
o TB can make you lose your “balance” or “power” – you need to
take TB treatment to regain your balance.
o The pots were also described as “symbols of the future” – which
you can rebuild “the tin falls, but you can still lift your tin”
(female, 18-30, peri-urban, KZN)
Unaided recall: Message take-out
 Positive knowledge acquisition – TB can be
cured even if you are HIV positive:
o Inspires hope.
o Helps de-stigmatize TB.
o One must take one’s family to the clinic,
knowing they can be cured.
Unaided recall: Message take-out
 Symbolism around the pots and pans on
people’s heads:
o “Story of the kettle and the pot” (idiom) –
do not judge someone else when you are
in the same situation.
o TB can make you lose your “balance” or
“power” – you need to take TB treatment to
regain your balance.
o The pots were also described as “symbols
of the future” – which you can rebuild “the
tin falls, but you can still lift your tin”
(female, 18-30, peri-urban, KZN).
Clarity – UR messaging
 Confusion / ambiguity over “180” – number
of days or pills? Still unclear after aided
recall.
 Ambiguity over whether can take TB
treatment whilst taking ART (gaps in
information).
 Some participants did not understand the
significance of the pots and pans.
 In one group participants thought the
narration needed to be stronger / more
present.
Influence on behaviour and
interpersonal communication
 There were no explicit examples of
participants taking a particular action in
relation to this advert. New information
acted as a catalyst for generating
conceptualised forms of action (going to
the clinic, getting tested etc).
 There were no clear examples of
interpersonal communication. In one focus
group (18-30, urban, Eastern Cape)
participants said that TB is not something
that is talked about openly. Would mention
ads in passing, not in depth discussions.
Unaided recommendations
 Several participants said they would like
clearer narration for clarification on how to
take your medication, and what the
characters learnt from going to the clinic.
 Narration was preferred to writing (some
are illiterate).
 Some participants wanted more from the
visual quality of the animation – more
colour, more vivid – the setting was said
not to be clear.
Aided recall: Message take-out
 After seeing the advert, discussants identified
certain features more clearly which led to
enhanced interpretations of messaging
 Participants liked how the HIV negative person
became ill first, showing that we are all susceptible
to HIV.
 The laughter was more clearly identified, and how
this follows on from the coughing. A common
interpretation was that one character thinks he is
better than the other one “the saying of the kettle
and the pot” – but we are all vulnerable to HIV
infection, and whether we are HIV positive or
negative.
The story of the pot and the
kettle
 “In as much as the other one is thinking
that he is better than the other one, they’re
in the same situation. Even the made the
cartoon’s head the pot and then the other
one the kettle, put more emphasis on it,
because if she hadn’t said it, even now
looking at it again, I wouldn’t have noticed.
But it does have a lot significance”.
The story of the pot and the
kettle cont.
 “The pot and the kettle are in the same pot,
as in they both go to the same fire, but
most of the time you find the pot. So when
they go to the same fire, they are HIV
negative and positive, so the TB is maybe
saying you are in the same pot. So they
are saying the Xhosas and the Zulus
understand the pot and the kettle thing, but
other cultures wouldn’t understand it”
(Female, 18-30, urban, Eastern Cape).
AR: Message take-out
 Advert was said to counteract stigma by
showing that TB affects HIV+ and HIV- people
and that one can be cured if you are HIV
positive.
 After aided recall participants commented
more extensively on features eg., the pots:
 More noticed characters getting tested.
 There was more clarity around treatment
taking time-period, and for HIV+ and HIV-.
 Pots symbolise that we are all the same /
balance the same things in life.
 Pots are our every day responsibilities.
Pots represent our everyday
world
 It represents your everyday things, your
routine that you do, I could say it
represents your world, and that when you
are weak, your world falls apart, because
it’s your basic needs, your kettle and
whatnot. So those are things that were up
straight when you were healthy, you were
able to carry them on, but when you are
weak, they start falling apart because you
cannot do certain things (Male, 18-30,
urban, Gauteng).
