Leeds Health Education Database 2015

Interventions using mass media

November 2013

For background information on the project including selection criteria click here. Please send any feedback on database and suggestions for items to include to sarah@hubley.co.uk

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Contents

1.   AIDS, STDs and Reproductive health

2. Family planning and population education

3. Maternal and Child Health - no entries for this category

4. Childbirth/safe motherhood  - no entries for this category       

5. Breast feeding promotion      

6. Oral rehydration therapy and the management of diarrhoea

7. Immunization uptake 

8. Acute respiratory infections - no entries for this category

9. Growth monitoring  - no entries for this category                                                                                      

10. Nutrition education                                                    

11.Control of Infectious diseases including tropical and parasitic diseases

12. Oral/dental health promotion                                  

13. Eye health and the prevention of blindness       

14. Environmental health including, water, sanitation and hygiene education

15. Chronic diseases, substance abuse and mental health

16. Miscellaneous health topics, patient education, accident prevention/safety education


Note: reference numbers refer to the papers location in the reference manager programme maintained at Leeds and have no special significance. Papers marked borderline did not meet the full criteria for inclusion in the database but were retained because of special features of the methodology used and their continued inclusion will be reviewed on a regular basis.

1. AIDS and Sexually Transmitted Diseases

Evian, C.R., De-Beer, M., Crewe, M., Padayachee, G.N., and Hurwitz, H.S. Evaluation of an AIDS awareness campaign using city buses in Johannesburg. S.Afr.Med.J.80(7):343-346, 1991.  Ref ID : 2548  (Borderline for inclusion in database)

Target Group/Country General Public in Johannesburg, South Africa

Intervention Methodology The use of city buses as “vehicles” for an AIDS The 6-month campaign run by the city council began August 24, 1989 with ads on the back of 30 buses stating: “Learn about AIDS and keep yourself safe. Phone 339-2345. JHB City Health Dept. “ This message was selected from a list of 10 possibilities by telephoning 52 random adults. The programme on the buses was part of a larger mass media campaign on HIV/AIDS.

Evaluation Method The evaluation consisted of telephoning 280 and 145 people selected at random from the Johannesburg telephone directory 2.5 and 6 months after the campaign. The evaluation assessed the acceptability, effectiveness, impact and cost-effectiveness of using buses, and determined what people could recall of the message. 255 (91%) of the person telephone in the first survey and 127 (87%) of the persons contacted in the second survey agreed to answer the questions. There was no baseline or control.

Impact Achieved 30.2 and 31.5% of the subjects in the 1st and 2nd survey recalled seeing the message. 72 and 67% recalled only seeing an AIDS message. 8.5% remembered the message accurately. 12.8% remembered that the message urged people to learn about AIDS. Only 1 person could remember a phone number and the City Health Department.  Of those who reported seeing the message, 35.1% and 55% of the 1st and 2nd series respectively reported taking some action which included visiting a doctor, telling others or wanted to learn about AIDS.  90.5% considered buses suitable for AIDS health awareness messages. This study showed that buses could be used as sites for posters to promote AIDS awareness.. It was estimated that a minimum of 57,970 persons saw the messages, at a cost of 7627 Rand for 6 months. However, only 229 persons telephoned the Health Department on the number provided which was disappointing. provided The main limitation with this study is the possible bias in sampling from using a telephone interview and lack of baseline. However, for the limited objective of establishing feasibility and acceptability of using buses for education, the methodology would seem appropriate.

Karlyn,A.S. (2012) The impact of a targeted radio campaign to prevent STIs and HIV/AIDS in Mozambique. AIDS Education and Prevention 13, 438-451. Reference ID: 9106

Target Group/Country Youth - in- and out-of-school, and adults associated with risk behaviours e.g. users of commercial sex in urban and peri-urban areas of Mozambique

Intervention Methodology There is a very good description of the "education-entertainment" radio campaign with a detailed listing of the messages for each target group.The targeted radio campaign followed up earlier mass media social marketing condom promotion radio activities. On World AIDS Day 1996 Population Services International launched the "So a Vida Oferece Flores" (only life offers flowers) national radio campaign using nine spots in Portuguese. The spots were designed to reinforce key messages from the PSI play of the same name using the same personalities, music and themes. Local language versions of the spots were broadcast 11 months later and were broadcasted 10,000 times over a two year period. and there was an attempt to segment the target with distinct messages The spots were targeted to youths aged 13-20 and adults 21-49.

Evaluation Method A cross-sectional study using a two-stage random sample of "at-risk" individuals; 754 individuals between the ages of 13 and 49 were interviewed.

Impact Achieved Over half (52.4%) heard the campaign and 45.5% recalled one or more radio messages. However, recall of specific messages in specific risk groups was low. A multivariate model demonstrates that among those exposed to the radio campaign, 97.2% reported intent to change their sexual behavior compared with 62.8% of those not exposed to the campaign (p < .001). Among those who recalled campaign messages, 86.1% attempted to change their behavior compared with 58% of those who had no message recall (p <.001). Success in changing behaviour was significantly higher among those with message recall (83.8%) than those without (56.8%, p < .001). Despite the limitations in using radio to target, exposure to the radio campaign has contributed to individual intent to change sexual behavior. The author comments that the this study illustrates the difficulties in using radio to target a specific group with a corresponding behavior change message. Although general recall of campaign messages was high per target group, the author concluded that campaign did not succeed in ensuring exposure to the intended target group. The strategy of airing all of the spots simultaneously with different but similar messages resulted in one spot "stepping on" another.
See also the study by the same athors of another aspect of the social marketing programe in Mozambique: Agha,S., Karlyn,A. and Meekers,D. (2012) The promotion of condom use in non-regular sexual partnerships in urban Mozambique. Health Policy and Planning 16, 144-151. Ref ID 9105 Ref ID: 9105

Tambashe, B. O., Speizer, I. S., Amouzou, A., & Djangone, A. M. 2013. Evaluation of the PSAMAO "Roulez Protege mass media campaign in Burkina Faso. AIDS Education and Prevention, 15(1) 33-48. Ref ID: 9068

Target Group/Country Truck drivers and seasonal workers and female sex workers along transport routesin Burkino Faso, West Africa

Intervention Methodology This study assesses the impact of the Prevention du SIDA sur les Axes Migratoires de l'Afrique de l'Ouest . The campaign is based around a 30 minute film drama entitled Roulez Protégé which was shown on television and through mobile video units. Volunteer peer educators were recruited among truck drivers and their assistants and were responsible for conducting large scale meetings of 100-300 in public places, discussion groups of 30 or less participants and condom distribution/demonstration. Other materials produced included audiocassettes and a flip chart. There were also billboards, radio and TV spots (detailed information not provided)

Evaluation Method A total of 764 and 1,032 truckers and helpers were interviewed in 1997 and 2011 along the Ouagadougou-Niangoloko trucking route. The data was analyzed to determine three outcome variables: whether they had spoken to a colleague about AIDS, whether they reported an intention to use condoms next time and whether they used a condom the last time they had sex. There were no controls.

Impact achieved Virtually all truckers (95.8%) had seen the Roulez Protégé message on a billboard, 45.1% had seen the spot on the television and 38% had heard the spot on radio. There was an overall increase in knowledge about HIV/AIDS however the authors point out that during this period there had been many other educational activities in the region. Logistic regression analyses suggest that the campaign did not have direct behavioral impacts. Exposure to radio spots and participation in group discussions were found to be significantly associated with truckers discussing AIDS with peers or reporting intentions to use a condom in the future. Exposure to Roulez Protege messages through television or billboards was not found to be significantly associated with interpersonal discussion or condom use intentions. Specific information is not provided on the number of meetings, group discussion sessions, bill boards. This evaluation is significant in that it shows that a two year intensive programme did not achieve behaviour change. Some information is reported from focus group discussions (no details of methodology provided) which suggested that the truck drivers did not consider television to be appropriate to their life style. Unfortunately there is nothing reported on the quality of the public meetings and group discussions and the performance of the peer educators.

Middlestadt, S., Fishbein, M., Albarracin, D., Francis, C., Eustace, M.A., Helquist, M. and Schneider, A. (1995) Evaluating the impact of a national AIDS prevention radio campaign in St Vincent and the Grenadines. Journal of Applied Social Psychology 25, 21-34.Ref ID : 8477

Target/Country Youth in St Lucia, St.Vincent and the Grenadines and Grenada,  Eastern Caribbean

Intervention Methodology Based on extensive formative research in the three Eastern Caribbean countries of a three-nation mass media radio campaign to promote condom use by teenagers was developed drawing upon Fishbein's Theory of Reasoned Action. A radio campaign lasting two months was targeted primarily to parents o teenage children, The central message was "When you can't protect them any more …..condoms can". Parents were urged to talk to their teenagers about sexual responsibility and safer sex.

Evaluation method A follow-up survey was conducted in St Vincent and the Grenadines. A multi-stage sampling plan was resulted in interviews carried out with 297 respondents (109 teenagers, 102 parents of teens and 86 other adults). 71.6% (213) of the sample not only reported hearing an AIDS-related ad on the radio but were able to correctly describe its content. Those were classified as 'exposed' to the campaign and the remaining 28.4% were classified as 'non-exposed'.

Impact Achieved The age breakdown of those exposed to the campaign was 15-19 yrs 39.6%; 20-29 yrs 24.4%, 30-44yrs 26.2% and 45-54 yrs 8.8%. Those exposed to the message were significantly more likely: (1) to believe that it is possible to protect oneself from AIDS than those not exposed (p<0.01); (2) to believe that parents and teens should discuss sexual responsibility(p<0.01); (3) to believe that their potential sex partners thought that they should use condoms(p<0.01); (4) to believe that their friends used condoms (p<0.01) and  5) to be aware of the existence of the AIDS hotline (p<0.01). There was little difference between the two groups in reported condom use 

Van Rossem,R. and Meekers,D. (2011) An evaluation of the effectiveness of targeted social marketing to promote adolescent and young adult reproductive health in Cameroon. AIDS Education and Prevention 12, 383-404. Reference ID: 9103

Target Group/Country Young people in Cameroon

Intervention Methodology The Horizon Jeune program included youth -targeted behaviour change communication and promotion and youth-targeted distribution of prudence condoms and Novelle oral contraceptives. The programme targeted adolescents through peer education, youth clubs, mass media promotion, and behavior change communications. Youths from the target population were involved in the development and production of all campaign messages which were disseminated through youth-oriented promotional events, peer education, and counseling, radio talk shows, brochures and other media.28 peer educators were recruited from the target population and were trained in social marketing and interpersonal behaviour change communication. Peer educators help to set up a network of youth clubs in six schools. Radio spots and talk shows were broadcast . The project t also targeted parents, teachers and community leaders and held events such as video broadcast, condom demonstrations at night-clubs during "Prudence Night", presentations at local soccer games and drama productions on reproductive health issues. The programme was based on the Health Belief Model and the concept of self-efficacy from Social Learning Theory.

