my Dissertation

This book entitled "Communicating Health,A content analysis of Girubuzima a documentary of RTV,is my own research done in the completion of the award of bachelors degree in Communication atr National University of Rwanda. It used content analysis methodology in assessing the reasons that make Rwandans continuing to have health problems though this documentary was there to help them improving their health state.The researcher come up with suggestion after remarking that there are some errors in the documentary that you find inside the research findings.


 DECLARATION I, Jean Louis Uwonkunda, hereby declare that, except where otherwise indicated the present research work is entirely a product of mine and has not been submitted to any other university or higher institution. Sincerely, …………… Jean Louis Uwonkunda June, 2012 DEDICATION To: My almighty God, My extended family, My beloved friend, My lecturers at National University of Rwanda, Writers of books on communication and health communication, And any other person who may have contributed directly or indirectly in the completion of this research, I dedicate this work! ACKNOWLEDGEMENTS My sincere gratitude goes to the National University of Rwanda, Faculty of Arts, Media and Social Sciences, and the School of Journalism and Communication direction who gave such an opportunity to students completing Bachelor’s degree to conduct a research as a learning process. Without such an opportunity and their support this work would remain a mere dream. I extend my gratitude to my supervisor Mr. Njuguna Joseph who used much of his time showing me the right way to adjust my research. Without him sincerely this work would not be possible. I would like also to express my deep thanks to my family, mother and father, responsible for my childhood and especially my uncle Protais Hakizimana who struggled for my studies in secondary as well as university on moral and financial supports. I am indebted to The Rwanda Health Communication director to have offered me the opportunity of conducting my research in the institution under his supervision. Again, the producer of Girubuzima documentary to facilitate me gets the data for analysis. I can not leave out my lecturers at National University of Rwanda, colleague students, and any other who willingly have contributed in gathering data and compilation of this work. May God Bless you all! TABLE OF CONTENTS DECLARATION i DEDICATION ii ACKNOWLEDGEMENTS iii TABLE OF CONTENTS iv LIST OF FIGURES AND TABLES vii ACRONYMS AND ABBREVIATIONS viii ABSTRACT ix CHAPTER ONE: GENERAL INTRODUCTION 1 1.1. Background of the study 1 1.1.1. Communication and development 3 1.1.2. Media messages and Public Health 3 1.1.3. Media and Health Promotion. 4 1.2. Communicating Health through media in Rwanda. 5 1.3. Background of Rwanda Health Communication Center. 5 1.3.1. Urunana 6 1.3.2. Girubuzima. 7 1.4. Statement of the problem 7 1.5. Objectives of the study 9 1.5.1. Main objective 9 1.5.1. 1.Specific objectives 9 1.6. Research questions 9 1.7. Significance of the study 10 1.8. Scope of the study 10 1.9. Limitations of the study 11 1.10. Research methodology 11 1.10.1. Content analysis 11 1.10.2. Sampling Techniques. 12 1.11. Organization of the study 13 CHAPTER TWO: LITERATURE REVIEW 14 2.0. Introduction 14 2.1. Conceptual framework of health communication 14 2.1.1. Communication 14 2.1.2. Health 16 2.1.3. Public health 17 2.2. Theoretical framework of the study 17 2.2.1. Health communication 17 2.2.2. Communicating Health through Media 19 2.3. Analyzing media contents 22 2.3.1. Analyzing a TV documentary 23 2.3.2. The process of content analysis 24 2.4. Examples of TV content analysis Worldwide 25 2.5. Theories of communication 26 2.5.1. The agenda setting theory 26 2.5.2. Attribution Theory 27 2.5.3. Two step flow theory 28 2.6. Conclusion 29 CHAPTER THREE: RESEARCH METHODOLOGY 30 3.0 Introduction 30 3.1. Content analysis 30 3.1.1. Using content analysis 31 3.2. Tools of data collection 32 3.3. Sampling frame 33 3.4. Units of analysis 33 3.5. Data analysis and processing 34 3.5.1. Data Analysis techniques 34 3.5.1.1. Editing 34 3.5.1.2. Coding 34 3.5.1.3. Tabulation 34 3.5.2. Quantitative data analysis 35 3.5.3. Qualitative data analysis 35 3.6. Conclusion 35 CHAPTER FOUR: PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS 36 4.1. INTRODUCTION 36 4.2. Presentation and interpretation of findings 37 4.2.1. Presentation of the Girubuzima documentaries in 2011 and the general contents. 37 4.2.2. The main subjects accompanied with themes of the Girubuzima documentaries in 2011 39 4.2.3. Themes available in the Girubuzima documentary in 2011 41 4.2.4. Geographic focus of the Girubuzima documentaries in 2011 43 4.2.5. Illustrations in the Girubuzima documentaries in 2011 43 4.2.6. The main sources and information of the Girubuzima documentaries 44 4.2.7. The Duration of the Girubuzima documentaries in 2011 46 4.2.8. The quality of the Girubuzima documentaries in 2011. 47 4.2.9. Figures of speech used in the Girubuzima documentaries in 2011 48 4.2.10. The place where the Girubuzima documentaries were made in 2011 52 4.2.11. The level of the public participation in the Girubuzima documentaries in 2011 53 4.2.12. The frequency of the Girubuzima documentaries in 2011 54 4.2.13. Target audiences of the Girubuzima documentaries in 2011 54 4.2.14. The idea for the Girubuzima documentaries in 2011 55 CHAPTER FIVE: SUMMARY OF FINDINGS, GENERAL CONCLUSION AND RECOMMENDATION 57 5.1. Summary of findings 57 5.2. General Conclusion. 58 5.3. Recommendations 59 REFERENCES 61 A. BOOKS AND REPORTS 61 B. UNPUBLISHED RESEARCH REPORTS: 63 C. INTERNET RESOURCES 63 APPENDICES 66 APPENDIX I: UNITS OF ANALYSIS i APPENDIX II: THE CODEBOOK iv APPENDIX III: TRANSCRIPTION OF THE GIRUBUZIMA DOCUMENTARIES xi LIST OF FIGURES AND TABLES Figure 1: The communication process 15 Figure 2: An Ecological Model of the Communication Process 16 Table 1: Girubuzima documentaries presented in2011 and the summary of their contents 39 Table 2: Subjects and themes of the Girubuzima documentaries in 2011 41 Table 3: Themes of the Girubuzima documentaries in 2011 42 Table 4: geographic focus of the Girubuzima documentaries 43 Table5: Illustrations in the Girubuzima documentaries 44 Table 6: Source and information given by the source in the Girubuzima documentaries 45 Table 7: duration of the Girubuzima documentaries. 46 Table 8: The quality of the Girubuzima documentaries 48 Table 9: Figures of speech in the Girubuzima documentaries 51 Table 10: where the Girubuzima documentaries was played 52 Table 11: The level of public participation in the Girubuzima documentaries 53 Table 12: the frequency of the Girubuzima documentaries in 2011 54 Table 13: Target audience of the Girubuzima documentaries 55 Table 14: Idea for the Girubuzima documentaries in 2011 56 ACRONYMS AND ABBREVIATIONS HIV/AIDS: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome. MOH: Ministry of Health RHCC: Rwanda Health Communication Center UNESCO: United Nations Educational, Scientific and Culture Organization PSA: Public Services Announcements BCC: Behavior Change Communication RTV: Rwanda Television HRC: Health Related Content PARC: Physical Activity Related Content CNLS: Commission Nationale de Lutte Contre le SIDA ABSTRACT The present work is a result of Communicating Health conducted using a content analysis methodology to reveal noticeable characteristics of the content of the Girubuzima documentary, a health documentary on RTV. The research was limited to the period of the year 2011 to provide possible ways to improve the content of this program so as to deliver health messages effectively and efficiently. This research was conducted after noticing that many health problems and diseases like HIV/AIDS, diabetes, heart diseases and diseases of poor sanitations have not reduced the gravity despite the four years the Girubuzima documentary has been being aired. In fact, the population pressure which brings about other health problems has called upon the need for family planning which is not custom made by the population still. In this work the researcher using a content analysis, he went through all documentaries produced in 2011 and analyzed messages into characteristics. Indeed a number of subjects were covered in this period such as health care and health policy. Again, themes like awareness on prevention, attitude change, medical treatment and medical calendar were tackled. The researcher also used other many units of analysis just to name few, illustrations, the frequency of the documentary, the interviewed source and the information they have provided. After analyzing the twenty documentaries as a sample for all 40 documentaries, the researcher noticed the some weaknesses in the Girubuzima documentary. To name few, Family planning was not well covered, victims were not given enough time to tell to the public their experience, the program owner didn’t care for errors and program regularity, messages were not repeated to remind important points and the program owner was more occasional than planned. In the end, the researcher left out recommendations for the next coverage of Girubuzima among others, involving the public and victims in the next presentation, making a follow up on presentation regularities, evaluating the public with Knowledge attitude and practice through feed back, using efforts in covering subjects and themes which were not well covered, meeting the public and discussing with them what would be part of next documentary presentations, and emphasizing on some groups that were found susceptible to health problems like youth, married couples, and rural people . CHAPTER ONE: GENERAL INTRODUCTION 1.1. Background of the study From far long ago, communication has been a vital need in the life of human beings. In fact, communication is embedded in the daily activities of human beings. Severin, et al. (1979) defined communication as the act of sharing information or knowledge to someone, or if there is exchange, putting them in common. It is also the transfer of information between a source and one or more receivers; a process of sharing meanings, using a set of common rules (Harding, 2006). In Rwanda and elsewhere in the world, people share information about economy, culture, politics, and health, among other domains. Harding stated that “no where can people live without communicating for Communication is central to our everyday functioning and can be the very essence of the human condition. Consequently, poor communication leads to problems and conflicts” (Harding, 2006). Apart from all the other domains stated above, communication in the domain of health would be of paramount importance if effectively applied. Indeed, the fact that Rwanda faced a critical communication crisis, especially in the 1990s, resulted in poor health conditions among the Rwandan population .A good example would be taken from the 1994 genocide when at least a million of people were killed, and others were left orphans, widowers, and others disabled in different ways. In addition, there has been a spread of many dangerous diseases and epidemics. Harsh epidemics like HIV/AIDS and Diabetes have been taking lives of the people. Again, in many rural areas of Rwanda, children and mothers are anguished of disease resulting from poor nutrition and sanitation, innate and infectious diseases. In all the cases, a big number of the vulnerable are not aware of the disease or the way to its treatment despite information that the Girubuzima documentary have been providing. Indeed, in some rural areas of Rwanda, dangerous diseases like diabetes, HIV/AIDS, heartburn, poor sanitation, and others, are confused with poison conditions, what make them seek for traditional healers as it is remarkable in media reporting. A good example was remarked on the 12th June, 2011, during the Ministry of Health campaign of hygiene and sanitation in Nkotsi sector, Musanze District. On this issue, William Nakafero, a resident of Nkotsi sector, testified that “a big number of People here live with different dangerous diseases as a result of not having toilets, and not using Kandagira ukarabe(hand washing system nearby toilets) while they claim they are empoisoned” . The need for communication in health domain in Rwanda, moreover, is highly linked its density. In fact, Rwanda having the over average of 321 inhabitants per square brings about many difficulties in communicating effectively health based policies like Family planning, health insurance, and behavior change. Nevertheless, health communication in Rwanda should be enhanced as the globe is worried about the spread of great epidemics and diseases which might arise in the future if no reliable measures taken. For this issue, World Health Organization predicted that in 2030 the rate of diabetes will have got the double because of poor health care services and poor nutrition in some countries especially African countries . Therefore, prioritizing health as said Gandhi, "It is health that is real wealth and not pieces of gold and silver.” Strongly justify the fact that effective health communication is a sole solution to problems facing people in Rwanda, and media are effective tools to reach the mass of the public. 1.1.1. Communication and development Communication plays a key role in development and it is impossible for development needs to be addressed effectively without involving the local media whereby messages about poverty reduction, people empowerment, eradicating diseases, job creation, among others reach the public. Important also is the participation of the public in making decisions aimed at development.(Melkote and Steeves 2001). Harding also cited Schofield (2004) and wrote that effective communication can act as a drug to prescribe. This means that patients dealt with professionals having good skills in communication, are likely not to get disease complications (Harding, 2006) Communicating health which is linked to communication for development is very important to community health in raising community awareness, influencing public opinion, mobilizing support and generating action as wrote (Pertschuk, 1987). This was also confirmed by Geist (2003:3), defining health communication as a symbolic process by which people, individually, and collectively, understands, shape, and accommodate to health and illness. Geist continue saying that Health communication is the study and use of communication strategies to inform and influence individual and community decisions that enhance health .When this communication is rich in content and effectively used, it becomes a key to the Development. 1.1.2. Media messages and Public Health Media is an important ally in any public health situation. It serves the role of being a source of correct information as well as an advocate for correct health behaviors. But before the media can take on that role, it needs to understand the virus, the issues surrounding it, policy and practices, and finally, recommended correct behaviors (Glik, 2004). Media can distribute accurate information and stimulate informed discussion that can in turn impact positively on health and development issues (Lupton, 1994). The cited above authors have mentioned the role of media in addressing health messages. Combs also clarified the need of media to set the public agenda. “It is commonly accepted that the media have the power to set the agenda for public discussion of issues, to decide what is important and should receive attention” (Combs, 1997). Within this perspective, Theoretical and research issues in health communications comprise the delineation of media content, audience needs and characteristics, the effects of media content on the audience, and the processes by which the media can be influenced to include healthier messages as confirmed Cline. He adds that important are the meanings and interpretations attributed to health messages in the media (Cline, 2003). In fact, media always set health agenda to the public telling them what to think about, how many people died, and why, what are the problems facing health in a given area, and how taking preventive measures. 1.1.3. Media and Health Promotion. Departing from the point that media serves the role of being a source of correct information as well as an advocate for correct health behaviors; Radio and television, are effective ways to persuade target audiences to adopt new behaviors, or to remind them of critical information. Hence, media inform people about disease and where to seek for help. Media also keep them updated about immunization campaigns. Radio Spots help health professionals reach a diverse audience with messages and help their trainings on health issues. This is the reality, the use of Radio and Television for health communication in Rwanda and elsewhere in the world. Community media, new media, are given nucleus importance in many countries to deliver health messages to a scattered audience as the following examples can confirm this point world wide: “Phaphama”, a Zulu word which means “woke-up” is a weekly show program aired every Monday on Soweto TV in South Africa. This programme deals with public health messages educating people about HIV/AIDS, blindness and tuberculosis. Radio program also was used in Swaziland to prevent the deaths of infants and young children from diarrhea. Radio broadcasts also were used to train health professionals to treat the disease, distribute relevant health materials and set up places where mothers could learn how to prepare medication properly. There are other many programs among others, Janjaruka in Kiswahili for ‘Be on your toes. (The new HIV segment on Radio Koch FM in Kenya). This is a radio program about health where people listen, get updated with health information, and call for feed back. Health o’clock is a radio program in Guatemala which proposes health themes for discussion every Saturdays, experts explain and people call for questions. Radio and Television were used for a Vaccination Campaign in Philippines in 2010 , Bazamuganga is a Radio Program on BBC with which a journalist ask questions to experts in health based on the Public questions and make a documentary for the audience serving as answer to the public questions. All these examples show the need for media to promote health and to make health messages available to the public. 