CHAPTER SEVEN: SUMMARY, RECOMMENDATIONS AND CONCLUSION

7.1 INTRODUCTION

This chapter aims to summarise the study while drawing conclusions and making recommendations related to the findings presented in the previous chapter. An overview of the results of the study that represent inferences drawn from findings. Finally, recommendations for further research are provided; these are drawn from the conclusions as well as the analysis of data.

As pointed out in Chapter One and Two, public health communication of HIV/AIDS needs to incorporate cultural aspects of the target audience to enhance and influence the understanding of the message. Different scholars emphasised the importance of socio-cultural aspects of the target audience in public health communication and the role that target communities play when their culture is considered in the message, such as in HIV/AIDS campaigns.

Consequently, in the perspective of this study, the data analysed on the relevance socio-cultural factors in the identified PHC messages, different socio-cultural factors were identified in the previous chapter their significance in the public health communication were discussed. In the same manner, the discussion of such factors on how they influence the interpretation of PHC messages were given in Chapter Six. The role that socio-cultural factors play in the understanding of PHC messages was also discussed in the previous chapter, as this forms the foundation of this study.

7.2 SUMMARY OF STUDY

The study investigated the socio-cultural factors that influence the interpretation of public health messages of HIV/AIDS in selected villages in the Berea district in Lesotho. The main focus was to find out how culture impacts people’s understanding of PHC messages, especially HIV/AIDS. To achieve good insight into the center of the study, the introduction to the study was discussed in Chapter One. It was stated that several countries introduced different communication campaigns to combat the rapid spread of this epidemic. However, all campaigns have not succeeded due to socio-cultural factors such as language, gender disparities, education, environment, religion, and other cultural practices in different communities across the world. In line with CSM, there is a lack of research that explains how the environment influences language as a surface structure of CSM and people’s perception of HIV/AIDS messages. This would help emphasise the value of language in creating and understanding of HIV/AIDS campaigns; as a result, help to combat this pandemic.

Chapter One indicated that the failure of public health communication campaigns was due to health practitioners who do not understand and incorporate socio-cultural factors when tailoring public health messages meant to educate the public about the spread of HIV pandemic and how it can be prevented. Notably, in Lesotho, culture is seen as the significant factor that influences HIV/AIDS prevalence, and failure to address cultural values and norms of Basotho will result in less attention to HIV/AIDS-related messages by the public. Being culturally sensitive when dealing with health messages will play crucial in promoting the effectiveness and acceptance of health messages by communities involved.

It was also indicated in Chapter One and Three that culture has both positive and negative roles towards successful acceptance of PHC messages by communities. Kreuter et al. (2002) assert that it is essential to integrate and understand the cultural values of the target audience in PHC as they lead to involvement and acceptance of PHC messages more efficiently. In this regard, Lutz (2017) acknowledges that having explicit knowledge and understanding of the culture of the target audience should be the first step of becoming culturally sensitive. This will allow societies to accept and see the relevance of PHC messages to them if their culture is incorporated into the messages.

The role culture in PHC was discussed, briefly indicating how the culture of an individual has a significant influence on how they deal with health issues as well as judging and committing themselves to the health messages. It was also shown that culture influences how individuals relate to one another, particularly within the dynamics of a sexual relationship. Some socio-cultural factors that influence behaviour towards HIV/AIDS campaigns were also identified. In Lesotho, these factors are likely to promote less understanding of HIV/AIDS messages because of the embeddedness of these factors in the people’s lives, and these factors influence behaviours towards health intervention communicated to the public (Liu & Chen 2010). Therefore, public health communication needs to consider such socio-cultural factors, particularly in sensitising society about HIV/AIDS issues.

In Chapter Two, the cultural sensitivity model (CSM) was discussed as a theoretical framework for this study. The relevance of this theory was given to put forth the importance of being culturally sensitive when dealing with PHC messages. This theory is then related to how the issue of culture can improve the understanding and interpretation of public health messages. Cultural sensitivity in health communication is explained as the conscious adaptation of health communication to suit the cultural background of recipients, based on practical, cultural characteristics and experiences of such recipients (Betsch, Böhm, Airhihenbuwa, Butler, Chapman, Haase, & Uskul 2015).

Scholars within cultural studies and communication argue that taking cultural values and norms of the target audience into consideration when tailoring health messages increases acceptance of such messages. For instance, Ahmad, Horrison, and Davies (2008) state that the inclusion of the CSM model/theory in healthcare interaction promotes cultural knowledge hence the communication process.

