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Eastern Media Advocacy Project

Evaluation Report

2014

Written by Rebecca Patrick & Anne Kyle

Women’s Health East acknowledges our Eastern Media Advocacy Project Partners

Women’s Health East acknowledges the support of the Victorian Government

EMAP Evaluation Report 2014 2

Contents

1. Executive Summary 3

2. Key Terms 5

3. Acronyms 6

4. Evaluation Methodology 7

5. Overview of Eastern Media Advocacy Project

and its beginnings 10

6. Best Practice: What the literature tells us 13

7. Evaluation Findings 26

8. Case Study 47

9. Recommendations 53

10. Conclusion 55

11. Reference list 57

12. Appendix 62


Executive Summary

This section provides a summary of the project origins, evaluation methods and key evaluation findings.

In 2011 Women’s Health East (WHE) initiated the Eastern Media Advocacy Project (EMAP) in

response to discussions with the Eastern Metropolitan Region (EMR) Regional Family Violence

Partnership. The Eastern Media Advocacy Project (EMAP) ensures that the voices of women who have

experienced family violence and sexual assault are heard through the media and public events. EMAP

has developed its strategies in accordance with the VicHealth primary prevention of violence against

women framework and an ecological understanding of violence against women (Vichealth 2007;

VicHealth 2011). Since its inception, EMAP has been implemented in three distinct phases. Phase One

involved recruitment and screening of family violence and sexual assault survivors from within the

EMR. Phase Two involved training of 29 survivor advocates and EMR workers. Phase Three involved

promoting advocates, resource development and employment of an EMAP project worker.

This evaluation report presents the key findings of an independently designed and implemented

impact evaluation for EMAP. Using a combination of qualitative and quantitative data collection

strategies (i.e. survey, interview and focus group techniques), the evaluation findings presented below

demonstrate EMAP’s impact on a) women participating as survivor advocates in the project and b)

media reporting of violence against women.

The evaluation report demonstrates that the EMAP has generally had a positive impact on survivor

advocates and local media. EMAP has positively impacted the self-‐confidence, knowledge and skills of

survivor advocates who have been involved in the project. The project has had a beneficial impact on

the personal and social development of survivors of family violence and sexual assault who have been

trained by EMAP. The project has also enabled ‘empowerment’ and assisted all advocates to move

forward in one way or another on their personal journey. In relation to media impact, the report

illustrates that EMAP has had many positive impacts on local print and public speaking event

organisers’ knowledge, attitudes and behaviours towards EMAP survivor advocates and responsible

reporting of violence against women. The quality of news articles that have been guided by EMAP

demonstrates accurate and sensitive reporting as compared to responsible reporting guidelines. In

the latter sections of the report, the evaluation findings and opportunities for project enhancement

are translated into a set of recommendations. Examples of these include: expansion of the sexual

assault media advocacy strategies; development of an advocate community; and reframing the EMAP


approach to media to accord with a ‘media as a strategy’ approach for primary prevention in public

health and health promotion.


Key Terms

Central to the Eastern Media Advocacy Project (EMAP) and therefore the conceptualisation of this

evaluation have been the concepts of ‘survivor advocate’ and ‘health promotion’. These terms are

defined below.

Survivor advocates are individuals with first hand experience of, or with, the issue for which they are

advocating. Survivor advocates use their lived experience as survivors and apply this within a range of

settings to help cultivate the changes required to improve the health and wellbeing of others who

have been exposed to the same problem (Clarke & Stovall, 1996). In the literature on cancer

survivorship, where the concept is well developed, survivor advocacy exists on a continuum that

begins at a personal level, extending to advocacy for others and finally on to public advocacy efforts

(Clark & Stovall, 1996). Survivors who become public advocates take on these roles in a ‘professional’

capacity in that they consider their efforts as extending beyond their personal needs. They therefore

usually undertake specific skills training to perform their roles (Grey, 1992).

It has been argued that survivors who the use media and public-‐speaking forums as their advocacy

platforms often become recognised as experts on the issues that have impacted their lives and the

lives of other with whom they share similar experiences (Leigh, 1994). In health promotion terms

media advocacy is a strategy consistent with ‘strengthening community action’.

Health promotion is defined as ‘the process of enabling people to increase control over, and to

improve, their health’ (World Health Organization 1986, p.1). Recognised as a professional discipline

within the broader arena of public health, health promotion practice is primarily enacted at a

community level, for example within community health services and non-‐government agencies

(Dempsey et al. 2010). Contemporary health promotion practice emphasises empowerment, gender

equity, community action, personal skills development, primary prevention and healthy public policy

(Keleher 2007).


Acronyms

DoHA-‐ Department of Health and Aging

DV Vic-‐ Domestic Violence Victoria

ECASA -‐ Eastern Centre Against Sexual Assault

EDVOS -‐ Eastern Domestic Violence Service

EMAP -‐ Eastern Media Advocacy Project

EMR -‐ Eastern Metropolitan Region

EVAs – Eliminating Violence Against Women media awards

FV-‐ Family Violence

PVAW -‐ Preventing Violence Against Women

SA-‐ Sexual Assault

VAW -‐ Violence Against Women

WHE -‐ Women’s Health East

WDVCS -‐ Women’s Domestic Violence Crisis Service


Evaluation Methodology

This section includes: an overview of the research and evaluation paradigm; data collection tools and

strategies; approach to analysis; and references to the key ‘questions’ that were required by this

evaluation project.

A ‘hybrid’ design (Curran et al., 2012; Fixsen et al., 2005) based on a public health-‐health promotion

pluralist approach to research (Raphael 2000; Tones & Thilford 2011) was used to enable

conclusions to be drawn about:

• Impacts of the EMAP for women participating as survivor advocates (including benefits and

challenges);

• Impact of the EMAP on the reporting of violence against women in the media (including

changes in media reporting); and

• What works and any areas for improvement for the EMAP (including recommendations for the

future).

Given the nature of the evaluation questions, the design required both process (i.e. reach of the

program) and impact (i.e. attitudes and behaviour) evaluation measures. Therefore the evaluation

drew on qualitative and quantitative data collection strategies including documentary, survey,

interview and focus group data. Feminist and narrative-‐based research (Podems, 2005; Chase, 2005)

methods were combined with project logic based evaluation techniques (Victorian Department of

Health, 2010) to enable a robust design fit for:

a) A feminist organisation

b) A public health/health promotion intervention; and

c) Communication of results to all key stakeholders.