Evaluation Method .Program effectiveness was examined using a quasi-experimental research design with a pre-intervention (n=1,606 - 805 intervention and 801 comparison) and post-intervention survey (n=1633 (811intervention, 822 comparison) in an intervention and comparison site. The intervention site was a cosmopolitan city located 40 miles outside Douala with population 86,000. The comparison site Bafia was 80 miles north of Yaounde with a population of 73,000 and sufficiently far away from the intervention site to prevent contamination.

Impact Achieved After about 13 months of intervention, knowledge of the program was nearly universal, and the majority of youths had direct contact with the program. The intervention had a significant effect on several determinants of preventive behavior, including awareness of sexual risks, knowledge of birth control methods, and discussion of sexuality and contraceptives. Among the female youths in the intervention site the proportion who became sexually active prior to age 15 yrs decline from 10% to 4% whereas the level in the girls in the comparison group increased from 9% to 13% (p= .000) - there was a similar decline with boys but it was not significant. The proportion of female youths who reported to have ever used a condom rose from 58% in 1996 to 76% in 1997 (p=0.001) with no change in the comparison site.. However, condom use was not yet consistent. Although the proportion of young men who reported using condoms for birth control also increased, this change could not be attributed to the intervention. Although this short intervention successfully increased the reported use of various birth control methods, including condoms, there is no evidence that the intervention increased use of condoms for STD prevention of sexually transmitted diseases.. This study is of interest for its application of the Health Belief Model. The authors point to the need for future programmes to place more emphasis on the need to use condoms with regular partners.

Vaughan,P., Rogers,E.M., Singhal,A. and Swalehe,R.M. (2011)  Entertainment-education and HIV/AIDS prevention: a field experiement in Tanzania.  Journal of Health Communication  5, 81-100. Ref ID 8751

Mohammed,S. (2012) Personal communication networks and the effects of an entertainment-education radio soap opera in Tanzania. Journal of Health Communication 6, 137-154. Ref ID: 8927

Target group/country General public in Tanzania

Intervention Methodology A radio soap opera Twende na Wakati (Let's go with the times) was broadcast in Swahili twice per week for 30 minutes from July 1993 through to the end of 1999. Four key HIV/AIDS prevention themes were covered: 1) that STDs should be treated; 2) that condoms can prevent HIV infection; 3) that AIDS is an incurable disease that is spread by sexual contact; and 4) that the various rumours about AIDS are false. The characters in the soap operas were designed to provide negative, transitional and positive role models for HIV prevention behaviours.

Evaluation Method The soap opera was not broadcast in one region (Dodoma) from 1993-1995 to create a comparison area so that an experimental design could be used. From 1995 to 1997 all regions received the broadcasts and Dodoma received the earlier episodes. Five surveys based on personal interviews were carried out from just priori to broadcast in imd 1993and at one year intervals. The questionnaire measured respondent's (1) personal characteristics, (2) exposure to and perceptions of the soap opera (3) knowledge of HIV/AIDS (4) relevant attitudes and (5) the practice of HIV/AIDS preventive behaviours. Respondents included females aged 15-49 and males aged 15-60 (ages ranges chosen to be inline with another national survey to allow comparison. 5 districts were chosen at random in the comparison area and 9 districts in the treatment area - each district with average sample size of 214.

Impact Achieved 47% of respondents in the treatment area reported listening to the soap opera which increased to 58% by 1997. Respondents reporting having heard the soap operas in the comparison area (e.g. through travel to other areas) was about 2%. 73% of listeners reported learning about AIDS from the soap opera in the treatment area in 1994 and 46% reported talking to someone about the programme content. In response to an unprompted question the numbers reporting adopting an HIV/AIDS prevention behaviour as a result of the programme was 16% in 1996 and 12% in 1997. Most listeners who reported adopting an HIV/AIDS prevention method, reported reducing their number of sexual partners (77% in 1995) rather than adopting condom use (15% in 1995). Between 1993 and 1993 there was a greater decrease in reported number of sexual partners in the intervention area (men 2.3à1.6; women 1.9à1.2) than comparison area (men 2.2à1.9, women 1.8à1.3) both for men and women (p<0.01). This evaluation is significant as one of the few evaluations of mass media in developing countries to use a comparison group.

Vaughan,P.W., Regis,A. and St Catherine,E. (2011)  Effects of an entertainment-education radio soap opera on family planning and HIV prevention in St Lucia.  International Family Planning Perspectives  26, 148-157. Ref ID: 8813

Target Group/Country General public in St Lucia

Intervention Methodology The entertainment-education radio soap opera Apwe Plezi was designed to address 37 educational issues identified in formative research. These included knowledge, attitudes and behaviour related to family planning, HIV prevention, gender equity, relationship fidelity and domestic violence. During the first phase between Feb 1996 to May 1997, 260 episodes were broadcast. Fir the second phase from July 1997 to September 1998 105 episodes were broadcast, The characters served as positive, negative and transitional behavioural role models and their fates provide learning experiences to demonstrate the consequences of alternative behaviours. Accompanying activities to promote and reinforce the radio dramas included a street theatre version performed 21 times, story updates in the local press posters, bumper stickers and billboards. The soap opera launched a new name for condoms - 'catapult'.

Evaluation Method A January 1995 survey of 753 men and women aged 15-54 yrs provided baseline data. Post-test surveys were conducted in June 1997 (n=741) and September 1998 (n=497) which were combined for the purpose of analysis. There were no controls. Respondents were considered regular listeners if they reported listening to the radio soap opera once a week or more and this was used to infer causal effects. A personal interview questionnaire was used which asked prompted (open-ended) questions first and then prompted questions. In addition 44 focus group interviews were conducted at intervals throughout the broadcast period to monitor listeners' responses. A hot line for telephone consultations was established and content analyses were undertaken on the recorded messages.

Impact Achieved According to the 1977 survey Apwe Plezi was the second most popular programme on Radio ST Lucia that Year and the 4th most popular on any radio programme. 65% did not listen, 23% reported to be casual listeners and 12% regular listeners. In response to an unprompted question on what they had learned from the programme 52-60% of regular listeners reported HIV, AIDS teenage pregnancy or drug abuse. The proportion of survey respondents who were aware of contraceptive pills increased from 77% to 83%between the pre-test and post-test (p<0.01).

Yoder, P.S., Hornik, R., and Chirwa, B.C. Evaluating the program effects of a radio drama about AIDS in Zambia. Stud.Fam.Plann. 27(4):188-203, 1996.  Ref ID : 4749

Target Group/Country Bemba speakers in northern Zambia.

Intervention Methodology The Nshilakamona radio drama portrayed two families in Lusaka and their friends as they responded to problems of raising teen-age children, friendships, making ends meet, sex relations, and AIDS. Messages were that everyone is at risk for AIDS, you can prevent HIV transmission, people should talk to their spouse and children about AIDS, condoms protect against HIV transmission, and it is safer to have only one sex partner. Broadcasts began August 1991 and ran for nine months.

Evaluation Method A baseline survey conducted shortly before the broadcasts began (n=1,613) and a follow-up survey (n=1,682) directly after the broadcasts ended. Both surveys were conducted in Copperbelt and Northern provinces. 1613 men and women in randomly selected households of ages 15-45 years were interviewed in each survey examining knowledge about the transmission and prevention of AIDS, reported condom use and attitudes towards condoms, and reported behaviour related to reducing the risk of HIV transmission. There were no controls. 665 of the 1992 sample were owned a radio and listened (to any programme) to the radio one or more times a week and was classifieds as the high access group and used a form of intervention group to compare with the remainder who where classified as 'low access'.

Impact Achieved Only about 40% of the 'high access' group claimed regular exposure to the radio drama. Knowledge of AIDS and the importance of taking measures to prevent infection increased in the overall sample between 1991 and 1992 (p<0.001), although no changes were reported in the proportions of men and women who stated they had sexual partners outside marriage, and the proportions using a condom to prevent HIV transmission. The surveys also found an increase in the percentage of respondents who had ever used a condom. However most of these increases were found in both individuals with high exposure to the program as well as low exposure. There were only 4 areas where 'high exposure' sub-sample showed a trend towards more change: knowledge of the extended period of infection, willingness to talk to spouses or children about AIDS, and, among women, reports that they had reduced their number of partners and believed that they were more vulnerable to AIDS. Otherwise they were no different in knowledge, attitude, or behaviour from those who had no or low exposure so it is likely that the changes observed were due to educational activities other than the radio programme. This is a very good example of how mass media might be evaluated in the absence of controls. It does seem unclear why the intervention group was defined as the group who had high exposure to radio and not the sub-set who reported high listening. Positive impact on the 'high exposure group' might also be attributed to the higher socio-economic status of that group.

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2  Family Planning and Population Education

Agha, S. & Rossem, R. V. 2015. Impact of mass media campaigns on intentions to use the female condom in Tanzania. International Family Planning Perspectives, 28(3)151-157. Ref ID: 9063

Target Group/County Middle and upper-income women in Tanzania

Intervention Methodology A mass media campaign using a social marketing approach designed to promote discussion of the female condom between partners. Messages were targeted to both men and women. The product was marketed as a method for couples who wanted to protect themselves against pregnancy and HIV. It was branded as "care," with the caption "For couples who care." A mass media campaign to promote the female condom was implemented during 1999.Radio messages promoting female condom use were aired in April -May and in October - November 1999. Advertisements for the "care " female condom were placed in newspapers. The messages discussed the female condom as a family planning method to avoid the stigma of distrust and infidelity associated with the male condom. Potential users were given a detailed explanation of female anatomy by community-based peer educators and health worker workers such as nurses, doctors and
pharmacists who were trained to counsel potential users (details of selection and training of peer educators not provided). Condoms were sold through pharmacies, NGO providers and community-based agents and priced at US$0.44 for a pack of two condoms.

Evaluation Method Data on 2,712 sexually experienced men and women in Tanzania, collected in an exit survey at 33 outlets that sell the female condom, were used to determine if a mass media campaign promoting the female condom had an impact on women's and men's intentions to use this method. Respondents were asked about their exposure to the mass media campaign, to peer education and to explanation of the female condom by a medical provider. They were also asked about their intention to use the female condom in the future. Path analysis was used to determine the impact of the three exposure factors on respondents' intentions to use the female condom. There was not control and no baseline

Impact Achieved 3% of the sample had used the female condom and 11% stated their intention to use it in the future. About 6% of respondents had been exposed to peer education and 6% had been given an explanation by provider on the use of the female condom (p<0.01). In contrast, about 38% of respondents had been exposed to the mass media campaign promoting the female condom (p<0.01). Mass media exposure significantly increased the likelihood that a man or a woman would discuss use of the female condom with a partner. In turn, discussion of the female condom with a partner strongly influenced the intention to use the female condom in the future. However, receipt of female condom-related message from the mass media did not directly affect either men's woman's intention to use the condom. Peer educators and providers had limited coverage, but they had a stronger impact than the mass media on an individual's intention to use the female condom. The study suffers the usual limitation of mass media studies in that it did not have controls. Lack of a baseline is less important with the introduction of a new product. It is disappointing that no information is provided of influences on the persons who were actually using the female condoms however given the small % of users this is understandable.