1.2. Communicating Health through media in Rwanda. Communicating health through media is not new in Rwanda. Indeed, due to the power of media in shaping and influencing people’s attitudes, messages and programs about health are aired on radio and television. For instance, Contact Fm, and Radio Rwanda has Health programs at night which take health subjects and discuss them with the public. Radio Salus also has a program called Imenye nawe which deals with reproductive health messages in preventing Sexual transmitted diseases, undesirable pregnancy, and HIV/AIDS spread. Urunana, Sigasira amagara are among other health programs broadcast on radios in Rwanda. Rwanda Health Communication Center (RHCC) is the main center assisting Rwanda Health Ministry to shape health messages aimed at educating people about issues related to health, raising people’s awareness on health problems, and changing their attitudes through the use of communication in various media outlets. 1.3. Background of Rwanda Health Communication Center. Rwanda Health Communication Center is a Government Institution responsible of assisting the Ministry of Health in coordinating and strengthening prevention measures based upon the National Behavior Change Communications (BCC) policy for the health sector. It is responsible for the following activities: a) Assisting the Ministry of Health in coordinating and strengthening prevention measures based upon the National Behaviour Change Communications (BCC) policy for the health sector, b) Increasing the access among target populations to correct information on key priority health issues, c) Build capacity at a decentralized level for Districts to disseminate correct health messages to increase knowledge and to increase adoption of healthier behaviours among target populations. To achieve its objectives, Rwanda Health Communication Center uses various programs on Radio and television in communicating health. Amongst there are, radio spots, radio soaps, TV segments, TV spots, TV series, messages for billboards, electronic billboards and lollipops, articles, booklets, pamphlets, leaflets and posters. The following are RHCC well known programs about health: 1.3.1. Urunana Urunana is radio Soap opera of Urunana Development Communication projects in collaboration with RHCC and Global Fund. In deed, this soap opera has started in October 1999 on Radio BBC by Urunana Development Communication assisted by European Commission. This project started operating in Rwanda in 2004 as a non - profit organization. Urunana soap was aimed at increasing the discussions amongst women from rural areas, but as well as it continues to aired even on radio Rwanda every Sunday at 6 Pm, The program includes health themes like raising awareness on malaria prevention and control, fighting against HIV/AIDS, especially Family Planning in which the soap got awards recently. According to information Released on their website the soap succeeded in educating Rwandan population from many areas in Rwanda about family Planning. For instance, in September 2011 in Cyungo, Rulindo District, Northern Province the project got an award for the contribution in teaching family planning. Currently the theater is very popular and is broadcast at BBC Radio on Tuesdays, Thursdays at 6:45 pm and Sundays morning at 7:30 am in Kinyarwanda. It broadcast also on National Radio; every Sunday at 6 pm . 1.3.2. Girubuzima. This documentary is made in two formats, audio and video. The audio format is presented at radio Rwanda, Contact FM and Flash FM whereas video is aired at RTV. All these programs have started in 2008 in May by Rwanda Health Communication Center and one segment is aired three times per week on Tuesday, Thursday and Saturday before news. According to the producer of the program, the aim was to address Public Health messages, warning Rwandan population about epidemics, raising their awareness on health problems and where to seek for help, providing to the population basic knowledge on Behavior Change communication in health domain. From the time it has started 122 were presented at the national television in video format . The name Girubuzima was used as a wish for good health to Rwandans and it was used based on Rwandan culture wishing one another the best especially cows. Hence, the best wish for RHCC to Rwandan population is health. In fact, effective communications in health issues need to be prioritized in keeping the good health state of the Rwandan population and the content analysis of Girubuzima documentary was a mere key to contribute to the effective communication of health in Rwanda. It has also looked upon health messages package for a possible Behavior change. 1.4. Statement of the problem Rwanda as well as other developing countries, struggles to adopt the effective communication for behaviour change in certain circumstances, and to raise people’s awareness on health matter. Rwanda Health Communication Center as the arm of Rwandan Ministry of health uses much effort to disseminate correct health messages to increase knowledge and adoption of healthier behaviours among Rwandans. From the time this centre started providing such information in various media outlets, especially in Girubuzima documentary, no research has been done to show how weak or strong it is nor did any researcher analyse the content of the aforesaid for its impact on the public. Therefore, at the other side health problems are still remarkable in Rwandan population even at a great rate due to the poor and inadequate information about health. Indeed, the statistics of HIV/ AIDS as it was in 2005 remain 3% while it increases in Prostitutes. According to Rwanda Biomedical Center statistics 82% of prostitutes are HIV/AIDS positive and a big number of them are the young. While there is no estimate statistics of children suffering from kwashiorkor, those born with HIV/AIDS are 15,000 in the whole country . Diabetes increased from 65,000 from 2007 up to 88,000 in 2010 in adults . No one can ignore heart diseases, obesity, disease of poor sanitation, and the number of unplanned births especially in youth students, Family Planning which is not custom made while the population density remain towering (321 inhabitants per square kilometer). In addition to this, 67% of Rwandans are under the age of 20, and fertility rate from 2005 up to now remains of 6.1% . This confirms the need for effective health communication, and the need of analysing the content of health documentary especially Girubuzima, a documentary on National Television. This study is of importance to contribute to how making a good and effective documentary aimed at communicating health in Rwanda. Especially for Rwanda Health Communication Center, the researcher through this study has suggested ways of improving the above said documentary for communicating health effectively and efficiently. 1.5. Objectives of the study 1.5.1. Main objective The main objective of this study was to conduct a content analysis of Public Health messages within Girubuzima, a Rwandan Television program from January to December 2011. 1.5.1. 1.Specific objectives This study was having the following specific objectives: i. To explore the nature of the Girubuzima documentaries presented in 2011 contributing to health communication in Rwanda. ii. To explore into characteristics the messages delivered by the Girubuzima documentaries iii. To identify the challenges of the Girubuzima documentaries through critical analysis of Public messages delivered by the documentary as well as opportunities. iv. To come up with suggestions and recommendations towards better documentaries for effective health communication in Rwanda. 1.6. Research questions The researcher was guided by the following questions to achieve objectives: a. To what extent has Rwanda Health Communication Center chosen content aimed at communicating health in Rwanda? b. What are the themes have Rwanda Health Communication Center chosen and developed to the public in tackling health communication in Rwanda? c. What weaknesses are noticeable in the Girubuzima documentary associated with health communication in Rwanda? d. What can be done to improve the Girubuzima documentary so as to be effective in Health communication in Rwanda? 1.7. Significance of the study Various programs, through media in Rwanda address health messages to the population including Talk shows, Radio spots, entertainment-education programs, and documentaries. This research is important for scientific purpose as an academic research, and for personal interest to contribute to the well being of Rwandan population and to explore the Girubuzima documentary. Despite four years the program has been aired, it is not clear how effective is the program to achieve the objective of RHCC. In fact, Students are still getting pregnant, and people are still dying of HIV/AIDS and diabetes as demonstrated herein above. In addition to this, some journalists do not know how to do effective documentary but still they do. After conducting this research the researcher provided suggestions and recommendation aimed at the improvement of the documentary so as to be effective in delivering health messages. 1.8. Scope of the study This study was conducted in Rwanda especially in institutions with responsibilities are related to health. The researcher analyzed deeply the content of the Girubuzima documentary, a video format aired at Rwanda National Television. The following are some of the issues that the researcher focused on while analyzing the documentary: a. The total number of the Girubuzima documentaries presented in 2011 and the general contents, b. The main subjects of the Girubuzima documentaries, c. figures of speech in the Girubuzima documentaries, d. Themes in the Girubuzima documentaries, e. The source of information in the Girubuzima documentaries, f. Illustrations used to explain a given subject in the Girubuzima documentaries, g. The frequency of each of the Girubuzima documentaries The study focused only on the Girubuzima documentaries presented from January to December 2011 because the period is closer to the time the study is conducted and data can be easily found. 1.9. Limitations of the study This study faced the time and financial barriers in that analyzing health messages of the whole year within a limited time was time and money consuming. So, as a student without any other funds it seemed difficult. Another barrier was that the study looked sensitive because the program is made by Health Communication Center which is the arm of Rwanda Ministry of health. Consequently, testing and correcting a decision maker would not easy even convincing them to provide data. However, the researcher kept up with the situation in explaining to those concerned with the present study about the objectives of the research, he ensured whoever concerned with the study that data would be used for academic reasons and that results would be communicated to them. To the constraint of time and money, the researcher used the available time and little financial means to come up with good result in available time. 1.10. Research methodology Research methodology is the part where the researcher shows which methodology used to gather data and to analyze them. Hence content analysis was the main method through which Qualitative approach was used to review documents in relation to this study, and quantitative to analyze and present the content of the Girubuzima documentaries in numerical values. In this study the Girubuzima programs quantity was analyzed in terms of subjects, themes, and frequency .while their quality resulted in how messages within documentaries are, constructive and informative among others. 1.10.1. Content analysis Content analysis is a research technique for the objective, systematic, and quantitative description of manifest content of communications (Berelson, 1952: 74).In fact, it is based on elements like, Audience whom the message are made, how messages are made, the content of the message, how the messages are made to the public (tools), and with which result. According to Harold Laswell, the following questions are of core importance in content analysis: “Who, says what, to whom, why, to what extend and with what effects?” It is also any technique for making inferences by impartially identifying definite uniqueness of the messages. (Holsti, 1969). Using Content analysis may offer opportunities such as: a. Revealing intentional differences in communication content detecting the existence of propaganda b. Identifying the intentions, hub or communication trends of an individual, group or institution. c. Describing attitudinal and behavioral responses to communications. When using a content analysis on a text, the text is coded or broken down, into manageable categories on a variety of levels- word, word sense, phrase, sentence, or theme, and then examined using one of content analysis basic methods: conceptual analysis or relational analysis. In this study, the 20 documentaries selected using systematic sampling, were gathered, classified according to themes, subjects, target, source of information, and idea for the documentary, illustrations, figures of speech and frequency. After that, the researcher went through each of the documentaries; analyzed it with characteristics and objectively with units to guide the study, lastly, the researcher made a presentation of the percentage of the efficiency. 1.10.2. Sampling Techniques. This study was aimed at studying and analyzing Girubuzima, a health documentary which has been existing for four years. The case study was applied taking the year 2011 from January to December, the period closer to the period of study and which have all the documentaries presented. Systematic sampling was used for the 40 documentaries presented in 2011 as a sample frame, 20 documentaries were selected as sample size with the interval of 2 obtained dividing the population to the sample size. 1.11. Organization of the study The study is made of five Chapters. Chapter one deals with General Introduction; Background to the study, Statement of the Problem; Objectives of the study, Significance of the study, Scope of the study, Limitation of the study, research methodology as well as organization of the study. The second Chapter concerns the theoretical and Conceptual frameworks through Literature Review. Chapter three Focuses on research methodology, describes the tool and Techniques used within the study. Chapter four is the analysis, presentation and interpretation of findings. The fifth chapter focuses on the summary of findings, general conclusion and recommendation. CHAPTER TWO: LITERATURE REVIEW 2.0. Introduction Along centuries, scholars have been demonstrating that communication escorts every activity of human beings. Lakshamana asserts that since then and now, communication is taking an excellent place in the economic, political, social, environmental, and health domains among others. He adds that communication is a prime mover in the development process (Lakshmana, 1963). Other researchers have tried to find out definitions for communication, yet they do not concur on which definition to take into account. Some of them continue to think communication as a relatively linear process of information transmission causing or contribution to change in knowledge, attitudes and/or behaviors whereas others views it as much ,more complex inseparable from culture which is sustained and challenged by global and local economic, political, and ideological structure and process. (Melkote and Steeves, 2001:33). This chapter is aimed at reviewing what other scholars have published in relation to this fastidious study of communicating health. The study also analyzes the content of Girubuzima, a health program on Rwanda national Television as poor communication in the domain of health is leading continuously to several health related problems. 2.1. Conceptual framework of health communication 2.1.1. Communication As mentioned early, Scholars have tried to find definitions of communication even if it is still difficult to adopt the same definition .However all of them meet on the idea that communication aims at sharing or transmitting meanings. According to the World Encyclopedia (1990), the word communication delivered from a Latin word “Communis” means “to share”. Sociologists and linguists define communication as a set of phenomena occurring when a person transmits information to one or more individual using the articulated language or other codes (tone of voice, gesture, gaze, breathing, appearance, Etc. Neher (1997) defines communication as the process of two or more people engaging in mutual awareness and sharing of facts, feelings or intentions through the use of global signs observable in some medium. It is also a simultaneous sharing and creating of meaning through human symbolic action (Desantis, 1999). Witzany (2006) insists on that communication is a process involving, the sender, transmitter or medium, the message, and the receiver. For him the science of communication is to conceptualize and rationalize the process of exchange, transmission of information between two entities (Individuals, groups of people, or machines). The following models of communication explain the process of exchange and the nature of the communication process within a continuing interaction. Figure 1: The communication process Source: John E.Barbuto, Jr., Communication breakdowns in Interpersonal Settings: an experimental application of a process-Based model, USA, 1991. Within this figure the idea is conceived by the sender and tries to put it into comprehensible words to the receiver, that’s Encoding, after encoding the message get to the receiver through the medium, and at turn continue interaction giving the feedback to the sender. In this study this model of communication process is important to draw the circulation of health messages among the public. An idea made by RHCC is sent to the population through television may reach those who have access on Television who at the turn share information with others in peer education to the interaction continues. In all the cases messages go through all the aforementioned stages. For instance if the documentary is about one of the methods of Family Planning, one mother will decode the message and encode it to another through the phone or on mouth. If the second accept and use it, she will provide the feedback and continue interaction. Citing Harold Lasswell, Mugume (2005) defined communication as a process answering five questions: Who says what, in which Channel, to whom, and with what effects? This means that we need to study and understand, the sender’s characteristics, the message and in which incident is delivered, the channel to convey messages, who receive the message and which impact after the message in other words the feedback. This process is illustrated in the following model: Figure 2: An Ecological Model of the Communication Process Source: Foulger, D. an Ecological Model of the Communication Process. Retrieved from http://www.davis.foulger.info/papers/ecological Model Of Communication.htm In this study, ecological model was involved to clarify the process of creating health messages to be communicated to a wide audience. Television is a mass medium through which health messages of Girubuzima overhaul to reach the public. The model helps shedding more insights on the process of creating messages by an agent from RHCC, specialists whom this agent contact and even pictures and illustration used to be decoded by the public using the same medium. Communicating health should not impede at the level of interpersonal nor sending messages without paying attention on messages, the extent, and the process, media, and audience accessibility. 