This pluralist approach and mixed methodology permitted the evaluators, in collaboration with the

project staff, to clarify 'what works', ‘what doesn’t’ and ‘what could be improved’ in relation to the

pre-‐determined goals and strategies that EMAP utilises. Illuminating the voices of survivor advocates

was prioritised within each step of the evaluation, in line with best practice (Anderson & Dana, 1991;

Reinharz & Davidman, 1992; Podems, 2005). The data collection tools and strategies included:

1. An online survey distributed between 28.10-‐8.11.13 to ‘active and contactable’ EMAP trained

survivor advocates (n=23). The 25 question survey tool was developed using Survey Monkey

and drew questions from existing validated tools (e.g. Self-‐confidence scales, Scorelogix). The

survey incorporated process and impact indicators drawn from the pre-‐determined draft


EMAP project logic model and evaluation framework. See Appendix 1 for the survey. Nine

survey responses were received and analysed.

2. Telephone interviews with survivor advocates (n=6 participants) that had undertaken the

media advocacy training and/or media advocacy work for EMAP (including public speaking

engagements) within the past 2 years. The interviews were semi-‐structured and contained

three open-‐ended questions. Interviews were audio-‐taped and transcribed verbatim. The

interview technique drew on the principles of feminist interviewing (Reinharz & Davidman

1992) as well as critical and feminist ethnographic traditions (Spradley 1979; Smith 1987;

Carspecken 1996) for both the collection and analysis of the data. See Appendix 2 for the

Interview Protocol.

3. A face-‐to-‐face focus group session at WHE with survivor advocates (n=3 participants) that had

undertaken media advocacy work for EMAP (including public speaking engagements) within

the past 6 months. As with the individual interviews, the focus group protocol was semi-‐

structured and contained three open ended questions with prompts. The focus group was

audio taped and transcribed verbatim. The techniques and analysis were similarly informed by

feminist and ethnographic traditions. See Appendix 3 for Focus Group Protocol.

4. A media snapshot of EMAP advocate-‐based articles (n=13) provided by EMAP for the period

2011 – 2013 assessed against responsible reporting guidelines. The articles included in the

analysis represented the total number of articles provided or able to be sourced online for the

reporting period 2011 to September 2013. A thematic analysis was performed on 100% of

articles available (n=13) print media articles using the combined criteria of the

EVAS/VicHealth/ Victorian Police/Media and Entertainment Arts Alliance (MEAA) journalist

code of conduct/International Federation of Journalists guidelines for reporting VAW/

UNESCO gender and reporting/UN development fund for women/Witness Video for change

guide/Chicago taskforce media tool kit. Nineteen common items were identified from these

guidelines and codes of conduct. Twelve criteria were then used to develop an EMAP’s

responsible reporting criteria media analysis tool. The overall approach to the media analysis

was modelled on the ‘technical report’ approach developed by Morgan & Politoff (2012) for

VicHealth.

5. Survey and/or telephone interviews with EMAP media and public speaking representatives.

Two short, 10 minute survey tools were developed within survey monkey and structured

around key process and impact indicators for journalists and public speaking event

coordinators. The surveys were administered either via email or via telephone interview

according to the availability of the interviewee’s. Twenty journalists (6 provided by EMAP and

14 identified through articles or by editorial staff at local new services) were contacted by the

evaluators. Three journalists chose to participate by completing the online survey, seven


agreed to participate by answering survey questions over the phone. In total 13 journalists

participated in the evaluation survey and/or telephone interviews. 65% (n=15) of public

speaking contacts provided by EMAP were contacted and 4 chose to participate in the online

survey.

6. Literature review involving: EBSCOHost database search using key search terms; a review of

the grey literature from key websites; and literature provided by EMAP. Relevant literature on

‘good practice’ or ‘transferable evidence’ was used to contextualise the evaluation findings and

presented in the final report.

7. Document analysis of existing EMAP data including training evaluations, project resources,

policy and procedures. A thematic analysis was performed to verify key process type

indicators. The approach drew from Wharton’s (2006) social sciences approach to document

analysis and data triangulation.

8. Case study to highlight how EMAP utilises media (including public speaking events) advocacy

to prevent violence against women in the area of sexual assault. This involved the collation of

data collected from multiple sources, including the survey of media representatives, the media

analysis (i.e. n=2 sexual assault print media articles and n=2 of the 6 sexual assault public

speaking transcripts provided by EMAP and advocate survey). The approach was based on

Stake (2005) and Yins (2009) approach to case study development.

This methodology enabled a triangulation of all the data collected and allowed the evaluators to draw

conclusions about the impact of EMAP on women and media reporting. The approach integrated data-‐

driven codes (e.g. inductive analysis allowing themes to emerge) with theory-‐driven ones (e.g.

deductive analysis using pre-‐determined indicators). The qualitative analysis, i.e. interviews and

focus groups, was performed in NViVo by grouping the information provided into themes, being

prioritized according to repetition and analyzed as valuable information to be either acknowledged or

addressed; whereas the quantitative data, i.e. from the surveys, were analyzed thematically using

SPSS software. The media analysis of EMAP advocate-‐based articles was analysed against responsible

reporting guidelines within the NViVO platform.


Overview of the Eastern Media Advocacy Project and its beginnings

This section provides an overview of the Eastern Media Advocacy Project and its beginnings. The latter

part of this section will provides a context in which the evaluation came about.

The Eastern Media Advocacy Project (EMAP) is led by Women’s Health East (WHE) in partnership

with the Eastern Centre Against Sexual Assault (ECASA) and the Eastern Domestic Violence Service

(EDVOS).

