Tele-health / by Robert Perreault & Marie-Claire Laurendeau

A dolescents and young adults take more risks than their elders . This tendency, which often has serious conse- quences for their health , is influenced as much by person- ality as by behaviour and environment. Yet too many pro- grammes for the young continue to ignore this fact, treating it as an entirely separate phenomenon unrelated to the life and devel- opment of young people . Pro- grammes tend to do little more than refine strategies based on media campaigns of limited range ; the questions on which they focus are not necessarily seen by young people as ''legiti- mate'' concerns, and the approach to problems is some- times seen as pointing an accus- ing finger . Consequently, they do not win the confidence of young people, much less their partici- pation. For this reason, since 1980, we have set up , in the context of our Tele-Health project in Montreal , Canada, several computer pro- grammes aimed at the general public. The programmes for adoles- cents and young adults emphasise above all the value of the young themselves. Rather than seeking at any price to eliminate undesir- able behaviour, they appeal to young people 's capacity to learn from their experience and that of others, and encourage their par- ticipation in finding their own solutions. These programmes show great respect for the forma- tive value of risk-taking, and ulti- mately have recourse more to the psychology of the adolescent than to improving behaviour . This individualised communication is of particular interest to young people because, unlike the mass media, which offer a single mes- sage to a large number of people, the computer approach makes it possible to offer as many mes- sages as there are interlocutors, resulting in inter-personal communication at reduced cost and without the anxiety aroused by tackling intimate questions with strangers. The young can finally come to grips with a deli- cate subject without feeling that they are being judged - and they do so in a very personalised fashion. The two programmes pre- sented below are not aimed solely at the young, but also at their mentors - the adults - who Tele- Health by Robert Perreault & Marie-Ciaire Laurendeau Dr Perreault, a psychiatrist, leads research on the application of high communication technology to health development Ms laurendeau, a psychologist, specialises in mental health promotion. They both work in Montreal, Canada. live with them on a daily basis . Based on a model inspired by social ecology, the programmes invite all the protagonists from a given environment to play a com- plementary role in the exercise. The open bar Intended for young people aged 16 to 24 , the Open Bar programme seeks to sensitise them to the need to behave responsibly in drinking alcohol. Its central element is interaction through the use of computer software which simulates an exchange between the user and an electronic ' 'barman'' . It can be used for about one week on an annual or semi-annual basis in the school or work environment and in certain public places . Pre- sented in a mobile kiosk, the software (focal point of the pro- gramme) can be surrounded by various types of animation devices - simulation of a fashion- able bar, background posters, a counter displaying brochures and/or video programmes. The Open Bar does not put emphasis on the acquisition of knowledge but rather offers a personalised exchange about various psycho- logical , cultural and social factors which influence our drinking habits. The programme tries to guide the individual towards a personal solution to the manage- ment of alcohol consumption in different social situations , and in this way the individual approach to the problem links up with collective consciousness-raising . J ean-Paul , the electronic barman, greets the young person in his "bar". He asks him (or her) questions relating to alcohol con- sumption habits, family history and personal life. He talks about himself and confides a ' little about his own experiences, both happy and unhappy, with alcohol. At the end of this exchange, the computer prints out a sheet of personalised recommendations , the text of which is built up from the profile provided to the machine through the user 's choice of responses. Thanks to the numerous pre- tests carried out among young people, it has been possible to minimise the moralising aspect of such messages and the young accept them willingly. More than 250 different messages can be generated in this way. The programme has been the subject of numerous studies. Its capacity to collect data - and already 4,000 respondents have used it - compares favourably with other research methods. It is currently being used in three Canadian provinces. An Open Bar programme was launched in October 1988 in Switzerland under the auspices of a French- speaking study group on alcohol and drug addiction. French, Ger- man and English versions are already in circulation. In each case, a cultural and linguistic vali- dation has been successfully carried out, showing the con- siderable transcultural potential of this type of programme. Clip and You Clip and You is an enterprise to promote mutual aid and the man- agement of stress among 70,000 college-level students in the metropolitan region of Montreal , Canada. Based on a participation and adaptation model, the central tool of the project is a compe- tition to write thematic videoclip scenanos. It has the following objectives: to show through the production of four videoclips how young people express their own solu- tions to social isolation, and to events in their lives which cause them to suffer stress; to enable educators to use initiative when faced with dealing with stress management and engendering mutual support ; to provide educa- tors with a stimulating tool in their promotional work at the local level; and to favour the emer- WORLD HEALTH 3/89 gence of new mutual aid projects among the young. Clip and You is divided into two major phases. The first is structured around a scenario- writing competition. Complete information and promotiona l material about the competition was made available to young people and distributed by the educators of each participating college with the support of our team. The production of this material, both written and graphic, went through a formative evaluation process in order to ensure that it was both attractive and comprehensible . During the six weeks' duration of the competition, the' control team encouraged the educators from the 22 participating institu- tions to organise at least one promotion week per different group (39 such weeks were arranged). To this end, we pro- vided everyone with additional material, lists of resources and, absolutely essential , a high level of media visibility for the project. This publicity helped to make the exercise particularly attractive and ensured that association with it was a desirable thing. At the end of the competition, four winning scenarios were selected by a prestigious jury, the winners receiving a cash prize and enjoying the privilege of partici- pating in the filming of their clip by professionals. As in the case of Open Bar, the local success of Clip and You was due to a considerable extent to its popular appeal. It gives young people a real voice, enabling them to express their view of WORLD HEALTH 3/89 things in public. In order to arrive at this point , we decided from the outset to put our videoclips on the market in the same way as other productions of this type. So we asked four celebrities to let the project use materials that they were on the point of recording. These materials were selected for their compatibility with the two project themes. We expected in this way to profit from the pub- licity surrounding the issue of the recordings . Taking advantage of the fame of these people, we set up a series of media events and invited rep- resentatives of the cultural and social press. Their joint presence in itself constituted a premiere and gave the project still greater visibility. The events covered were the launching of the project, the announcement of the winners, the filming of the videoclips and the gala premiere at which they were screened. The team made a special effort to talk about the project and its themes on all the radio and tele- vision broadcasts that are popular with young people, as well as on several programmes aimed at adults. Because of the innovative nature of the project , and also because of its entertainment value, it proved possible for us to negotiate a screening on a chan- nel specialising in showing video- clips and widely watched by the young. Now that we have four video- clips available, two about mutual support and two dealing with stress management, we have created an animation kit which we are placing at the disposal of "Isolation is a factor of stress". A script-writing competition challenges young people to produce video-clips on stress management. Photo WHO/J-P. Daulte anyone interested in the mental health of young people aged between 12 and 20. Apart from the clips, the kit includes an animation guide and a poster, large numbers of which have been published and which can be given or sold in aid of a local cause. The kit was prepared with a view to helping any animator who has had minimal training in health questions to make effective use of it. Sophisticated communication technologies, which permit active participation by the user, have the advantage of making possible programmes that are subjective and cultural rather than simply informative . Through the mass media they can reach a wide public. This wider approach therefore reflects the findings of scientific literature about health promotion, namely that to inform is not enough. If success is to be achieved, the next step is to reduce any obstacles to the use of the information and to influence major variables in the emotional held. Having access to the computer, for example, leaves young people in complete control of the learning situation, and that is an essential factor in the process of achieving autonomy. If we want to help them to become responsible for their behaviour, we must state this intention clearly from the outset. Our methods need to con- vey a sense of deep respect for the life experiences of individ- uals, and to encourage them to find out for themselves how best they can improve their own health. Let me emphasise that this aspect is not just something that has emerged from technological progress, but is simply a matter of having respect for other human beings . •