2.1.2. Health According to World Health organization (WHO) constitution, health is a state of complete physical, mental and social not merely the absence of disease of infirmity. It is a state of equilibrium between humans and the physical, mental, and social environment; compatible with full functional activity (Harding, 2006). Health is determined by the personal, social, cultural, economic, and environmental factors that influence the health status of individual or population. (Brussels, 1999). This point is important in communicating health as we need to understand health before starting to communicate it. It is also coupled to what Rwanda Health Communication Center emphasizes on in their documentary, Girubuzima, a wish for good health. 2.1.3. Public health Public health is not a new term because even if it is modern concept of human development in science, it has root in antiquity. Winslow (1920) defines public health as a science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choice of the society, organization, public, and private, community and individual. This field is concerned at improving health and quality of life through prevention and treatment of disease and other physical, mental health condition through surveillance of cases and the promotion of healthy behavior, Promotion of hand washing, breastfeeding, delivery of vaccination, and distribution of condoms to control the spread of sexually transmitted disease (Winslow, 1920). This field is very significant in the present study of analyzing a health program like Girubuzima, because its main focus is to deliver public health messages, and all public health measures are effectively if there is a use of apt media in dissemination of messages. 2.2. Theoretical framework of the study 2.2.1. Health communication Health communication is the art and techniques of informing, influencing, and motivating individual, institutional, and /or public audience about important health issues. The area of health communication involves disease avoidance, health endorsement, health care policy, and the business of health care as well as enhancement of the quality of life and health of individual within the community (Ratzan, 1994). It encompasses the study and use of communication strategies to inform and influence individual and community decisions that enhance health. Health Communication links the domain of communication and health and is increasingly recognized as a necessary element of efforts to improve personal and public health (Umulisa, 2010). Effective health communication should equip the public with the tool and knowledge to respond appropriately to health crises such as Flu outbreaks, HIV/AIDS , Malaria, etc. It should take essential measures to prevent disease and to protect, maintain, and improve their own health, such as good nutrition, regular exercises, responsible sexual behavior, eschewing destructive behavior such as cigarette smoking, drug abuse . The content of health message should have the following elements to have an impact: a. Valid without errors of fact, interpretation or judgment b. Available, the message should be aired through media accessible to the public. c. Balance, the content need to present benefits, risks, and the necessary sources should be consulted. d. Consistent over time and with information from other resources. e. Cultural competent accounting all stages for special issue for selecting the population. f. Reliable that means credible keeping up to date. g. Repeated over time to reinforce the impact with a given audience and to reach new generation. The elements listed above are very important to this study for they show the need for communication in health domain and content analysis of a program aimed at communicating health issues. While we have stated elements for the message to have an impact, there is a number of other elements which can be barriers to effective communication in health domain including: a. Low health literacy on the side of the public because while health messages are in form of written communication the illiterate/semi-illiterate often cannot access the information. Thus, health literature should be custom-made for each target audience and written in a style appropriate to their level of comprehension. b. Limited Internet access is another barrier because many people depend on internet for health information which sometimes is not accurate. In developing countries, access to internet is sometimes limited which does not facilitate the public. c. Lack of research activity in developing countries: Research and evaluation are required in order to design, develop and implement effective health communication interventions. Unfortunately, most research is done with an eye to solving health problems in the developed world, while pressing health problems in the developing world are often neglected (Edejer and Torres, 2000). d. Inability of health workers to communicate with patients: Due to various communication hurdles such as language barriers, socio-cultural differences etc., health workers sometimes have difficulty transmitting vital health information to their patients This may be the same to any other trying to communicate health. Moreover, given the shortage of human resources, which is a common problem in developing countries, health workers often deal with multiple patients at a time, making communication even more difficult (Barbara and Shaw, 2009). 2.2.2. Communicating Health through Media Mass media are tools for the transfer of information and ideas to both general and specific audience. Thus, sophisticated societies are reliant on mass media to disseminate health information and this has reduced the world size. Kreps and Thornton (1992:144) noted that media extend people’s ability to communicate, to speak to others far away, to hear messages, and to see images that would not be available without media. Mass media are capable of facilitating short-term, intermediate-term, and long term effect on audience: Short term includes exposing audiences to health concepts; creating awareness and knowledge; altering outdated or incorrect knowledge; and enhancing audience recall particular advertisement or PSAs , promotion or program names. Intermediate-term include the mentioned above and add change in attitudes, behaviors, and perceptions of social norms. Finally, long term incorporate all the aforementioned tasks in addition to focused restructuring of perceived social norms and maintenance of Behavior Change (BC). Media educate, shape the public perceptions, and advocate for a particular policy in health or point of view (Dermott and Albrecht (2011)). Mass media set health agenda in case that what public official or members of media select for the public consumption influence how people think about health issues, and what they think about them. In USA when Rudolph Giuliani, the mayor of New York City publicly disclosed he had prostate cancer prior to the 2000 New York Senatorial elections many news media reported the risks of prostate cancer Prompting grater public awareness about the incidence of the disease and the need for Screening. According to Davis (1997), when risks are highlighted in the media particularly in great details, the extent of agenda setting is likely to occur based on the degree to which the public sense of outrage and threat is provoked. Where mass media can be especially valuable is in the framing of issue . Media cultivate perceptions. Media exposure overtime shapes audience perceptions. Television is a common experience and serves as what S.W Little John calls “a homogenizing agent”. It has the potential to deliver messages about HIV/AIDS, and other sexual transmitted diseases, Cancer and so on (Davis, 1997). According to the research made in 2000 on Americans, mass media has been the major sources of information about HIV/AIDS and other transmitted Infections. 96 percent of 1,290 men aged of 22-26 reported hearing about these subjects through television, advertisements, radio or magazines. The same research confirmed that media has the ability to improve reproductive health and promote population control, especially in developing countries including Rwanda. Media made people aware of modern contraception and where to access it, as well as linking family planning to other reproductive health care and to broader roles for women (Davis, 1997). Media Communication about Family planning and population control creates awareness, increases knowledge, builds approval, and encourages healthful behaviors (Melkote and steeves, 2001). An example of using media in population control was remarked in Egypt where nearly all households have television, population control objectives have been achieved through televised PSAs. Data also support the positive effects of mass media messages on contraception use in Zimbabwe, Ghana, Nigeria, and Kenya (Smith, 2011). In a 1999 Tanzania based study, a team of researchers led by Everest M. Rogers showed how the popularity of radio soap Opera promoted self-efficacy with respect to discussing contraception with spouses (Dermott and Albrecht, 2011). The same case in Rwanda, the soap opera Urunana owned by Urunana Development Communication is revealed powerful in teaching family planning, behavior towards HIV/AIDS, and Sexual transmitted diseases. Imitating actors, the public end up changing behavior. In this case media facilitate Behavior Change Communication (BCC), an approach to promote and sustain positive behavior change in individuals and community. Media advocate for Health. Media being an important ally in any public health situation plays a vital role linking health workers and large public, trains professionals and patients in effective communication (Eng and Gustafson, 1999). Examples: In order to disseminate Information about Avian Influenza to the wide public, the US government tasked the Academy for Educational Development with the responsibility of disease so that they would be able to report about it effectively. Within the same perspective, when Ebola and Swine Flu were entrenched in Rwanda; media were the first to report about it and warn the public. Media were used to prevent, the deaths of infants and young children, the said death was mainly caused by Diarrhea in Swaziland. Training professionals how to treat the disease, distribute relevant health materials and set up places where mothers could learn how to prepare medication properly (Barbara and Shaw, 2009). Through Media, Health communication can contribute to all aspects of disease prevention and health promotion and it is relevant in various contexts such as: Health professional patient-relation, individual’s exposure to, search for, and use of health information, individuals’ adherence to clinical recommendation and regimens, the construction of public health messages and campaigns, the dissemination of individual and population health risk information that’s risk communication, images of health in the mass media and the culture at large, the education of consumers about how to gain access to the public health and health care systems and development of telehealth applications (Piotrow, et al.1997). For individual, effective health communication raise the awareness of health risks and solutions, help them find support from others of the similar situation, and reinforce attitudes. It can increase request for appropriate health services delivery and reject inappropriate ones. For the community, it influences the public agenda, promote positive change in the socio-economic and physical environment, improve the delivery of public health and health care services, and encourage social norms that benefit health and quality of life (Umulisa, 2009). Health communication has another area in disseminating health messages through public education campaigns in quest of changing the social climate to encourage healthy behavior, create awareness, change attitudes, and motivate Individuals to adopt recommended behavior (Maibach, and Parrot, 1995). 2.3. Analyzing media contents After the role of media in delivering health messages herein, let’s have a look at what media lug to the public. According to Cline (2003) the research issue in Health communication comprises the delineation of media content on the audience needs and the process by which media can be influenced to include healthier messages. Berelson (1952), notes that to content analyze media is to determine the presence of certain words, concepts, themes, phrases ,characters or sentences to quantify this presence in an objective manner. Content analysis is very important to explore how the content of a given media product is made to achieve certain objectives. Referring also to the formula of Harold Laswell who says what, to whom, why, to what extend, and with what effects,Holsti (1980) offered a broad definition of analyzing the content of media, as any technique for making inferences by objectively and systematically identifying specified characteristic of messages. To this regard, we analyze the content of media for the following reasons: a. Make inferences about the antecedents of a communication b. Describe and make inferences about characteristics of a communication c. Make inferences about the effects of a communication. Analyzing media content is also important to be able to make links between causes (program content) and effects (audience size). You may analyze media content also to evaluate the effectiveness of a given media program and improve it (Palmquist, 2011).It is also a good way to link media content to public content because media may give the audience what they don’t need. For instance if the purpose of an advertisement is to promote the use of the product; increase awareness, then increase sales; The purpose of a documentary on AIDS in southern Africa might be increasing awareness of ways of preventing AIDS and in the end to reduce the level of AIDS (UNESCO, 1970). In this study it is necessary to analyze the content of Girubuzima with intention of finding out what it holds to the public according to their needs and health message characteristics. 2.3.1. Analyzing a TV documentary Analyzing a Television documentary is a very difficulty but important work which needs much attention. In this work the researcher referred to different professionals with their various Criteria to analyze the Girubuzima TV documentary. Bob Nowlan, a professor at University of Wisconsin Eau Claire has given questions for beginning the critical analysis of documentary films. These include pointing out the subject matter, themes and the purpose of the documentary, the selection of what to film and not, the combination of records and voice over, illustrations used, and image accompanied with sounds (Nowlan, 2001). In his Introduction to Documentary, Bill Nichols also wrote that a good documentary should be interactive or participatory, having coherence of events, real instead of being fiction, having subject matter-themes or content, identifying the target audience and providing communicative functions such as to inform,discuss,engage,enlighten,intervene,explore and express (Nichols,2001). Charles K (2001) and Young man (2007) also pointed out some important criteria of a good documentary including to be interesting, constructive, informative, clear, unbiased without leap in logic, having enough details to describe but not to bore, and it should also have communication function like entertaining, informing or persuading the public about a very important point. All these professionals in film documentary have in common some criteria to put into account when analyzing critically a TV documentary. Such criteria are, just to name few, the subject matter, themes, illustrations, the target public, the relevance of what to film or not, and the communication functions. 2.3.2. The process of content analysis In using content analysis as a methodology in research, the researcher needs to: a. Select content to analyze: this include picking from a huge content the focus representing the whole. If it is the TV program, choose program entities to represent the whole. b. Units of Content: Making units of content involves the presence of certain words. If themes use a short unity to stand for a long one, use the theme to represent and episode of TV program. c. Prepare content for coding: This stage involves converting TV or Radio program in written words or record the program, then make it clear fore analysis. d. Coding content: This includes summarizing responses into groups for a program; write the frequency of the series. e. Counting and Weighting: This is the process where the researcher count or weight using computer software of another suitable method. f. Draw Conclusion: Through this stage, the researcher show what was said and what was not said during analysis. She/he compares the content found in the analysis to other set of content expected audience). She/he makes a report of finding and summarizes it explaining coding principles and lastly draw conclusion. In this step the findings of content analysis become much more meaningful when units are large (the whole TV or Radio program) and when those findings can be compared with audience research finding (Dennis, 2007). 