Agha,S., Karlyn,A. and Meekers,D. (2012) The promotion of condom use in non-regular sexual partnerships in urban Mozambique. Health Policy and Planning 16, 144-151. Reference ID: 9105

Target Group/Country Adults in Mozambique

Intervention Methodology The intervention used a social marketing approach. JeitO Condoms at a subsidized price were introduced in April 1995 (a Portuguese word meaning style, flair and ability). At the time of the study in 1996 the social marketing activities had been underway for 18 months in four provinces and 6 months in the rest of the country with sales through 1500 outlets. IEC support activities included mass media advertising particularly through radio and a network of 80 community-based agents and 10 theatre groups.

Evaluation Method A multi-stage probability sample of 5142 men and women aged 15-49 in urban and peri-urban areas in all 10 provinces. Interviews were included both men and female interviewers and the questionnaire used was an adapted version of the Knowledge Attitude Behaviour Practices survey of WHO translated into local languages. Respondents were first asked if they knew of JeitO. Those that knew of Jeit O were asked : "Through which means of communication did you hear about JeitO?" Response options included posters, promotional material, music cassettes, pamphlets, radio, television, newspapers, theatre and peer groups. A simple count of these elements was used as a measure of intensity of exposure to the communications campaign. There was no baseline. There was no control.

Impact Achieved Intensity of exposure to advertising and knowledge of a condom source are associated with higher levels (p<0.0001)of reported condom use during last non-regular sex, even after adjusting for socio-demographic and other variables. Condom use was 20% among those exposed to less than two sources, 25% among those exposed to two sources and 35% among those exposed to three or more sources of Jeito advertising (adjusted for province, age, sex, education, number of assets, radio listenership). The authors note that like many similar studies, this relies on self-reported data. Also that , while suggesting that the communication components of social marketing had had an impact, the authors note that the level of condom use in non-regular sex was still quite low and a more intensive approach is needed to tackle the problem. Note – lack of a baseline in this case is acceptable because the condom brand did not exist before the programme. A more detailed evaluation of a targeted mass media component of this programme has also been published . See also the following study on a different aspect of the same programme in Mozambique: Karlyn,A.S. (2012) The impact of a targeted radio campaign to prevent STIs and HIV/AIDS in Mozambique. AIDS Education and Prevention 13, 438-451. Ref ID: 9106

Bailey, J. and Cabrera, E. Radio campaigns and family planning in Columbia (1971-1974). Bull.Pan.Am.Health.Organ. 14:126-134, 1980. Ref ID : 883

Target Group /Country Women at reproductive age in 14 cities in Colombia

Intervention Methodology Three radio campaigns sponsored by the NGO Profamilia were carried out to increase attendance at family planning clinics  and legitimise the concept of family planning in 14 Colombian cities in 1971-1974. The campaigns consisted of radio announcements which usually give clinic hours and addresses and stress that any woman can come to the clinics. They do not mention specific family planning methods or how to use them. The 1971 and 1972 campaigns lasted for 6 months and the 1974 campaign lasted for 3 months

Evaluation Method Three approaches to evaluation were used. 1) Starting 3 months before the 1971 and up to 5 months after the 1974 campaign all new acceptors of family planning were asked how they had learned about the services 2) The average rate of new acceptors before the campaigns were determined an any increase over and above this rate was credited to the campaign; 3) trends were determined in the rate at which new accepters were coming in before the campaign and these trends were projected through the campaign period - the campaign was credited with all increases above the levels indicated by those projections. There were no controls.

Impact Achieved There were increases in % of new accepters citing radio as their source of information during each campaign period and the % declined in the intervals between campaign. By treating the persons who had cited radio in the pre- and in-between campaign periods as a form of 'noise' to be subtracted from the % during the campaigns, it was estimated that in 1971 there were 4,072 acceptors who came as a result of the radio. Most persons citing radio as sources came from the three large cities Bogota, Monteria and Medellin and it is possible that women from the smaller cities were more likely to know about the clinics from other sources. Using each of the three evaluation approaches, the apparent campaign cost of attracting each new acceptor was between US9.54 ad US17.72in the 198=71 campaign, between US$3.33 and $9.7 in the 1972 campaign and between $7.85 and $24.05 in the 1974 campaign. The evaluation method 1 based on women's recall of their source of information were in the middle of the above range and it is suggested that it is the best method to use. This evaluation method of plotting impact over time and showing increases during the campaign periods and falls when there are no campaigns provides a convincing evaluation procedure when controls are not possible - the equivalent of showing a dose-response relationship. However it does imply that the changes produced by the campaign are not lasting and there is a continual need for radio campaign. However it should be noted that the objective of the campaign was a simple one - of notifying the community of the time and availability of a service.

Bertrand,J., Salazar,S.G.d., Mazariegos,L., Salanic,V., Rice,J. and Sow,C.K. (1999)  Promoting birth-spacing among the Maya-Quiché of Guatemala.  International Family Planning Perspectives  25, 160-167. Ref ID 8686
Target Group /Country Mayan populations in El Quiché Guatemala

Intervention Methodology An intervention project was conducted in 1993-1996 to increase knowledge about and use of contraceptives, and to improve attitudes toward birth-spacing. The strategy consisted of four components: 1)increasing the numbers of volunteer promoters; 2)increasing quality of services through training , supervisory visits and continuous supply of contraceptives; 3) inter-sectoral collaboration with other development agencies; and 4) an IEC programme. The IEC programme consisted of a national television messages directed at the whole population and media specifically designed for this illiterate Mayan community - including two radio spots, a vehicle-mounted loudspeaker for market place and other community settings and a video produced in local language for showing to meetings and triggering discussions.

Evaluation Design The effect of the intervention was assessed using program-based data (routine service statistics from the leading family planning organization) and population-based data (a 1992 baseline (n=846 married Mayan women aged 15-49) and a 1996 follow-up survey (n=958) conducted in eight municipalities. There were no controls but multivariate analysis was used to attribute impact on programme activities.

Impact Achieved Knowledge of at least one method and positive attitudes toward birth-spacing increased dramatically over the period between surveys. For example, while only 42% of Mayan women in 1992 knew of a modern method, 95% of those interviewed in 1996 did so; moreover, the proportion who responded that birth-spacing was "good" more than doubled over the period (from 43% in 1992 to 88% in 1996). Current contraceptive use similarly rose from 5% to 18% in the period between surveys. The number of volunteer promoters, who are able to reach Maya-Quiché women in remote rural areas, increased notably--from 79 in 1993 to 144 in 1995. The study design could not rule out confounding factors. However, logistic regression revealed that program-related variables (i.e., contact with the private family planning clinic and exposure to birth-spacing messages in the mass media) and previous reproductive experience (i.e., having experienced a mistimed pregnancy) were important predictors of contraceptive use, once social and demographic factors were controlled for. The three-percentage-point annual increase in prevalence among Mayan Guatemalans achieved during this intervention demonstrates that the pace of contraceptive adoption can be accelerated in this hard-to-reach population. However, the process requires an influx of resources and a long-term commitment on the part of program administrators and donors raising issues of sustainability

Black, T.R.L. and Harvey, P.D. A report on a contraceptive social marketing experiment in rural Kenya. Stud.Fam.Plann. 7:101-108, 1976. Ref ID : 893

Target Group /Country Males aged 18-30 in Meru District of Kenya

Intervention Methodology Social marketing approach was used to launch the Kinga Condom in October 1972.. A pinkish-brown lubricated condom  was chosen to be packaged from vertically hung cardboard dispensers holding 12 packets of 3 (each packet with an instructional leaflet) that could be bought for a single coin 50 cents - a price that provided a sales incentive to the retail outlet and distributor. An advertising agency was briefed to develop a promotional programme focused on males 18-30 yrs with the slogan "Kinga - things for men to plan their family with". Messages advocating the heath and economic benefits of child-spacing went out in leaflets, radio (weekly 15 minute question and answer programme, brief announcements) and 6o second spot at commercial village cinema shows, metal shop signs, "dayglo" shelf signs (but posters and cheap leaflets were not used because they quickly deteriorate and would lower the image of the product). These were supplemented with a mobile field education unit which went ahead of the sales/distribution van to carry out family planning instruction, distribute pamphlets and free samples at village markets.

Evaluation Method Sales of condoms were monitored from shops. In May 1972 an independent Nairobi-based market research firm conducted interviews with 506 male respondents aged 16-45  from Meru and 350 from a control area Kirinyaga. Follow-up surveys were conducted after 6 and 12 months of marketing in the test and control districts . In the final survey in November/December 1973 the Meru sample consisted of 499 and the Nirinyagi sample of 350. 200 of the Meru and 105 of the Kirinyaga sample were repeat interviews.

Impact Achieved Estimated total retail sale in Meru of 91,3000 pieces during the 12 months - 18 months after the campaign ended sales in Meru were still running at 5,000 per month. When wholesalers in a remote district were supplied with Kinga without promotional effort - consumer demand was too low to justify continued distribution suggesting that advertising was an important variable. The number of persons reporting use of condoms in Meeru rose from 4% baseline to 15% at the end of 12 months (p<0.01) In Meru prior to the programme 4% of the sample compared to the control district where levels remained at 1%. This rise was due largely to increased use among young married males who had reported that they had bought the condom as a contraceptive for use with both wives and girlfriends. The expenditure was equivalent to $0.11 per fertile couple which was substantially less than $0.030 per household spent to promote detergents and 0.28 per potential customer spent on advertising patent medicines. (However in making such comparisons, it should be remembered that sales of commercial products generate income and it is not clear how much sales of condoms might cover the promotional costs. This study was done in the era before AIDS and in carrying out this economic viability today it might be appropriate to factor in the costs of provision of health care to families to cover both care of increased population and treatment/care for persons with AIDS/STDs.

Foreit,K.G., de Castro,M.P.P. and Franco,E.F.D. (1989)  The impact of mass media advertising on a voluntary sterilization program in Brazil.  Studies in. Family Planning  20, 107-116.Ref ID: 4380

Target Group /Country Men in Saõ Paulo, Brazil

Intervention Methodology Four advertisements ran for ten weeks in eight magazines. There were a total of 27 insertions - 18in weekly magazines and 9 in monthly magazines with an estimated target readership of 4.4 million men over 30 years of age.

Evaluation Method  A before and after time series analysis utilizing the single Pro-Pater Saõ Paulo clinic. Service statistics for the years 1984-1985 provided the baseline; clinic performance was continuously monitored during the intervention and for a 12 month post-intervention period. There were no controls.

Impact Achieved   Clinic performance doubled during the campaign and stabilized at 54% percent higher than baseline. 18% of the new clients arriving during the campaign period reported having seen a magazine ad, as opposed to 4% of new clients in the post campaign period (p<0.01). The advertisement selectively attracted the target audience without bringing in large numbers of ineligible candidates The cost for the advertising campaign was offset by additional revenue generated by the increase in vasectomies performed.

