Background. Solving the problem of how to provide effective health education on diseases subject to social taboos is an immediate need. The social stigma of HIV/AIDS is particularly prominent in the developing world, where 95 percent of all HIV-infected persons live. Millions of people are risking death from HIV/AIDS while cultures and laws resist change. New approaches must be created to provide education despite whatever social, structural, cultural, and legal barriers exist. Fortunately, the emergence of new media and information and communication technologies (ICT) has provided new ways to help bypass social taboos and provide effective education in ways which were not possible in the past. This dissertation discusses these challenges and presents criteria for evaluating the efficacy of various educational campaigns aimed at promoting awareness relating to taboo topics using a specially designed HIV/AIDS curriculum—Interactive Teaching AIDS—as an exemplar. In health interventions, knowledge is a necessary, although seldom sufficient, step to bring about changes in attitudes and behaviors.
The Interactive Teaching AIDS (ITA) application was developed, tested, and optimized over a two-year period to promote HIV/AIDS education despite social and cultural challenges. It incorporates key pedagogical and communication theories and approaches in order to maximize its efficacy. To provide psychological comfort and promote coherent understanding, this ICT-based application couples the presentation of biological aspects of transmission with culturally-familiar euphemisms and metaphors to communicate ideas about prevention measures. Through a rigorous, iterative, research-based process, the 20-minute application provides detailed yet accessible culturally-appropriate explanations of all key aspects of HIV/AIDS prevention. The process included the development of multiple prototypes and over 150 iterations in total, starting with concept maps, screenplays, storyboards, and low-fidelity paper prototypes, eventually leading to interactive versions of the curriculum in multiple media, including a final version in Adobe Flash.
Methodology. High school and college students ( N=386) from New Delhi, Haryana, and Punjab, were randomly selected across four institutes in India. No one refused to participate. Students at three of the four institutes were assigned to the intervention group, and students at the fourth institute were assigned to the control group. Intervention students received the ITA application. All students received a baseline pretest, followed by an immediate posttest, and finally a retention test one month later to assess outcomes. The assessments measured knowledge of HIV transmission and prevention methods as well as attitudes regarding social acceptance of those infected with the virus.
Results. Experimental students exhibited statistically significant gains in posttest knowledge (p<.001) and positive changes in attitudes (p<.001), even after controlling for pretest knowledge, gender, mother's education and father's education. One month later, the experimental students retained significant amounts of prevention knowledge (p<.001) and displayed positive changes in attitudes (p<.05). On the 40-item knowledge assessment, the experimental group scored 8.25 points higher than the control group participants during the posttest, and 7.03 points higher during the retention test. At onset, males performed significantly better on the pretest than females ( p<.01), however, after interacting with the ITA application, there was no differences between the knowledge gained and retained by males or females in the posttest or retention test, closing the achievement gap. Although HIV/AIDS is generally considered a taboo topic to discuss throughout India, 98.6 percent of intervention students indicated they were comfortable learning from the application, and 94.5 percent said they learned more about prevention through the ITA tutorial than through any other prior communications channel, including television and school. Results revealed that after watching the animated tutorial, a significantly greater proportion of intervention students indicated they felt less afraid of interacting with HIV-infected people rather than feeling more afraid (p<.001) and were less afraid of being infected with HIV rather than more afraid (p<.001). One month later, students exposed to the intervention were significantly more likely to share information with others (p<.001) and were actively seeking additional HIV/AIDS information on their own (p<.001).
Conclusion. For people living in areas that cannot easily access explicit HIV/AIDS materials due to social, cultural or other constraints, these results suggest that it is possible to design curricula that are socially-acceptable and accurate, that promote significant gains in learning, retention, and changes in attitudes. Furthermore these materials can encourage learners to proactively seek more information regarding the taboo topic and share prevention information with others. Educators who are reticent to teach about such subjects due to embarrassment or lack of health expertise can utilize such applications to educate students. Such efforts can also close the knowledge gap between female and male learners.