Paul - I agree with all of your comments.  I, too, have been misled by 
focus groups for the reasons you mentioned.  The real test of pictures 
should be by having people use them.  Pilot testing is more reliable than 
focus groups.

There is another issue we need to keep in mind - the image that the 
organization producing the education materials wants to project about 
itself - and this was mentioned by Ceci and Len Doak as well in talking 
about supervisors.  While stick figures would have worked as well in the 
Eldercare materials, the American Geriatrics Society wanted something that 
looked more "professional."  So we ended up with simple line drawings that 
looked like real people.  To address the problem of ethnicity and gender, 
we consciously included an equal number of Latino, African American, and 
Caucasian figures in each chapter.  So far I have not heard any complaints 
about ethnicity in those materials.

I think that Paul's point about using Caucasian figures in Tanzania because 
they did the job and were available is important.  The average person who 
is seeking help will usually overlook "politically correct" issues because 
the materials give the information he or she needs.

I want to thank Sunil for sharing his article.  I will read it with great 
interest and share my thoughts - hopefully tomorrow.  I wish that we could 
have sent our review article to the list surv as a pdf file - but I don't 
have it in that format.  I sent an email to the journal's editor asking if 
he can get me a pdf copy.  If he does, I will send it out on the list surv 
as well.

One additional thought I want to share is about using photographs.  I have 
seen some excellent photo novelas that tell a story about changing health 
behaviors (such as encouraging Latino women to have mammograms).  When they 
include pictures of people like those in the intended audience, then 
viewers can identify with the characters in the story which should help 
make the message stronger.  The photo novelas that I saw also used text - 
largely in the form of speaking balloons - to insure that the viewer 
understands the intended message.  My hunch is that photo novelas can be 
very effective.  However, when writing our review article, I could not find 
tightly controlled experimental/control studies that proved this.  Some 
rigorous research on photo novelas would be an important contribution to 
our field.

We considered using photographs in the Eldercare materials and rejected 
them for several reasons.  First is the problem of representing different 
types of people.  Photographs are so detailed that they give viewers many 
reasons for saying "they're not like me."  Second, as I mentioned in the 
slide talk and was mentioned by Ceci and Len as well - people with poor 
reading skills are especially likely to attend to irrelevant details and 
photographs are loaded with detail.  While photographs are very good at 
gaining attention and for generating emotional responses, but they are less 
good at controlling how viewers interpret the message.  Simple line 
drawings combined with simple text are the best way to insure that the 
audience is interpreting the picture the way we intend.   Marcia Trenter 
made an important point in her earlier message - about how pictures, by 
themselves without accompanying text, can lead to many and often unintended 
interpretations. I'm attaching a cartoon from the New Yorker that makes 
that point too.

Peter
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