AR – Unintended Messaging
 Increased attention to how one character
laughs at another – interpretation that he is
laughing because the other one is sick.
 One participant (female, rural, Eastern
Cape, 30+) thought that TB was
transmitted through germs on the pots and
pans to the other character.
 Some confusion over the bird and the dog.
One participant attributed TB infection to
the dog. (Male, peri-urban, 30+, Gauteng).
Aided recall - Recommendations
 Desire to see different social classes in the
ad, and within different settings.
 Gap in information identified – if you are
positive do you take same treatment as
someone who is negative? Need for clarity.
 Gap in information: Does it take longer for
an HIV positive person to be cured than an
HIV negative person?
 Desire for clearer narration, either written
or spoken.
Aided recall - Recommendations
 There should be the same level as
attention on TB as on HIV in media
campaigns. TB is a serious threat.
 Ad could have reached a broader audience
by including more modern items like
laptops, rather than just pots and pans –
implication that this is not just targeted at
people from a poorer socio-economic
background.
AR - Recommendations
So it wasn’t more appealing to a vast
number of people. I would maybe
take the same journey, but on the
screen divide it into two different
worlds. So the other one might have
kettles on the head, and maybe the
other one, have things that speak to s
now, like your laptop, things that are
more (Male, 18-30, urban, Gauteng).
Open your windows and cover
your cough: Overall views
 Overall this advert was well-liked, although
engagement was not as strong as with the
other two adverts. Participants thought the
advert and its messaging was clear.
 Some saw the ad on TV in different
languages, others saw it in English. Those
who heard it on the radio heard it in Zulu.
 Participants like the animation and the
setting of the household, which they could
relate to. The characters were thought to
be a family, or a group of friends.
Open your windows and cover
your cough: Overall views
 Key messages centred on infection control
through opening your windows and
covering your cough, and also the
importance of supporting someone who
has TB rather than ostracising them.
 In some groups there was poor unaided
recall, especially of key features such as
the hand washing action.
 Some participants said they did not derive
anything new from the ad, having been
exposed to this information from past
campaigns.
Overall views
 “I like the advert, I think it has a big impact
on the community. It shows that a person
with TB should not be an outcast, we
should not reject or run away from a
person with TB. And when we are sitting
with a person with TB, we should make
sure that the area is well ventilated so that
the wind can blow in and germs go out. I
like it” (Female, 18-30, peri-urban, KZN).
Unaided Recall: Message take-out
 The main overall message taken from this advert
was about infection control through opening
windows, allowing for ventilation and for TB
germs to be let out of the environment:
 “It shows us how to prevent the spread of TB. Like
it can go out, and we should open the windows
and have air bricks inside the house so that it goes
out, that kind of ventilation. It shows that TB can
actually be taken out of the environment through
those mechanisms” (Male, 30+, peri-urban,
Gauteng).
 Some said that this was a new message and that
previously they had thought you needed to close
the window in order for germs not to come in.
UR: Message take-out
 The knowledge that you can prevent TB through
opening your windows was said to be empowering
because it allows you to sit next to someone or live
with someone without contracting TB if you take
this action:
For me, we’ve already said it, but I think it was
important that it, well personally, it created that power
in knowledge in terms of when you know that okay,
you can still sit with someone who has TB and not get
it because of ventilation. You are empowered by that
knowledge, and then you don’t stigmatise it or run
away from it. You know that you can live with a person
and not get it because both of you have been
responsible in that way. (Female, 18-30, urban,
Gauteng).
UR: Message take-out
 The second most common message derived from
this advert was about coming together to support
someone who has TB.
 Sticking together and not excluding someone who
has TB was connected to the way the characters
continue to sit together even though they know
one of them is ill.
 Support was said to be important for treatment
adherence.
 Support is essential in de-stigmatising TB.
 One participant saw a progression from the first
advert (180) where they have moved on from
stigmatising TB and are now accepting and
supporting the TB infected character.