The project grew out of discussions that occurred at the Preventing Violence Against Women working

group of the Eastern Metropolitan Region (EMR) Regional Family Violence Partnership. Jane Ashton

from Women’s Domestic Violence Crisis Service (WDVCS) was invited to the working group to speak

about WDVCS’s state-‐wide media advocacy project (MAP) which works with women who have

experienced violence in a family violence context. A collaborative decision was made by the working

group to develop the Eastern Media Advocacy Project, modelled on the WDVCS with WHE identified

as the lead for the project. It was also decided to have a separate and specific focus on women who

have experienced sexual assault with support from ECASA. EDVOS offered its support for the family

violence component of the project.

In September 2011, WDVCS supported WHE during EMAP’s inception, including in the delivery of the

initial training, and now these programs support each other with media advocacy opportunities. The

development of the program, in particular the advocate training, was enabled by funding from the

EMR Regional Family Violence Partnership and ECASA. EDVOS and ECASA assisted in the recruitment

and screening of advocates. The delivery of the family violence training was led by WDVCS in

partnership with EDVOS and WHE. The development and delivery of the sexual assault training was

led by ECASA in partnership with WHE.

To guide the project an EMAP Steering Committee was formed with membership reflecting the

different components of the project i.e. ECASA for sexual assault and Eastern Domestic Violence

Service for the family violence component. In its initial stages WDVCS also participated in the steering

committee, and more recently in 2013 the steering committee was expanded to include two media

advocates as a part of its membership.


The project has been implemented in three distinct phases:

Phase 1 -‐ project promotion across the region, alongside recruitment and screening of family violence

and sexual assault survivors from within the EMR;

Phase 2 – training of advocates and EMR workers. Advocate training involved 26 women from across

the Eastern region, aged 20-‐63 across two distinct streams: 1) women who had experienced family

violence and 2) women who had experienced sexual violence (with women identifying the group

which held most resonance with their personal experience). The advocates training was run over 3

days and included background information on violence against women, public speaking and media

skills development. Worker training targeted relevant practitioners from within the Eastern Region

and focused on how to work with journalists when reporting on violence against women.

Phase 3 – advertising advocates, resource development and employment of an EMAP project worker

to manage media (primarily print media) and public speaking event opportunities; and to support

EMAP advocates.

More recently WHE has increased its focus on regional level capacity building providing additional

workforce training on proactive use of the print media for the prevention of violence against women.

In July 2013 WHE went to tender, alongside WDVCS, to commission an independent evaluation

consultant to conduct an impact evaluation in relation to:

Objective 1. Women’s experiences as advocates within EMAP; and

Objective 2. Eastern metropolitan region media reporting of violence against women.

The ensuing report presents the findings of this evaluation process.

Statewide context of Violence Against Women and the Media.

The development of EMAP should be viewed within the context of work being progressed in

addressing violence against women and the media.

In early 2004, The Family Violence in the News Project was established by Child & Family Services

Ballarat and Pact Community Support. Concerned about the portrayal of family violence in the media,

this rural partnership led to the development of three important documents: the Family Violence in

the News: Media Toolkit (Thomas, 2005 Ed 1, Thomas & Owen 2010, Ed 2), and the Family Violence in

the News: Strategic Framework (Owen & Thomas 2007). This work was instrumental in gaining

support and funding for a range of other projects including the EVA Awards and the WVCS MAP


project both of which began in 2008. It also led to a piece of research ‘Family violence reporting:

supporting the vulnerable or re enforcing their vulnerability?’ (Thomas & Green 2009) which

analysed articles about family violence in five Australian newspapers over a 15 week period. Another

influence on the development of media strategies to address violence against women in Victoria has

been, and continues to be, the work of MindFrame at a national level into the media reporting of

mental illness and suicide.

EMAP, situated within a not-‐for-‐profit regional level health promotion agency, developed its strategies

in accordance with the VicHealth primary prevention of violence against women framework and an

ecological understanding of violence against women (VicHealth, 2007; VicHealth, 2011). Their work

has also been informed by a University of Melbourne longitudinal study titled ‘Victorian print media

coverage of violence against media’ (Politoff & Morgan, 2010). This study and associated VicHealth

publications examined coverage of violence against women and trends in the portrayal of violence

against women in news and print media (Politoff & Morgan, 2010; VicHealth, 2011; VicHealth, 2012).

Informed by the findings of these key documents EMAP has developed a suite of regionally

appropriate strategies including sector/worker training and a targeted approach to addressing media

reporting of sexual violence (Flanagan & Imbriano 2012 ; VicHealth, 2011).

WHE is a current member of the Victorian Cross-‐Sector Advisory Committee on Violence Against

Women & the Media. This committee, led by DV Vic, aims to provide a collaborative space to examine

and support the state-‐wide strategic coordination of activities in relation to the prevention of violence

against women and the media.

Achievements and reach of the project to date include: 48 public speaking activities; and 40 media

outputs across print media, television and radio. More recently WHE has increased its focus on

regional level capacity building providing additional workforce training (n = 1 training sessions and n

= 26 participants) on proactive use of the print media for the prevention of violence against women.


Best Practice: What the Literature tells us.

This section summarises the background evidence that has supported the development of EMAP’s project

strategies. It provides an overview of transferable evidence for understanding and framing violence

against women prevention programs, survivor advocacy and media advocacy work from a public

health/primary prevention perspective. It the latter part it also elucidates evidence for good practice in

health promotion, survivor advocate and women’s empowerment programs.

Violence against women prevention programs

Since the release of seminal reports such as VicHealth’s (2004) The Health Costs of Violence and the

WHO (2005) Multi-country Study on Women’s Health and Domestic Violence Against Women there has

been a proliferation of prevention of violence against women (PVAW) programs across Australia.

These reports highlighted the need for multi-‐sectorial approaches to enable interagency prevention

action at global, regional and local levels (WHO 2005 VicHealth 2004). VicHealth (2006), a leading

health promotion organisation in Victoria, called for primary prevention strategies (e.g. strategies to

prevent violence before it occurs) to complement current intervention efforts to support those

affected by violence. VicHealth’s (2006) framework for strategies to prevent VAW and its

consequences has guided the development of programs across Victoria. The framework suggested

three prevention levels:

• Intervention e.g. strategies implemented after violence has occurred, to deal with the violence,

prevent its consequences and ensure it doesn’t happen again.

• Early intervention e.g. strategies targeted towards individuals and groups who exhibit early

signs of violent behaviour or being subject to violence; strategies to change behaviour or

increase the skills of individuals and groups.