Gupta,N., Katende,C., & Bessinger,R. 2013. Associations of mass media exposure with family planning attitudes and practices in Uganda. Studies in Family Planning 34(1) 19-31.

Target Group/Country General population (70% rural, 30% urban) in Uganda

Intervention Methodology The Delivery of improved Services for Health (DISH) project operated in 12 of the country's 56 districts and activities included: training of nurses and midwives, strengthening of support services for procurement, distribution and storage and conducting communications activities.
The campaigns employed short radio and television spots and a weekly radio drama called "Choices " that integrated family health messages. DISH assisted the Ministry of Health in distributing the national "yellow flower " logo and the new "rainbow over the yellow flower " logo to identify health facilities offering family planning and integrated reproductive health services, respectively, and implemented a publicity campaign encouraging couples to visit facilities displaying the logos to obtain information and services. Posters, flip charts for service providers, and a newsletter entitled "Health Matters " were distributed to health-service facilities. Newsletters were also distributed with newspapers and during community events. A range of other community education activities included drama performances, video shows, and village meetings. All materials were produced in three or four languages. Additional activities were conducted in the DISH districts, including the broadcast of a weekly radio program called "Capitol Doctor " and the social marketing of contraceptives. The Protector TM brand of condom, the Pilplan TM brand of oral contraceptive,and the Injectaplan TM brand of injectable contraceptive were marketed through radio advertisements as well as on billboards and posters at health-service facilities.

Evaluation Method Data are drawn primarily from the 1997(n= 1,697 women aged 15-49 and 900 men aged 15-54) and 1999 (n=1,786 women and 1,057 men of same ages). Delivery of Improved Services for Health (DISH) evaluation surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Additional time-trend analyses rely on data from the 1995 (n=2,316 women and 663 men) Uganda Demographic and Health Survey. Logistic regressions are used to assess the associations between BCC exposure and family planning attitudes and practices, controlling for individuals' background characteristics. To minimize the biases of self-reported exposure, the analyses also explore cluster-level indexes of the penetration of BCC messages in the community. There were no controls

Impact Achieved In 1999,20 percent of women and 30 percent of men of reproductive age were currently using a modern contraceptive,a sharp increase from the 1995 prevalence rates of 13 percent and 14 percent,respectively.
Between 1995 and 1999 reported exposure to family planning messages in the media increased considerably.In 1995,fewer than half (47 percent)of the women surveyed reported that they had heard a family planning message on the radio in the last six months, whereas four years later nearly three-fourths (73 percent)said they had heard one (see Figure 3).Among men, this proportion increased from 61 percent to 79 percent over the same period. Exposure by means of television, posters, and print materials, although generally increasing, remained much less frequent. Men tended to be exposed more often than women to family planning messages, reflecting a pattern of higher proportions of men than women who listened to the radio or watched television overall. More women and men who had heard BCC messages in the media were more likely to practice family planning p<0.001) -or to say they intend to do so in the near future(p<0.05), compared with those who reported little or no campaign recall. Contraceptive prevalence was much higher in 1999 among women who had heard messages on the radio (35% compared to 6% among those with no BCC exposure)
After effects of selected sociodemo-graphic characteristics were controlled, the data show that among current nonusers, women who had seen or heard of family planning logos were more than two and a half times more likely to be contraceptive users and almost two times more likely to intend to use a method in the near future than were those who had not been ex- posed to such logos. Exposure to radio advertisements for family planning services or contraceptives was also found to have positive effects on respondents ' intention to use a method (p<0.001. Among men, exposure to the family planning radio programs broadcast in DISH areas was seen to have a strong effect on both contraceptive use (p<0.001) and intentions (p<0.05). Men who were exposed to radio advertisements were also more likely to be contraceptive users (p<0.001). This study provides a good example of the use of regression analysis to show associations between exposure and impact. As with all such studies the data can be equally be interpreted as indicating that persons who are highly motivated are more like to seek out, listen to and recall campaign messages.

Health Unlimited (1997) Report on the birth spacing campaign evaluation (Cambodia), London: Health Unlimited.. Ref ID : 6859 (Borderline for  inclusion in database)

Target Group /Country Women in Cambodia

Intervention Methodology In October and November 1996 the first large mass media campaign on birth spacing in Cambodia was aired on radio and on TV.

Evaluation Method  Data from government health facilities in Phnom Penh were monitored. 45 interviews were conducted with drug sellers, pharmacists and providers in private clinics. 432 married women and men aged 15 to 44 in Phnom Penh, Kandal, Prey Veng, Kampong Cham and Kampong Chhnang provinces were interviewed to determine recall of the Birth Spacing Campaign. There was no control or baseline (apart from attendance data at the government hospital).

Impact Achieved   The number of new clients reported by providers in all government health facilities in Phnom Penh was higher in October and November when compared to the number in August and September. Of a total number of 45 drug sellers, pharmacists and providers in private clinics, 22 (81%) percent said that they had more clients for contraception in 1996 when compared to 1995 and 20 gave their opinion that this increase was due to the Health Unlimited campaign. 43 percent of the respondents in the survey of women said that they had heard and seen messages on both radio and TV. 69% recalled at least one spot, song or programme on TV and 87% at least one spot or programme either on radio or TV or on both. A limitation of this evaluation is that actual numbers of increased new clients at private providers are not given - only whether the providers considered the attendance had increased. Also the data from the survey of women is only on coverage and not impact.

Jato,M.N., Simbakalia,C., Tarasevich,J.M., Awasum,D.N., Kihinga,C.N. and Ngirwamungu,E. (1999)  The impact of multimedia family planning promotion on the contraceptive behavior of women in Tanzania.  International Family Planning Perspectives  25, 60-67. Ref ID 8678

Target Group /Country Women of reproductive age in Tanzania

Intervention Method The FP Communication Project operated during 1991-94 and educated men and women about the health benefits of modern contraception. The multimedia campaign relied on radio spots in 1993 and 1994, a radio serial drama called Zinduca during 1993-94, a Green Star logo, posters, leaflets, newspapers, and audiocassettes. Other campaigns were carried out by five other organizations using radio and television.

Evaluation design Nationally representative data were obtained from a 1994 KAP Survey (n=4225)  drawn from 20 regions. Women were asked whether they had heard, seen or read any family planning messages in the last six months in five media channels - radio, newspapers, posters, leaflets and television. Additionally, respondents were asked specifically whether they had heard Zinduka! or had seen the family planning logo campaign. They were also asked if they could name up to seven media sources with family planning messages. Information was also gathered on current contraceptive use, visits to health centers and communication about family planning with their spouse.

Impact Achieved 55% of women had been exposed to family planning messages in the previous six months. Radio was the most widespread source of family planning information reaching 49% of respondents. 23% of women had seen family planning messages in newspapers, 18% from posters, 8% from leaflets and only 4% from television. Roughly half of the radio listeners or 23% of all respondents recalled hearing the programme Zinduca! Current use of modern methods was far greater among women who recalled family planning messages that among those who did not (18% v. 3%).Contraceptive prevalence rose sharply as the number of media courses. 9% of women exposed to one media sources were using a modern method, compared with 15% for two media sources, 19% for 3 and as high as 45% among women exposed to six media sources. Women exposed to one media source of family planning messages are 1.5 times as likely as women not exposed to any of the 7 media sources to be practicing contraception (p<0.001) while for women exposed to six media sources the likelihood is 9.2 times more (p<0.001). Women exposed to FP messages were more likely than other women to discuss FP with their spouses and to visit health facilities. These effects remained after controls for residence, education, age, marital status, parity, approval of FP, partners' views on FP, and radio ownership. A difficulty with this kind evaluation is the assessment of the direction of causality.

Kane,T.T., Gueye,M., Speizer,I., Pacque-Margolis,S. and Baron,D. (1998)  The impact of a family planning multimedia campaign in Bamako, Mali.  Stud. Fam. Plann.  29, 309-323. Ref ID: 8059

Target Group/Country Urban households in Bamako, Mali

Intervention Methodology An integrated multimedia campaign featuring family planning messages saturated the 900,000-person city of Bamako, Mali, for three months during the spring of 1993. With traditional theatre and music, family planning messages were repeatedly broadcast on radio and television that conveyed information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for communication between spouses, and that Islam, the predominant faith of Mali, does not oppose family planning. Note planning of this programme incorporated elements of Fishbein's theory of Reasoned Action and Social Learning theory of Bandura. The educational component of the intervention is very well described.

Evaluation Method A pre-intervention baseline survey was carried out in November December 1992 with a sample of 402 men and 422 women, and the post-intervention survey was carried out in July-August 1993 with a sample of 418 men and 450 women.  The survey assessed respondents' exposure to the mass media interventions, their agreement with the messages and actions taken, as well as their knowledge and use of contraceptives, attitudes towards family planning, awareness of project services and background socio-demographic variables. There was no separate control and multivariate analysis was used to  relate changes with degree of exposure to campaign activity.

Impact Achieved Results indicate a high level of exposure to the messages. Typically over 90% of men and women in the second sample reported seeing family planning play/s messages on television or radio representing a significant increase over the baseline (p<0.01). Initial levels of contraceptive knowledge were already high There was an increase in the % of respondents who stated their intention to use modern methods of contraceptives in the future (p<0.05). A dramatic drop was found in the proportion of men and women who believe that Islam opposes family planning (p<0.05). Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with intensity of exposure to the project (p<0.01) interventions, after controlling for relevant variables. The main limitation with using this approach and not using controls is the possible explanation that people who most sympathise with family planning messages might also be the ones who are more likely to recall the television and radio programmes and messages and this is discussed  by the authors of the paper.

Kim,Y.M., Marangwanda,C., Nyakauru,R. and Chibatomoto,P. (1998) Impact of the promotion of youth responsibility project campaign on reproductive health in Zimbabwe 1997-1998 (Evaluation Report),  Harare/Baltimore:  Zimbabwe National Family Planning Council/Centre for Communication Programs, John Hopkins University. Ref ID8724

Target Group/Country Young people in five urban centres in Zimbabwe

Intervention methodology The Promotion of Youth Responsibility Project (PYRP) was initiated in October 1995 by the Zimbabwe National Family Planning Council. with the aim of increasing young people's knowledge of reproductive health issues and to encourage them to adopt behaviours that reduce the risk of pregnancy and STIs including HIV/AIDS. An intensive six-month multimedia campaign was mounted in five sites using a variety of communication channels, including posters, leaflets, newsletters, radio, drama, campaign launch events, peer educators, and a telephone hot line. Campaign support activities included: a message design workshop to develop information, education, and communication (IEC) materials, training programs to help leaders of drama groups and supervisors develop youth dramas, and seminars to solicit the support of media personnel and local leaders.To improve the quality of youth counseling at health facilities, a reproductive health training and counseling manual was developed for service providers. Selected service providers from youth organizations then attended a two-week training of trainers (TOT) workshop to learn how to use the manual. Afterwards, these trainers conducted one-week courses in interpersonal communication and youth counselling skills for family planning service providers and two-week courses for peer educators

Evaluation Method .
A baseline survey with 1400 respondents was carried out April/May 1997 3 months before the campaign with a follow-up survey of 1400 sample one year later which include the questions from the baseline with additional questions about exposure to the youth campaign. The survey was carried out in the 5 experimental sites and 2 comparison sites who were not true controls because they also received the radio broadcasts and posters and had been exposed to other educational activities.