2.4. Examples of TV content analysis Worldwide The Effect of Day Part on Gender Portrayals in Television Commercials: A Content Analysis. A research conducted by Craig and Stephen. Gender portrayals in 2,209 network television commercials were content analyzed to compare differences between three day parts, the sample was chosen from three time periods: daytime, evening prime time, and weekend afternoon sportscasts. The results indicate large and consistent differences in the way men and women are portrayed in these three day parts, with almost all comparisons reaching significance at the .05 level. Although ads in all day parts tended to portray men in stereotypical roles of authority and dominance, those on weekends tended to emphasize escape form home and family. Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising is another research made with aim of studying whether ads meet their educational potential or not, prompt consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. Researchers drawing conclusion, they said that despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health. A Content Analysis of Health and Physical Activity Messages Marketed to African American Children during After-School Television Programming is another research made by Corliss Wilson in 2006 with the aim of examining the number of food advertisements African American children is exposed to during children’s television programming aired on predominantly African American and general television stations. Using a content analysis to identify and analyze the health-related content (HRC) and physical activity–related content (PARC) of food advertisements shown during children’s television programming, they settled Three sets of television advertisements from 3 stations (Black Entertainment Television, The WB [Warner Bros], and Disney Channel) served as the sample during a 1-week period in July 2005 (July 11-15), from3 PM to 9 PM. The result showed that in total, 1098 advertisements were recorded, with 256 food and beverage commercials used for this study. Results indicate that 36.3% of all commercials were based on fast food restaurants, 31.3% were for drinks,16.8% were for candy, 13.7% were for cereals, and 2.0% were for snacks (percentages do not total 100 because of rounding). Compared with the WB and Disney Channel, Black Entertainment Television had significantly (P=.001) more food and beverage advertisements. Few HRC or PARC advertisements were shown. Of 256 food and beverage commercials, only 8.2% contained HRC and 9.4% had PARC. Also, the HRC and PARC scenes contained messages that were implied vs. explicitly talking about the health or physical benefits of the product. Conclusions: African American children are overexposed to numerous types of food and beverage advertisements. These advertisements do not provide an adequate level of positive HRC and PARC messages. Consequently, the messages that are portrayed May undermine efforts to teach African American children about the importance of healthy living and physical activity. 2.5. Theories of communication In the present theoretical framework, it is essential to highlight some theories important to the entire work especially because a theory is a set of ideas which are suggested by professionals to help explaining a fact or event. In this work, we have used agenda Setting theory, attribution theory, and two step flow theory not because they are the only one which can explain events in this work but because they are more relevant to it. 2.5.1. The agenda setting theory The agenda setting serves to describe how media are powerful in influencing the public. Media tell the public what is important to think about and how to do it. With their research conducted investigating presidential Campaign in 1968,1972, and 1976 McCombs and Shaw focused on awareness and information to assess the relationship between what voters in one community said were important issues and the actual content of the media messages used during the campaign. They concluded that mass media exerted a significant influence on what voters considered to be the major issues of campaign. So, agenda is the creation of public awareness and concern of most important issues by the news media. Two basis assumptions for them underlie most research on agenda-setting: (1) the press and the media do not reflect reality; they filter and shape it/ (2) media concentration on a few issues about subjects leads the public to perceive those issues as more important than other issues. This was valued by Ratzan (1994) where he said that a health messages should pass through media accessible to the public which is able to repeat it as much as possible to remind important points but also to remind them relevant issues . This theory was applied in The Case of Girubuzima documentary where in all the documentaries the word Girubuzima were repeated at least four times, on introduction, every break or while the presenter was interviewing the source and at the end of the program. This was made even the presenter to be called Girubuzima by the public. Some of these documentary messages are printed on cars and billboards to remind the public and which show the extent of agenda and the pervasiveness of media. 2.5.2. Attribution Theory This theory suggests that people tend to hold others more responsible for negative results than positive outcomes and that their success results from the favor they may have got from others. In fact, People see or witness some events or observation and imagine what comes after or the reason behind. Fritz Heider,the initiator of this theory gave an example to a driver you see throwing the bottle of Fanta through the car grass and directly you conclude judging that the intention was to kill you or another one else. For him the first step is to perceive an action, the second you judge intention, and thirdly you attribute disposition . In this work attribution theory may result in that people hearing about drugs and methods of family planning they may think of making them not giving birth perpetually as it happens for some that vaccines are to block them from giving birth which make some of them not attending such services. It is also the same when the public observing images on the screen, the place where the documentary was made they can critically think about the reasons of use and make judgment which divert them from the intention of the presenter. 2.5.3. Two step flow theory This is the theory introduced by Paul Lazarsfeld, Bernard Berelson, and Hazel Gaudet. The core assumptions were that information from media moves in two distinct stages. Individuals (opinion leaders) who are able to digest media information .Opinion leaders receive information and then take them to the public after interpreting the content. According to Katz and Lazarfeld (1955), Opinion leaders are influential in getting people to change their attitudes and behavior and are quite similar to those they influence. In this work the theory is relevant in that the Rwandan ministry of health in its decentralization approach of health activity and through Girubuzima, it was remarked where health advisers from every cell in Rwanda get trained on health issues and get materials helping them to give first aids like to test and give medicines of Malaria, and advising pregnant women. At their turn health advisers go back in the village where they educate the population about health situation in Rwanda and how to cope with health problems . 2.6. Conclusion Health communication was given little value in many African countries including Rwanda. This fact led to many health problems such as epidemics like Malaria which became a chronic disease in Africa, diseases like HIV/AIDS whose rate has never decreased in Rwanda from 2005 until now but which has increased in prostitutes 82%, and Diabetes. Again, poor communication in health issues was remarked in different human abuses. A good example is for the women using drugs, especially prostitutes (36, 5%), non-protected sexual intercourses leading to unplanned pregnancies in the young, and poor adherence to family planning. Even if a great step has been taken to reduce infant mortality, 31% women are still giving birth home which can increase the rate of infant deaths. Therefore, the stated problems and diseases of poor sanitation explain the need for effective communication in health domain. The fact that socio-economic, cultural and historical condition dominated Rwandan media in many years also justifies that there is a need of focusing more on health communication. In this chapter finally, health communication as an art and technique of informing, influencing, and motivating individual, institutional, and public audience about important health issue was justified to be prior. CHAPTER THREE: RESEARCH METHODOLOGY 3.0 Introduction This chapter is concerned with how the research is conducted with an appropriate methodology in gathering and processing data. According to Creswell (2003), Methodology can refer to the theoretical analysis of the methods appropriate to a field of study or to a body of methods and principles particular to a branch of knowledge including the assumptions and values that serve as rationale for research and the criteria the researcher uses for interpreting data and reaching conclusion. Using a given methodology, the data or findings may be processed qualitatively, quantitatively, or mixed. The researcher chooses a problem to study from literature or environment, and selects a suitable methodology to use. It is possible also that some researchers committed to a particular methodological perspective and will select a research problem related. In the present research work, we opted for the use of content analysis. 3.1. Content analysis Content analysis “is a research technique for the objective, systematic, and qualitative description of manifest content of communication” (Berelson, 1952: 74). It’s a research tool focused on the actual content and internal features of media. Citing Berelson, Palmquist (2011) mentioned that content analysis is used to determine the presence of certain words, concepts, themes, phrases, characters, or sentences within texts or set of texts and to quantify this presence in an objective manner. Hence content analysis called again Text analysis is a methodology in the social science for studying the content communication. The present methodology enables the researcher to include a large amount of textual information and systematically identify its properties. It is also a summarizing, quantitative analysis of messages that relies on the scientific method (including attention to objectivity, intersubjectivity, a priori design, reliability, validity, generalisability, replicability, and hypothesis testing) and is not limited as to the types of variables that may be measured or the context in which the messages are created or presented (Neuendorf, 2002:10). 3.1.1. Using content analysis According to Berelson (1952), content analysis is classified into two main categories: the first category is conceptual analysis which is concerned with choosing a concept for examination and the number of its occurrences within the text recorded. The second category which is not far from the first is Relational analysis which deals with examining the relationship among concepts in a text. Historically, content analysis may have been developed by Alfred R.Lindesmith in 1931 to refute existing hypotheses. This methodology gained popularity in 1960s by Glaser and referred to as “the constant comparative method of qualitative analysis”. He and Straus 1968 referred to their adaptation of it as “grounded theory”. Since the 1980 Content analysis has became an increasingly important tool in media evaluation or media analysis and other various careers in communication (Palmquist, 2011). Advantages of content analysis are the following: a. Allowing both quantitative and qualitative operations. Quantitatively in case that text is broken down to be studied in numeric units, and qualitatively for describing and exploring the messages. b. Providing Valuable historical/cultural insights overtime through the analysis of texts. Analyzing the presence of certain words in a given speech may present characteristics of a leader of an institution for a given time. This may also help in evaluating the image of an institution. c. Providing insights into complex models of human thoughts and language use. Human communication is very complex and hard to understand; using the present methodology may be a good way to get insight on the complexity of human thought and a key way to understand the trend. d. Being an unobtrusive means of analyzing interactions. For instance communication between two or more people may be studied identifying the frequency of certain words and determine its occurrence quantitatively. e. Being used to interpret texts for purposes such as the development of expert system (since knowledge and rules can be coded in terms of explicit statements about the relationships among concepts). f. Looking directly at communication via texts or transcripts, and hence gets at the central aspect of social interactions etc. The methodology helps to make the presentation of communication in understandable ways. Disadvantages of content analysis are: a. Time consuming because going through a given program with aim of determining the presence of certain word, coding it and interpreting them quantitatively takes a lot of time. b. Difficult to automate or computerize. This refer to the fact that sometimes computer facilitate the work and reduce the time consumption, for the way that it requires reading, listening, or viewing attentively, and objectively the program or a text to point out most important elements does not favor the computer work but mind. So the computer may be involved only at the stage of analysis with appropriate software to point out the frequency of given concept. c. Tending to simply consist of word counts. Focusing more on text and concepts frequency makes a researcher using much attention in word counting than going deeper in understanding. This methodology is appropriate to this study which takes into account a health program, and with the aim of determining which message is made for which kind of audience, how, by who, and what is the content. The researcher looked at some units of analysis among which there are subjects covered, themes, and the frequency of the program along the year 2011. 3.2. Tools of data collection Data are collected by the researcher using techniques like interviews, questionnaires, documentation, focus group, or interviews. The key point is that the data collected are unique to the conducted research until the time to be published no one else has access to it (Kelly, 2005). Tools may be primary when they are collected by the researcher and they may be secondary when the researcher uses data collected by someone else. In this research only the code book was used as a tool to collect and analyze documentaries. It was used listing all categories of Girubuzima documentaries presented from January to December 2011, and the researcher analyzed the content without involving any other. The codebook used in this research is a form usually used in content analysis for classifying and recording the units. According to Busha and his colleagues, the researcher who uses this form as coding instrument should clearly indicate the categories and make provision for making the category into which each unit rating scales (Busha, et al., 1980). 3.3. Sampling frame A sampling frame is a list of the target population where a sample is drawn from using different sampling methods. In this study the list of the 40 documentaries presented was got in collaboration with the producer of the documentaries. The 20 documentaries presented in 2011 were selected using systematic sampling and they were analyzed using units of analysis. The sample was selected because all the 40 video documentaries could not be processed in a limited research period and with the complexity of audio and video analysis. 3.4. Units of analysis Analyzing the content of the Girubuzima documentaries here are units of analysis used: a. The total number of the Girubuzima documentaries within the year 2011 and their contents b. Figures of speech used in the Girubuzima documentaries c. Subjects of the Girubuzima documentaries d. Themes in the Girubuzima documentaries e. The sources/actors of information in the program like officials, ordinary people, professionals and victims f. Information given by the source in the Girubuzima documentaries (experience, documentation, neither experience nor documentation) g. The frequency of the subject of the Girubuzima documentaries (the extent that a given subject appeared on TV). h. Illustration used to transmit messages in the Girubuzima documentaries i. The Girubuzima documentaries were also analyzed in terms of quality (constructive, informative, coherent, interesting, unbiased, and persuasive) j. The target public of the Girubuzima documentaries (unmarried females, unmarried males, children, married couples, victims of disease or violence, all groups at the same time) k. The place where the Girubuzima documentaries were played (Hospitals, Hotels, and offices). l. Geographic focus of the Girubuzima documentaries (Urban areas only, rural areas only, both rural and urban areas) m. The level of public participation in the Girubuzima documentaries (High participation, medium, low or no participation) 3.5. Data analysis and processing After getting all the needed data, the following step was to process them. This process includes inspecting, cleaning, transforming, and modeling data with the goal to highlight useful information, suggestions, and supporting decision making. This also includes evaluating the data analytically and logically point to point. In this study, the researcher alone analyzed the data based on units of analysis, calculating percentages, and through tables to make them better understandable. 