• Primary prevention e.g. preventing violence before it occurs by changing environments so they

are safer for women, building the skills and knowledge of individuals or changing behaviour.

Such interventions do not necessarily have a focus on violence but address its underlying

causes e.g. gender inequality.

VicHealth (2006) advises basing the primary prevention approach along similar lines to anti-‐smoking

and speeding campaigns i.e. a whole of community approach (VicHealth, 2006). Within the VicHealth

(2007) prevention framework for action, promoting equal and non-‐violent relationships among

women and men as well as non-‐violent norms is prioritised. Actions at the individual, group,

organisational, community and society level are identified along with priority population groups (e.g.


women, women with disabilities, CALD communities); evidence-‐based strategies (e.g. advocacy,

communication and social marketing) and priority settings (e.g. media and popular culture, health and

cyberspace and new technologies) (VicHealth, 2009).

Role of the media in violence against women

The power of the media cannot be under-‐estimated in influencing community attitudes toward public

health issues including violence against women (Politoff & Morgan, 2010). This is due to the media

continuing to play a significant role in setting and framing the public agenda (Wallack, 1996; Wallack,

Woodruff, Dorfman, Diaz, 1999).

According to VicHealth (2012)

‘media coverage of violence against women offers an important contribution to public

understanding of this social issue. Newspapers are far-reaching and authoritative sources of

information, and a key source of public information. The relationship between media, knowledge,

public opinion and policy is complex, but there is little doubt that media coverage matters’.

Internationally, The Commission on the Status of Women (2004) and UN Division for the

Advancement of Women (2008) has also pointed to the media as the vehicle through which public

attitudes towards VAW could be changed. The Commission (2004) believes this can be done by

disseminating information to the public on women’s rights and the remedies available for violations

of those rights through the media. The use of wide-‐ranging media has proved to be an effective tool

for promoting the type of large-‐scale social changes required.

Numerous studies and literature reviews have been conducted internationally and in Australia that

demonstrate how VAW is represented in the media (Genovesi, Donaldson, Morrison & Olson, 2009;

Politoff & Morgans , 2010). The overarching theme is that when family violence and sexual assault is

reported within the media, its serious nature is often minimised, and this in turn diminishes the status

of women (Politoff & Morgan, 2010; VicHealth 2006; Wallack et al, 1999). According to McManus et al

(2005) in applying a feminist critique, whether intentional or not, family violence was covered ‘less

frequently, representatively and with less depth than other kinds of crime’.

More recently Morgans & Politoff (2012) longitudinal study of Victorian print media coverage of

violence against women found the reporting of VAW by the print media was much less problematic

than that included in previous international studies. However Morgan and Politoff (2012) did identify


several areas still requiring improvement, including: individualising the problem; lack of information

about support services; emphasis on stranger danger; sensationalising and/or making the issue

mundane; the non-‐use of women survivor advocates as commentators on the issue; and lack of

context for sexual violence.

Sexual assault and the media

Sexual assault has been connected to the desensitisation that occurs through the portrayal of violence

in the media and popular culture. Sexual assault is currently understood as an act of violence that

reflects the unequal power between men and women. The literature also emphasises cultural and

social factors that contribute to a society that condones sexual assault and VAW. Several studies have

demonstrated a connection between men’s exposure to extreme violence on film and a decreasing

ability to empathise with real victims and an evaluation of female victims of sexual assault as being

less significant (Miedzian, 1993). Images of masculinity and femininity in the media are also thought

to encourage the association of masculinity with ‘violence, dominance and power’ (The Advocates for

Human Rights, 2010). Theorists have also argued that the media contributes to the perpetuation of

sexual assault through the commodification of women’s bodies. In a western society were, youth, in

particular men, are bombarded by a culture that sexualises commodities and commodifies women’s

bodies, the resulting messages are 1) sex is something to be consumed and men are entitled to it; and

2) sex is something that can brought and sold and therefore taking it by force is theft not a violation

(The Advocates for Human Rights, 2010; Medzian, 1993; Baker, 1997).

In 2008 the UN Division for the Advancement of Women stated

Media representations significantly influence societal perceptions of acceptable behaviour and

attitudes. Training journalists and other media personnel on women’s human rights and route

causes of VAW may influence the way in which the issue is reported and thereby influence societal

attitudes (UN, 2008).

Since then, there have been a number of media advocacy projects designed to achieve this goal. Take

Back the News (2001-‐2009) is one example of a media advocacy project that was implemented to

confront the misrepresentation and under-‐representation of sexual assault in mainstream media. Its

aims were to improve both the quantity and quality of media coverage of sexual assault and to raise

awareness about sexual assault in order to foster greater dialogue and greater public responsibility.

The project provided survivors of sexual assault with an outlet to publish their stories in their own

words. Other core strategies included training local community activists to review and respond to


media representation of sexual assault and distribution of resources to support media advocacy

within print newspaper and related events. (Take Back The News, 2007).

However, the evaluation of such sexual violence media advocacy projects and associated violence

against women primary prevention initiatives is a relatively new science and there is little evidence to

demonstrate effectiveness to support best practice approaches. Across the literature, there is a gap in

the evaluation of community-‐ and societal-‐level strategies to prevent both family and sexual violence

(Casey & Lindhorst, 2009; DeGue et al., 2012; VicHealth, 2007). As such it has been necessary to

transfer knowledge from other public health media advocacy projects to support strategy

development with the EMAP.

Media as a strategy

The media, ‘may not tell people what to think but it certainly tells people what to think about’

(Wallack , Dorfman, Jernigan & Themba, 1993). Agenda setting theory and associated media advocacy

research argue that ‘by reporting on some issues and not others, the mass media influence what

issues people think about and how they think about them’ (Caburnay et al, 2003). In this way the

media influence not just the discussion of an issue but the boundaries and context around the issue as

well (Wallack & Dorfman, 1996, Wallack et al, 1999).