Impact Achieved Significant increases were achieved in knowledge of contraceptive methods (p<0.001) and reproductive health issues (p<0.01). Significantly greater (p<0.001) proportions of young people in the campaign sites reported talking about reproductive health issues with friends (72% in campaign group cf. 33% in comparison), with siblings (48% cf. 20%), with parents (44% cf 15%)), with teachers (34% 14%) or with their partners (24% cf 13%). More (p<0.01) reported visiting a health centre (28% cf 10%) or a youth centre (11% cf 2%). More than half (53%) of all respondents in the campaign sites reported that they had said "no" to sex as a result of exposure to campaign activities and materials compared with 32% in comparison sites (p<0.01). There was a greater level (p<0.05) among the 304 young people in the campaign sites and 94 in the comparison who had had some sexual experience in the following self reported actions: adoption of monogamy (21% cf. 2%), stopping having sex (13% cf 3%), used condoms (9% and 0%) and avoided sugar daddy (8% and 1%). The greater a respondent's exposure the campaign (measured in terms of how many of the 8 components a respondent saw, heard or attended), the more likely she or he was to report taking some action in response. Young people with limited campaign exposure (1-2) components reported on average taking two actions in response compared with nearly 5 actions reported by those with intensive campaign exposure (5-8 components)

Kim,Y.L., Kols,A.N.R., Marangwanda,C. and Chibatamoto,P. (2012) Promoting Sexual Responsibility Among Young People in Zimbabwe. International Family Planning Perspectives 27, 11-19. Reference ID: 9094

Abstract: Target Group/Country Young people in Zimbabwe

Intervention Methodology A six month multimedia campaign promoted sexual responsibility among young people in one urban and four semi-urban sites.
The campaign was based on the Steps to Behavior Change framework, which synthesizes theories of communication and behavior change into a practical model to guide reproductive health communication pro g r a m s .1 5 The framework describes five stages through which people pass as they change their behavior: knowledge, approval, intention, practice and advocacy. Effective communication campaigns determine the stage that their audience is at and focus their energies accordingly. The campaign's logo, a yellow triangle with a blue circular "youth-friendly" seal, was featured on all materials. •Posters. A series of eight posters carried messages like "Value your body and a happy future lies ahead" and "You may think you are ready for sex, but are you ready for the consequences?" In campaign sites, 10,000 copies of each poster were distributed.. •leaflets . Five leaflets—on abstinence, how to say no to sex, postponing sex, delaying parenthood and STIs—were produced, and 19,000 copies of each were distributed. In addition, the popular older ZNFPC booklet Facts About Growing Up continued to circulate. •Newsletter. Peer educators and schools distributed 100,000 copies of Straight Talk, a four-page newsletter on reproductive health issues of importance to young people. Each of the three issues included advice columns and articles written by young people. •Radio programme . . During the campaign, 26 episodes of Youth for Real, a one-hour radio variety show, were broadcast nationwide. This weekly program, which has continued to air since the campaign ended, combines information and advice with entertainment such as music and mini-dramas. Listeners can phone the show to ask questions of a peer counselor and doctor. •Launch events. To mobilize community support for the campaign, local committees spent months planning elaborate launch activities and garnered substantial support from local businesses. Popular musicians attracted large crowds to the launches, which featured different activities at each site, including speeches, dramatic performances, drum majorettes, soccer games, donkey parades and a parachute drop. Adults who influence youths—including chiefs, counselors, church leaders, parents, siblings, teachers and service providers—attended the launches. •Dramas . During the first two months of the campaign, two community theater troupes performed daily at schools, churches and town centers, presenting interactive dramas on reproductive health issues. Peer educators accompanied the troupes and facilitated a discussion with members of the audience after each performance. •Peer educators. Peer educators aged 18–24 w e re recruited from the community and trained to speak with groups of young people at schools, churches and town centers and with individuals at home. Four educators were assigned to each grow t h point and six to Mutare. A hotline was installed at the Mutare Youth Centre staffed by peer educations and operating 8 hours a day.

Evaluation Method A pretest questionnaire was administered to 973 young people aged 10-24 in the five intervention sites and to 453 in the comparison site and a post-test was given to 1000 in the intervention and 400 in the comparison site. The comparison was not a true control as the young people could receive the radio programmes and some of the materials. In addition to repeating the questions asked at baseline, the sample were asked questions to determine their exposure to the campaign. Logistic regression analyses were conducted to assess exposure to the campaign and its impact on young people's reproductive health knowledge and discussion, safer sexual behaviors and use of services.

Impact Achieved The campaign reached 97% of the youth audience. Awareness of contraceptive methods increased in campaign areas, but general reproductive health knowledge changed little. As a result of the campaign, 80% of respondents had discussions about reproductive health--with friends (72%), siblings (49%), parents (44%), teachers (34%) or partners (28%). In response to the campaign, young people in campaign areas were 2.5 times as likely as those in comparison sites to report saying no to sex (p<0.01), 4.7 times as likely to visit a health center (p<0.01), and 14.0 times as likely to visit a youth center. (p<0.01), Contraceptive use at last sex rose significantly (p<0.05) in campaign areas (from 56% to 67%). Launch events, leaflets and dramas were the most influential campaign components. The more components respondents reported exposure to, the more likely they were to take action in response. Given that the comparison group were also exposed to elements of the campaign, this intervention has achieved some impressive results.

Kim,Y.M. and Marangwanda,C. (2013) Stimulating men's support for long-term contraception: a campaign in Zimbabwe. Journal of Health Communication 2, 271-279.Reference ID: 9095

Target Group/Country Men in Zimbabwe.

Intervention Methodology A 1993–1994 male motivation campaign to encourage couples to use modern contraception using a diverse mix of radio and television programming, print materials, and community events. The campaign was conducted for 6 months from September 1993 to March 1994 in five sites, including three cities (the capital, Harare; Zimbabwe's second largest city, Bulawayo; and a small city, Gweru) and two offcially designated rural "growth points,"Gutu Mupandawana and Murehwa.
The 6-month campaign was divided into three brief phases, each featuring its own slogan. In a reference to Zimbabwe's football team, heralded as the "Dream Team," the first phase of the campaign asked men, "Do you have a dream?" and explained how family planning could help make that dream a reality by limiting the size of their families. The second phase advised men to "Play the game right" by consulting a service provider about the many contraceptive methods available. The third phase encouraged men to include their partners in family planning decisions with the slogan, "It takes two to plan a family." The idea of winning was reiterated throughout the campaign because it was a compelling, virile image that planners thought would prompt men to take action. The campaign included 10 main elements, grouped into three categories: mass media, print materials, and community events. The mass-media efforts included two radio dramas created expressly for this campaign and broadcast weekly over a 6-month period. One drama used the Shona language, and the other used the Ndebele language. The stories showed how family planning improved the lives of responsible male characters, who served as role models; in contrast, large families contributed to the downfall of weaker characters. Radio and television spots used sports analogies to promote the use of longterm and permanent contraceptive methods for limiting family size, to encourage men to consult service providers, and to urge men to discuss family planning with their partners. The campaign also used various print media. A series of 10 posters displaying pictures of prosperous, happy families carried messages urging the use of long-term and permanent contraceptive methods for health and economic reasons. Three pamphlets were distributed at clinics and campaign events—one discussed the health and economic benefits of family planning, the second reviewed available contraceptive methods, and the third described male and female sterilization. Photos of famous football players illustrated a series of three newspaper and magazine advertisements that urged men to limit family size with long term and permanent contraceptive methods, to consult family planning service providers, and to plan their families jointly with their wives. The campaign sponsored .five types of community events. Zimbabwe's most popular teams played in a four-game football tournament, the "Family Planning Challenge Cup." Performing at half time, larger-than-life-size puppets portrayed a couple and the contraceptive methods they adopt. Fans attending the games received family planning literature and condoms. Dori dramas staged at public venues featured the same giant puppets. The Amakhosi Theater Troupe performed live dramas at campaign launch activities and in heavily traf.cked public venues. The plays were designed to make audiences aware of the need for family planning, especially the need to limit family size. An all-day family festival launched the campaign in each of the five campaign sites. Processions through the streets attracted large audiences to the festivals, which included assorted musical and dramatic performances, speeches, and competitions, all with family planning themes, to entertain the crowds. Health workers gave motivational talks at workplaces, colleges, beer halls, and other places where men congregate. They urged male involvement in family planning and the use of long-term and permanent contraceptive methods by both women and men. The project also included a training component to correct a bias among service providers toward short-term contraceptive methods (particularly the pill) and to improve counseling skills.

Evaluation Method Household surveys of randomly selected men ages 18–54 and women ages 15–49 were conducted both before and after the campaign. A baseline survey of 1,019 respondents was conducted in July 1993, two months before the campaign was launched, and a follow-up survey of 1,016 respondents was conducted in May 1994, two months after the campaign was concluded. Family planning service statistics were collected in the campaign areas from 23 health facilities randomly selected from among those administered by the MOH, Harare and
Bulawayo City Health Departments, and ZNFPC. There was no control because the campaign was carried out in the two largest cities and there were not other equivalent cities in Zimbabwe to designate as controls.

Impact Achieved The campaign reached 88% of men and women in the 5 campaign areas. The percentage of respondents using a modern contraceptive method rose steadily, from 30% to 66%, with increasing exposure to the campaign. Women and men exhibit similar patterns. Individuals exposed to three or more campaign elements are 1.6 times more likely to use a modern family planning method, even when controlling for gender, marital status, residence, age, education, and socioeconomic status (p<0.01). The regression analysis also found that campaign exposure was associated with knowledge and approval of modern family planning methods. People exposed to three or more campaign components are 2.5 times more likely than others to know at least three modern methods and 1.6 times more likely to approve of using a modern method.
29% of men with high levels of exposure to the campaign (i.e., to four or more components) reported taking some action in response compared with just 16% of those with medium exposure levels (two or three components) and 2% of those with low exposure levels (none or only one component; p< .001).
Four of the components—the radio drama, radio and television spots, posters, and pamphlets—each reached more than one-half of the intended audience in campaign sites, with the radio drama having the greatest reach of all.them. In discussing the validity of the findings the authors point to the problem of not being able to establish a true control and the possibility that persons with greater interest in the subjective might actively seek out the IEC broadcasts. They also point to the short time interval of only 10 months between the pre and post test. They provide a thoughtful discussion of the issues of reaching men and the risks that male-oriented messages might reinforce male stereotypes rather than challenging

Kincaid, D. L., Merritt, A. P., Nickerson, L., Buffington, S. D., de Castro, M. P. and de Castro, B. M. (1996) Impact of a mass media vasectomy promotion campaign in Brazil. International Family Planning Perspectives, 22, 169-175. Ref ID: 6773

Target Group/Country Men aged 25-49 y in cities of Sao Paulo, Fortaleza and Salavador, Brazil

Intervention Methodology A mass media campaign conducted in 1989 in 3 Brazilian cities. The specific communication objectives were to increase knowledge and awareness of vasectomy and to increase the number of vasectomies obtained by lower middle-class med age 25-49. The 1989-1990 campaign n was implemented in four distinct phases: Pre-campaign public relation events were held; television spots were broadcast in May and June of 1989; these spots were broadcast in September of 1989; and a follow-up mini-campaign was conducted early in 1990. The slogan "Vasectomy is an an act of love" served as the main them for the campaign. A companion piece for radio featured a father explain vasectomy to his son followed by a slogan. The pre-campaign public relations promotion included issuing press releases that described the project and personally contacting key members of the Brazilian press.