Supporting not stigmatising
someone with TB
“It was a group of people sitting in the kitchen playing cards,
and while they were playing cards one of them coughed. They
opened the window for ventilation reasons, as we have already
established. Drawing from that, I could say, drawing from the
first advert to this one, it could be days when the character who
broke down in the first advert is taking their medication now”.
“Everyone knows about it, that he or she has TB, and it could be
between that period of 180 days taking your medication and
now it’s moved from stigmatising TB, because they are playing
together, and they have accepted and they are supporting him.
They open the window for ventilation reasons because, well,
from my knowledge TB does spread from air particles and
whatnot” (Female, 18-30, urban, Gauteng).
UR: Message take-out
 The third overall message taken from this advert
was on covering your mouth when you cough.
This did not come through as clearly as the
opening your windows, or support message during
unaided recall.
 You must cover your mouth when you cough and
your windows are open “you do not just cough
anyhow” (Male, 18-30, peri-urban, KZN).
 When discussing covering one’s mouth as a
method of infection control, additional messaging
was derived over the issue of how to dispose of
phlegm – with a tissue, or to cover it with soil (gap
in information).
UR recall: Message take-out
 Washing your hands as a method of
infection control was the final message
derived during unaided recall.
 This was not as common as the other
methods of infection control, as participants
could not remember the action clearly. This
only came through as a stronger message
during aided recall discussions.
UR recall: Clarity
 Participants did not have clear recall of the washing of
hands. Some remembered the running water, but the
association with hand washing was not clear.
 Some did not see the hand of the person who was
coughing, said to be a feature of the animation.
 Need for information around how to dispose of sputum
if you cough into your hand.
 A few participants were unclear about the ad because it
conflicted with other messages that someone with TB
should not catch cold, so you should keep your
windows closed.
 There was some unintended messaging, as two
participants thought that it was possible to catch TB
through playing cards (Female, 18-30, peri-urban,
KZN; female, 30+, rural, Eastern Cape).
Influence on behaviour and
interpersonal communication
 Several participants spoke about how viewing this ad
encouraged them to educate and communicate with
others.
 One participant (female, 18-30, urban, Gauteng) said
that the advert helped her and her family as they
attempted to get her father to adhere to his TB
treatment (although it was not clear whether they were
successful).
 One participant said that this advert would encourage
her child to teach another child to cover his mouth
when he coughs (Female,18-30, urban, Gauteng).
 Another participant spoke to his sons about infection
control (covering your mouth and washing your hands)
(Male, 18-30, peri-urban, KZN).
Aided recall: Message take-out
 After seeing the advert the washing of hands and
covering of mouth actions were said to be clearer.
 There was a more in depth engagement with the
washing of hands action including that you must
immediately wash your hands, and not just before
preparing or eating food.
 The association between coughing and washing hands
was observed to be important, and new messaging.
 A further message was about protecting one’s family
through infection control
 The bacteria were more clearly observed after aided
recall, and how they are quick to exit when the window
is opened.
Recommendations
 There was a call for more information
about the signs and symptoms of TB, apart
from just coughing.
 A few participants wanted more information
in this advert about where to get tested.
 Discussions indicate that there is a gap in
information around infection control when
you cough. If you cough into your hand,
where do you dispose of the sputum /
phlegm? Many areas do not have running
water.
Recommendations
 Some participants wanted clearer
narration, with more information provided
at the beginning as well as the end of the
advert. It was said that, currently, “if you do
not use your mind well you will not get the
message of the advert” (female, 18-30,
peri-urban, KZN).
 Some would like brighter colours in the
advert.
 Participants liked the household setting for
TB infection control, and suggested other
popular, public spaces like a taxi or car.
Animation
 There were mixed and diverse responses
to the animation.
 In general animation was met with a
positive response, but some participants
disliked what were often described as
“popeyes”.