In Chapter Three, an extensive literature review was given. This involved the history of HIV/AIDS in Lesotho by showing significant statistics. These statistics help in understanding the seriousness of this epidemic in Lesotho. It was indicated that the Southern African region has the highest HIV/AIDS infection rates in the world, leading to increased high mortalities in the SADC. For example, Lesotho is the second country around the world with the highest HIV/AIDS prevalence. The chapter further discussed different socio-cultural factors by indicating how they influence the interpretation of public health communication campaigns of HIV/AIDS in Lesotho. Chapter Four discussed factors that affect the effectiveness of HIV/AIDS messages and indicated how such factors influence people’s understanding of this pandemic.

In Chapter Five, the methodology used for this study was discussed. It was stated that the method used followed a qualitative approach, as this allows the data to be analysed from various perspectives. Also, the population and sampling techniques used in this study were discussed. The sample for this study comprised of four selected villages from Berea district, in Lesotho. The villages are Ha-Makebe, Ha-Fusi, Maqhaka, and Ha-Foso. This study used a purposive sampling method for participants who took part in this research. The data was collected through face-to-face interviews and focus group discussions. The analysis of data was based on the themes and categories that emerged when the researcher coded data. Chapter Four concluded with a review of the ethical considerations that guided this study.

7.2.1Summary of the Findings

This section provides a summary of the research findings analysed in Chapter Six Data analysis began by finding the perception of community members towards HIV/AIDS campaigns as well as messages contained in such campaigns. The analysis started with religious beliefs, where it was found that all participants are Christians. Participants also showed that religiously they are not allowed to engage in sexual activities before marriage as this exposes them to HIV/AIDS infections. They also indicated that for married people, they should be faithful to one another. As for the use of condoms, the majority of participants pointed out that their religion is against the use of condoms, as this encourages people to have multiple sexual partners. Following these views of the participants, it is clear that religion is one of the cultural factors that help people to behave well so that they can avoid contracting HIV/AIDS.

An analysis of participants’ knowledge of HIV/AIDS revealed that communities are knowledgeable about HIV/AIDS and they are aware that PHC campaigns are meant to sensitise them about the impact of HIV/AIDS, and as a result, they need to avoid actions and behaviours that might lead them to contract HIV/AIDS. This study also revealed that HIV/AIDS campaign helped people to be aware of the danger of this pandemic, and as a result, they are changing their behaviour towards things that might expose them to HIV infection.

Most campaigns that were mentioned by respondents are VMMC, PrEP, PEP, Condom Use, Test and Treat, VCT, and TDG. The majority of the respondents indicated that the central message of these campaigns is to curb the spread of HIV/AIDS in this country and other parts of the world. The most suppressing issue that was revealed when analysing perception and understanding of these HIV/AIDS campaigns by communities is that some participants still believe that the use of condoms is not a hundred percent safe in preventing HIV/AIDS. As for VMMC, older men in the communities believe that it is meant to do aware of traditional circumcision, but they came into consensus with other participants that VMMC reduces the chances of men from contracting HIV/AIDS.

When collecting data, the researcher had to report himself to community leaders or chiefs. It is protocol in Lesotho that when the outsider wants something in the village, he or she has to report to a chief or a community leader as a way of introducing the purpose of his or her research. In this case, the researcher wanted to find the views of participants for HIV/AIDS. The findings revealed different opinions about this pandemic, including factors that influence perceive HIV/AIDS the way they do. Some participants mentioned that HIV/AIDS kills and people need to take care of themselves, and on the other hand, others indicated that culture, in general, contributes to the spread of HIV/AIDS.

HIV/AIDS is a disease that is sexually transmitted, through using the same razor, needles, injections, and other cultural practices like traditional initiation or circumcision. This study discovered that different socio-cultural factors affect people’s understanding and interpretation of HIV/AIDS messages in Lesotho and other parts of the world. Concerning the first research question that seeks to find the relevant socio-cultural factors in the identified PHC messages, participants noted different socio-cultural factors that appear to have an impact on how people understand and perceive HIV/AIDS messages in Lesotho, especially in the rural areas. The findings also indicate that socio-cultural factors have both a negative and positive role in PHC messages. For instance, gender disparities, concurrent sexual relationships, migration, and poverty were found to play a significant role in the spread of HIV/AIDS, and individuals perceive this pandemic. These findings also helped in answering the research question that seeks to find out the role that socio-cultural factors might have in PHC message. In answering this question, participants revealed that socio-cultural factors play both positive and negative roles in understanding PHC messages of HIV/AIDS.