The structure of news stories or news framing, which is the persistent pattern by which the media

organise and presents the news, can be problematic for public health advocacy. News stories are

frequently presented as ‘the event not the underlying condition; the person, not the group; conflict,

not the consensus; the fact that advances the story, not the one that explains it’ (Gitlin 1980 cited in

Dorfman et al, 2005). Various studies suggest that public health issues are rarely portrayed in the

news in ways that encourage audiences to comprehend the underlying causes of problems or their

potential solutions. Health stories, similar to other news, reinforce values of individualism and

personal responsibility that feed dominant socio-‐cultural perspectives (Dorfman et al, 2005;

McLoughlin & Fennel, 2000; Perkis et al, 2006).

Without appropriate framing, the representation of preconditions and determinants of health is

problematic within news coverage. In an analysis of 600 articles from the Dutch press it was found

that: representations of the determinants of health are largely incompatible with etiological

assumptions of health promotion; substantial attention is given to medically related determinants

themes; very few articles contain behaviour as determinants themes; most articles cite one authority


only and there are low rates of non-‐health professionals i.e. such as advocates/survivors; individual

determinants are more frequently reported than social determinants; and vulnerability by social

economic status, race and ethnicity is mentioned in very few articles (Commers et al. 2000).

These issues have encouraged public health and health promotion practitioners to develop strategies

to work more broadly with media to address the systematic and underlying determinants of many

health concerns. Working within a media setting involves intentionally positioning an issue within a

societal context to generate discussion through the mass media. Public health media advocacy is

recognised as an effective strategy to achieve this (Wallack et al, 1993).

Media advocacy within public health – health promotion

Media advocacy represents a fundamental change from traditional public information and social

marketing approaches as it purposefully uses the media as a political tool to target and pressure

policymakers for social change and to mobilize widespread support to reinforce this pressure

(Wallack & Dorfman 1996). In media advocacy, the desired outcome is the ability of community

members to be heard and to exercise influence over the policy environment. This differs from social

marketing where the message is the product and the media is the vehicle to deliver it (Wallack &

Dorfman, 1996). Although contemporary social marketing does engage communities in diverse ways

it still essentially reflects a belief that the key problem is the information gap; if people just had the

right information, then they would behave in a healthy manner. Media advocacy, on the other hand,

defines the basic problem as a power gap. Media advocacy addresses this power gap by working with

groups to develop skills to exert more influence on the process of developing public policies. By

gaining access to the media and framing public health problems from a public policy perspective,

community groups can apply pressure strategically to key decision makers, (Wallack & Dorfman,

1996). ‘It stimulates authentic voices, advocates who can legitimately speak from the perspective of

those most affected by the issue or policy (Wallack & Dorfman, 1996)’. From a health promotion

perspective, media advocacy simultaneously facilitates individual and community level empowerment

through strengthening community action.

As such media advocacy in public health and health promotion practice is characterised by an

emphasis on: linking public health and social problems to inequities; changing public policy rather

than personal behaviour; focus on reaching opinion leaders and policy makers rather than those who

have the problem; working with groups to increase participation and amplify their voices; and

reducing the power gap rather than filling the information gap (Dorfman, 2003).


Much of the documented evidence about public health media advocacy challenges and strategies is

within the literature on health behaviours and/or campaigns against harmful products e.g. tobacco,

alcohol, fast food. In a U.S.A study of 1373 articles that addressed diet, physical activity or tobacco, it

was found that few were prominently located in the paper, and only half had a primary prevention

focus. A large majority had no local angle, local quotes or call to action for individuals or the

community, and only 10% were generated by local reporters (Caburnay et al, 2003). This study found

that in smaller communities, local media subsystems and the local newspaper can be valuable and

influential community resource. This study also highlighted the crucial role of a particular style of

news reporting called ‘civic journalism’ (also known as advocacy journalism)(Caburnay et al, 2003).

This type of journalism is thought to facilitate partnerships between journalists, public health

advocates and the community and in turn motivate the community to engage in solving community

problems (Caburnay et al, 2003).

Impact of Responsible Reporting Guidelines

Suicide reporting is an issue that has relevance to public health media advocacy strategy development

and the reporting of ‘sensitive issues’. In a U.S.A study of violent death reporting within 56

newspapers it was found that newspaper articles are much more likely to report on deaths from

homicide compared to deaths from suicide. The importance of the disproportionate newspaper

reporting is the effect it has on the public perception of community health needs (Genovesi et al

2010). The over-‐reporting of homicide may lead to the public being concerned with crime and assault

rather than being aware of the magnitude of suicide in the community. This study found deaths from

suicide were not reported in a wider public health frame and lacked prevention and referral

information (Genovesi et al 2010). Jamieson et al (2003 cited in Genovesi et al 2010) found in a

similar study that less than 50% of suicides reported in newspapers included any information on the

context or causal factors and less than 10% mentioned mental health issues as a potential contributor.

Beyond resource and time limitations and media culture, other reasons why suicides are thought to be

under-‐reported include: social stigma attached to the victim and their family and/or fear of copycat

behaviour if suicide details are too extensive. This is despite several studies having found a decrease

in suicides when the media followed suicide-‐reporting guidelines (Gould et al, 2009 cited in Genovesi

et al, 2010). Etzersdorfer and Sonneck (1998) compared the number of attempted and completed

suicides in the Vienna underground railway system between 1980-‐1986 and found that completed

and attempted suicides were significantly higher when media coverage was sensational compared to


when responsible reporting was adopted. In a follow up study Niederkrotenthaler and Sonneck

(2007) found the drop in attempted and completed suicides had been sustained since the guidelines

on responsible reporting of suicidal acts were introduced and adhered to.

Alcohol Advertising also has particular salience for public health media advocacy. During the early

1990s the Dangerous Promises campaign, (set up by the Trauma foundation in San Francisco and the

Los Angeles commission on assaults against women), successfully lobbied American alcohol

companies to adopt a code of ethics to curb their sexist, derogatory or commodifying imagery of

women to advertise their products (Woodruff, 1996). Recognizing the challenge was akin to a ‘David

and Goliath battle’ the campaign organisers used media advocacy initiatives as the central component

of the campaign to pressure the alcohol industry into adopting their code of ethics (Woodruff, 1996).