 It was said that older viewers would not
respond as well to the animation as
younger viewers, or people living in rural as
opposed to urban areas.
Animation: Positive responses
 Positive responses to the animation
included:
o Liking the ways that the characters moved
– often in unison, showing support for the
person living with TB (180)
o Liking the colours in the advert and how
they direct to a certain action, such as
hand washing in the infection control
advert.
o Enjoyment of the music, identified as
‘marimba’ which was said to be catchy and
an easy way to recognise the advert
Animation: Positive responses
o Participants liked the black and white
colours of the animation, which was said to
be more serious as compared with other
cartoons.
o The animation seen not to type-cast people
by class or race. This was said to be
particularly important in conjunction with
the issue of TB stigma, so that TB is not
immediately associated with older or
younger people, a particular race or class.
o The advert also reaches young children as
well as adult viewers:
Animation: Positive responses
The characters I think it is best. It relates
to kids, it relates to adults. It is the best
one. As the brother has said, it relates to
kids yes, they can watch and see that
there is a message in these cartoons. In
the same way adults do not like
cartoons. But at the end of the advert as
an adult, you will end up wanting to see
this advert and you will get the message
(Female, 18-30, peri-urban, KwaZulu
Natal).
Animation: Negative responses
 Negative responses to the animation:
o That some participants could not identify
with or relate to the animated characters: “I
think the cartoons are not humanoid
enough, they are confusing if they are
human-like or just a strange creature”
(Male, 30+, rural, KwaZulu Natal).
o That older people or those living in rural
areas would not be able to relate to the
animated characters“ [older people]don’t
take consideration of the cartoons” (Male,
30 +, peri-urban, Gauteng)
Animation: Negative responses
o Sometimes there was a lack of clarity
around certain features of the messages
due to the animation, such as showing a
real hand for covering your cough in the
infection control advert, and in the HIV / TB
co-infection advert some participants
thought that TB was transmitted through
the pots and pans.
o Finally certain features of the animation
were said to be distracting or confusing,
such as the dog and the bird.
General: Slogan
 Slogan generally spontaneously
remembered and was well-liked.
 ‘We’ in We beat TB associated with support
and countering stigma and discrimination
against people living with TB. “We” beat TB
instead of “I” beat TB is heard as message
to counter isolation.
 Slogan perceived to reinforce that TB can
be cured in the presence of HIV.

General: Slogan
I think even the voices, “we beat TB”, that
thing, it sticks in you that no matter what
status you have, you can always beat TB,
you can always be treated (Female, 18-30,
Urban, Gauteng).
 During aided recall participants added to
the point about “we” adding that it can refer
to a personification of the pills and the “we”
becomes the person and the pills unified in
the fight against TB.
 Slogan perceived to encourage positivity
and to become a sub-conscious reminder.
General: Slogan
 The slogan is perceived to be a brand
associated with the TB adverts.
 The slogan with “little voices” was easily
recognisable and associated by
participants as “that’s the TB advert”.
 I would say don’t change the idea, the
style, because people relate to it. So next
time, the minute they see it, they’ll identify
with the product, that it is the TB brand. It
will become like the trademark (Male, 1830, Urban Gauteng).
General: Other TB adverts or
programmes
 Little or no recall of previous or current TB
adverts apart from an advert called Stop
TB. This remembered vaguely.
 Aspect liked from Stop TB advert was the 5
steps. Suggested these are incorporated in
We Beat TB.
 Paucity of TB information on TV. Sources
of information reported were storylines in
Soul City and 4 Play: Sex Tips for Girls.
 Call for more attention to TB in mass
media.
Questions and gaps in TB
knowledge
 Critical and common gaps about
symptoms of TB apart from coughing.
 Questions ranged from whether there
were symptoms to look out for prior to the
appearance of a cough; to straight forward
requests for more information on
symptoms of TB.
 Request for more detailed information
about when to take action, for example,
how long to wait before going to a clinic to
seek treatment for a cough.