3.5.1. Data Analysis techniques 3.5.1.1. Editing Editing involves detecting and correcting errors to ensure completeness, accuracy, consistency, and evenness of the code book. Thus, this is relevant in elaborating coding and tabulation during the information tabulation. Along this study, editing was done in comparison between the content of the messages presented within programs and the codebook serving as direction to detect missing, forgotten, or misused. 3.5.1.2. Coding Codes are used in transforming information provided from the data in a symbolic language less vague language. It refers to the process of converting unit into coded values (typically numeric) for the purpose of data storage, Management, and analysis. In the present study, the Information from the 20 documentaries was coded according to the categories of chosen coding frames and represented by a numerical code. 3.5.1.3. Tabulation This is the process of arranging data orderly in form of rows and columns. It is also putting them into some kind of statistical tables such as percentages and frequency of information. Currently, tabulation and tables were made including percentages depending on predictable data in rows and columns. 3.5.2. Quantitative data analysis Quantitative research involves analysis of mathematical data. The aim is to categorize features, count them, and put up statistical models in an effort to make clear what was observed (Miles and Huberman, 1994). The current study analyzed the total number of documentaries presented along the year, 2011, and then the messages according units of analysis. 3.5.3. Qualitative data analysis Qualitative research involves the analysis of data such as words, for example from interviews, observation, pictures (video), or objects (Miles and Huberman, 1994). The aforesaid was used in the current study with interpretation of illustrations, quality of documentaries, and how the documentary was presented (participation of the public all these were boarded and analyzed qualitatively. 3.6. Conclusion When used properly, content analysis is a strong data cutback procedure. Here the profits are the fact that content analysis is a systematic and replicable technique for compressing a bundle of words of the text into less content based on open system of coding. So, the aforementioned benefits and description along the present research, the choice of content analysis as a suitable methodology has offered opportunities to the researcher to respond to the objectives of the research conveniently. CHAPTER FOUR: PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS 4.1. INTRODUCTION This research was conducted to content analyse the Girubuzima documentaries of 2011 into characteristics. It mainly aims at finding out what subjects and themes were covered in 2011, then what was not covered, and finally what are the observable weaknesses in the documentary. The research was done after observing health problems still remarkable in Rwanda after long time the Girubuzima documentary was being aired at RTV. Indeed, the rate of harsh epidemics and diseases kept rising. For example HIV/ AIDS remains at 3% from2005 until now and mostly increase in Prostitutes up to 82%. Diabetes, heart diseases, obesity, disease from poor sanitation, and cancer remain also persistent. In addition, family planning and especially unplanned births among the young mostly caused by different human abuses, all were not tackled at a considerable extent.All the facts prove that the Girubuzima documentary has not achieved it’s objectives in the period of the study along the whole period it has been delivering health messages. Having dealt with theory, and for the above mentioned reasons, in this chapter the researcher used content analysis and went through the documentaries produced in 2011 then deeply analyzed them to find out what may have been the weakness of the program and to provide possible ways of improvement. Through this chapter, all the 20 documentaries were analyzed checking how trustworthy there are, what the content of each documentary is with what kind of characteristics. Hence, in this part the researcher reaches the cited objectives answering the guiding questions as cited in the previous chapters. In this framework, some steps were followed to prepare the content for coding. Step one was transcription along which the researcher viewed the sample of the Girubuzima documentaries produced in 2011 and tried to transcribe the audio-visual content into text. With step two, the researcher viewed the Girubuzima documentaries and tried to ask some questions supposed to be answered with the data. The researcher took into consideration all of the units of analysis as mentioned in the previous chapters and selected the sample of 20 Girubuzima documentaries out of the 40. This part will be more concerned with counting and weighing the content on the basis of units of analysis. 4.2. Presentation and interpretation of findings 4.2.1. Presentation of the Girubuzima documentaries in 2011 and the general contents. In the year 2011, the 40 Girubuzima documentaries were aired on the National television. After selecting 20 as a sample of the study, the researcher analyzed them and presented the findings existing in the following table. This table demonstrates that two or one documentaries were made in one month .Therefore, where there is one documentary, the reasons were that instead of making four documentaries in one month, RHCC made two documentaries and one radio spot. The table also demonstrates the main contents in terms of subjects and themes in brief. Months Documentaries per name and the extent per year Subjects The general description of the content January Circumcision 1 (5%) HIV In these subjects RHCC raised awareness on HIV prevention, prevalence, advocacy to people having mouth abnormalities, and call their attention to attend medical treatment for such abnormalities freely. Operation smile 1 (5%) Operation smile February Intestinal worms 1 (5%) Intestinal worms In these subjects there is raising awareness on, prevention and to breastfeed well, attitude change in not spreading intestinal worms, and what to do for the welfare of the public Breastfeeding well 1 (5%) Breast feeding well March Community Health Conference Health policy Raising awareness on intestinal worms spread, attitude change, welfare, health service delivery, prevention and advocacy Intestinal worms II 1 (5%) Intestinal worms April Ibirimi (uvula) 1 (5%) Uvula The documentaries delivered messages aimed at attitude change in children violence, Prevention of teeth disease, welfare , medical treatment, warning on consequences of traditional healer’s practices, and health service delivery Dental disease 2(10%) Dental diseases May Malaria at Karembure1 (5%) Malaria Raising awareness on health service delivery, prevention, awareness, health activity decentralisation for the welfare of the public, advocacy and attitude change. June CNTS. Blood transfusion Blood transfusion The documentaries delivered messages on attitude change, warning the public about the dangers of some drugs while misused, calling their attention in blood giving, the welfare and prevention of household accidents. household accidents 10% Care for medicine use July Mother and Child Health week 5% Health week In this documentary there is the calendar of medical activities aimed at the welfare of the mother and child, attitude change, advocacy, and prevention of health problems affecting them. August Vasectomy 1 (5%) Family Planning Methods(Vasectomy) In this subject there is attitude change, warning the public about the increase of the population and dangers brought about, medical treatment, correction of misconception and the welfare of the population September Health insurance 1 (5%) Health Insurance Health service delivery, attitude change, warning the population about the effects of not having health insurance, prevalence, raising their awareness on opportunities about health insurance. October Hepatitis 1 (5%) Hepatitis In these documentaries, there is a medical treatment of hepatitis, warning, raising awareness, and care for the population, prevention of hepatitis in taking appropriate food, attitude change on the spread of the disease, setting agenda of the public on mental health. Mental Health Day 1 (5%) Mental Health day November Migrant workers5% and Diabetes 10% HIV Awareness on HIV prevention methods including abstinence, fidelity, and condom use, welfare of the public, warning about the danger of HIV, and misconception correction or rejection. December CNLS 1 (5%) HIV Awareness on HIV Prevention through attitude change, abstinence, fidelity, and condom use, health policy, prevalence, and misconception rejection. discordant couples 1 (5%) HIV Table 1: Girubuzima documentaries presented in2011 and the summary of their contents The table above demonstrates clearly the documentaries presented in the whole year and the extent of each documentary. In addition to this, the table sheds light on subjects and the main contents of every documentary which are more clarified along this chapter. 4.2.2. The main subjects accompanied with themes of the Girubuzima documentaries in 2011 The overall objective of RHCC as said the producer of the program in interview, is to provide the population with basic knowledge about public health, and behavior change which enables them to avoid some public health disease and to cope with the situation in which disease/epidemics may entrench in the country. It also enables them to seek for good health changing attitudes in given circumstances like birth control, getting health insurance and not spreading some diseases. In this study the researcher pointed out subjects chosen by Rwanda Health Communication Center and the main themes within subjects to educate the public with objective of finding out which was covered at which level and which was not covered. In the following table there is public health disease that the researcher preferred using their names, health care (follow up for health activities in some sites and to explain to the population about health issues, health weeks and days),Health policy( this subjects includes the health conferences, and summits by the government). Subjects number Themes within the subject Health Care in subjects like(Uvula, Intestinal worms (2), Dental disease, breastfeeding well, operation smile, blood transfusion, Mental health day and health week 10 (50%) Attitude change 4 (40%) Health Service delivery 8 (80%) Welfare 3 (30%) Medical calendar 4 (40%) Health policy delivered in Community Health Conference and Health insurance 2 (10%) Attitude change 2 (100%) Health service delivery 2 (100%) Welfare 1 (50%) Family Planning method (vasectomy) 1 (5%) Medical treatment 1 (100%) Method of family planning (vasectomy) 1 (100%) Attitude change 1 (100%) HIV 4 (20%) Prevalence 2 (50%) Attitude change 3 (75%) Prevention (methods of prevention like abstinence, fidelity and condoms) 4 (100%) Malaria 2 (10%) Health service delivery 2 (100%) Prevention 4 (200%) Advocacy 1 (50%) Hepatitis 1 (5%) Prevention 1 (100%) Medical treatment 2 (200%) Attitude change 1 (100%) Diabetes 1 (5%) Prevention 1 (100%) Prevalence 0 (0%) Attitude change 1 (100%) Medical treatment 1 (100%) Table 2: Subjects and themes of the Girubuzima documentaries in 2011 The table 2 above, subjects associated with themes, demonstrates health subjects and the themes covered. In the period of the study health care was given the high scale at 50%, followed by HIV/AIDS at 20%, health policy and Malaria 10%,hepatitis,diabetes, and family planning 5%. This fact can confirm that the program owner are committed to raise people awareness in eradicating epidemics like malaria, HIV/AIDS, diabetes, and hepatitis. The documentary shows that the government through ministry of health is committed to the welfare of the population but there is still much to do about family planning, and attitude change which may be done through public lecturing, peer education, and participatory communication meeting the population and give them the opportunity to express their opinions about health problems and methods to cope with them. 4.2.3. Themes available in the Girubuzima documentary in 2011 As mentioned in the above table, while choosing the subjects to develop for the public, some themes were given much attention in delivering health messages. Thus, the researcher investigated them in terms of attitude change as an educative approach to tell people what not to do for not having health problems, health service delivery as an evaluation and reminder of health activities and services, welfare where hygiene and sanitation were involved, medical treatment as a way of methodologies used by health workers and professionals to treat some disease and health abnormalities, medical calendar as a schedule for health activities, prevalence as providing statistics of some disease or activities to eradicate health harms. Advocacy as call for help in some areas where health problems occur, and method of family planning to control the population. The following table shed more lights on these themes. Main themes number Percentage Attitude change 14 70% Health service delivery 4 20% Welfare (evaluation and delivering activities aimed at well being) 4 20% Medical treatment(treatments of some disease by professionals) 4 20% Medical calendar(schedule of health activities like vaccines and medicines) 4 20% Prevalence(the rate of some disease or health service available) 2 10% Advocacy 1 5% Method of family planning(vasectomy) 1 5% Prevention of diseases 10 50% Table 3: Themes of the Girubuzima documentaries in 2011 The main objective of the Girubuzima documentary is to provide basic knowledge to Rwandan population through raising their awareness on health threats and how to keep their health well. Hence, themes were investigated in terms of attitude change with the proportion of 70%, prevention presented in the whole year at 50%, followed by health service delivery, welfare, medical treatment, medical calendar, and warning available at 20% in this period of study. The low proportion was found on methods of family planning and advocacy with 5%. So it is clear that family planning was given low coverage considering the population growth which causes some health threats such as poverty, malnutrition diseases, and family conflicts. 4.2.4. Geographic focus of the Girubuzima documentaries in 2011 A given health program/documentary or public lessons may focus on one area depending on the needs for that area or may be the area is susceptible to some health problems. Messages also may be available to a given area depending on the access to media. In the present work, the researcher went through the programs to find out which area from urban and rural areas was given much coverage and why. The researcher also pointed out the number of documentaries covered both rural and urban areas trying to compare their health situations. This may demonstrate the weakness of some documentary makers who do not want to go far for investigation it may be also a way of revealing the program weakness in delivering health messages. The following table demonstrates geographic focus of Girubuzima in 2011. Geographic focus elements number percentage Urban areas only 18 90% Rural areas only 1 5% Both Urban and rural areas 1 5% Table 4: geographic focus of the Girubuzima documentaries In this table the researcher noticed that urban areas were covered at 90% in the year 2011 whereas the proportion of rural areas was at 5% the same to both rural and urban areas. According to the producer of the program the reason of focusing in urban areas was for electricity and access to television. But it is doubtful whether it is the really reason because in rural areas some residents have television and even some of these areas have got electricity. In addition to this, such areas are susceptible to some of diseases and it was even mentioned in the documentary that people in rural areas are vulnerable to diabetes, disease of poor nutrition and poor sanitation even health problems. 4.2.5. Illustrations in the Girubuzima documentaries in 2011 Rwanda health Communication Center used illustrations to facilitate understanding of the population. According to the world encyclopedia (1990), images, gestures, breath, appearance and other codes communicate more than words or sounds. this was also pointed out by the professor Bob Nowlan advising to check whether the documentary film maker use any other kinds of illustrative or suggestive material (such as animated or still photographic images, and dramatic reconstructions or reenactments) to get her or his points across . The researcher investigated illustration in terms of animated images and cartoons, victims, pictures and real images as presented in the following table. Animated images and cartoons were referred to pictures, drawings, and body organs moving as alive, cartoons referred to images used in the place of human being. The researcher used also real images to refer to shapes or images of things existing like banana, pills, and materials at the hospital and machines. Illustrations names Number Percentage Animated images and cartoons 8 40% Victims(patients on operation, and victims of a disease or violence) 11 55% Pictures and real images 19 95% Table5: Illustrations in the Girubuzima documentaries All along the year 2011 pictures and real images took the high proportion of illustrations at 95% followed by Victims at 55%. Animated pictures and cartoons were used at 40%.Using real people to teach the public about the effects of a disease is very crucial but it seems offending or against ethics and deontology which prohibits using wounded or people with pains on screen while they can be identified by the public. Better they are used hiding identity or face, in the period of a study cartoons and animated pictures were not used at a good level though they may be the one to deliver health information in documentaries after real people. 