Evaluation Method The average monthly numbers of calls and clinic visits in the 6-month period preceding the campaign, during the 6-week campaign period, and in the 6 months after the campaign were, recorded at three clinics. There were no controls.

Impact Achieved The average monthly numbers of calls and clinic visits in the 6-month period preceding the campaign, during the 6-week campaign period, and in the 6 months after the campaign were respectively, 15, 35, and 12 at the PRO-VAS clinic in Fortaleza; 39, 105, and 85 at the CEPARH clinic in Salvador; and 529, 1911, and 679 at Sao Paulo's PRO-PATER clinic. The mean numbers of vasectomies performed per month before, during, and after this campaign, respectively, were 12, 25, and 7 at the PRO-VAS clinic; 32, 51, and 59 at CEPARH; and 303, 550, and 542 at the PRO-PATER clinic. In-depth analysis of PRO-PATER clinic data revealed that the dominant source of referrals among clinic callers shifted from friends and relatives (55%) before the campaign to television spots (58%) during the campaign period. Although the television spots accounted for US $78,615 out of the total campaign budget of $172,910, they resulted in a total net gain of 3264 clinic visits/calls and 1854 vasectomies, for cost-effectiveness ratios of $53 per call/visit and $93 per vasectomy (actual cost, $110). Trend data for the 1981-92 period suggest, however, that the 1989 campaign only temporarily reversed a long-term downward trend in the number of vasectomies performed by the PRO-PATER clinic. The authors suggested two possible reasons for the downward trend in vasectomies at public health clinics - cost and the availability of alternative places to go for vasectomy, but the present study did not provide the data to investigate these two explanations. Notes: This intervention is also described in REF ID 9235. The evaluation design did not have a control but the striking dose response effect provides a strong indication that the increased uptake was an effect of the campaign.

Kincaid, D.L., Yun, S.H., Piotrow, P.P.T. and Yaser, Y. (1993) Turkey's mass media family planning campaign. In: Backer, T.E. and Rogers, E.M. (Eds.) Organizational aspects of health communication campagns: what works? pp. 68-100. Newbury Park, London, New Delhi: Sage Publications] Ref ID : 7319

Target Group/Country National programme in Turkey

Intervention Methodology An intensive national campaign was run from October to December 1988 to promote the concept of family planning as opposed to the narrower concept  of birth control to increase women's awareness of modern contraceptive methods  and their availability, to promote discussion between partners about family planning and family size and to generate support for the national family planning programme. Focus group discussions among women were used to generate campaign message themes which were communicated through television spots, dramas ( including a three-part drama"Sparrows don't migrate") and documentaries supported by radio and print media. Extensive use was made of humour, music and emotional drama in the context of realistic interpersonal situations

Evaluation Method  A base-line survey was carried out of a stratified random sample of 2,147 married women aged 15-44 and a follow-up 1-2 months after the national campaign ended of 2,145. This was supplemented by six focus group discussions and three targeted 'day after' surveys and review of records of 28 family planning clinics

Impact Achieved   Evaluation showed a high coverage - 80% of married women were exposed to the campaign, 63% said that they had talked to their husbands about family planning and 10% of married women said they had visited a family plannng clinic as a result to the campaign and a further 20% said that they intended to make a visit. There was an increase in use of modern contraceptive method (4.2%) over the four-month period compared to the typical annual increase of 1-2% per year during the years before the mass media campaign. While provided in-depth discussion of the campaign, this report does not include raw data on the evaluation or any significance tests.

Kiragu,K., Hulzen-Sienché van,C., Obwaka,E. and Odallo,D. (1998)  Adolescent reproductive health needs in Kenya: a communication response. Evaluation of the Kenya Youth Initiatives Project,  Baltimore:  Centre for Communication Programs, Johns Hopkins University. Ref ID8723

Target Group/Country Young people aged 10-19 years in Kenya

Intervention Method The Kenya Youth Initiatives Project started in 1994 with an aim to encourage healthy and responsible sexual behaviour among youth. The educational component included two radio programs, the Youth Variety Show, which broadcast 79 episodes, and Dau La Ujana, which broadcast 26. The Youth Variety Show was an interactive, hour-long English-language program that aired on Saturday mornings. The show was hosted by well-known personalities and was designed to provide young people with information related to growing up, with a special focus on reproductive health. Each episode featured a panel of adolescents and expert guests who would discuss various issues to stimulate open dialogue. Telephone calls from young listeners were also taken on the air to encourage participation and exchange of perspectives and experiences and to answer questions.Dau La Ujana was a 15-minute radio drama in Kiswahili, broadcast Sunday evenings. The story revolved around a teenage girl and her interactions with her supportive parents and boyfriend, whose parents were not supportive. In the context of the story, the show explored many of the issues teens face, using humour and proverbs generously to convey messages about responsible sexual behaviour.

Evaluation Method Questions related to the programme objectives were included in an on-going commercial market research survey covering various product areas.  803 person aged 15-24 were surveyed 10 months after start of broadcasts and 779 8 months later after the broadcasts had finished. The samples contained 84.1 and 794 % from rural areas for the first and second survey and had a representative mix of socio-economic groups. Data was gathered from three centres that serve young people. Each day new clients were interviewed and asked how they learned about the facility.

Impact Achieved 54% and 55.9% of the young people interviewed had listened to the Youth Variety Show in the first and second survey, translating to over 3.3 million adolescents. Roughly 41 percent of the adults interviewed in the post-programme survey were also listening to the program. Nearly a fifth of the youth had become avid listeners of the program, making time to listen to the weekly program regularly. Just about 40 percent of youth and adults questioned in the first survey were also listening to  Dau La Ujana (there was no second survey data as the programme had to be discontinued because of cuts). Analysis of data from three youth-serving sentinel sites showed that radio had become the leading source of referral to youth clinics. At the inception of the program, only 23 percent of the youth (n=191) cited radio as the main source of referral; within four months of the initiative's commencement, 56 percent of the youth cited radio, while all other sources of referral declined or remained unchanged. The Youth Variety Show reached the 3.3 million youth at a cost of 0.03 US$ (three cents) per adolescent reached. Nearly 1. 1 million youth recommended the program to others, at a cost of 0.09 US$ per youth to encourage others. Over 800,000 took an action as a result of the show, at a cost of 0. 12 US$ per youth. Among these, 60,000 visited a youth clinic or wrote or called the program producers, translating to $1.62 per youth who took such an action, about the cost of a loaf of bread. These data show that reaching young people and encouraging positive health behaviour can be achieved at relatively little cost.

Montazeri, A. (1995) Health education campaign on population control: lessons from Iran. Public Health 109, 425-430. Ref ID : 4131

Target Group /Country Billboards reaching generaal public in Tehran, Iran.

Intervention Methodology A health education campaign using a billboard on population control in Tehran. . Picture shows a "red traffic light and alongside it there the top "Two children are enough". The report does not give the duration of the campaign .

EvaluationMethod A sample of 68 adults aged 20 to 40 years participated in the study. Each respondent was shown a picture of the campaign billboard. They then filled in a short questionnaire. The main objectives of the study were to measure recall rates and to assess attitude of the subjects.

Impact Achieved   78% had seen the campaign advertisement, 68% of respondents claimed that the campaign was likely to change their attitudes towards population control, and 87% of participants perceived the main  family planning idea of the campaign correctly. It is intriguing that respondents believed the campaign to have more effect on other people (65%) than themselves (54%), (P< 0.00001).

Piotrow, P.T., Rimon, J.G., Winnard, K.D., Lawrence Kinkaid, D., Huntingdon, D., and Convisser, J. Mass media family planning promotion in three Nigerian Cities. Stud.Fam.Plann. 21(5):265-273, 1990. Ref ID : 4383

Lettenmaier, C., Krenn, S., Morgan, W., Kols, A., and Piotrow, P. Africa: using radio soap operas to promote family planning. Hygie 12(1):5-10, 1993.  Ref ID : 236

Target Group /Country General public in three cities of Nigeria-Ilorin, Ibadan and Enugu, Nigeria

Intervention Methodology "Enter-educate approach" Family planning skits, prepared with advice and support from the local service providers, were included in existing popular Television entertainment shows. A three year coordinated multi media approach using service statistics as an indicator of the campaigns Intervention:  January 1984-March 1987.  Four radio spots broadcast 169 times, five television broadcast 110 times, two newspaper advertisements for six weeks, six posters 1500 copies, publicly- orientated state campaign launch, family planning songs by nurses and mothers in health care clinics.

Evaluation Method Questions asked in a recall survey among the exposed population in Enugu (n=299) and Ibadan (n=831)and clinic data was monitored during and after the campaign.

Impact Achieved About half of those surveyed in both cities had seen the television episodes. Of those who had watched, 69% (Enugu) and 99% (Ibadad) respectively, recalled the family planning messages and 69 and 88 %, respectively, recalled specific clinic sites mentioned. Following the media promotion the number of new clinic clients per quarter in Ilorin increased almost fivefold ( in the original clinics evaluated); in Enugu, the number of new clients per month more than doubled; and in Ibadan, the number of new clients increased threefold. The authors claimed that the success of the three programmes was due to audience analysis and pre-testing of methods and messages, close links with the media producers and broadcasters and health providers  and use of popular television programmes to transmit family planning messages

Piotrow, P.T., Kincaid, D.L., Hindin, M.J., Lettenmaier, C.L., Kuseka, I., Silberman, T., Zinanga, A., Chikara, F., Adamchak, D.J., Mbizvo, M.T., and et a Changing men's attitudes and behavior: the Zimbabwe Male Motivation Project. Stud.Fam.Plann. 23(6 Pt 1):365-375, 1992.  Ref ID : 59131.

Target Group/Country Men in Zimbabwe

Intervention Methodology A multimedia communication campaign was conducted between 1988 and 1989 to promote family planning among men in Zimbabwe. The campaign consisted of a 52-episode semi-weekly radio soap opera, about 60 motivational talks, and two pamphlets about contraceptive methods.

