14.

I. TO WHAT EXTENT HAD PEOPLE SEEN THREE V.D. POSTERS ?

All informants were shown coloured reproductions of these three V.D. posters, and were asked if they had noticed any of then displayed anywhere.

The following table shows the results of this question.

Thus 12, of the whole sample said they had seen The Bride, and 10% had seen Tomorrow’s Citizen. Only 1% said they had seen Easy Girl-Friend.

It should be noted that at the time of interviewing the display of these posters had only recently commenced. Some 45,000 Crown Folio copies (15” x 10”) of The Bride and some 50,000 Crown Folio copies of Tomorrow’ s Citizen had been distributed to local authorities for general display in public lavatories and elsewhere. 5,000 Double Royals (40” x 25”) of each of these posters had been distributed for display in the L.F.T.B. underground stations. The distribution of Easy Girl-Friend posters had been restricted to certain port areas, and to some 500 copies.

Analysis by region shows that the proportion who had seen the Bride poster was very much higher in London than in any other region, and higher in Northern England than in the two other regions. There are similar regional differences in the figures for Tomorrow’s Citizen, but they are not so sharp. Not more than 1% in any of the four regions had seen the Easy Girl-Friend poster.

Analyses by Education, Income and Marital status showed no differences in the proportions who had noticed these posters. However, more men than women had noticed the Bribe poster, and this difference is most marked in the 41-50 age group.

15. 16.

II. OPINIONS AND CRITICISMS ABOUT INDIVIDUAL POSTERS

While they locked at the coloured reproductions of the three posters informants were asked what they thought about each one in turn, and their comments were recorded.

The purpose of collecting the opinions of a sample about these particular posters was to estimate what effect the posters might have on the general public when they were widely displayed. It should be pointed out, however, that people may react differently to posters presented for inspection during the course of an interview from the way they would react to such posters if they noticed them displayed on a hoarding or in a railway station.

The fact that the reproductions were smaller than the actual posters (they measured 9” x 13”), and that they were observed at closer range than usual, may have influenced to some extent the reactions they produced in the people who were asked to comment on them. There is also the possibility that during an interview when posters are shown for individual inspection and comment, informants may tend to show stronger reactions than they would in a more generalised situation, and may be more favourable in their judgments (though, as will be seen below, quite a fair proportion of’ people did make adverse criticisms).

The advantage of collecting opinions about posters displayed in this way is that the conditions of attention are more or less stabilised, sc that comparison of the effects of the three posters concerned can be made.

Each informant’s comments were summed up under one of the following heading:

Taking all the favourable opinions together it will be seen that Tomorrow’s Citizen - received the highest proportion of favourable comment (70% ), The Bride came next (67 favourable comments) , and 59% of the sample made favourable comments about the Easy Girl-friend poster.

There was a very great variety of comments made on the posters, expressing all degrees of liking and disliking. The only practicable way of dealing with the replies was to group them into broad categories, as shown in the table above.

It is necessary, however, to describe in more detail the various types of comment which were included in the categories.

FAVOURABLE COMMENTS ON POSTERS

“Very striking, effective, attracts attention “

In this category are gathered together all those favourable comments which particularly mention that the pesters are striking and likely to catch one’s eye, e.g. “slap you in the eye”, ‘‘bound to attract attention”, “arresting” and so forth.

“Very good, good, grand: alright, fair, quite good” - plus approving comments .

It was not possible to distinguish the different degrees of approval expressed by such terms as “good”, “alright”, “quite good”, etc. Consequently all comments of this type have been classed in the same category.

The approving comments fall into three or four main groups in relation to each of the three posters, and are summarised below.

The Bride

Tomorrow’s Citizen

Easy Girl-friend

Special Appeal

Small proportions of the sample (shown in the table above) said they thought that the posters under consideration would have a special appeal to certain kinds of people.

The Bride would appeal to the young, to girls and men and engaged couples.

Tomorrow’s Citizen would make a special appeal to parents and women, because of the child.

Easy Girl-friend would, it was thought, carry a special message to “those girls”.

UNFAVOURABLE COMMENTS AND CRITICISMS ON POSTERS

A summary is given below of the unfavourable comments and criticisms on each of the three V.D. posters. This includes critical comments made by (i) the people who qualified their general approval of the posters (3-4, of the sample) and (ii) those who expressed unqualified disapproval of the posters (5-16 of the sample),

The main criticisms of each of the three posters are shown separately.

The Bride

15% of the sample made critical comments about the poster, About a quarter were to the effect that the poster was not striking enough, or that the colours did not show up.

A slightly smaller number said the opposite - that the poster was too forceful outspoken, frightening or crude: some of these people thought the poster should not be shown in public at all, while others expressed such opinions as “it’s horrible, but a good warning”.

Further criticisms made by small groups of informants were that:-

A small number of critics doubted. if the message of the poster would reach the people concerned, or commented that the poster would have a limited appeal.

Tomorrow's Citizen

Over one third of the people who made criticisms of this poster (8% of the sample) considered that the picture itself was not forceful or striking enough, that the figure of the boy was too insignificant, or that the colour-scheme and general lay-out would not catch the eye.

Others complained that the poster did “not tell you anything”, or that the picture was confusing - did not make its message clear.

Quite a number of people suggested that the results of V.D. should be emphasised or shown in the picture.

Easy Girl-friend

About a fifth of the criticisms made of this poster (20% of the sample made criticisms) were to the effect that the picture is not striking enough, that the poster is too small, or that the skull would be more effective if it were white instead of a dark colour.

Roughly the same proportion criticised the poster on the grounds that it was too gruesome, blatant or crude. Some of these people considered that though the poster wad terrifying it should nevertheless be shown, e.g. “Terrible, but I 17. suppose it is necessary”. Others disapproved of displaying such a poster at all, e.g. “Disgusting, I call it: whoever thought of putting things like that up?”