4.2.6. The main sources and information of the Girubuzima documentaries According to Ratzan (1994), the content of health messages should be balanced and made from the well informed person, consistent and available to the public. Selecting who to answer which question also may reflect the type of information you may get. In this work the researcher investigated and pointed out the sources and information to find out the accuracy, and consistency of information to deliver health messages. The main actors/sources of information Number% Information given by the source Officials(presidents of associations and institutions, Permanent Secretary, minister) 11 (55%) Experience 8 (73%) Documentation 3 (27%) Professionals in health field (doctors, health advisers and counsellors) 12 (60%) Experience 12 (60%) Ordinary people (members of associations, students, children and other people found in various areas) 8 (40%) Documentation 3 (37.5%) Experience 0 (0%) Neither experience nor documentation 5 (62.5%) The presenter of the program (RHCC agent in charge of capacity building) 9 (45%) Documentation 9 (45%) victims(HIV positive people, diabetics, victims of violence, their parents and relatives) 4 (20%) Experience 3 (75%) Neither experience nor documentation 1 (25%) TOTAL of source and information delivered 44 (100%) Experience 23 (52.3%) Documentation 15 (34.09%) Neither experience nor documentation 6 (13.6%) Table 6: Source and information given by the source in the Girubuzima documentaries The table 6 above demonstrates that the fist category was professionals used at 12 (60%) in all the 20 Girubuzima documentaries, followed by officials used at 11 (55%), the presenter (RHCC agent) 9 (45%), ordinary people 8 (40%) and victims 4 (20%). This have provided the use of information based on experience at 23 (52.3%), documentation 15 (34.09%) and information which were neither experience nor documentation were at 13, 6% given by the number 6. In this table it is clear that the big number was experience 52.3% which may provide accurate health information from the source but it was not at a good extent. The documentation with 34, 6% may provide accurate information or not because it is not clear whether the source used trustful source of documentation or not. The same to 13.6% of neither experience nor documentation. It is not negative but it would be better if experience were used at the high percentage. In the future presentation RHCC needs to use victims giving testimonies. 4.2.7. The Duration of the Girubuzima documentaries in 2011 The extent of documentaries were another element that the researcher investigated to notice whether the documentaries were long or short because time-span may affect the attention and understanding of the public especially when the same information is repeated or if the time was not used appropriately. In all these case a long documentary may bore the public in stead of educating them. Duration interval Number of documentaries Percentage 3-4 minutes 4 20% 5-6 minutes 12 60% 7-8 minutes 4 20% Table 7: duration of the Girubuzima documentaries. In this table the duration is not the same to all documentaries. It is noticeable that the interval of 5-6 minutes got a high proportion of 60%, followed by 7-8 minutes and 3-4 minutes both which have 20%. In this study especially for the Girubuzima documentaries duration the researcher remarked that in some documentaries space was wasted which made some program taking a lot of time. For instance in the documentary entitled CNLS the producer has forgotten to check the documentary and remove what is not important because cartoons have taken two minutes without any information. So before airing a given program the owner of the program should watch it to get sure whether there is no error or information given unexpectedly. This may also give an idea about the weakness of RHCC to make a follow up .if not so they should have corrected it before or during presentation period because it is three times a week. 4.2.8. The quality of the Girubuzima documentaries in 2011. The researcher has chosen to investigate the quality of the Girubuzima documentaries based on criteria given by some professionals like professor bob Nowlan, Bill Nichols, and Youngman as mentioned in chapter two. These criteria include Constructiveness, informative, interesting, unbiased, coherence, persuasive and clear . By constructiveness the researcher considered how useful the content is considering the source, the target public and their needs. Pointing out informative as a quality, He based on how information were delivered, in which illustrations and if they can solve the public problems or achieve objective By interesting the researcher investigated how interactive the presentation was and participation of the public; Then, unbiased for the researcher meant not basing on one side but taking both sides or being neutral for the presenter, coherence meant the flow of ideas and events from the starting until the end were considered, and before ending, persuasive meant that the message was convincing and answering the question of the public while clear meant that whatever used was understandable to the public. The following table provides the result of this investigation. Criteria for the quality of the documentary Number of documentaries Percentages constructive 12 60% Informative 16 80% Coherent/organised 18 90% Unbiased 11 55% Persuasive 8 40 Interesting 10 50% Clear 12 60% Table 8: The quality of the Girubuzima documentaries In the table 8, the high proportion was given to coherence 90 %, informative 80 %, constructive and clearness 60 %, whereas unbiased was at 55%, Interesting was 50%, and the low proportion was persuasive 40%. As mentioned the professionals cited above, all these elements should be well balanced in the documentary so as to make changes on behavior of the public or to present interests in providing a solution to health problem as it is the case of the Girubuzima documentary. So, it is clear that RHCC has tried at a given extent but they need to improve on how to make interesting, clear, convincing and unbiased documentaries. This would be possible giving the public an equal chance to express their health problems to be solved; they should be also participating rather than being passive. RHCC needs also to be realistic than basing on opinions. 4.2.9. Figures of speech used in the Girubuzima documentaries in 2011 Figures of speech are the use of a word or words diverging from its usual meaning. They often provide emphasis, freshness of expression, or clarity. However, clarity may also suffer from their use, as any figure of speech introduces an ambiguity between literal and figurative interpretation (Jansen, 2008). Thus readers, listeners, and viewers should be able to understand both figurative and literal interpretation. If not, they may end up not getting the meaning appropriately. In this study the researcher pointed out figures to see which was given much space and why. In interview, the producer of the program said he emphasized on the three figures: realism, metaphor and symbolism to deliver message and for him these figures get the attention of the public. In the following table the researcher investigated not only the three ones but also some others depending on the relevance in delivering message, and their frequency. But for the constraint of time it was not possible to point out all of them. Figures of speech Description Number Percentage Realism In realism figure the presenter explained medical activity or event with facts of a situation observable to viewers. For instance in operation smile she explained showing examples, “behind me health professionals are giving new smile”. She said. This was live and she said it having a child who was operated. 16 80% Metaphor As metaphor is a comparison between two unlike things having something important in common, in documentaries there is where the presenter took intestinal worms as a weevil and lice because or of them makes pains in whatever they get in. a weevil for plants and intestinal worms for people and animals. 26 130% Symbolism A symbolism was used in the context that some pictures or images were symbolising disease or events. For example in HIV subject there is where she used a cartoon to symbolise HIV, a cross in CNT was used for blood transfusion as a help to save life. 14 70% Personification This picture consists of giving inanimate things, animals or others the human traits. In the Girubuzima documentaries, cartoons were used explaining what should be done by human beings like in intestinal worms while explaining their effects on the life of children and symptoms they used a cartoon acting like a child. Cartoons also were used taking medicines, washing clothes and materials to give an example, showing how they are spread; cartoons were used attending to the call of nature in the bush. 35 175% Neologism Neologism refers to using terms that has been recently created or used. For instance in the documentary entitled uvula, the presenter used the name given to this guca ibikweto (to cut shoddier shoes) in Kinyarwanda. Again in the documentary operation smile, having this mouth abnormality was called mouth of a rabbit(umunwa w’urukwavu) 10 50% Proverbs Proverbs commonly used in Rwanda are short sentences used to refer to some thing, to give advice but sometimes. For instance in malaria at Karembure documentary there is a use of a Kinyarwanda proverb Uwambaye ikirezi ntamenya ko cyera! just to mean that Rwanda is advanced in health sector and that it is on a good way eradicating malaria that neighbouring come to learn from it. Another used in smiling operation was Akuzuye umutima gasesekara ku munwa to mean that the joy you have or what is in you can be observed when laughing or at your face . 10 50% Euphemism Euphemism refers to using inoffensive term instead of the one considered to be offensive. This is mostly important in Kinyarwanda words For instance instead of saying wesi, umusarani which are in English latrine, they used Ubwiherero in Kinyarwanda. In stead of using Gusambana (committing adultery, the presenter preferred using gukora imibonano mpuzabitsina (sexual intercourse) 35 175% Metonymy In this figure a word is used describes a quality or features of something. For instance to say a bottle in stead of beer. To be circumcised was compared as to close the door for HIV; a good smiling was used as quality of smiling operation. 17 85% Repetition In repetition an idea or words are used many times explaining one thing. For instance the word Girubuzima was repeated many times starting the documentary, taking a breath, or ending it to set an agenda for the public or to remind them important point to think about. On HIV subject also, abstinence, fidelity and condoms were more repeated as methods of HIV prevention. “I protect my life using condom”, “we have chosen to use condom” these are some quotes from the actors in the Girubuzima documentary. 22 110% Table 9: Figures of speech in the Girubuzima documentaries As mentioned above figures of speech are the way languages are used innovatively. In this table the high proportion was for euphemism and personification with 175%, metaphor was used at 130%, repetition of the same idea 110%, metonymy 85%, realism 80%, symbolism 70%, neologism and proverbs were used at 50%. In this entire table the researcher was not only concerned on how the figure was used or how much it was used but also we can query whether the message was decoded or understood by the public especially for some figures like metonymy, metaphor, proverbs, and symbolism which sometimes cause ambiguity in interpretation. Here it is to notice that anyone who analyzes a figure of speech should analyze both literal and figurative interpretation of a figure of speech . 4.2.10. The place where the Girubuzima documentaries were made in 2011 The place where the documentary or a theater was played is very important and it can affect the main message because whatever appearing in the documentary or images where the documentary is played may distract the public instead of paying attention to the message even if they don’t take side in the message of the documentary. A good example is that when a teacher is teaching in a classroom where there are some good pictures of famous players, students may pay much attention on the pictures rather than to the teacher. According to attribution theory people perceive an event and based on their judgment they attribute to it the meaning . Health documentaries while played in a hotel the public may give much attention to what is in the hotel than to what the presenter tells them. And based on the judgments they make, they may end up attributing meaning differently from what the presenter wanted to give. The following table shows some of the places where the documentaries were played. Place Numbers of documentaries Percentage Hospital 6 30% Hotel 2 10% School 3 15% Offices (doctor,P.S of health ministry, head of CNLS offices’ ) 4 20% Other places (market, residence, car station,gardens,or in the porch(veranda) 15 75% Table 10: where the Girubuzima documentaries was played In this table it was demonstrated that in 2011 the Girubuzima documentaries accounted 6 (30%) documentaries made at hospital may be for medical treatment and medical service delivery, 2 (10%) made in hotel may be to avoid noise, 3(15%) made at school especially those involving students, 4(20%) were made in offices for officials interviews, Other places like market, residence, station, and the porch (veranda) accounted 15(75%) which was the greatest proportion. As mentioned early the choice of a given place may have been caused by the availability of the source of information or the choice of the presenter for the quality of pictures and sounds. In this way as said Ratzan (1994), any image in the documentary should be related to the contents. So while explaining health activity or any activity involving patients and doctors it may be helpful to use the hospital. 4.2.11. The level of the public participation in the Girubuzima documentaries in 2011 The documentaries are made to provide information to the public for their benefits. According to Freire Paulo, a Brazilian theorist in his Critical pedagogy, any project, policy or program for its success, should give a say to the public. The beneficiaries need to get consulted in all stages of a project. In this research, the Girubuzima documentary owners need to meet the public while developing the program which will be noticeable during the presentation, the public giving their views, asking questions to be answered by a professional. Public participation Number of documentaries percentage High Participation 3 15% Medium participation 9 45% Low participation 8 40% Table 11: The level of public participation in the Girubuzima documentaries In the table 11 the public participation was investigated in terms of high participation where the presenter interacted with the public, medium participation where some questions were asked while the presenter was at the field and low participation where there was no question or suggestions by the public. The term low was used because there is where the presenter sounded as she was an intermediate between them and professionals For instance “when I am talking with the public, some ask me questions about Uvula, can you please…”. In this way, it sounds that she met the public and gets their questions and views before making a documentary. Thus the researcher calculated the participation and the documentaries accounted 3 (15%) of high participation, 9 (45%) of medium participation and 8 (40%) of low participation. This may confirm that the good level of public participation was low in 2011, the period of the study which will be helpful if the next presentation to take into consideration. 4.2.12. The frequency of the Girubuzima documentaries in 2011 According to Ratzan (1994), the message should be repeated over time to reinforce the impact with a given audience and to reach new generation. This helps the public to remember important points and to set the public agenda. In the following table the researcher checked how much time the Girubuzima documentaries appeared at the RTV without counting the normal times every documentary should get presented a week. Frequency time Number of documentary Percentage once 17 85% twice 1 5% Three times 2 10% Total 20 100% Table 12: the frequency of the Girubuzima documentaries in 2011 In this table 17 (85%), the high scale shows that all 17 documentaries were not repeated. They appeared only the normal time (three times per week), 1 program presented at 5% was repeated twice and two documentaries presented by (10%) were repeated three times. The reasons of this repetition as noticed in their contents were that some programs were not finished or some changes were made after the presentation. This includes where the prevalence were changed, new drugs were discovered or there is new information about new preventive methods of disease were made. 4.2.13. Target audiences of the Girubuzima documentaries in 2011 The target audience was investigated in this research because given information may be relevant to one group of the public and not to another. This was confirmed also by Professor Bob Nowlan that a documentary should have the group the most target depending on their needs and the content of the documentary. Some diseases like cervical cancer is common to females but not to males. This is important also to find out who is most targeted for which reasons. In fact, for the Rwandan culture, circumcision and vasectomy are related to males only. This was even identified by the presenter selecting the target in word “let me turn on you the head of the family, in this conversation your contribution is relevant in birth control”. This was said by the presenter in the documentary entitled vasectomy. Because it is difficult to say that one group of the public is targeted by some documentaries only, the researcher preferred to use the word mainly to mean that such group was the main one targeted depending on the content .The following table demonstrates target audiences. Audience targeted Number Percentage Unmarried Female mainly 3 15 % Unmarried Males mainly 2 10% Youth mainly 4 20% Married Couples mainly 1 5% Victims of diseases or violence mainly 3 15% All groups mentioned above at the same time 7 35% Total 20 100% Table 13: Target audience of the Girubuzima documentaries The table 13 demonstrates that all the groups at the same time were targeted at 35% which is the high proportion. It was followed by youth and victims with 25%, unmarried female 15%, males at 10%, and married couples 5% .The low proportion is for married couples, unmarried males and victims. In the first chapter, it was said that youth especially students are vulnerable to health problems because they are in teens. Some ladies get involved in human abuses which result in undesirable pregnancy. Boys start taking drugs in the period of teens. Married couples also need special messages in their families especially to strengthen their social life. The owner of the program should think about these groups in the next Girubuzima documentary coverage. 