Evaluation Method Changes over time were measured by comparing a subset of a follow-up survey conducted from October to December 1989 to a baseline survey conducted from April to June 1988. Men exposed to the campaign were also compared to men who were not exposed.

Impact Achieved The follow-up survey revealed that the campaign reached 52 percent of men aged 18 to 55. Among married Shona-speaking men, use of modern contraceptive methods increased from about 56 percent to 59 percent during the campaign. Condom use increased from about 5 percent to 10 percent. Awareness and current use of modern contraceptives was also higher among men exposed to the campaign, primarily because of their greater awareness of condoms. Men exposed to the campaign were significantly more likely than other men to make the decision to use family planning and to say that both spouses should decide how many children to have.

Rimon II,J.G., Treiman,K.A., Kincaid,D.L., Silayn-Go,A., Camacho-Reyes,M.S. and Coleman,P.L. (1994)  Promoting sexual responsibility in the Philippines through music: an enter-educated approach. Occasional paper series no. 3,  Baltimore:  Centre for Communication Programs, Johns Hopkins School of Public Health. Ref ID 8722

Target Group/Country Young people in the Philippines

Intervention methods The Philippine young people's Project was carried out between 1987 and 1990 used an enter-educate strategy which involved a multi-media campaign centred around two 'pop' songs and music videos with messages about sexual responsibility and prevention of teenage pregnancy. These coincided with the launching of a telephone hotline 'Dial-a-friend'. A singer was teamed up with a group to produce the songs and commercial sponsorship was also received for the project. Free television and air-time was given to play the records and for appearances of the group. Volunteer counsellors were trained for the telephone hotline which was also promoted through TV and radio spots.

Evaluation Method A Baseline survey of 600 12-24 year olds before the programme was followed by a mid-project survey of 600 more and a final survey of 600 youths.  A monitoring system was set up to the hotline in which counsellors were trained to log in each call and collect information on the profile of the caller, the type of caller, their problem and the assistance provided. There were no controls. Statistical analysis of data is not presented in the report.

Impact Achieved The song hit top of the charts in several radio stations. There was extensive coverage in newspapers and television. 92% of youth questioned in the second survey recalled the song and almost most of them (90%) liked it and many (70%) could appropriately interpret the message. 51% said it had influenced their behaviour and, 44% said they had talked about their behaviour with friends and 25% said that they had sought information about contraceptives as a result of hearing about it. Recall of the song was higher among females (60%) than males (43%) but a higher percentage of males  (33%) than females (22%) said that they had sought contraception after hearing the song. The video was the highest recalled of all pop videos by the sample (21%). Counsellors received 8000 calls in the first four months and 22285 calls over 19 months. Most callers were female, about half the callers had specific problems to discuss, the most common problem being about boy-girl relations. Counsellors considered that more than half (62%) of the problems were satisfactorily resolved as a result of the counselling.

Rogers,E.M., Vaughan,P.W.Swalehe,R.M.A., Rao,N., Svenkerud,P. and Sood,S and Sood,S. (1999)  Effects of an entertainment-education radio soap opera on family planning behaviour in Tanzania.  Studies in Family Planning  30, 193-211.Ref ID: 8809
Vaughan,P.W. and Rogers,E.M. (2011)  A staged model of communication effects: evidence from an entertainment-education radio soap opera in Tanzania.  Journal of Health Communication  5 , 203-227.Ref ID: 8808

Target Group /Country Communities in Tanzania

Intervention Methodology A radio soap opera Twende na Wakati (Let's go with the times) was broadcast in Swahili twice per week for 30 minutes from July 1993 through to the end of 1999.Three character types are featured in the soap operas; positive and negative role models, who share or reject, respectively, the educational issues in the targeted values and transitional charters whose attitudes and behaviours change during the soap operas. Communications of Innovation and Stages of Change theories were combined to produce a staged model on which the intervention was based. This included the six stages 6 stages: Pre-contemplation, contemplation, preparation, validation, action and maintenance.

Evaluation Method  The soap opera was not broadcast in one region (Dodoma) from 1993-1995 to create a comparison area so that an experimental design could be used. From 1995 to 1997 all regions received the broadcasts and Dodoma received the earlier episodes. Five surveys based on personal interviews were carried out from just priori to broadcast in 1993and at one year intervals. Respondents included females aged 15-49 and males aged 15-60 (ages ranges chosen to be inline with another national survey to allow comparison. 5 districts were chosen at random in the comparison area and 9 districts in the treatment area - each district with average sample size of 214. The number of new and continuing adopters of family planning methods since January 1990 were obtained by clinic's intake records gathered from a sample of 79 Ministry of health clinics - 20% of the new adopters were asked to recall sources of influence. Data from annual Demographic and Health Surveys were also drawn upon.

Impact Achieved Between 1993-1995 there was an increase in self-efficacy as indicated by a respondent's belief in the ability to determine one's family size, increased by 11% in the treatment area and 6% in the comparison area (p<0.05).The proportion of married women who practice family planning ("always use" and "sometimes use") increased by 10% in the treatment area and decreased by 11% in the comparison area (p<0.05 and p<o.01 on two tests used). Between 1994 to 1998 25% (3,739) of the new family planning adopters reported, in answer to an unaided recall question, that their main source or channel of referral in adopting a method was "Twende na Wakata" on its own or in combination with another source. The validity of the six stage model of adoption is discussed. In the intervention area the had observed increases in the % of respondents in the maintenance stage, decreases in the % in contemplation and validation stage and little change of % of respondents in the pre-contemplation, preparation and action stages.

Sharan,M. and Valente,T.W. (2015) Spousal Communication and Family Planning Adoption: Effects of a Radio Drama Serial in Nepal. International Family Planning Perspectives 28, 16-25. Reference ID: 9101

Target Group/Country Couples of reproductive age in Nepal

Intervention Methodology Two entertainment-education radio serials, supplemented with radio spots, national-level orientation workshops, district-level training workshops and print materials. The radio serials are Cut Your Coat According to Your Cloth, directed at couples of reproductive age, and Service Brings Rewards, a distance education program for family planning service providers.

Evaluation Method Panel data from a population-based survey in Nepal were collected over three waves, from 1994 to 1999. The baseline survey was conducted in September–October 1994 among a sample of 3,403 respondents—2,716 women and 687 men, who were predominantly husbands of a subsample of women. A follow-up survey took place in January 1997. The total sample size was 3,621—2,950 women and 671 men. In all, 1,905 women and 149 men were interviewed on both occasions. A third survey was carried out in March 1999 among a sample of 3,152 women and 665 men. Data from 1,442 women interviewed at all three waves of datacollection were used to assess changes in couples' family planning decision-making, identify predictors of spousal communication and family planning use in relation to program exposure, and clarify temporal relationships among these variables. Five spousal communication questionnaire items were included in all three waves of the survey: whether couples had ever discussed family planning, whether they had discussed it in the past 12 months and whether they intended to discuss it; whether women believed their spouse approved of family planning; and whether they were aware of the number of children their spouse wanted. Exposure to the campaign was measured by a questionnaire item that asked respondents whether they had ever listened to Cut Your Coat According to Your Cloth. Family planning use was measured by a question asking women if they were currently using any contraceptive method (traditional or modern).

Impact Achieved Women exposed to the program had significantly elevated odds of believing that their spouse approved of family planning and of having discussed family planning with their spouse (odds ratios, 1.8-1.9 p<0.01) . Those who communicated with their spouse had elevated odds of using family planning (10.2 p<0.01). Spousal communication at baseline was associated with subsequent family planning use, independent of campaign exposure. In addition, among couples who had not already been discussing family planning, exposure led to communication, which in turn led to family planning use. Over time, husbands' dominance in making family planning decisions gave way to joint decisionmaking and an increase in women's decision-making power. The authors point to some selectivity bias in panel members vs dropouts and discuss the effect on the data. The study attempted to control for selective exposure – that persons using contraception at the outset were more likely to listen to the programme.
The authors point to some selectivity bias in panel members vs dropouts and discuss the effect on the data. The study attempted to control for selective exposure – that persons using contraception at the outset were more likely to listen to the programme.

Story,D., Boulay,M., Karki,Y., Heckert,K. and Karmacharya,D.M. (1999)  Impact of the Integrated Radio Communication Project in Nepal, 1994-1997.  Journal of Health Communication  4, 271-294. Ref ID: 8650

Target Group /Country Communities in Nepal

Intervention Methodology Multimedia reproductive health campaign which began in 1995. It consists of two entertainment-education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and promotions, and complementary print materials.

Evaluation Method Impact data from a variety of sources, including a pre- and post-intervention panel survey of currently married women (n = 2716, pre- and n=1905 - the same women as the pre-test), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. There were no controls.

Impact Achieved   The study found  improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization clinic data, all attributable by regression analysis to the RCP (p<0.0001). A significantly higher (p<0.001) proportion of the women who adopted family planning between 1994 and 1997 or used contraceptives continuously during that period reported exposure the RCP communications compared with women who were continual nonusers or who discontinued during the period. The likelihood of a causal relation between the intervention and adoption is reinforced by the multiple sources of data - the survey and clinic data which both pointed to an effect.

Valente, T.W., Kim, Y.M., Lettenmaier, C., Glass, W., and Dibba, Y. Radio promotion of family planning in The Gambia. International Family Planning Perspectives 20(3):96-100, 1994. Ref ID 3161

Lettenmaier, C., Krenn, S., Morgan, W., Kols, A., and Piotrow, P. Africa: using radio soap operas to promote family planning. Hygie 12(1):5-10, 1993.  Ref ID : 236

Target Group /Country Families in the Gambia

Intervention Methodology Radio materials were designed to convey the beliefs that Islam supports the use of modern contraception, that the modern methods are safe, that family planning service providers are knowledgeable and caring, and that couples should discuss family planning. 30-second radio spots and a 39-episode radio drama were aired as components of the campaign

Evaluation Method Baseline interviews carried out with of 399 in December 1990 and post-intervention survey with sample of 402 in August 1991 (samples aged 16-64yrs with equal mix of males and females). The questionnaire tested knowledge (whether aware of 8 modern methods of family planning), attitudes (12 part attitude scale) and practice (whether used any of 8 modern contraceptive methods). 721 new family planning acceptors at 8 clinics were interviewed

Impact Achieved   People who heard the serial drama could name significantly more contraceptive methods than those who had not (p<0.001)and they were significantly more positive about family planning (p<0.001). Those who heard the program were also more likely to use a modern method than those who did not (p<0.001). The effect of the campaign was greatest among uneducated individuals; program exposure was associated with an increase in knowledge from 3.8 to 5.2 contraceptive methods (p<0.001), an increase in positive values from 9.9 to 11.3  (p<0.001), and an increase in contraceptive users from 10% to 27% (p<0.001). 61% of the 721 new acceptors had heard the programme. 72.7%% of those who had heard the drama said that they had been motivated by it come to the clinic

Valente, T.W. and Saba, W.P. (1998) Mass media and interpersonal influence in a reproductive health communication campaign in Bolivia. Communication Research 25, 96-124.Ref ID : 8322

Target Group /Country Urban population in Bolivia

Intervention Methodology A reproductive health communication campaign using both mass media and interpersonal methods in Bolivia drawing on communications of innovation theory. Following focus groups and secondary analysis of previous surveys a campaign was developed with the themes "Reproductive health is in your hands", Get information and services where you see this logo" and You decide how many children you have", 11 TV and radio spots were developed and broadcast over a 7 month period from October 1995 with 1000 transmissions in each of the four major cities and about 300 transmissions each of the 3 next smallest. The campaign was re-broadcast nationally over an intensified 3 month period from October 1995 to January 1996.