A small number of the critics complained that the poster was unfair because it put the blame for the spread of V.D. on the girls. Several people asked “what about the Easy Boy-friend?”

Others thought that the poster would be of greater value if it gave more information about the results of V.D., and details of how treatment could be obtained.

Some informants felt that the nessage of the poster would not reach the right section of the community, while others considered that display of the poster should not be general, but should be limited to certain localities, for example ports and camps.

18. 19.

III. WHICH OF THE THREE V.D. POSTERS WAS CONSIDERED MOST STRIKING. AND WHY? ”

poster considered most striking

With the three posters in front of them for comparison, people were then asked which they thought “the most striking as a poster”.

Field workers reported that there was some variation in the interpretation of “most striking”, some people tending to name the poster which they preferred rather than the one which caused the greatest initial effect. For instance in many cases people named The Bride or Tomorrow’s Citizen as the “most striking” although, as field workers pointed cut, their immediate reaction by gesture or exclamation was greatest when they saw the Easy Girl-friend.

The general analysis of replies and a breakdown by age is given below.

By Age Group

“The Bride” was considered most striking by lower proportions of people than the other two. Young people between 16 and 20 chose “Tomorrow’s Citizen” slightly less frequently than people in the older age groups. “The Easy Girl-friend” was chosen more frequently by people up to the age of 40 than by those over 50 years of age.

The Bride was chosen by a greater proportion of people in the lower education group than in the higher group: 21% as against 15% in the higher group.

Analyses by income group, sex and marital status show no significant differences.

Reasons for choice of posters

All those who decided which poster they considered to be the most striking, were asked to give reasons for their choice.

A very great variety of reasons was presented. However, these fall into three general categories relating to

Informants’ replies to the questions were summarised under the headings shown below:

Considering each of these three posters objectively, it may be said that the “Tomorrow’s citizen” poster has been purposely designed to appeal to people’s sense of responsibility for the young and innocent, and that the poster carries a definite message urging all grown-ups to make sure that they do not risk endangering the lives or health of young people, by themselves being carriers of such dangerous disease as V.D. This poster therefore carried a positive message.

“The Bride”, though it carries a rather similar message, was presumably designed to appeal mostly to men. Thus it directly concerns a narrower section of the public, and at the same time the wording on the poster implies a reproach to those with V.D. and is not so constructively suggestive.

“The Easy Girl-Friend” directly concerns only a relatively small section of the community; but this poster perhaps gains by its unusual presentation, and certainly by the warning details it gives of the possible results of V.D.

More than half of those who chose “The Easy Girl Friend” and “The Bride”, and as many as 89, of those who chose “Tomorrow’s Citizen”, noted the appeal to people’s feelings of decency and responsibility for others.

A third of those who chose ‘‘The Easy Girl - Friend” chose it for its pictorial qualities. This reason was least important in the case of “Tomorrow’s Citizen”.

People who considered the “Easy Girl - Friend” and “The Bride” most striking more frequently did so because “Subject matter good: Explains well: results, causes and dangers emphasised”.

These results support the conclusions of those who have made studies of the psychological aspects of advertising. Namely that the main factor in successfully impressing a message on people’s minds is the choice of a central idea or theme which coincides with the interests, wants, habits or feelings of the majority of people: furthermore, that positive rather than negative suggestions are more likely to produce the desired results.

Henry C. Link (Journal of Applied Psychology, 1943.) showed, from experimental tests on this subject, that compared with the selection of a central theme of interest such factors as size, repetition, position, use of colour or black and white in advertisements were relatively unimportant.

The main differences shown by analyses of these results were that married people chose ‘‘Tomorrow’s Citizen” for the appeal of the child rather more frequently than did single people. (53% as against 40%).

Those in the higher education and income groups commented more frequently than others on the striking pictorial qualities of “The Easy Girl - Friend”.

20. 21.

IV. TO WHAT EXTENT HAD PEOPLE SEEN V.D. “CONFIDENTIAL TREATMENT” POSTERS, AND WHERE HAD THEY BEEN SEEN

To what extent had Confidential Treatment posters been seen?

Everyone interviewed was shown a copy of a “Confidential Treatment” poster. These posters were designed so that a space left in the centre of the poster could be filled in with details of the whereabouts and times of attendance at local V.D. Clinics. They were widely displayed on hoardings, in public buildings and stations, etc., and not confined to display in public lavatories as had been the case with previous placards which gave the addresses of places where confidential advice could be sought on V.D.

Informants were asked “Have you seen a V.D. poster in your own district or place of work, with a space in which the address of the local V.D. clinic is written?” If so, “Was it the Confidential Treatment poster or some other poster?”

The following table gives the total figures and shows the differences between the four main regions.

The Confidential Treatment poster was seen more frequently in the North. In London a relatively high proportion saw other posters.

Analyses by education and by income show no significant differences. On the other hand, there are interesting sex and age differences, as shown in the following tables.

A lower proportion of people over 50 than of people between 20 and 40 years of age said they had seen the posters.

A much higher proportion of men than of women had seen posters giving the address of local V.D. clinics. Further the difference between the proportions of men and women who had seen them increases with age.

Where had Confidential Treatment posters been seen ?

People mentioned having seen the Confidential Treatment poster less frequently in public lavatories in comparison with other posters which they had seen indicating the address of the local V.D. clinic. Analyses of these results show no important differences.

INCIDENCE OF DISPLAY OF V.D. POSTERS ON STAIONS AND IN PUBLIC LAVATORIES OF TOWNS VISITED DURING INQUIRY

While field - work was in progress, investigators visited when possible at least one railway station and public lavatory in the town or district where they were working, to find out whether any of the new V.D. posters were being displayed there.

