MEDIA USE AND PREFERENCE RELATED TO CORONARY HEART DISEASE OF THE COLOURED POPULATION OF THE CAPE PENINSULA THE CRISIC STUDY

Sum m ary A s a part o f a comprehensive coronary risk factor study among the coloured population o f the Cape Peninsula (the C R ISIC study), the media use and preference o f the population were examined with a view to suggesting appropriate media fo r conveying health messages. A stratified sample (N = 976) was randomly drawn fro m the coloured population in the age group 15 to 64 years in the Cape Peninsula. Data were collected by means o f a pre-tested questionnaire. Analysis o f the data showed that information on the prevention o f heart disease was obtained in greater measure fro m the mass media than fro m interpersonal communication. A s fa r as media preference is concerned, television was considered the most effective medium fo r conveying information to the community, fo llow ed by instruction given to school children. Greater use o f health educators to convey health messages, as well as a multi-media approach, is suggested fo r a successful intervention programme.


S um m ary A s a part o f a com prehensive coronary risk fa cto r study am ong the coloured population o f the Cape Peninsula (the C R IS IC study), the media use and preference o f the population were exam ined with a view to suggesting appropriate m edia fo r conveying health messages.
A stratified sample (N = 976) was random ly drawn fro m the coloured population in the age group 15 to 64 years in the Cape Peninsula.Data were collected by means o f a pre-tested questionnaire.Analysis o f the data show ed that inform ation on the prevention o f heart disease was obtained in greater measure fr o m the mass media than fr o m interpersonal com m unication.A s fa r as media preference is concerned, television was considered the m ost effective m edium fo r conveying inform ation to the com m unity, fo llo w e d by instruction given to school children.
Greater use o f health educators to convey health messages, as well as a multi-m edia approach, is suggested fo r a successful intervention programme.

IN TR O D U CTIO N
In previous reports of the coronary risk factor study am ong the coloured population of the Cape Peninsula (C R ISIC study) it was shown that this population had a poor coronary heart disease (C H D ) risk factor profile and that there was a great need for an effective C H D prevention program m e (Steyn K. et al. 1985(Steyn K. et al. , 1986(Steyn K. et al. , 1987a(Steyn K. et al. , 1987b(Steyn K. et al. , 1989a(Steyn K. et al. , 1989b -accepted for publication).In order to develop an intervention program m e for CH D , which will attem pt to improve the population's knowledge and behaviour regarding C H D a situation analysis is essential.Such an analysis should contain a disease profile, inform ation on cultural and dem ographic m atters, inform ation on the knowledge, attitudes and beliefs concerning the disease entity, and on the use and preference in respect of com m unication media.As a part of the comprehensive C R ISIC study in which the above factors were studied, the media use and preference of the population were examined with a view to suggesting media for conveying health messages.STUDY PO PU LA TIO N AND M ETH O D S By using a multi-staged probability sampling technique an age and sexstratified sample of 976 respondents was random ly draw n from 485 120 coloured people in the age group 15 to 64 in the Cape Peninsula as reflected in the 5% subsample of the 1980 census.In each household draw n, only one member was selected.Criteria for exclusion from the study were pregnancy, being bedridden, mental retardation, carcinom a, leg am putation, drug therapy to counter tuberculosis, hospitalisation for more than one week during the previous three months and an inability or unwillingness to participate.The realised sample is shown in Table 1.
Trained field workers visited respondents in their homes.D ata were collected by means of a pre-tested questionnaire.Two questions concerning media use and preference were asked: one on the media (sources) from which inform ation about C H D prevention was obtained and the other on which media they considered to be the most effective in providing their ^ com m unity with inform ation on the ^ prevention of CH D .

RESU LTS Sources of Inform ation
The sources of inform ation through which the respondents had learnt how to keep their hearts healthy are shown in Table 2. Inform ation was obtained in a greater measure from mass media (television, written material, radio and posters) than from interpersonal com munication.Of the mass media television was mentioned most often (males 70%, females 67%), followed by reading m atter (males 57% , females 55%) and the radio (males 41%, females 40%), and lastly posters displayed in public places (males 44%, females 37%).Although there were relatively small differences between the different age groups, it is interesting to note that the males as well as the females in the younger age group (15 to 24 years) mentioned written materials and posters more often than did those in the older age groups, whereas they mentioned the radio less often.D octors and nurses as sources of inform ation featured in the fifth place (males 22%, females 24%) with more than one-third of the respondents of both sexes in the oldest age group (55 to 64 years) mentioning this source, whereas respondents in the youngest age groups mentioned it to a lesser extent.Only 14% of the males and 18% of the females learnt about preventing heart disease at day hospitals or clinics.In the youngest age group 42% of the males and 38% of the females stated that they had received inform ation from teachers.These percentages were much lower for the older age groups.Their place of work as a source of inform ation was mentioned by only 16% of the males and 11% of the females.The least mentioned source was schoolchildren conveying inform ation at home.
According to their answers to this question, respondents were further sub divided into eight categories (Table 3).
It appears that • 14% of the males and 17% of the females received no inform ation at all (1) on the prevention of CH D .• mass media as the only source of inform ation (3) was mentioned by approxim ately one-third of both males and females.• mass media as the only source (3), combined with people other than health personnel (5) (in other words without any inform ation from health personnel), was mentioned by 58% of males and 50% of females.• health personnel as the only source (2), combined with people other than health personnel a n d /o r mass media (6, 7 and 8) was mentioned by 28% of the males and 31% of the females -i.e. less than a third of each sex group received inform ation from health personnel.• the three types of sources -mass media, health personnel and people other than health personnelcombined (8) was mentioned by only 16% of the males and 17% of the females.