4.2.14. The idea for the Girubuzima documentaries in 2011 Like in news coverage, it happens that journalists cover events for the opportunity rather than observing a problem or what will lead to problems so as to predict and warn the population. This is where sometimes propaganda may crop up. The researcher through the following table demonstrated the main ideas on which the documentary was made in 2011. This element was chosen to clarify whether RHCC made documentaries based on planned events or whether it was their initiative to educate the population based on the actual health situation. Idea for the documentary Number Percentage Conferences 1 5% Testimony 2 10% Health week 2 10% National health Policy 8 40% International Days 2 10% No Special event 5 25% Table 14: Idea for the Girubuzima documentaries in 2011 In this table it is clear that National health policy like fighting against epidemic disease, population control, vaccines and special visit in some areas was at the origin of the Girubuzima documentary as it is remarkable at 40%, the proportion of international days was 10%, testimony 10%, Health week 10%, and conferences 5%. 25% of the documentaries were made without originating at any event. This is where we can say that RHCC met the population and made documentaries to educate them about health issues. Thus the proportion demonstrates that RHCC was more events oriented than investigating and find solutions to health problems. CHAPTER FIVE: SUMMARY OF FINDINGS, GENERAL CONCLUSION AND RECOMMENDATION 5.1. Summary of findings The main impulse of the present study was to make a systematic content analysis of Girubuzima, a health documentary on RTV in a period of 2011. In this perspective, the researcher made a review of different research works and books on health communication so as to partake of ideas from other researchers. The researcher also went through 40 documentaries aired in 2011 and sampled out 20 documentaries which he judged to be worth of representing the remaining others. The researcher pointed out some weaknesses which may have challenged some of the objectives and targets of the Rwanda Health Communication Center. Moreover, the researcher sought after some recommendations important for the next Girubuzima coverage. The frequency of a documentary and agenda setting are relevant to reinforce the impact of health messages to the public as suggests Ratzan (1994). In this period of study, it was found out that the frequency of the Girubuzima documentaries was weak up to 15%. On the source of information, the documentaries focused more on officials, experts and the presenter whereas victims were not consulted enough for testimony and experience. Instead, opinions of the public and the presenter were at a good scale of 13, 65%. On the one hand, the documentaries in this study period, as clarify the findings, were highly characterized by awareness on prevention, attitude change, and service delivery. On the other hand, themes like advocacy, and family planning were given little attention in this period of the study. In the same viewpoint, the geographic focus of the Girubuzima documentaries in 2011 was positioned in urban than rural areas. In this framework, Ratzan (1994) keeps on reminding that media for health communication should be available to the public. Rural people must have access to media and they have many experiences to share with the rest of the country about health because they are the most vulnerable of health problems according to researches. Pictures and real pictures in this period of study were highly used in terms of illustrations while real images, cartoons, and charts were not well used. There were also use of figures of speech and the proportion gives repetition, euphemism, personification and metaphor to be highly used while realism was not high. Figures of speech are very important in using language creatively but they may be a challenge for understanding especially when the viewer does not have skills on them. The study also pointed out some points about the participation of the public of the Girubuzima documentaries in 2011 and it was clear that the public was not given a say at a good scale. The high participation was 15%. Where participation appeared, was for questions and testimony. Places where documentaries were made were mixed but hospitals were not used at a good extent. Documentaries were event oriented rather than being planned and they were result of documentation than experience. 5.2. General Conclusion. At a given extent, on the one side, Rwanda health communication center put a great effort in health communication especially through the Girubuzima documentary. This was remarkable in the coverings of, health care, public health diseases and attitude change. On the other side, RHCC has much to do in health communication and that must be more than providing skills to the public, but applying Knowledge Attitude and Practice. Attitude change is a very good element which would be consistent in the repetitions of health messages, and using the media available to the public which facilitate them to express their views. The problems pushing the researcher to conduct the present study were caused by some of the elements and challenges that the responsible of the program was not able to control. Such challenges are, among others, the best choice of source and information to the public, to let beneficiaries take role in the development of projects which target on them. This would be fruitful for the success of a project as Paulo Freire, a Brazilian theorist points out. For him the public have experiences and knowledge to share with others and they may know even what is not known by policy makers. In Rwanda people are still facing health problems; they are even unable to protect themselves due to inadequate skills on health matter and behavior change. To get the adequate skills would be possible in case there is collaboration among health actors to provide powerful messages targeting the public in a consistent way. Rwanda health Communication center needs to improve health messages provided in the Girubuzima documentary through the best choice of information and sources, providing an opportunity to beneficiaries to express their views on equal share, covering public health messages on a good position, and providing the public with ample equipments and skills enabling them to resist health risks. This is also among what the researcher recommends in this research after analyzing the Girubuzima documentaries into characteristics using content analysis and based on elements suggested by various professionals in health communication. 5.3. Recommendations Health communication is a very important field in delivering health messages and public health concerns .It involves informing, influencing and motivating the public. It also focuses on disease avoidance, health endorsement, health care policy, behavior change and enhancement of the quality of life. Health communication should equip the public with the required tools and knowledge to respond to health crises. So, in this framework, effective media should be used to deliver health messages effectively and efficiently. Not only media but also government, health institutions and NGOs should work hand in hand to tackle health problems. At the completion of the work “communicating Health, a content analysis of Girubuzima, a documentary of Rwandan television from January to December 2011”, the following are the recommendations that the researcher would like to leave out for the future improvement of the Girubuzima documentary so as to solve problems identified in the fourth chapter and to improve the quality of life of all Rwandans. 1. The researcher recommends Rwanda Health Communication Center, the responsible of Girubuzima to give the public an opportunity to express their opinions about health while gathering information. This includes not focusing only on urban areas but also balancing information of both rural and urban areas because even if the people in rural areas do not have easy access to television, they have experience and information to share with others. They are even the most vulnerable of health problems. 2. RHCC should not be more event-oriented in their coverage to make Girubuzima documentaries. Instead, they should focus on planned events aimed at educating the public with balanced sources. This may be achieved when they go to the field and discuss with the public about health problems or make observation of health conditions and develop the documentary to provide solutions or to guide the public on how to behave. 3. The results of content analysis showed that the content of the documentary in the period of this study was not educative enough in achieving their objectives and enabling the public to resist health risks. The researcher recommends RHCC to improve the quality of documentaries through the balanced choice of sources of information, the public participation, evaluating Knowledge Attitude and Practice, and then checking for errors before the presentation. 4. In terms of subjects, family planning was not covered at a good extent nor was it well understood or custom made by the population. The researcher recommends the responsible of the program to focus on this subject in the next coverage using a participatory approach with beneficiaries and groups which were found they were not well targeted like married couples and the young. 5. The study pointed out that the documentaries missed frequency and regularity. This may be the result of carelessness and deficiency in the follow up. This was remarkable while the researcher missed saved or stored documentaries at RHCC. The researcher recommends the responsible of the documentary to make a follow up on the presentation of the Girubuzima documentary and to make archives of everything they produce. 6. The researcher recommends RHCC to use figures of speech and illustrations paying much attention to the level of the literacy and interpretation of the addressed public. They should also increase the public literacy through trainings of opinion leaders and health workers in rural areas. 7. 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Themes in the documentary Prevention 10 (50%), advocacy 1 (5%), health services delivery 4 (20%), welfare 4 (20%), attitude change 14 (70%), medical treatment 4 (20%), medical calendar 4 (20%), prevalence 2 (10%) The content in documentaries was based on some main elements. They were either to raise the public awareness, to update them on health situation, to prevent a given disease, to attend health activities or to pay attention in some circumstances. Sources of information Officials 11 (55%), professionals 12 (60%), ordinary people 8 (40%) the presenter 9 (45%), victims 4 (20%) Watching the documentary, the researcher identified also who was interviewed to provide information. This was the source of information Information provided Experience 23 (52.3%), documentation 15 (34.09%), neither experience nor observation 6 (13.6%) Information provided was identified observing the source, specialization and how she/he was explaining even mentioning sources. Illustration used Animated images and cartoons 8 (40%), victims 11 (55%), pictures and real images 19 (95%) Animated images were identified as images given effects to refer to other events. This is like explaining the movement of food in stomach or microbes in organism. Others were identified watching documentaries. Geographic focus Urban areas 18 (90%), rural areas 1 (5%), both rural and urban areas 1 (5%) Interviewing the producer of the program, observing the place, illustrations and the public interacting with the presenter, the researcher identified geographic focus of Girubuzima in 2011. Figures of speech used in the documentary Euphemism 35 (175%), metonymy 17 (85.5%), personification 35 (175%), repetition 22 (110%), Metaphor 26 (130%), realism 16 (80%), symbolism 14 (70%), neologism 10 (50%), proverbs 10 (50%) Figures of speech as explained in the previous chapter are ways of using the language creatively. This was also applied in illustrations used to explain a health activity or event. These figures were identified watching attentively every documentary. Duration of the documentary 3-4 minutes 4 (20%), 5-6 minutes 12 (60%),7-8 4 (20%)minutes This was identified watching documentaries but also at the time counter of the playing scheme of the computer. Quality of the documentary Constructive 12 (60%), informative 16 (70%), Coherent/organised 18 (90%), unbiased 11 (55%), persuasive 8 (40%), Interesting 10 (50%) and Clear 10 (50%). The quality of the documentary was given by the usefulness of information provided in it, the source of information, the flow of information, how partial or impartial ,how attractive and participative it were and illustration used in it The Place where the documentary were played Hospital 6 (30%), hotel 2 (10%), school 3 (15%), offices 4 (20%), other places15 (75%) The place in the documentary was identified depending on illustrations, activities and the actors playing. Public participation High participation 3 (15%), medium participation 9 (45%), low participation 8 (40%) Public participation were identified through the questions asked, suggestions and feedback provided during the presentation. Thus calculating the average of participation we got the mentioned levels. The frequency of the documentary Once 17 (85%), twice 1 (5%), three times 2 (10%) The frequency was identified observing how much times a documentary appeared on RTV without taking into consideration the normal time (Tuesday, Thursday and Saturday) after the production the documentary. Audience targeted by the documentary Unmarried females 3 (15%), unmarried males 2 (10%), children (youth) 4 (20%), Victims 3 (15%), married couples 1 (5%). All groups at the same time 7 (35%) The content of the program, the level of the public the presenter interacted with, the special remarks she gave and idea of who mostly was targeted. This is what the researcher wrote in. Ideas for the documentary Conferences 1 (5%), testimonies 2 (10%), Health week 2 (10%), Health policy 8 (40%), International Day 2 (10%), No special event 5 (25%) The most events pushing the producer to make a documentary were an idea for the documentary. RHCC would have pushed by events of the day or would have planned what to do depending on priority or breaking events. Beneficiaries also may have proposed the topic while giving feedback on e-mail. APPENDIX II: THE CODEBOOK Units of analysis Names of the Girubuzima documentaries analyzed Circumcision I Operation smile Intestinal worms I. To breastfeed well Community Health Conference 1.Duration 5-6minutes 7-8minutes 7-8minutes 3-4minutes 7-8minutes 2.Main actors/source of information Officials, victims, and the presenter Officials, and the presenter professionals, the presenter, and ordinary people Officials ,the presenter(RHCC worker) and professional officials 3.Information given by the source Experience and documentation Experience and documentation Experience, Documentation and neither experience nor documentation Experience and documentation Experience and Documentation 4.The Main subjects in the documentary HIV/AIDS Health care(operation smile) Intestinal worms Health Care Health Policy 5.The main themes in the documentary Awareness on prevention, HIV/AIDS prevalence and attitude change Awareness on medical treatment, attitude change and advocacy for people with health abnormalities Awareness on Prevention and attitude change Awareness on breast feeding ,welfare and prevention Welfare, health service delivery and prevention 6. Geographic focus/origin Urban areas only Urban areas only Urban areas only Urban areas only Urban areas only 7.Illustration used in the documentary Cartoons and pictures Victims Pictures, and cartoons Victims Victims and pictures 8.the quality of the documentary Constructive, informative, clear and unbiased Constructive, informative,interesting,clear, and unbiased informative,clear,unbiased,coherent and persuasive balanced Constructive informative and coherent Informative ,persuasive and unbiased 9.Girubuzimafrequency Three times Once Once Once Once 10. Figures of speech used to deliver information Symbolism, Euphemism and Repetition realism ,metaphor, Symbolism and Proverbs Symbolism, Metonymy, Repetition and personification Realism and Proverb Metaphor 11.Where the documentary was played Hotel Hospital School Home Market 12. Public participation. Low participation Medium participation Medium participation Low participation Low participation 13.The main targeted public audience All groups of the public at the same time All groups of the public at the same time Children(Youth) Married female All group of the public at the same time 14.Idea for the Documentary Health Policy Health Policy and testimony No special event No special event International Conference Unit of Analysis Names of the Girubuzima documentaries analyzed Intestinal worms II Ibirimi (uvula): Dental diseases Malaria at Karembure CNTS: Blood transfusion. 