This subsidiary investigation was made in 55 towns or districts where the V.D. inquiry was carried out.

V.D. posters were seen on the railway stations in 35 of these places, and in public lavatories in 18 of them. In 17 towns no V.D. posters were seen on the railway stations, and in 22 towns none were seen in the public lavatories. Information is not available about the display of V.D. posters on railway stations in 3 of the towns and in public lavatories in 15 of the towns.

It may be of value to mention a few constructive suggestions made by investigators, with regard to the conditions under which some of these posters were displayed. It was suggested that they would be more effective if placed.

There were suggestions that it might be advisable in certain places to place the posters high up, and possibly in frames, so that they could not be torn down or defaced - as had happened in some of the towns visited.

It was also felt that the relatively small size of the V.D. posters was a disadvantage from the point of view of their publicity effectiveness, since they were very often overshadowed and rendered ineffective by other large posters on either side of them.

I. DO PEOPLE AGREE WITH INFORMATION AB0UT V.D.

BEING PUBLICISED IN NEWSPAPERS, MAGAZINES, POSTERS, RADIO, FILMS, LECTURES?

After the questions dealing with attitudes to the three V.D. posters which were shown, a general question was asked to find out whether people agreed or disagreed with information about the venereal diseases being publicized through the various

Media used by the Ministry of Health.

Informants were asked to say whether they agreed or disagreed with or were doubtful about the use of six types of publicity media for telling people the facts about V.D. These were newspapers, magazines, posters, radio, films, lectures.

It will be seen that in the case of each media the majority of people were in agreement.

Analyses by education, income, sex and age showed no marked differences between the proportions who agreed or disagreed with or were doubtful about any of these six media being used to publicise information about V.D.

23.

II. COMMENTS ON THE USE 0F THESE SIX MEDIA OF PUBLICITY

Everyone was asked for comments on the use of such media for giving publicity to the subject of V.D. and the remarks were recorded.

Of the sample of 2,587 people interviewed, 1,660 made comments about the use such media in general, and 927 emphasised their agreement or disagreement or expressed doubt about the use of particular media.

The majority of comments, both general and specific, reiterated agreement or disagreement: but some people made comments which qualified their previous statements of general agreement, or gave their reasons for doubting the suitability of using certain media for publicising information about V.D.

Through only very small proportions of’ the whole sample were adversely critical of use being made of any of the six publicity media concerned, the types of critical comment expressed are summarised below, since they give some indication of the opinions voiced by a critical and articulate minority.

Many of the critics were concerned about children and young people getting a distorted view of sex by seeing or hearing V.D. publicity before they were sufficiently well - informed to understand the significance of the problems. Some parents appeared to dread the possibility of having to answer awkward questions that their children might ask.

A good proportion of the critics considered that the publicity should be more informative, that the facts about V.D. should be explained more clearly, though without exaggeration, and that more emphasis should be laid on the seriousness of the diseases.

Some considered that the V.D. posters should be bigger and should show or explain more clearly what the results of V.D. maybe.

Others stressed the necessity for frequent changes in the presentation of information about V.D., particularly in newspaper or magazine articles, as people tend to overlook articles and advertisements with which they become too familiar.

It was pointed out that newspapers, magazines and particularly lecutres only make an appeal to certain sections of the community. This is true also for radio publicity, since many people do not possess wireless sets and those who do are often not at home. However, a fair number of the critics thought that information about V.D. given on the radio and by means of lectures might have good effects if expounded by the right people e.g. the Radio Doctor or Padre, and by medically qualified lecturers who would be able to answer fully any questions that were asked.

Some suggested that lectures would be more effective if given to members of clubs or similar organizations as part of a series of lectures on varied topics. It was thought that lectures might draw larger audiences if they were attractively

planned and included lantern slides or films.

A few critics considered that films about V.D. were not suitable for exhibition in places of amusement. Some thought that such films should be announced in advance; others suggested that it would be useful to show V.D. films to groups of men and women at their places of work.

24. 25. 26.

III. SUGGESTIONS ABOUT INCREASING OR INTENSIFYING V.D. PUBLICITY

A question was designed to find out what more the public thought the Ministry of Health might do in their publicity campaign against V.D. Though the question asked “Do you think there are any other ways the Ministry of Health could put over publicity about V.D.?” a high proportion of the suggestions made were to the effect that more intensive use should be made of publicity media which have already been employed in varying degrees in the V.D. campaign.

As well as suggestions about other ways of publicising V.D. the following tables show the proportions of people who suggested that more intensive use should be made of media already employed, since these give some indication of the relative importance which is attached to particular media for giving information to the public about V.D.

Attitudes of the whole Sample towards Further V.D. Publicity

Thus 38% of the sample made some suggestion or other for enlarging the sphere of or intensifying existing publicity.

Interviewers considered that the comparatively high proportion of people who were not able to make any further suggestions may have already been referred to that six publicity media used in the V.D. campaign, had already been referred to previous questions. This factor, together with reported difficulty in thinking of other means of publicity on the spur of the moment, may also account for the relatively high proportion of “don’t knows” and “no answers”.

Analyses by Education, Income, Sex and Age

The differences shorn in analyses by education, income, sex and age are that:-

Suggestions made for further publicity about V.D.

The content of the suggestions made may be summarised as follows:-

Income and education group analyses on this question showed parallel tendencie the lower income and education groups suggesting more frequently that more could be done in factories and places of work, and the higher groups suggesting more teaching of children in schools.

Analyses of suggestions for further publicity made by age group and sex showed up no differences of any significance.

Of those who said that more should be done in factories and at places of work, the majority suggested that lectures should be organised, either during the lunch hour or at other times, and that films should be used for illustration. Other suggestions were that notices should be put up, pamphlets distributed, and that welfare Officers should give information or where necessary talk personally to individuals about V.D.