The campaign argued the cumulative effect of sexist alcohol advertisements fostered an environment

in which women are less likely to be taken seriously and alcohol was seen to grant permission to

engage in or condone a range of abusive behaviours towards women. This argument was supported

by 64% of women who reported that their partners were violent when they were drinking alcohol

and at least half of all ‘acquaintance rape’ reportedly involved alcohol.

In summary the key elements that contributed to the success of this campaign and hence can be

considered as transferable evidence include:

1. Start With Community Advocacy. Media advocacy combines the power of the media with the

legitimacy of community advocacy. If an effort is not rooted in the true concerns of the

community, not only will it fail to compel community members, but journalists will also find

the goals and spokespeople less credible. Media advocacy is not a strategy used alone but

rather a tool for advocates who want to magnify their efforts via the power of the media.

2. Focus on Public (not individual) Health. To be successful media advocacy must highlight the

public (aka community) health perspective of news stories. This means emphasizing the

broader social and economic context of problems rather than focusing solely on the individuals

with the problem. Similarly, it means promoting change through shared responsibility and

public policy rather than putting the burden on individuals to change behaviors.

3. Set the Agenda. Numerous studies have illustrated the mass media’s powerful agenda-‐setting

effect, i.e. the more coverage a topic receives, the more likely it is to be a concern of the general

public. To raise a particular issue on the public consciousness, media advocates must focus the

media’s attention on their issue and maintain media interest over time.


4. Gain Access. To get journalists to cover their issues, media advocates observe the conventions

of newsworthiness. A story will be covered only to the extent that journalists perceive it to be

controversial, timely, relevant, in the public’s interest, or in line with one of several other

criteria of ‘newsworthiness’. Gaining access to the media often involves calling journalists’

attention to the aspects of the story that meet these criteria.

5. Reframe the Debate. Once advocates have the media’s attention, their task is to reframe the

dominant view of health problems from one of individual matters to one of public issues.

Role of survivor advocates in media advocacy

The use of survivor advocates, including survivor advocates who have experienced family violence

and/or sexual assault, in the media is an emerging trend. As such there is little documented evidence

that demonstrates the explicit benefits for, and impacts on a) the survivor advocate and b) community

attitudes, of programs that use VAW survivor advocate-‐based approach to media advocacy. Indeed,

there is a dearth of peer-‐reviewed evidence to demonstrate the health impacts for survivor advocates

of participating in media advocacy. That said the use of survivor advocates as a vehicle for promoting

primary prevention messages within public health and health promotion practice is well established.

Survivor advocates have been used as ‘an authentic source of messages’ and to support attitudinal and

behaviour change in the areas of injury prevention (e.g. road traffic injuries), cancer early detection

and prevention (e.g. breastcancer) alcohol, and gambling campaigns (e.g. the Victorian Responsible

Gambling Foundations 2013, 100 days Challenge).

McLoughlin & Fennell (2000), demonstrate how survivorship was used constructively through the

mobilization of their advocacy to influence change at policy and regulatory levels. After living through

the experience of being locked in a car boot survivor Janette Fennelle, successfully worked with

prevention experts to change government policy in relation to car manufacturing. Fennell’s advocacy

work led to the mandating of trunk releases mechanisms in all new cars as well as retrofitting older

cars. Key to the success of the Fennell advocacy campaign were:

1. Problem definition: The TRUNC program used the Fennell experience as the ‘hook’ to generate

coverage of the issue.

2. Becoming an expert: In the absence of readily available data and information Fennell became

the expert on the issue and was therefore able to steer discussion towards the issue and away

from her personal experience.

3. Selecting an appropriate intervention: Working with prevention experts, a simple inexpensive

remedy to the issue was developed. Their focused approach further enabled them to link the


events with the solution and reorient the media attention to the solution (i.e. the trunk release

mechanism) rather than her personal story.

4. Targeted and controlled media exposure: By managing their media exposure they were able to

control their message and capitalise on the scale of the mass media they worked with.

In this way Fennell was able to reframe her personal story from one of ‘freak horror story’ to a

prevention message that could not be ignored by car manufacturers, policy makers and importantly

the community.

Cancer survivor advocacy

Prior to1980 breast cancer was poorly understood and rarely discussed. This began to change when

women with international profiles (e.g. Betty Ford and Nancy Reagan), began speaking publicly about

the personal impact of the disease (Braun, 2003). Their stories and the attention they were able to

attract achieved two things:

• Increased awareness of breast cancer and made it more acceptable to talk about it publicly;

and

• The instigation of a movement that has achieved greater awareness, discussion, debate,

research, and changes in clinical practice that have significantly improved health outcomes for

women with breast cancer.

During the 1980s cancer peer support programs lead to an advocacy movement that has had positive

impacts for the health and well being of cancer survivors as well as improved, awareness,

understanding, clinical research and public policy about cancer. Clark and Stovall (1996) argue that

successful survivorship that has focused on building skills and competencies has lead to self-‐advocacy.

Key competencies that enable this include, information seeking skills, communication skills, problem

solving skills and negotiation skills. These then become a suite of competencies that enable cancer

survivors to advocate for themselves as well as for others. In this context Clark and Stovall (1996),

see advocacy as a continuum that begins at a personal level but has the potential to broaden to group,

community and public policy advocacy efforts.

Braun (2003) argues survivor advocates (celebrity and non-‐celebrity) have been central to the

success and proliferation of breast cancer advocacy programs. Breast cancer survivor advocates have

been utilized in:


1. Priming the market: Survivors that have shared their stories have created the foundations for

public discussion of breast cancer.

2. Engaging consumers: Survivors have been included in public education programs, e.g. to

elucidate early signs, promote mammography and encourage women to engage in self-‐

examinations.

3. Establishing political advocacy: Survivors took their stories and key messages to businesses,

government and scientific communities to engage them in their cause.

4. Mainstreaming advocacy: Survivors established a strong enough base for ongoing efforts

(nationally and internationally) in the future. The importance of survivors in this last step has

seen significant changes in community understanding, awareness of, treatment, and early

intervention of breast cancer.