1.Duration 3-4 minutes 7-8 minutes 5-6minutes 3-4minutes 5-6minutes 2.Main Actor/Source of Information Ordinary people, the presenter, and officials Ordinary people, victims and professionals Professionals and ordinary people Professionals, and ordinary people Professionals, officials, and ordinary people 3.Information given by the source Documentation Experience,documentation,neither experience nor documentation Documentation, neither experience nor documentation Documentation and experience Experience and documentation 4.The Main subjects in the documentary Intestinal worms Health care(Uvula) Dental disease Public health disease(malaria) Health care(blood transfusion) 5.The main themes in the documentary Awareness, attitude change on intestinal worms spread, and prevention Awareness, Medical treatment, medical calendar and attitude change Awareness on teeth disease, prevention and attitude change Awareness on prevention, and attitude change, Advocacy, awareness on the role of blood and what the blood is, and attitude change 6. Geographic focus/origin Urban areas only Urban areas only Urban areas only Rural areas Urban areas 7.Illustration used in the documentary Cartoons Victims Pictures and victims Pictures, cartoons and victims Animated images, a blood donor and pictures 8.the quality of the documentary Constructive,interesting,unbiased,coherent and persuasive Constructive,interesting,unbiased,coherent and persuasive Constructive,interesting,unbiased,coherent and persuasive Constructive, informative, coherent and unbiased Informative,coherent,persuasive and clear 9.Girubuzima frequency Once Once Twice Once Once 10. Figures of speech used to deliver information Realism,Euphemism,repetition and Personification Realism and metaphor Realism,Euphemism,neologism,symbolism and metonymy Realism, symbolism, repetition and personification Symbolism,metaphor,repetition and Metonymy 11.Where the documentary was played School, and other places Residence’s home School and hospital Health worker’s home and veranda Hospital 12. Public participation. High participation Medium participation High participation High participation high participation 13.The main targeted public audience Students(Children) Children(youth), traditional healers Children All groups All groups(blood donors) 14.Idea for the Documentary No special event Testimony No special event Health policy Health week, health policy Units of analysis Names of the Girubuzima documentaries analyzed Household accidents Mother and Child Health week Vasectomy Health insurance Hepatitis 1.Duration 5-6minutes 5-6minutes 5-6 minutes 5-6 minutes 7-8 minutes 2.Main Actor/Source of Information Professionals and victims Officials and ordinary people professionals officials professionals 3.Information given by the source experience Experience, neither experience nor documentation experience Documentation and experience experience 4.The Main subjects in the documentary Health care for medicine use Health policy/Health week Family planning Health policy and health care Hepatitis 5.The main themes in the documentary Attitude change, awareness on household accidents Welfare, attitude change, health service delivery and advocacy Awareness on methods of family planning, attitude change and medical treatment Awareness, health service delivery and attitude change, Awareness on hepatitis, attitude change and prevention 6. Geographic focus/origin Urban areas Both urban and rural areas Urban areas Urban areas Urban areas 7.Illustration used in the documentary images pictures Animated images, pictures No illustration Animated images and pictures 8.the quality of the documentary Interesting , coherent, constructive, informative, clear and unbiased Informative, coherent and persuasive Informative,clear,coherent,and constructive Informative, coherent and persuasive Informative, coherent and unbiased 9.Girubuzima frequency Once Once Once Once Once 10. Figures of speech used to deliver information Symbolism and repetition Symbolism,repetition,and metonymy Metaphor, symbolism,Euphemism,metonymy,and proverbs Symbolism and proverbs Symbolism and metaphor 11.Where the documentary was played hospital Office ,hotel and other places offices Hospital and office Hospital 12.Public participation Medium participation Medium participation Low participation Low participation Low participation 13.The main targeted public audience All groups said Married couples and children Married couples All groups said All groups said 14.Idea for the Documentary Testimony and health care Health week Health policy Health policy No special event Units of analysis Names of the Girubuzima documentaries analyzed Mental Health Day Migrant workers-Condom use Diabetes II. CNLS(HIV) Discordant couples 1.Duration 5-6 minutes 5-6 minutes 5-6 minutes 5-6 minutes 5-6 minutes 2.Main Actor/Source of Information professionals,victims,and ordinary people Officials, ordinary people, and the presenter Officials and the presenter. Officials,professionals,and the presenter professionals and the presenter 3.Information given by the source Experience, documentation, no experience and documentation Documentation and experience Documentation Experience and documentation Experience and documentation 4.The Main subjects in the documentary Health care /Health day HIV/AIDS Public health disease(Diabetes) HIV/AIDS HIV/AIDS 5.The main themes in the documentary Awareness on mental health, welfare, attitude change and health services delivery Awareness on HIV prevention, welfare, health policy and attitude change Awareness on diabetes, medical treatment and attitude change Awareness on HIV prevention, welfare, and attitude change Awareness on HIV prevention, and attitude change 6. Geographic focus/origin Urban areas Urban areas Urban areas Urban areas Urban areas 7.Illustration used in the documentary No illustration Pictures and real images Cartoons,pictures,and images Cartoon and pictures No illustration 8.the quality of the documentary informative ,interesting, clear and unbiased Constructive, Informative, clear, coherent, and interesting informative ,coherent and persuasive Informative ,interesting, constructive, persuasive and clear Coherent, and persuasive 9.The frequency of the documentary Once Once Three times Once Once 10. Figures of speech used to deliver information Euphemism ,neologism and repetition Realism and metaphor Symbolism Personification, symbolism Metaphor, and Realism Personification, Symbolism and metaphor Symbolism and metonymy 11.Where the documentary was played Other places At the border Residence Hotel and Office Office and other places 12. Public participation. Medium participation Medium participation Medium participation Low participation Low participation 13.The main targeted public audience Victims(people with mental problems and their relatives), groups Married couples(International drivers and workers and their wives) Victims of Diabetes, married males and females and married couples All groups said above Married couples(an HIV positive and another who is not) 14.Idea for the Documentary World Mental day No special event No special event HIV/AIDS World day No special event APPENDIX III: TRANSCRIPTION OF THE GIRUBUZIMA DOCUMENTARIES Month Program name Time limit description contents January 1.Circumcision 00-1.03 -The presenter introduces what Circumcision is about. -Audience attraction and raising awareness 1.04-2.55 A doctor explains its role in HIV prevention. -Awareness on prevention 2.56-3.59 “People should not only rely on circumcision but also other preventive method.” Says the doctor -Rising awareness on Abstinence, fidelity, and condom use and attitude change. 4.00-5, 00 No consequence of circumcision on circumcised -Verbal mis conception rejection /attitude change 2.Operation Smile 00-1.12 Introduction of the program by the presenter. Appeal or audience attraction 1.13-2.00 A doctor raises misconceptions about operation smiling. -Attitude change 2.01-3.54 Schedule of operation activities. -medical calendar 3.55-4.30 People testify how important it is. -verbal behaviour acceptance and testimony 4.31-5.00 The doctor explains how victims should not get stigmatized. - attitude change February 1.Intestinal worms 00-1.10 the presenter explains what the program is about -Appeal/Audience attraction and raising awareness 1.11-1.52 Intestinal worms their life and reproduction. Raising awareness on intestinal worms and attitude change 1.53-5.6. Children asks question on consequence and prevention -Awareness/attitude change 2.Breastfeeding well 00-40 the presenter introduces and gives an overview of the program Appeal/Audience attraction and awareness 41-2.27 doctor explains ways of breastfeeding well -Raising awareness, and attitude change. 2.28-4.00 The doctor explains role on the side of a mother and baby - Awareness and attitude change. March 1.Community Health Conference 00-53 the presenter introduces the program with the word Girubuzima and gives a brief introduction on the program -Appeal or Audience attraction , awareness and agenda setting 54-1.28 MOH representative explains what CHC is. Raising awareness, and health care 1.29-4.30 It involves disease avoidance, health adviser’s capacity building, health service delivery, disease treatment in the villages by health advisers and care in reducing death of pregnant women. Raising Community awareness, health care. 4.31-6.30 The presenter gives the conference agenda and lets MOH P.S explains health decentralization. Health policy calendar and health service delivery. 2.Intestinal worms II 00-1.00 The presenter introduces Girubuzima, thanks schools and population in general for hygienic issues. - Appeal or Audience attraction. -Agenda setting for hygiene and sanitation 1.01-1.20 One student explains the importance of kandagira ukarabe on health. - Attitude change 1.21-2.40 “For the negative effects there is poverty, death, economic crisis for all level of the population” explains the doctor. Raising awareness and attitude change 2.41-3.26 Students remind others modes of prevention including hand washing habit. Verbal behaviour acceptance and persuasion. April 1.Ibirimi (uvula 00-48 The presenter introduces with Girubuzima say and introduces children violence. -Appeal, awareness and agenda setting. 49-1.38 One mother of a victim explains what happened to her child. -Testimony, raising awareness, and attitude change 1.39-2.42 A doctor explains and corrects misconceptions on uvula. - Verbal misconception rejection and attitude change 2.43-4.43 Mother’s testimony progresses - Raising awareness, and persuasion 4.44-5-29 “negative effects include breathing problems, swallowing effects” ,explains the doctor - Awareness on prevention and attitude change 5.30-6.10 The mother explains what happened to her after going at the hospital - Testimony on misconception and attitude change 6.11-7.10 Mother advises people Attitude change 7.11-7.40 A doctor gives advices on what to do in the case of uvula -Awareness and attitude change 2. Dental diseases 00-1.19 The presenter introduces the program and starts a dialogue with students about what causes teeth diseases. -Audience attraction, knowledge testing, awareness, and attitude change. 1.20-3.37 The presenter introduces the causes of dental disease, the doctor explains how teeth get damaged when not blushed after eating food containing sugar and other diseases related -Rising awareness, and attitude change 3.38-4.28 Parents should reduce giving food containing much sugar to their kids and they should remember to blush teeth after eating. -Advices on prevention. Behaviour acceptance and Verbal misconception rejection 4.29- 5.10. Parents should take responsibilities in preventing their children from dental diseases. -Advices on prevention and persuasion 5.11-6.10 “I always blush my teeth after eating, you should also do the same” explains one child. - Visual behaviour acceptance /attitude change May Malaria at Karembure: 00.1.13. The presenter introduces the program. -Audience attraction 1.14-2.40 The presenter asks a health adviser how far they are eradicating malaria, and they continue discussions about activities involved. -Raising awareness, and health care. 2.41-3.11 “cutting bushes near houses, using mosquito nets, joining health adviser for any problems, and going to the hospital while disease get complicated is what we advise the population” says a health adviser -Raising awareness on prevention and attitude change 3.12-4.00 Ordinary people remind ways of Malaria prevention. -Verbal behaviour acceptance /attitude change June 1. CNTS Blood transfusion. 00-48 The presenter introduces with Girubuzima say and call upon the Audience to blood donor habit. -Audience attraction and creation of interests 49-3.40 Doctor explains that blood help all nutrients reach all the parts of the body -Raising awareness 3.41- 4.10 Mostly, women need blood while they have aborted or sometimes when giving birth, children after malaria recovering, and after any other accident. -Raising awareness, advocacy, and warning. 4.15-4.55 A blood donor explains that blood giving it is giving health and doing a divine work. -Verbal and visual Behaviour acceptance /attitude change 4.56-5.55 “No consequence to the blood donor after the transfusion”, says the doctor. -Attitude change 5.56-6.10 The presenter concludes mentioning dates of blood transfusion and blood week. -Medical Calendar and awareness 2.Household accidents 00-1.16 The presenter introduces the program with Girubuzima. -Audience attraction. 1.17- 3.10 The frequent accidents are for kids who drink pesticides by mistake, and fire accident. -Rising awareness and attitude change 3.12-4.30 One mother explains what happened to a neighbour taking a drug as salt. - testimony and attitude change 4.35-6.5 The doctor explains household accident prevention by reading etiquettes on medicines, keep away of children all sorts of health unfriendly products and go to the hospital when you think a given accident occurred. -Raising awareness and prevention July. Mother and Child Health week 00-1.27 The presenter introduces the program and gives the summary of what the week is about. -Audience attraction. 1.28- 3.9 There will be the second cervical cancer vaccination, providing tablets to fight against intestinal worms, giving Vitamin A to children, pregnant women tablets to increase blood, and other health care services -Medical calendar and information. 4.00-4.8 An agent from health ministry explains more about why focusing on Malaria. -Raising awareness and attitude change 4.9-5.00 Dialogue between one resident, a child, MOH agent, and the presenter about the schedule of activities and the role of MCH. -Information, verbal behaviour acceptance, and persuasion. August: Vasectomy 00-1.12 Introduction with vasectomy as one of family planning method. -Audience attraction. 1.13-1.51 A doctor says it is preventing sperms from meeting ovum by blocking the path of sperms. -Raising awareness on medical treatment. 1.52-5.30 Dialogue between a presenter and a doctor on misconception about vasectomy, who is for, who’s not, and the procedures. -Verbal misconception rejection or correction. (attitude change) September Health insurance: 00-1.09 Introduction in new scheme of health insurance. -Audience attraction 1.10-3.50 MOH P.S explains health insurance improvement and its contributions in health services delivery - Health policy and attitude change. 3.55-5.00 Resident categories. The first category contribution will get paid by state, 2nd category will pay three thousands while the third will pay seven thousand per year. -Information and health policy 5.01-6.38 The contributions may be paid in two periods depending on means. -Attitude Change and persuasion. October 1.Hepatitis I. 00-1.00 Introduction on the spread of hepatitis -Audience attraction. 1.02-1.40 Hepatitis is a disease of the liver while microbes affect it and says it can be caused by alcohol. -awareness and attitude change 1.41-4.29 Someone can get, hepatitis while taking dirty food affected by hepatitis virus, hepatitis B, C, D, E while get spread in blood. Awareness and attitude change 4.30- 7.5 Symptoms appear in steps and they include vomiting, loss of appetite in the first step, eyes become yellow, brown urine leading to Cancer. - Awareness on symptoms and attitude change 2.Mental Health Day 00-1.14 Introduction and creating audience interest. -Audience attraction 1.15-2.30 There were trainings of people on the side of mental disease who will help others. -Attitude change 2.32-3.50 A neighbour of someone with mental disease explains care for such a person and treatments. -Verbal behaviour acceptance /attitude change 3.53- 4.25 A Counsellor explains the first aid for people with mental disease and the presenter concludes with activities on mental day. -Information, verbal behaviour acceptance, and medical calendar November 1.Migrant workers 00-1.19 The presenter introduces with information that migrant workers can get easily HIV/AIDS and introduce them to condom use. -Audience attraction and attitude change 1.20- 2.30 Condom is important in our trips and we use them. We use also peer education, books of information, and centers for HIV/AIDS education -Verbal behaviour acceptance and persuasion 2.31- 4.00 These centres help migrant workers to get condoms and information on prevention. Not only them but also their wives need such preventive skills. -awareness, attitude change and health policy 4.02-4.48. Our wives also have associations with the same objectives as ours. Behaviour acceptance /attitude change 4.49-5.00 Drivers present condoms -Visual, Verbal behaviour acceptance Or (attitude change) 2.Diabetes 00-1.5 The presenter introduces with a wish for cow, children, and health, and introduces a doctor to explain more. -Audience attraction 1.17-1.50 it is a high increase of sugar in human body over 1.40 Information and attitude change 1.51-2 .54 Hunger, and pains in the sex for women are other symptoms -Awareness on symptoms 2.55-5.00 the most vulnerable are people who are fat, having a relative with diabetes, people having disease of high blood pressure, etc -Raising awareness on diabetes and attitude change 5.02-5.10 The presenter introduces the next presentation about effects of diabetes. -Creation of interests December 1.CNLS 00-1.54 The presenter introduces with a wish for health, the role of condom and introduces world health Day on HIV/AIDS. Audience attraction and creation of interests, health Day. 1.55- 3.40 “HIV/AIDS is spread through having a non-protected sex”, Says CNLS head -Information and attitude change 3.42-4.40 “We have chosen to use condom.” Say people -Verbal behaviour rejection 4.42- 5.20 “I like my life and I use Condom”, says one person -Attitude change 2.Discordant couples 00-57 Introduction on how can an HIV positive live with someone and do not contaminate the partner Audience attraction and creation of interests. 59-2.35 About eight thousands are in this group but it is difficult to explain why. Getting affected depends on how blood got in contact, and the capacity of the virus. Awareness on HIV prevalence, and attitude change 2.40-3.50 No blood is immune to HIV/AIDS. - Attitude change 3.53- 4.30 They need to use Condoms and other ways to protects who is not HIV positive. Awareness on prevention and warning.