The majority of the people who thought that more public lectures should be organised, suggested that these should be for the benefit of young people, and entrants to the Forces. They mentioned Youth Clubs, Scouts, Rangers, etc. as organisations to whose members such lectures could suitably be given. A few people also suggested lectures to mothers at clinics and else where Some people felt that attendance at such lectures should be compulsory; others stressed the importance of getting doctors, nurses and other qualified people to give the lectures wherever possible.

The “miscellaneous” category includes suggestions that public exhibitions of wax models and photos of actual cases of V.D. should be organized, on the lines of some such exhibitions seen on the Continent during the last war.

28. 29. 31. 32. 33.

I. DO PEOPLE KNOW WHAT THE VENEREAL DISEASES ARE?

First of all each informant was asked “Do you know what the venereal diseases are?”

The results for the whole sample are as follows: —

The proportion saying “Yes” compares favourably with the figure 69% which represents the affirmative answers on the previous inquiry. In both cases these results show people’s own estimates of whether they knew what the venereal diseases were, and a “Yes” answer does not necessarily mean that the informant has correct knowledge, but only that he thinks he knows.

The extent of peoples knowledge was plumbed more thoroughly in subsequent questions.

Analyses of results by Region, Education, Income, Age, Sex, Marital Status, and War Service

Analysis of these results by region shows that a significantly higher proportion of people in the Midlands and S. Wales and a lower proportion in the Southern and Eastern region said they knew what the venereal diseases were.

84% of those with higher education as against 71% of the lower education group said they knew, and a similar difference is shown in an analysis by income: 85% of the people in the higher income group and 73% of those in the lower group said they knew what the venereal diseases were

Analysis by age-groups again indicates that significantly smaller proportions of young people between 16 and 20 knew what the venereal diseases were. In the previous inquiry 42% of people under 20, as compared with 69% of the whole sample said they knew what the diseases were.

Significantly lower proportions of people aged under 20 than of those in the other age group claimed to have knowledge about V.D.

There is only a slight difference in the frequencies with which men and women said they knew what V.D. were, men 83%, women 78% (standard error of differences 29

An analysis was made of the answers given to this question by people who were married, single or widowed, as it was thought that this factor night influence their knowledge of V.D. The analysis shows that significantly higher proportions of married than of single people said they knew.

It should be noted, however, that the single group contains a higher proportion of young people between 16 and 20(38% as against 1% in the married group), and, as has been shown above, people 16 and 20 had less knowledge about V.D. than those in older age groups.

Men were asked if they had been in the last war, or this. There is a statistically significant, through not very great, difference between the proportion in the two groups, those who had and had not been in the last war or this, who answered “Yes” to this question.

It should be pointed out that 11% of the men interviewed were between 16 and 20, the least we11 - informed age group as regards V.D., and as these young men were not likely to have been in the Forces during either wars the difference shown between the two groups above may to some extent be due to age rather than war experience.

Further questioning of people with limited knowledge about V.D.

People who said they knew “a bit, not much”, about the diseases, and those who replied “no” to this first specific question about V.D. were asked in a further question whether they knew anything at all about the diseases, and if so what.

It can be seen from the table above that 15% of the people who said they only knew a little or were ignorant of the facts about V.D. mentioned either the names of one or other of the diseases, or the cause or some of the results of the diseases. 14% did not volunteer any specific information but said that they had heard of the diseases from books, plays, films, radio, posters and qualified people.

Thus 29% of the uncertain people, or 7% of the whole sample of 2,587 showed that they knew something, at any rate, about the diseases. This, when added to 30. the 74% who replied that they knew what the diseases were in response to the original question, brings the proportion of the total sample who indicated that they had some definite knowledge of V.D. to 80%

Knowledge claimed about V.D. analysed by answers to subsequent questions

In order to provide a check on the answers of those people who either said (i) they knew what the venereal diseases were, or (ii) replied that they “Knew a bit, not much” and subsequently enlarged on this by answers to the supplementary question which showed a reasonable knowledge of the subject, answers given by this group of people were analysed by the replies to four other questions which sought

for more detailed information about V.D.

As was shown before the proportion of people in this group amounts to 81% of the total sample, or 2,116 individuals.

(a) The Names

Informants were shown a card on which were typed the names of twelve diseases and were asked to select those names which applied to the venereal diseases. Table 33 shows that of those who said or showed that they knew something about V.D. previously, 91% were able to select at least one name correctly. However of the others as many as 64% were able to select a name correctly which suggests that their replies to the previous questions were misleading.

(b) How the diseases are spread

The table above shows that almost twice as high a proportion of the people who said they knew something about V.D. as of those in the other group, said that V.D. was spread by direct contact and through sexual intercourse, but as many as 34% of the latter group were able to state the cause precisely.

(c) The Symptoms

Again a substantial proportion of those who denied having knowledge of V.D., 32%, were able to say something about the symptoms.

(d) The Results

Reference to the analysis given below(p.33)of replies to the question which asked what the results of V.D. might be will show that the majority of people who said they knew what the results of V.D. were did in fact know about at least one of the serious after - effects.

THE CONCLUSION which can be drawn from this series of cross - analyses is, therefore, that the majority of people who claimed to have reasonable knowledge about V.D. in answer to the preliminary questions, did have correct knowledge about the name/s, cause, symptoms and possible results of the diseases. There were, however, relatively small proportions of these people, who had claimed to know about

V.D. who subsequently showed that their knowledge about the names, cause, symptoms and possible results was inaccurate.

On the other hand, fair proportions of the people who had indicated that they had confused knowledge or knew nothing about the venereal diseases, in answer to the preliminary questions, gave replies to the later questions which showed that they also had a certain amount of accurate knowledge about the subject,

34. 35.