Along the continuum of advocacy the needs of survivor advocates evolve from support to enable their

own survivorship through to support to enable their role as an advocate (Clark and Stovall, 1996). The

further a survivor advocate moves along the continuum the more diverse the advocacy community

become. In this context an advocacy community includes survivors and people with technical

advocacy skills i.e. researchers and health professionals working together. The impact of these ‘joined

up’ advocacy efforts have been demonstrated in the breast cancer movement i.e. where the impact of

advocacy efforts have been multiplied (Clarke and Stovall, 1996). The breast cancer example

highlights that when survivors are adequately supported and empowered in their advocacy roles, they

are able to maximise the ‘power of their personal stories’ to engage the public with health and social

justice issues (Leigh, 1994).

The stark contrasts in knowledge, awareness and understanding of other cancers highlights the

potential power of effective media advocacy along with the narrow cast approach of the media. That

the success of the breast cancer advocacy movement has not been translated across the spectrum of

cancers (Kromm, Smith & Singer, 2007, McKensie, Chapman, Geechan and Holding, 2010)

demonstrates the impact of the ‘silo’ approach to issues taken by the media. Kromm, Smith & Singer

(2007), conducted a thematic content analysis of print news articles of ‘non-‐celebrity’ cancer

survivors in 15 leading national daily newspapers in North America and found that overall news

coverage involving survivors of breast and prostate cancers (the two cancers with the most

established advocacy communities behind them) received the greatest attention. Similarly in

Australia, McKensie et al (2010) found breast cancer received 13 times the number of media reports

compared to colorectal cancer. DoHA (2010) has noted the importance of mass media coverage,

particularly those that involve a celebrity survivor in increasing public awareness of certain cancers.


This demonstrates not just the impact of survivor voices but also the necessity of them to help

facilitate media coverage (Kromm, Smith & Singer, 2007). This is exemplified by the lack of attention

given to bowel cancer that has struggled to attract celebrity and or survivor advocates to work with

the media (McKensie, et al, 2010). A negative consequence of this has been that the public perception

is that colon cancer is more rare than breast or prostrates cancer (DoHA, 2010).

McKensie et al (2010) argue the significant difference in media attention between different cancer

advocacy programs can be attributed to the celebrity ‘hook’ or celebrity survivor that is able to attract

media attention. This literature highlights both the barriers and enablers of survivor advocacy in the

media as well as demonstrating the powerful role the media has in influencing public knowledge and

concerns.

In summary, the key transferable messages gleaned about media advocacy and survivor advocates

within the public health literature relevant to the current project strategies are summarised below:

• The purpose of media advocacy needs to be clearly articulated and understood;

• Each media engagement needs to have a clear goal and plan for how to achieve the goal;

• Each media opportunity needs to be considered for the opportunities it presents including the

scope of the publication/ broadcast, potential audience, syndication and online availability (ie

online versions, and incorporation into social media);

• Key messages need to be clear and readily able to be incorporated into interviews and other

media engagements;

• Survivors need to have a clear understanding of and ability to articulate their messages to

media;

• Media opportunities need to be considered in terms of their reach and impact; and individuals

within the media need to be assertively encouraged (by establish direct and indirect

relationships) to take interest in and support the issues being discussed.

• Media advocacy needs to be ongoing and always looking for new opportunities.

Evidence for best practice in survivor advocate empowerment

Empowerment is a health concept that is central to public health – health promotion practice and

consequently women’s health programs. Empowerment is conceptualised as both a process (i.e. set of

strategies) and outcome (i.e. improvement in health status) within health promotion programs.

Empowerment strategies within health promotion programs are directed at the individual,

organisational and community level and include the practices of enabling, mediating and advocating.


At the level of individuals, empowerment draws upon psychological theories including locus of

control theory and concepts of self-‐efficacy derived from social learning theory (Keleher 2007).

Empowering health teaching practice in health promotion work is characterised by empowering

behaviours i.e. validating, affirming, linking self to others, solution seeking and empowering attitudes

i.e. non-‐judgemental, empathetic, belief in a person’s abilities (Keleher 2007). Empowerment

interventions that include group dialogue, collective action, advocacy, leadership training and transfer

of power to participants are thought to be the most effective in improving individual and community

health status, addressing the determinants of health and reducing health disparities within the

broader community (Keleher 2007).

Given the centrality of empowerment in health promotion and women’s health work the following

section will highlight transferable evidence that supports the design of EMAP strategies.

The literature on women, advocacy and empowerment highlight practice strategies that enable

survivors of violence to benefit from and participate in social change initiatives. Parsons (2001) study

of domestic violence and advocacy groups highlighted the importance of the environment or ‘context’

for the development of advocacy competence. This study highlighted the importance of: a safe

environment in which women could join with others who share common experiences that may have

been devaluing and demoralising; facilitating opportunities for interaction and for sharing common

experiences e.g. where comfort can be gained from knowing one is not alone in the experience; the

presence of support e.g. being nurtured, trusted, encouraged, and challenged; the experience of feeling

accepted e.g. understood and not being judged and able to ‘come out’; being validated in their

experience e.g. confirmed, being heard and learning they were not crazy; and the presence of

interdependence and assuming responsibility for the wellbeing of each other e.g. collective support

and mutual aid (Parsons 2001).

According to Parsons (2001) these conditions allow women’s acceptance of themselves and

encourage them to be less blaming of and to believe in themselves. Parsons (2001) study also

demonstrated the practice strategies or interventions that helped women to develop competence and

change. They included: the opportunity to have a voice; receiving support; learning about social

problems; having an advocate and being an advocate; having helping professionals and peers who

believe in them; having to make own decisions and take risks; being confronted and challenged;

having and being a role model; and trying out new behaviours and skills (Parsons 2001). ‘The

opportunity to work and learn in mutual relationships with others was essential for participants. It


gave them the courage and skills to act collectively for social change and justice, not just for

themselves but for the good of others’ (Parson 2001).