Questions and gaps in TB
knowledge
 Myths and gaps in information about the
transmission of TB:
 Sharing of eating and drinking utensils
with someone who has TB;
 Kissing someone who has TB;
 Whether pregnant women with TB can
transmit TB to their unborn children;
 Strong beliefs exist about the association
of pollution, dust, and smoke in the
development of TB, with many believing
that these are causes of TB.
Questions and gaps in TB
knowledge
 Gaps in information about TB prevention:
 Noted by many that there are many HIV
prevention methods but the only ‘tool’ they
had in relation to TB prevention, was to
cover one’s cough.
 Questions about the risks of getting TB in
relation to having had TB in the past, and
whether risk is increased if a person is
living with HIV.
 If those vaccinated still develop TB and if
yes, why.
Questions and gaps in TB
knowledge
 Gaps in information about types of TB:
 Some had heard about multi-drug
resistant TB (MDR), extremely drug
resistant TB (XDR) but wanted information
about how these forms of TB come about.
 Some participants had heard about TB
that affects the spine and other parts of
the body, apart from lungs. There were
requests for information about symptom
presentation for these types of TB and
how diagnoses are made.
Questions and gaps in TB
knowledge
 Gaps in information about TB treatment:
 Role of alcohol in TB treatment: 1) does
intake of alcohol while on TB treatment
interfere with the medication and or cure,
and 2) how to encourage or support people
who drink excessively and who default on
their TB treatment.
 Common question: whether PLWHA and on
ARVs can take TB treatment as well. Can a
person take ARVs and TB medication
simultaneously or should person suspend
their ARV treatment during TB treatment.
Questions and gaps in TB
knowledge
M4: The issue of mixing medication is very
dangerous! They did not show any danger
there because these are related diseases
and medicine can be mixed I guess.
M1: As an HIV positive person you should
first finish your TB medication before
continuing to HIV.
F3: You have to take the TB treatment first
because it is short but the HIV treatment
takes long (Males and females, 18-30, periurban, KwaZulu Natal).
Questions and gaps in TB
knowledge
 Is TB treatment the same for people living
with HIV and those not living with HIV?
 Does length of TB treatment vary between
PLWHA and those who are not.
 Is length and type of treatment for MDR TB
and XDR TB different from regular TB and
if so, how?
 Length of treatment versus the daily
dosage of TB treatment. 180 days known
but not what the dosage is (once daily
dose?180 pills? More than 180 pills?
Questions and gaps in TB
knowledge
 Is TB treatment the same for people living
with HIV and those not living with HIV?
 Does length of TB treatment vary between
PLWHA and those who are not.
 Is length and type of treatment for MDR TB
and XDR TB different from regular TB and
if so, how?
 Length of treatment versus the daily
dosage of TB treatment. 180 days known
but not what the dosage is (once daily
dose?180 pills? More than 180 pills?
Questions and gaps in TB
knowledge
 Challenging stigma & discrimination:
 Noted that that TB is not spoken about
openly or easily, especially rural localities
visited.
 Participants explained that there was a
strong inhibitor against talking about TB in
their communities because of its
association with HIV.
 Participants recommended communitybased activities that would promote TB
information & debunk myths & stereotypes.
Conclusion and
recommendations
 The overall objectives of the adverts were
achieved. Participants identified and
recalled the main messages from each of
the adverts.
 There is a significant discrepancy in the
views of urban viewers as opposed to periurban and rural viewers with regard to the
use of animation (the latter would prefer
the use of ‘real’ people). Despite dislike of
the format, message recall unhampered.
 Suggest continue with current format.
Conclusion and
recommendations
 Exposure to the adverts took place over 18
months in 3-month bursts with 3-6 months
break in-between. This contributed to
conflation of messages between adverts,
which serves to re-inforce messages.
 Evidence of We beat TB brand recognition
but it is still elementary. Suggest other
mass media to accompany adverts
(pamphlets, billboards, posters and
continuation of radio broadcast).