II. KNOWLEDGE OF THE NAMES USED FOR THE VENEREAL DISEASES

In order to find out whether people knew the names of the venereal diseases, and if so which particular names they used, each informant was shown a card on which were typed the names of 12 diseases. Five of these names applied to V.D. and were interspersed among the other seven names, none of which referred to V.D.

The list of names printed on the card ran as follows:-

1. Diarrhea. 2. Gonorrhea. 3. Piles. 4. Pox. 5. Colitis. 6. A dose.

7. Uremia. 8. Cystitis. 9. Syphilis. 10. Pyorrhea. 11. Dermatitis.

12. Clap.

To avoid the possible embarrassment caused by mentioning the names used, and to make the conditions of the question similar for everyone, informants were asked to give the number’s opposite the name or names which they thought applied to V.D.

The proportions of people who indicated names correctly are shown in Table 37.

The majority knew the names “syphilis” and “gonorrhoea”. Smaller proportions knew the other names.

Since some people selected more than one wrong name and others selected two names, one of which was correct and the other wrong, it was necessary to make a separate analysis to show the proportions who (a) indicated at least one correct name, and (b) selected only wrong names, didn’t remember any names or gave no answer to the question.

The results of this analysis are as follows:-

Analyses of Results by region, education, Income,

Age and sex

There are certain regional differences in the proportions knowing these

Analysis by educational standard shows that considerably higher proportions of people who had had secondary, technical, etc, education were conversant with the names syphilis and gonorrhea. About equal proportions of both groups knew the colloquial names,

A parallel situation is disclosed in an analysis by income groups.

There are interesting variations in the frequencies with which certain of the names were know by people in different age groups, as the table below shows.

Significantly lower proportions in the youngest and eldest age groups selected the names syphilis and gonorrhea. Relatively low proportions in the younger groups knew “pox”, “clap” and “a dose”.

Analysis by sex makes it clear that these colloquial names were knows by far higher proportions of men than women.

Significantly fewer women also mentioned syphilis and gonorrhea, and a higher proportion were unable to indicate any names which they thought might apply to the venereal diseases.

Did a higher proportion of the people who had seen M.O.H. publicity about

V.D. know the correct names for the diseases?

To find out what effect Ministry of Health publicity might have had in making people aware of the correct names of the venereal diseases, the answer to the question “What name do you use for the venereal diseases?” were analysed in the two groups, those who had and had not noticed M.O.H. publicity about V.D.

88% of those who had seen the V.D. publicity, were able to name correctly at least one of the venereal diseases. In contrast to this among those who have not seen the publicity, only 51% were able to give a right name. Thus, possibly the Ministry of Heath’s publicity has succeeded in supplying the correct terminology to some part of the public which was hitherto uninformed on the subject; though this difference may be due to the fact that the better informed sections of the community pay more attention to publicity.

36. 37. 38. 39.

III. KNOWLEDGE OF HOW THE VENEREAL DISEASES ARE SPREAD

All informants were asked, “How are the venereal diseases spread?” In some cases both correct and an incorrect answer were given. The answers were then classified separately so that the percentages in the table below add to more than 100.

Over two thirds gave answers which showed that they knew how the diseases we spread, but “lavatory seats” and other incorrect answers were also given. 19% said they did not know.

Comparison of these results with those of the previous inquiry, made in April, 1943, shows some increase in the proportion giving the correct answer, but the proportion mentioning other “causes”, such as lavatory seats and towels, has not decreased. This suggests that recent publicity has been effective in increasing knowledge about V.D. in this respect, but that it has not succeeded in dispelling the erroneous idea that V.D. can also be contracted from lavatory seats, etc.

Analyses by Region, Education, Income, Age, Sex

In the following tables the proportions giving different answers are shown where there are differences between groups and in some other cases.

The proportion saying “I don’t know”, is slightly higher in the Midlands and Wales then elsewhere. “Immoral conduct, etc.” is given rather more frequently in the North then in other regions.

Analysis by education groups again indicates that those who had had more education were more fully informed.

Similarly those in the higher income group mentioned the way the V.D. are actually spread rather more frequently than people in the lower income group, a higher proportion of whom were unable to say.

As on the previous inquiry, analysis by age group shows that the youngest group did not have as much knowledge about V.D. as the others. People between 51 and 60 gave correct answers less often than those between 21 and 40.

About equal proportions of men and women gave correct answers, but women mentioned lavatory seats as a source of infection significantly more often than men.

Results of a supplementary question as to how venereal diseases are spread

An attempt was made to estimate what proportion of the people who had been unable to answer the question “How are the venereal diseases spread?” did in fact have some idea about this, but had been too reticent to mention it.

It was felt that reticent people might admit having knowledge about V.D. if the onus of mentioning sexual intercourse were shifted when they were asked, (1) “Do you know of any ways V. D. are spread besides sexual intercourse with an infected person?” and (2) “ Is sexual intercourse the main way?”

These two questions were put to people who had made no reply to the original question or had said they did not know how V.D. was spread.

The answers to the first of these additional questions show that 34% of the people who were asked the question, 6% of the total sample, said they thought V.D, could be caught otherwise than through sexual intercourse; the most prevalent belief being that the diseases could be caught from lavatory seats.

However, when these people were asked “Which is the main way that V.D. is spread?” 37% (i.e. 7% of the total sample) replied that had known of sexual intercourse. In 9% of cases investigators got the definite impression from the informant's attitude and conversation that they really knew intercourse to be the most important way, though they were still unwilling to admit this knowledge. 5% definitely did not know that V.D. was contracted through sexual intercourse and 49% did not answer the second additional question.