Similarly, Brown and Ziefert (1988) development model for primary prevention demonstrates that

sexual assault survivors can use the knowledge and awareness gained from crisis intervention and

self-‐help as a platform for growth in social competence and empowerment. They highlight the

significance of group membership in facilitating movement from the more reflective stages of

personal healing to the more active stages of competence and empowerment. This competence has to

do with the skills of the individual and the opportunity to structure their environment. In facilitating

women’s development, change efforts need to target the individual e.g. modifying belief systems,

removing emotional blocks and learning new skills. These skills are also identified by Clarke and

Stovall (1996) in the breast cancer literature as critical elements of survivorship. Environmental

change efforts need to ensure increased support, increased access to valued social roles and the

creation of new social roles. The final stage in the journey is empowerment where individual and

collective action by women on behalf of women to confront institutional victimisation of women

occurs. Empowerment is the stage where women begin to confront the environmental sources of

stress with the goal of social change. ‘It can only be accomplished through joining together with others

with common concerns and needs. Without the skills learned in dealing with private issues and the

unity and strength developed in the group context, empowerment is difficult’ (Brown and Ziefert

1988). Brown and Ziefert (1988) found that the crucial variable which allows group members to use

their new competence in their personal lives and to empower themselves to act for change is an

enabler or group facilitator.

From a health promotion perspective, these studies demonstrate psycho-‐social health benefits and

the empowerment of women through core strategies of personal skill development and strengthening

community action. They demonstrated the utility of appropriate ‘empowerment strategies’ and the

potential for an ‘outcome of empowerment’ for individual women and groups of women involved as

survivors in PVAW/VAW advocacy projects.

The above review of literature and transferable evidence provides a context for the EMAP project and

the strategies they have engaged. In ensuing sections of this report, the literature is used to support

the analysis of key findings and the development of recommendations.


Evaluation Findings

This section is structured under subheadings that correspond with the 5 evaluation questions. It tells the

story of key impacts and processes and contains narratives, quotes and qualitative analysis. Each section

draws on a raft of the data that was collected (e.g. surveys, interviews etc). At the end of each major

section the findings are briefly discussed in relation to the literature along with key recommendation. A

two page ‘indicative’ case study that illuminates key project impacts and processes is embedded at the

end of this section.

Survivor Advocates

Three overarching evaluation questions informed the assessment of impact of the EMAP for women

participating as survivor advocates (including any benefits and challenges). In the following section

the key findings for each question are presented.

Evaluation Question 1 – EMAP Enabling Advocacy

Evaluation question 1 was: To what extent has the EMAP enabled advocates (Group 1 – family violence)

and (Group 2- sexual assault) to undertake public speaking and work with the media?

This question was answered through advocate surveys, interviews, a focus group and a review of

training evaluations. Whilst there were some pre-‐determined evaluation indicators (e.g. perceived

confidence in media engagement) the approach prioritised ‘lived experience’. As such, the key findings

are presented as a narrative and describe the nature of as well as context for advocate media

experiences.

The survey, interviews and focus group confirmed that EMAP had enabled advocates to undertake

public speaking and work with the media. These media experiences where primarily print media and

public speaking engagements but also spanned radio, television and social media. According to the

survey (Q19), four respondents had done between 2-‐5 media activities, one respondent 2-‐5 times, one

more than 10 times. However, three of the nine survey respondents had not undertaken any media

advocacy citing reasons of illness, travel and court proceedings. This statement by advocate 3

highlights the reason why media advocacy work is not always appropriate or timely


I haven’t participated in any media interviews or anything because I’m in the middle of court

proceedings and he’s threatening defamation of character.

The survey (Q22) indicated the tendency for either ‘positive’ or ‘extremely positive experience’ with

both media and public speaking events. For example, advocate 2 in speaking about her experience

with a major newspaper found them to be

..helpful and sympathetic and just really nice. So I’ve had absolutely no problem at all.

Advocate 6 in speaking of her experience of a local newspaper

found it quite good…it was a man that was interviewing and he was very sensitive.

Advocate 4 in speaking about her experience of a public speaking event experience stated

sometimes are a bit harder than others but any time I’ve done one I’ve felt very prepared, felt well

supported by staff of WHE. And always felt really welcomed by the event and by the people at events

I’ve gone to. So it’s always just been incredibly positive.. for days I’m thinking wow, that was fabulous

and how amazing that I could get up in front of people and share and make a difference in some

way.

Perceived confidence in media and public speaking activities was another key theme confirmed within

the survey (Q16,17,18) and interviews. The advocates perceived degree of confidence with ability to

tell their story to journalist and/or public speaking event was confirmed in the survey (Q16) with the

average confidence for both being ‘quite confident’. In reporting on her feelings of confidence

advocate 2 stated

I got a heap of help from WHE, to talk about my key messages, they didn’t tell me what I could

say, because I got so much briefing from the course.. so I just felt really confident going into the

interview room.

The following statements demonstrate advocate confidence in media and public speaking activities

highlighting where they attribute their confidence emanating from:

Support and encouragement from the project co-ordinator (advocate 1)

Every opportunity I’ve had I’ve felt very supported by the program and by WHE so it’s been a very

positive experience for me (advocate 2)

I felt confident to manage the media because of the training (survey respondent)


The project co-‐ordinators pre-‐briefing

input to my speech, help me shaping it.. resulted in me feeling very confident when I got up to

speak, that what I am about to say I can have confidence in (advocate 4)

The wider women’s health network has done really well in helping the media understand that

they’ve got to be sensitive with women and not ask them damning question (advocate 4)

Several of the advocates explained that this was contrary to their expectations

I just sort of imagined that they’d be going why did you stay, and blaming me. It was nothing like

that at all (advocate 2)

The above statement also gives voice to another theme emerging from both the survey and interviews

around sensitive and accurate reporting.

I was so impressed with the way that they [media] deal with this arena… Her experience was

that they always give you a draft and an opportunity to reword or withdraw content. She rewrote

it and sent it back to him.. and he said “no problem”. They don’t quibble, they don’t argue, they

don’t test you or make you feel guilty, they just take it out and I am so incredibly please with that.

I haven’t had anything that I’ve thought “Damn it, I’ll never do this again because they didn’t

listen to me” I’ve always had a really positive experience. (advocate 5)

This experience may in part explain why in the survey (Q18) that the advocates felt ‘somewhat’,

‘quite’ or ‘extremely confident’ in their ability to motivate journalists to promote accurate and

sensitive reporting.

Despite ‘no negative impacts on confidence’ being reported in the survey, the interviews revealed

several challenges or discomforts associated with media experiences. Advocate 1 found

..after you give the speech, somehow psychologically we are not that well.. that

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