The above revelations are in agreement with Nweze, Eke, and Nweze (2017), who advocated that there is an interconnection between HIV/AIDS and poverty because poverty is a symbol of limited human and monetary resources. Similarly, the findings of this study are incongruent with studies conducted in Mozambique and Namibia (USAID 2009), which revealed that traditional and cultural practices increase the vulnerability of people to HIV/AIDS.

Participants were also in agreement that inconsistent use of condoms, practicing sexual activities before marriage, polygamy, alcohol abuse, and religion exacerbate the chance of people to contract HIV/AIDS. These findings are in congruence with the results of previous studies on the effects of culture on the spread of HIV/AIDS (see, for example, Nxumalo, Okeke and Mammen 2014; Fritz et al. 2010; Shuper et al. 2010; Udeh et al. 2016 Airhihenbuwa & Ford 2015). These studies previously revealed that socio-cultural factors contribute to the HIV/AIDS infection in most societies.

Regarding the data analysed based on how identified socio-cultural factors influence the interpretation of PHC messages, participants indicated that the identified factors have different influences on how PHC messages of HIV/AIDS are perceived. For instance, intergenerational relationships, as well as early marriage, force young women to depend on men financially, and as a result, they are not able to negotiate safe sex or use condoms consistently whenever they engage in sexual activities. These findings indicated that young girls and boys would not see HIV/AIDS as dangerous as the benefits they receive from “sugar mummies and daddies.”

For the data analysed around the objectives of this study, it clear that this study seeks to know the relevance of socio-cultural factors in the identified PHC messages, determine how the identified socio-cultural factors influence the interpretation of PHC messages as well as to establish the role that socio-cultural factors could play in the understanding of PHC messages. To accomplish these aims, participants mentioned different socio-cultural factors that affect and help them to understand the PHC messages of HIV/AIDS. The identified socio-cultural factors by participants found to play different roles in the PHC messages of HIV/AIDS in Lesotho.

It was also noticeable from the data analysed that majority of participants acknowledged that mass media as a communication strategy that is to inform them about general health issues, especially HIV/AIDS, that severely affect their lives. In other words, most informative information about HIV/AIDS is that it is transmitted to them via mass media. Among the mass media that was identified by participants include radio, newspapers, billboards posters, and brochures. These findings are backed by what Kolobe and Bertha’s (2018) study found that mass media is an effective strategy for the Basotho population in communicating public health issues related to HIV/AIDS. It also tallies with the findings of AVERT (2018) results that the mass media approach is an effective strategy for increasing people’s knowledge about HIV/AIDS.

Data collected for this study revealed that there are men who still believe that having multiple partners shows that they are real men. This practice is found to be dangerous to the men themselves as well as their partners. Miller (2014) argued that such socio-cultural practices make men and their sexual partners vulnerable to the pandemic in Lesotho. Also, see (Hlalele & Letsie 2011; Hildebrand et al. 2008).

Notwithstanding, the majority of participants believed that socio-cultural factors or rather the culture, in general, are embedded in people, and as a result, people act according to the norms and values they learn from their culture. According to the views of Airhihenbuwa, Chandra, and Juliet (2014), all cultures have some health belief systems to explain the causes of illnesses, how to treat or cure the disease, and who should provide the health services.

Another socio-cultural factor that was identified in this study is language. Participants showed that language is an essential factor that determines whether messages are successful or not. The findings also revealed that the use of indigenous language when talking about the PHC issue, especially HIV/AIDS, makes people accept messages easily. These findings are similar to studies conducted previously (see Kolobe & Bertha; Moqasa &Salawu 2013; Lubinga & Jansen 2011; Bwanali 2008). This finding also helps us to understand the relevance, influence as well as the role that language play in understanding public health communication. Even if the proper language for the target community is used will enhance the effectiveness of PHC messages.

It was shown in data analysed that medical circumcision and traditional circumcision that there was a misunderstanding between the ministry of health and traditional custodians of what medical circumcision should be named. This made people not to understand the purpose of VMMC as they believed it was introduced to compete with traditional circumcision. Later on, people understood the meaning of this HIV/AIDS campaign and encouraged its practice more than TMC. Participants indicated that they would encourage their boys or partners to be medically circumcised as this form of circumcision is performed in a healthy environment and is an effective strategy for HIV/AIDS reduction as compared to TMC. Even though the majority of participants prefer this form of circumcision, there is believe that it was introduced to reduce the African population because there is a myth that at forty years, all men who circumcised through VMMC will not produce children.