If the numbers of people who mentioned “sexual intercourse” in answer to the second additional question, and those who definitely seemed to know that sexual intercourse was the main cause of V.D., are considered in conjunction with those who gave correct answers to the original question, it may be estimated that some 80% of the civilian population aged under 60 knows how the diseases are spread, although many of them think that they are spread by lavatory seats etc., as well as by sexual intercourse.

Did a higher proportion of the people who had seen M.O.H. publicity

about V.D. know how the diseases are spread? “

To estimate the effectiveness of the Ministry of Health publicity about ways in which V.D. may be spread the question “How are they spread?” was analysed by the two groups, those who had and those who had not noticed the M.O.H. publicity about V.D.

(Percentages add to more than 100 because some people mentioned more than one way in which they thought V.D. could be spread.)

The table above shows that a much higher proportion of the people who had noticed the M.O.H. publicity about V.D. said they knew that the venereal diseases were contracted through sexual intercourse or direct contact. Conversely, people. 40. who had not noticed the publicity said much more frequently that they did not know how the diseases were spread. About the same proportion of both groups gave incorrect answers.

These results suggest that the Ministry of Health’s publicity has succeeded in teaching people how venereal diseases are spread, though it is possible that those who knew more about V.D. in the first place paid more attention to the publicity. It is clear that more needs to be done if incorrect ideas on the subject are to be dispelled.

41. 42.

IV. KNOWLEDGE OF THE SYMPTOMS OF THE VENEREAL DISEASES ?

Everybody interviewed was next asked if they knew what the symptoms of V.D. were. This question was framed in three alternative ways, as on the previous inquiry, and the investigator used the form of question which was most suitable for each informant.

“What are the symptoms?”

“What would you tell anyone to look for to see if they were infected?”

“How do these diseases first show themselves?”

Where one person gave two answers to this question the more specific answer was counted.

A rough comparison can be made between these results and those obtained in response to the same question asked on the previous inquiry; thought it should be pointed out that on the previous inquiry the question was only asked of selected informants, women who had seen the V.D. statement and agreed with its publication, and men who had seen it and agreed with it, if the investigator thought the question would not cause embarrassment.

It can be seen that there is a tendency towards more specific answers on the present inquiry: the increase in negative answers can probably be accounted for by the fact that on the present inquiry the question was asked of everyone, whether or not they were made reticent or embarrassed by the subject of V.D., whereas these people were excluded from the previous sample on which answers are based.

Analyses by Education, Income, Age and Sex

Analysis of the answers by educational standard shows that considerably higher proportions of those with elementary education were unable to say what the symptoms of V.D. were and people with secondary, technical and further education were noticeably more specific in the answers they gave. There are similar though slightly less marked differences between the answers given by people in the two income groups.

Analysis by age shows that people between 21 and 50 were better informed about the symptoms of V.D. than those in the younger or older age groups.

There are no very marked differences between the proportions of men and women who showed knowledge about the symptoms of V.D., though men tended to be a little more detailed in their answers. On the other hand rather more of the women than of the men could not say or did not remember what the symptoms were.

Did a higher proportion of the people who had seen the M.O.H. publicity about V.D. know what the symptoms of the diseases are ?

Answers to “What are the symptoms of V.D.?” have been analysed by the two groups, those who had and those who had not noticed the M.O.H. publicity about V.D.

It is clear that greater knowledge of the symptoms of V.D. is shown by those who have seen the Ministry of Health’s publicity than by those who have not.

43. 44. 45. 46.

V. KNOWLEDGE OF WHAT THE RESULTS OF THE VENEREAL DISEASES MAY BE

As a further check on people’s knowledge about V.D. informants were asked whether they knew what the results of V.D. might be.

80% of the sample said that knew what results might be expected.

People who said they knew what the results of V.D. might be were then asked to state the results they knew about. Many people mentioned more than one possible result. Each result mentioned was classified separately and consequently the percentages below add to more than 100.

It will be seen that blindness was the result most frequently mentioned. The fact that V.D. sometimes causes insanity was also mentioned by quite high proportions. A fifth of the sample commented on the possibility of V.D. being given to wife or husband or inherited by the children of an infected person, and about the same proportion mentioned the particular effects that the diseases might have on children.

13% said that V.D. might possibly cause death.

It appears from this table that the majority of people who said they knew what the results of V.D. were did in fact know about at least one of the serious results, though a fair proportion gave rather vague ill-defined answers which show that their knowledge of the subject is far from complete.

Analyses by Education, Income and Age, Sex, Marital Status and War Servicie

Analyses by both income and education groups show that in both cases larger proportions of those in the higher groups knew at least to some extent what the results of V.D. might be.

People in the higher education and income groups were also able to mention more results when asked what the results were.

In an analysis by age groups again it appears that young people between 16 and 20 were less well informed on the subject than others; significantly lower proportions in this group were able to give any indication as to what the results of V.D. might be.

However, of those who said that they did know what the results might be roughly equal proportions of people in all the age groups mentioned each possible result. Those between 21 and 50 mentioned more results per person than people in the youngest and oldest age groups.

There is a difference in the proportions of men and women who said they knew what the results of V.D. might be.

When a comparison is made of the results of V.D. mentioned by the two groups, it is seen that men referred to the possibility of death and blindness in adults more often than women; women on the other hand were more concerned than men with the possibility of the disease being passed on to children who might be born with a deformity, mental deficiency, or blindness.

Slightly more married than single people said they knew what the results of V.D. might be, though there were no differences between the proportions in these two groups who referred to particular results.

Again it should be borne in mind that there is a higher proportion of young people between 16 and 20 in the single group.

Analysis also shows that rather more of the men who had been in the last war or this, than of those who had not, knew something about the results.

As was pointed out in a previous analysis of this kind, the difference may to some extent be due to the age composition of the two groups.