Media Preferences
The respondents were also asked to select the three media which they considered to be the most effective for conveying inform ation to their com m unity on the prevention of heart disease from a list and to place them in order of priority.The results are shown in Table 4. Television was chosen most often: 78% of the males and 79% of the females listed it as first, second or third choice -similar percentages occurred in each age and sex category.This was followed by instruction given to schoolchildren (males 55%; females 50%).Again the trends were similar for each age and sex group.Newspapers (males 31%; females 36%) featured in the third place, lectures (males 30%; females 29%) in the fourth and day hospitals/clinics in the fifth (males 19%; females 26%).The two least preferred media were pam phlets and magazines.
When the respondents' first choices only were considered, the first five sources of inform ation in order of preference were television, instruction at school, lectures, posters and day hospitals/clinics (table not reported).Newspapers as a source was a very popular third choice.

DISCUSSION
In view of the disease pattern related to CH D , the apparently increasing CH D m ortality rate and the poor coronary risk factor profile of the coloured population, the need for a C H D intervention program m e for this population group is evident.In the development of such a program m e the im portant role of media use and preference should not be overlooked.

No Information Received
With reference to the seriousness of the C H D problem am ong the coloured population, the finding of this study that 14% of the males and 17% of the females had received no inform ation on C H D prevention at all is disconcerting.Effective ways will have to be found to reach every member of the population.In this study a num ber of possibilities that need exploring came to light.

Television
The most outstanding aspect of the findings is that television was not only the medium mentioned most frequently as a source óf inform ation on the prevention of heart disease by all the age and sex groups, but that it was also the most preferred source, both as first choice and overall as one of three most effective ways of reaching the com munity.This suggests that more use can be made of television in a health com m unication programme.The interest in this audiovisual medium also suggests that video programmes can be shown to good effect in clinic/day hospital waiting rooms.In this setting the electronic media should ideally be used in com bination with interpersonal com m unication between viewers and health personnel in order to ensure that inform ation is correctly understood and questions answered.Interpersonal com m unication could for instance take the form of small group discussions.

Radio
The radio, although mentioned as a source of inform ation by approxim ately 40% of the respondents, was listed as one of three most preferred sources of inform ation by less than 20% of the respondents.This finding should be considered together with the greater preference for television.It should be borne in mind that the population in this study was an urban one and therefore had greater access to television sets than would a rural population.In the rural areas the radio may well be a more popular source of inform ation.In the hospital or clinic setting tape cassettes can, as in the case of video programmes, be a useful aid to health guidance if used in conjunction with interpersonal com m unication.

Printed Material
A nother im portant finding is that printed material (magazines, pam phlets, books, newspapers) was the second most im portant source of inform ation concerning C H D prevention.However, when preferred sources are considered, it seems that newspapers were popular (both as third choice and overall as one of three most preferred ways of guidance) whereas pam phlets and magazines were at the bottom of the list.This finding may be due to a greater exposure to newspapers than to pam phlets and magazines and would suggest that more attention should be paid to using newspapers more extensively for conveying inform ation on the prevention of CH D .Concerning the relative unpopularity of pam phlets, it should be borne in mind that pam phlets are often designed for nationwide and cross-cultural use and thus may not attract or hold the attention of all readers.It is suggested that any inform ation material such as pam phlets, posters and videos should not only be designed for a specific target group but that it should be developed in co operation with members of the group to ensure that it ties up with the language and idiom, perceptions and needs of the group.

The School
The school as a preferred source of inform ation was mentioned second most frequently both as a first preference and overall as one of three most effective sources of guidance on C H D prevention.M However teachers as an actual source was™ mentioned by less than one-quarter of the respondents.These findings suggest that the school can be used more effectively to teach C H D prevention.It also seems that the school years are an ideal time for health education as lifestyle, which is an all-im portant factor affecting the incidence of CH D , is learnt in childhood and is very difficult to change in later years.Ideally trained health educators should be used for the health programmes in schools.

Place of Employment
As far as their place of work was concerned, it is interesting to note that only 16% of the males and 11% of the females mentioned it as a source of inform ation on C H D prevention.As a preferred source it was mentioned as one of three most effective sources by 22% of the males and 12% of the females.The M place of work was not perceived as an effective source by the majority of the respondents.However if it is taken into account that a large part of a person's time is spent at work and that his experiences at work greatly influences his lifestyle, the possibilities of education at work should be seriously considered in any C H D intervention programme.Trained health educators with appropriate aids should be available to visit workplaces to give talks to the workforce.

Health Personnel
A desire for interpersonal com m unication was expressed by almost one-third of the respondents who suggested lectures as one of the three most effective ways of teaching the com m unity about CH D prevention.A preference for receiving inform ation from day hospitals/clinics was also listed by 19% of the males and 26% of the females.Less than half the respondents reported that they had received inform ation on C H D from health personnel.Nursing staff could contribute to effective health guidance but the real need is for appropriately trained health educators.
They could for instance assist by leading group discussions after the viewing of television programmes and by treating every contact with patients as an opportunity for health education.Health education should become an im portant aspect of any health service and should be greatly expanded.
Preferred sources o f inform ation (first, second a n d th ird choices jo in tly ) according to sex a nd age TA B LE 4* Since a stratified sample was used percentages for each sex group were standardised separately against the 5% subsam ple of the 1980 census.