7.3 LIMITATIONS

The purpose of drawing a boundary for the study is mainly to direct attention to a particular area. In light of the limited time and resources, the study focused on a PHC program in four (4) rural areas in the district of Berea, Lesotho. The rural areas areHa-Makebe, Ha-Fusi, Maqhaka, and Ha-Foso. These rural areas are currently absorbed in cultural practices that have the potential of exposing people to HIV/AIDS infections. The majority of community members in these identified villages are not fluent in the language, and this forced the researcher and his assistants to conduct focus groups and personal interviews in the indigenous language, which is Sesotho. These were then translated into English for easy transcription and consumed a lot of time for the researcher.

This study is purely qualitative, and this limited the researcher to provide only qualitative information, whereas scholars argue that the research that incorporates both qualitative and quantitative approaches is credible and easily generalised. Thus, this limits the broad generalisation of this study. I understand the shortcomings of using one research approach in a study. The study also adopted a purposive sampling method when choosing participants who could help in providing adequate information. I was mindful that there might be ways for participants to influence each other as they belong to the same communities.

The researcher provided through analysis of the data based on the identified factors that affect the smooth interpretation of HIV/AIDS messages in Lesotho, and this does not mean that the identified factors apply across the world, and they affect people differently. Therefore, the findings of this study can be generalised in Lesotho because of the type of messages contained in the PHC message. The probability exists that there might be some issues identified in this study, which might be generalised in some parts of the world, which influence how people approach, perceive, and understand HIV/AIDS messages.

The sensitivity of issues surrounding Basotho cultural practices, especially sexual matters and language, restricted the researcher and his assistants from asking questions as freely as they wished to. Most of the things that surround how HIV/AIDS is transmitted are taboo in Basotho culture, and as a result, participants were not comfortable in giving their views around other people, and this forced the researcher to have followed up the interview with some participants after focus group discussions.

7.4 RECOMMENDATIONS

This study aimed to investigate the socio-cultural factors that influence the interpretation of public health messages of HIV/AIDS in selected villages in the Berea district in Lesotho. While doing this research, some shortcomings were identified, and they informed the recommendations that are outlined below.

7.4.1 Recommendation for Further Research

The following have been identified as the issues for further research in the study that calls for further research:

1. This study advocates that to create consistency in the cultural health communication campaigns, similar research has to be conducted in other areas of Lesotho and other parts of Africa.
2. This study also recommends that efforts should be stepped up in the study of culture and health communication. This is because the culture is not static but keeps on changing, and as a result, what this study discovered as major socio-cultural factors that influence interpretation and understanding of PHC might change as time goes on.
3. Scholars argue that using multiple methods in research is more suitable than one method. Therefore, it is suggested that the study of this nature should be conducted using a mixed-methods approach to allow qualitative and quantitative approaches to harmonise each other.
4. Research is also needed to assess cultural values and methods across communities that stimulate individuals to ignore health messages in general.