Did a higher proportion of the people who had seen M.O.H. publicity about V.D. know what the results of the diseases may be ?

It will be seen from the table below that almost twice as great a proportion of those who had come across Ministry of Health publicity as of those who had not, said they knew what the results of V.D. might be.

Here again the Ministry of Health’s publicity campaign seems to have had a considerable effect in giving people information about V.D, which they did not previously possess.

47.

VI. KNOWLEDGE OF WHAT PEOPLE SHOULD DO IF THEY HAVE V.D.

Informants were asked “What would you advise anyone to do if they thought they were infected?”, to find out how aware they were of the necessity of seeking advice and whether they knew of the facilities provided for the treatment of V.D.

As will be seen from the table overleaf the majority of people said that the thing to do if one were infected would be to visit a special V.D. clinic, a hospital or some kind of health centre, or to seek medical advice.

Analyses by income and education show a tendency, which is slight as between the two income groups but a little more marked between the two education groups, for people in the lower groups in both cases to mention special V.D. clinics less often and health centres and dispensaries etc., more often than people with higher incomes and education respectively. This may be due only to an unimportant difference in terminology, or it may indicate a less favourable attitude to special V.D. clinics on the part of the lower income and education groups.

The only difference shown in an analysis by age is that people between 51 and 60 mentioned V.D. clinics and V.D. hospitals rather less than did the younger people.

49. 50. 51.

I. POINTS ON WHICH FULLER INFORMATION ABOUT V.D. IS DESIRED

All informants were asked “Is there anything more you would like to know about V.D.?”

Results show that only about a third of the sample answered this question in the affirmative, and investigators who carried out the inquiry suggested various reasons which they considered might account for this low proportion.

It is possible that some people did not wish to appear too curious about the details of V.D., and may have felt that if they had shown too much interest in knowing more about the subject it might be assumed that they had personal problems connected with it.

Some people may have been unaware of the incompleteness of their present knowledge and therefore could not say what further information they would like to have. Others might have been able to make suggestions if they had had longer to discuss the matter and find out where the gaps in their knowledge lay.

A certain proportion may have felt that, in fact, they knew enough about V.D. already, whereas others may not have been sufficiently interested to want to extend their knowledge or to know anything about the subject.

Those who said they would like more information were asked to say what particular aspect of the subject they would like to know more about.

The following table shows the proportions (i) of those who wanted to know more and (ii) of the whole sample, who mentioned various aspects of V.D. they would like to know more about.

A quarter of the people who were asked this question were anxious to know more about the symptoms of V.D. and how the disease can be identified.

It will be seen that of those who said they would like more knowledge about V.D. 40% could not mention any particular points on which they wanted enlightenment.

Analyses by Income, Education, Age, Sex, War Service and Marital Status

People in the lower income group said rather more often than those in the higher group that they would like to know more about V.D., the proportions saying “Yes” being 36% for the lower group and 27% for the higher. The numbers in the higher group who made suggestions are too small to allow comparison of proportions in the two groups who mentioned different aspects of V.D. they would like to know more about.

There are no differences between the replies made by those in the two education groups.

Significantly higher proportions of the people in the two youngest age groups than in any of the others said they wanted to know more about V.D. People between 51 and 60 were less anxious to know more about it than other groups. There are, however, no important differences between the proportions in any of the groups who mention particular aspects of the diseases they would like to know more about.

About the same proportions of men and women said they would like to have more information about these diseases; but more women than men wanted to know how V.D. is caught and what the symptoms are.

Analyses shows that rather a higher proportion of the men who had not been in the Forces during the last war or this than of the men who had been, said they would like to know more about V.D.: the proportions are 37% as against 25%. There are no differences in the proportions mentioning any particular aspects of the subject on which they would like information.

More single than married or widowed people said they wanted to know more about V.D., though the proportion in each group who made the various suggestions are about equal. Again it should be remembered that there is a higher proportion of young people in the “Single” group.

Did a lower proportion of those who had already seen M.O.H. publicity about V.D. want further information?

Whether people had previously seen Ministry of Health publicity about V.D. or not, does not seem to have influenced their desire to learn more about the subject.

As the table below shows, almost equal proportions of those who had and had not seen publicity said that they would like to know more about V.D.

Did a lower proportion of the people who said they knew what V.D. was want further information ?

The following table shows that a significantly higher proportion of people in the groups who showed less adequate knowledge about V.D. said that they would like to know more about the subject.

52.

II. SUGGESTIONS FOR IMPROVEMENTS IN FACILITIES FOR TREATMENT OF V.D.

A question was asked about the facilities for treatment of V.D. to find out whether people had any helpful suggestions to make as regards the conditions under which treatment is at present available.

The question was “Do you think there are any ways in which it could be made easier for people to get treatment?”

About a quarter of the people interviewed said they did not know how satisfactory the present conditions were, or for other reasons could not give any opinion on the subject. An additional 40% of the sample considered the existing conditions satisfactory, or else thought that it would always be a difficult matter and that it would not be easy to improve the facilities.

A certain proportion did, however, make constructive suggestions, as the table below shows.

There were no great differences in the frequencies with which these suggestions. were made by people in the two income or education groups, though those in the higher income group tended to be less satisfied with existing conditions, and a significantly greater proportion in the higher education group stressed the necessity for a change in the general attitude towards V.D.: 12% of the higher group made this suggestion, as against 5% in the lower group.

The only significant difference shown in an analysis by age is that fewer of the young people between 16 and 20 than of those between 21 and 50 gave any opinion on the subject. (65% as against 76%).

This is also the only difference between the sexes, 81% men as against 68% women giving an opinion.

In this connection it seems important to record that during interviews quite a number of complaints were made by informants about the attendance at treatment centres being too public. It was pointed out that people were often embarrassed by being recognised by friends or neighbours while in a queue outside a centre, and were thus discouraged from continuing, or even starting, treatment.

53. 54. 55.

III. SUGGESTIONS OF METHODS OTHER THAN PUBLICITY WHICH MIGHT BE USED TO REDUCE THE INCIDENCE OF V.D.

All informants were asked the question “What else do you think should be done to stamp out V.D. apart from publicity?”

Of the whole sample 56% had one or more suggestions to offer.

Fieldworkers commented that this question was too difficult for many informants. The knowledge of the V.D. problem possessed by many people does not go any further than that contained in the Ministry of Health’s publicity campaign, which has so far concentrated mainly on symptoms, results, and the necessity for getting prompt treatment for V.D. A large number of people who had not previously considered this question were unable to form any opinion on the spur of the moment.

A certain proportion of people who made no suggestions, considered that it is impossible to stamp out V.D. or that it rests with people themselves to avoid catching it, or to avail themselves of the treatment offered. Characteristic replies were “Nothing will ever alter some people - you’ll never be able to stamp it out.” “It’s up to people themselves to get rid of it.”

Other people confirmed opinions previously expressed in favour of the Ministry of Health’s publicity campaign. “Only publicity can do any good.” “Must get rid of ignorance about V.D - that is the only way of stamping it out.” - were typical comments.

Analyses by education, income, sex, marital status and age clearly show that certain groups of people have more constructive suggestions to make than others. Men have more suggestions than women; people in the higher education and income groups more than those in the respective lower groups; married people more than single people. Fewer of those under 20 years of age had suggestions to offer than of those in other age groups.

Approximately equal proportions in all the groups did not answer the question.

The table below shows the proportions of the whole sample, making different suggestions.

Percentages add to more than 100 because some people made more than one suggestion.

The variety of replies, and the fact that they tend to overlap, makes it necessary to describe in detail the main contents of certain of the classifications used.

Category 1 contains remarks on the lack of parental supervision of young girls, and lack of police supervision of the activities of women and girls in public houses and on the streets. There is frequent mention of excessive drinking as one of the causes of the spread of V.D. A number of people comment that young girls should not be allowed in public houses, and that there should be stricter enforcement of the law against selling drinks to people under 18. Replies in this category generally lay the blame for the spread of V.D. upon girls.

Category 5 A number of suggestions were made for the provision of better

entertainment and social facilities for young people and members of the Forces, and for general constructive measures to discourage immorality and provide alternative interests.

Category 9 Sex education here should be interpreted in the widest sense, as replies included not only those which urged for more sex instruction for children, but also those which advocated that lectures and advice be given to dispel ignorance of sexual questions among adults and young people alike. Some people considered that the schools should provide sex instruction, others that it was up to parents to tell their children more.

Category 10 Included miscellaneous suggestions, some of which centred round the need for higher moral standards and the moral approach to the subject. A small number of people commented that drink is responsible for much of the spread of V.D., but few suggestions were made of specific measures which should be taken. Isolation of all infected persons was a measure put forward by a small number of informants.

57. 58. 59.

I. THE DIPHTHERIA IMMUNISATION CAMPAIGN

Did people remember points stressed in the publicity ?

The question was formulated as follows:-

“The Ministry of Health have published special information telling people about the dangers of diphtheria. Do you remember the points they emphasised specially about this?”

The sample here is decreased from 2,587 to 1,694 because as the inquiry was started before Christmas and continued a month later, it was felt advisable to limit the length of the inquiry slightly, and it was considered that on some of the questions on publicity sufficient information had already been collected to give a clear picture of the situation. The proper balance of the sample is not affected by the reduction.

The proportions remembering points were relatively low in the lower education and income groups and in the older age groups. Men recalled points less frequently than women. There are only small differences between different regions.

What points from the Publicity were remembered?

Of the 1189 people who remembered details about the information given in the publicity on diphtheria, four - fifths said that the main point emphasised had been the value of immunisation, inoculation or injection. Some informants echoed the slogan “Diphtheria is deadly, immunisation is the safeguard”, others said the immunisation prevents or decreases the risk of death from diphtheria.

The 6% who said that their children had been immunised could legitimately be grouped with the 57% who mentioned immunisation, since they have indirectly affirmed that the main message of the publicity was to urge parents to have their children immunised. Thus the proportion giving the “critical” answers given is 63%.

It is worth mentioning that no significant difference is shown between the answers given to this question by people who were able to recall in the two income groups on this inquiry, whereas in a previous inquiry into public attitudes towards diphtheria immunisation (July - August, 1942) much lower proportions in the lower income groups had any knowledge about the cause, danger or prevention of diphtheria. It may possibly be clamied, therefore, that the recent publicity about diphtheria has had a particular effect in making members of the lower income group more knowledgeable about the subject.

publicity media from which information was obtained

Following the question on diphtheria publicity informants were asked to say from what source they had gathered their knowledge on this subject. They were asked about each or eight media.

It will be seen in the table below that outdoor posters and notices in newspapers were responsible to a large extent for making people aware of the danger and necessity of immunisation against diphtheria.

Newspapers and magazines were mentioned more, and posters less, frequently in the South and East than elsewhere. In London a rather low proportion mentioned radio, which is consistent with the results relating to V.D. publicity. Newspapers are also mentioned less frequently in London than elsewhere.

Analysis by sex shows that women had noticed diphtheria publicity at the cinema somewhat more frequently than men (21% as against 16% with a Standard Error of 2%).

People in the higher education group had noticed publicity on posters hoardings, and in newspapers and magazines more frequently than those in the lower group. The only marked difference, shown in an analysis by income is that people in the higher group had seen publicity in magazines more often than the others.

Analysis by age shows that younger people noticed publicity on posters, in magazines and in films more frequently than older people.