7.4.2 General Recommendations

1. Based on the data analysed, it was identified that there are no policies that link HIV/AIDS message design to the local culture, which results in a lack of acceptance of PHC messages related to this pandemic. As noted by some participants, most HIV/AIDS messages are on a western culture where some issues like language, age, poverty are not considered. Therefore, the researcher believes that HIV/AIDS should be taken into consideration during the design and improvement of cultural policies and interventions, as this will play a vital role when health practitioners design HIV/AIDS campaigns. This will also help health practitioners to consider the culture of their target audience.
2. Culture should be considered as a critical issue in the HIV/AIDS prevalence in Lesotho and the whole world. This means that health practitioners, especially those who deal with HIV/AIDS campaigns, should be trained to be competent to the culture of their target audience whilst they are balancing this with their work ethics. For instance, a sexually explicit language in Lesotho is seen as a taboo and cannot be discussed publicly; there, they should know the lighter words that they can use if they indent to address the sexual matter in their campaigns. Health workers in this study indicated that due to cultural issues surrounding sexual issues, they are not able to communicate freely with people because of ethical issues that are linked to sex. Another problem that was found to be disturbing among communities is the issues of alcohol and drug abuse, which lead to the lack of condom use, which exposes people, especially women, to HIV/AIDS infections.
3. It is a fact that the purpose of health communication campaigns is to promote healthy behaviour and lifestyle. Data analysed in this regard revealed numerous conflict issues that prohibit intended healthy behaviour amongst people. Participants indicated some of the messages they receive, which are related to HIV/AIDS, are not acceptable in their culture. For instance, some participants showed that messages should culturally sensitive so they can be acceptable to all members of communities. Therefore, it is recommended that public health practitioners should consider the implementation of socio-cultural factors when designing HIV/AIDS prevention strategies as this will allow the target audience to accept and interpret HIV/AIDS messages positively. This will also assist in achieving the desired goals for eradicating HIV/AIDS prevalence in Lesotho and other parts of the world. To achieve the effectiveness of HIV/AIDS communication campaigns in Lesotho, cultural values, beliefs, and norms of the target audience should be prioritized in the development of HIV/AIDS messages or campaigns.
4. According to data analysed in this study, different socio-cultural factors such as languages, education, religion, and gender disparities were found to play a part in the spread of high HIV/AIDS prevalence in Lesotho. Based on the analysed data, measures should be taken to reduce the promotions that do not consider or integrate culture in their design, as this will instill the value of culture in public health practitioners who deal with HIV/AIDS campaigns. Also, public health workers should be encouraged to familiarise themselves with cultural aspects of their target audiences so that PHC messages can be accepted by target communities.
5. From the analysed data, it was revealed that the environment and education as socio-cultural factors play a pivotal role in understanding health messages. These factors contribute to how individuals perceive and interpret messages. For instance, someone from rural areas who did not attend school will not understand the terminology used when formulating such messages. Thus, essential steps should be taken to address all socio-cultural issues in the more extensive public health messages or campaigns. This is because how public health messages are tailored and disseminated are perceived differently around the country, and this affects the understanding and effectiveness of such messages. For instance, public health practitioners should understand the characteristics of their target audience, as this will aid how health messages are processed.
6. The data analysed indicated that there is a lack of condom use amongst communities, especially among men. This was communicated by participants who reported that when they are under the influence of drugs is hard for them to use condoms, especially when they come across beautiful women. Another reason that was put forth by some participants concerning the lack of condom use is that sex is enjoyable without a condom, while other participants showed that the use of condoms is against their beliefs. Therefore, health practitioners who deal with HIV/AIDS issues should try harder to encourage people to use condoms as this will discourage loose sexual behaviour amongst societies, and as a result, the culture of self-discipline in sexual practices will improve. Unless people change their sexual behaviour, HIV/AIDS prevalence in Lesotho and all over the world will not change.
7. It is also recommended that health practitioners (HP) should do their research on different socio-cultural factors within communities before the designing health messages, as this will allowed them to understand how communities associate themselves with various socio-cultural factors. This, however, will assist HP in designing effective campaigns. At the moment, most health communication campaigns are somehow haphazard and disregard the cultural issues involved in societies in Lesotho. This issue itself brings failure in most communication campaigns meant to sensitise people about the HIV/AIDS epidemic. For instance, it was revealed in data analysis that the nature of communication that is applied in health communication campaigns in Lesotho is a top-down form of communication where the target audiences are told what to do instead of involving them when formulating or tailoring health messages. The involvement of communities by health practitioners during the formation of PHC messages will allow communities to engage their cultural aspects in the message and, as a result, increase the acceptance of such messages by target groups.
8. Communities must be encouraged to build health communication campaigns in their areas with the help of professional health practitioners to address health issues like HIV/AIDS. In this way, health professionals will learn from communities of what is acceptable and not acceptable in their culture, and as a result, culturally sensitive health communication campaigns will be achieved.
9. Finally, data analysed revealed that the majority of HIV/AIDS campaigns lack cultural sensitivity, which results in the ineffectiveness of such campaigns. For instance, VMMC in several campaigns as compared to TMC, which is a cultural practice in Lesotho, and this makes people who like TMC not to take VMMC seriously. Besides this, there was a perception amongst some participants that HIV/AIDS is meant to reduce the black population and does not consider their cultural practices, which lead to loose behaviour in children. Perception such as this emanates from culture and could lead to ignorance of HIV/AIDS messages. In this regard, public health communication campaigns (HIV/AIDS programs) should dwell more on cultural sensitivity and educating communities on the social and cultural practices that contribute to the risk of HIV/AIDS in Lesotho, Africa and across the world. This will aid in sensitising communities or societies about the danger of specific social and cultural practices that expose them to HIV/AIDS, and as a result, the spread of this epidemic will be reduced successfully.

7.5 CONCLUSION OF THE STUDY

The main objective of this study has been to find socio-cultural factors that influence the interpretation of HIV/AIDS messages in Lesotho. This study has looked at four villages at Berea district in Lesotho, namely: Ha-Makebe, Ha-Fusi, Maqhaka, and Ha-Foso as the central area of the study. Appropriate literature has been reviewed, and data have been collected using different methods to find relevant factors that impact the interpretation of HIV/AIDS messages in Lesotho, particularly in the abovementioned villages. The findings of this study revealed that socio-cultural practices play a part in the spread of HIV/AIDS as well as hindering people from understanding and interpreting health messages effectively.