Evaluation Method Two studies were conducted approximately 1 yr apart. Ss in Exp 1 (2 samples of young adult residents of 7 of Bolivia's largest cities; n = 2,300 each, approximately) were surveyed two months before and just after the first campaign . A 2nd sample was acquired a year later and interviewed in Sept 1995 and in Feb 1996. It consisted of 800 randomly selected residents in one city not previously sampled and was a panel study in that it sought to follow up the same persons.. Awareness of reproductive health was defined as being able to say that reproductive health referred to being able to decide when and how many children to have, obtaining prenatal or postnatal care and breastfeeding.

Impact Achieved 72% recalled hearing or seeing a radio/TV spot on reproductive health. In the first pre- post-test awareness of reproductive health among married women increased from 59% to 72% (p<0.01). Regression analysis in the first study  showed that exposure to the educational programme was associated with family planning method awareness ,reproductive health knowledge, reproductive health attitude, communication with someone on family planning in previous 6 months and current use of a contraceptive method (p<0.001). In the second (panel) study there were increases over the 6 months in family planning awareness (47% to 57%, p<0.001), reproductive health knowledge (49-54%, p<0.001) and communication to another person about family planning (33%-50%. P<0.001). Significant increases in levels of current contraceptive use were reported with both groups but there is a discrepancy between figures reported in the text and shown in the figures and clarification is needed with the authors to determine what change was obtained.

Westoff, C.F. and Rodriguez, G. (1995) The mass media and family planning in Kenya. International Family Planning Perspectives 21, 26-31,36. Ref ID : 6782

Target Group /Country Women of childbearing age

Intervention Methodology Booklets, posters, films, videos and  radio programmes about family planning. Messages: emphasis on keeping families small.

Evaluation Method Analyses of data from the 1989 Kenya Demographic and Health Survey. Media exposure: the Guttman scale was used to  develop a cumulate scale of media exposure. Media messages and behaviour: demographic, socioeconomic and cultural variables were controlled for using logit and ordinary linear regression models

Impact Achieved 66% heard the message on the radio.  Results of the Guttman scale showed the proportions of women receiving family planning messages: no messages 30%; Radio only 41.7%; Radio and print media poster 21.0%; All media including television 7.0%. A large proportion of women received no messages or received them from the radio only.  The proportion of women who had ever used a contraceptive increased with cumulative exposure to various sources of media (P<0.001). Exposure to media increased the likelihood of the use of a modern family planning method v traditional method, but this was not significant. Prevalence of women currently using a contraceptive rose from 15% (never exposed to the media) to 50% (exposure to all types of media), (P<0.01).  Women exposed to all sources of media were more likely to currently use a modern method (P<0.01). There was a strong association of exposure to media messages and intention to use a contraceptive method (P<0.001). The desire to limit fertility is more associated with young and low parous women (P<0.01). Exposure to greater sources of media messages is associated with a decrease in the perceived ideal number of children (P<0.001). Women exposed to no messages report an average of 5.5 children as their ideal family size, while those exposed to three types of messages report 4.7 children as ideal. Note that a strong statistical association between having heard or seen family planning messages in the media and behaviour is not proof of a cause-effect relationship.

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5 Breast feeding

Hugo, J. and Skibbe, A. Facing visual illiteracy in South African health education: a pilot study. Journal of Audiovisual Media in Medicine 14(2):47-50, 1991. Ref ID : 2513  (borderline for inclusion in the database)

Target Group/Country Women at ante-natal clinics at a hospital in South Africa

Intervention Methodology A talk using illustrations to clarify the basic concepts of breast and bottle feeding. The illustrations, designed by a medical illustrator and validated by specialists, attempted to convey the following information: 1) breastfeeding creates a stronger bond between mother and baby than does bottle feeding; and 2) clean water, sterilized bottles, and correct formula mixture all directly affect the health of bottle-fed babies.

Evaluation Method For the purposes of the study, the researchers conducted 2 successive antenatal clinics at Tygerberg Hospital in 1989. During the first clinic, following real-life situations, a health education nurse gave a 10-minute talk. During the 2nd clinic, a follow-up questionnaire was conducted. 47 pregnant women attended both clinics.

Impact Achieved  In the follow-up session, 45 (96%) women indicated a positive preference for breastfeeding and 40 (85%) stated that bottle feeding may be harmful to the baby. The study revealed that while only 9% of the women could correctly identify both simplified and detailed black-and-white illustration, 66% were able to identify colour pictures. The finding indicate an ability by illiterate patients to read and interpret instructional illustrations. As an intervention evaluation this is not of a high standard but the publication does provide a good example of the issues involved in understanding of visuals and has therefore been retained in the database.

Haider,R., Kabir,I. and Ashworth,A. (1999)  Are breastfeeding promotion messages influencing mothers in Bangladesh?45, 315-318. Ref ID: 8651

Target Group/Country Women in Bangladesh

Intervention Methodology  A national breastfeeding promotion campaign in Bangladesh in 1989 which should to reach mothers who delivered at home and promote the following three messages: 1)feed the baby colostrums immediately after birth; 2) for the first 5 months breastmilk alone is insufficient; 3) when the baby is 5 months old, along with breastmilk feed him/her family foods. No information is provided on the methods used, timing and appeals.

Evaluation Method A random sample of 1100 lower middle class mothers in Dhaka, with infants aged 0-6 months, were interviewed in 1995. There was no baseline and no controls.

Impact Achieved Although 99 per cent of mothers fed colostrum within 3 days of delivery, 92 per cent also gave one or more traditional prelacteals, and 68 per cent gave postlacteals. This could be due to ambiguity of the message, which simply advocated giving colostrum without indicating its exclusive use, thereby appearing compatible with traditional perceptions that colostrum alone is insufficient. Ninety-nine per cent of mothers reported hearing the breastfeeding messages or receiving advice, and 97 per cent stated that they understood the meaning of exclusive breastfeeding. But this concept was not correctly understood, as many thought it meant feeding breastmilk and water. The prevalence of exclusive breastfeeding was 15 per cent, and complementary foods were introduced early (median 30 days). Many mothers doubted the message that breastmilk alone is sufficient for 5 months. This study provided valuable information on the status of breastfeeding but the absence of a baseline and controls severely limits its value as an evaluation of the mass media campaign.

McDivitt, J.A., Zimicki, S., Hornik, R., and Abulaban, A. The impact of the Healthcom mass media campaign on timely initiation of breastfeeding in Jordan. Stud.Fam.Plann. 24(5):295-309, 1993. Ref ID : 30

Target Group/Country Communities in Jordan

Intervention Methodology  A two day lactation seminar on lactation management for health professionals Two intensive radio and television campaigns involving drama, testimonials and advice from a fictitious female Doctor (May 15 - July 15 1989, mid March - end April 1990). Messages: "initiate breast feeding within the first hours after birth", benefits of colostrum, that breast milk is all the child needs for the first 4 months of life and advice on some common breast feeding problems

Evaluation Method Intervention study using mass media/seminars given by health professionals evaluated through a systematic random sample of mothers. Two surveys: Baseline survey (1988), before seminar/ media campaigns, mothers n= 800 *Post intervention survey (1990), after the seminar/media campaigns, mothers (with children < 20 months) n=777 interviews followed baseline survey format with additional questions regarding breast feeding. Measures: 1) behavioural outcomes: change in whether mother breast fed or not, change in early supplementation, change in timely initiation of breast feeding 2) knowledge of breast feeding initiation and colostrum 3) exposure to media breast feeding programme.

Impact Achieved  The mass media breast feeding campaign reached 73% of mothers (1990). Significant increases in: Initiation of breast feeding 90.5% to 97.2% (p< 0.0001), timely initiation of breast feeding 40% to 54% (p 0.001), Slight, but not significant, decrease in early supplementation of breast feeding before 3 months 50% to 60%. Knowledge: significant increases that breast feeding should start within 6 hours of birth 51% to 75% (p<0.0001) and the benefits of colostrum 40% to 70% (p<0.0001). It had a positive impact on mothers knowledge and timely initiation of breast feeding at home and in public hospitals but not in private hospitals. Authors conclude that providing information to mothers needs to be part of a programme supported by hospital policy and staff practices.

Monteiro, C., Rea, M. and Victora, C. (1990) Can infant mortality be reduced by promoting breastfeeding? Evidence from Sao Paulo City. Health Policy and Planning 5, 23-29. Ref ID : 7239

Target Group/Country Women in Brazil

Intervention Methodology An ambitious breastfeeding promotion programme was launched in Brazil in 1981 which included the use of mass media,  health personnel training and re-organization of health service routines,

Evaluation Method A total of 300 children aged under 8 months attending health services in metropolitan São Paulo was sampled 1981 and 380 in 1987. Data were collected form the mother or caretaker on the type of milk consumed and infants were classified as either fully breastfed (breast milk only), partially breastfed (breast milk and any type of cow's milk) or artificially fed (cows milk only). Cause specific infant mortality rates were obtained from the vital statistics office. São Paulo  was used for the evaluation because of the high coverage or vital registration data. The potential impact of the programme on infant mortality rates was estimated using the relative risks associated with breastfeeding obtained in a case-control study in a similar urban population in southern Brazil

Impact Achieved  A comparison of two health surveys carried out in Greater Sao Paulo before (1981) and after (1987) the implementation of the programme showed an important increase in the median duration of breastfeeding from 84 to 146 days respectively., During this period the infant mortality rate in Sao Paulo fell by 49%. The observed change in feeding practices may have been responsible for a reduction of 12% of this 49%  - one quarter of the observed decline in infant mortality. The calculations suggest that the programme may have led to reductions in deaths caused by diarrhoea of 32%, in respiratory infections of 22% and in deaths due to other infections of 17%. In the absence of controls and supporting information on reasons for breastfeeding it is difficult to attribute the increase in breastfeeding to the campaign. However, this evaluation provides a good example of what can be achieved with macro-level data to evaluate a national campaign. 

Rea, M.F. and Berquo, E.S. Impact of the Brazilian national breast-feeding programme on mothers in greater Sao Paulo. Bull.World Health Organ. 68(3):365-371, 1990. Ref ID : 5846

Target Group/Country Women in Brazil

Intervention Methodology A broad-based national breast-feeding programme using radio and television was launched in Brazil in 1981 that was preceded by an evaluation of infant feeding habits in two metropolitan areas of the country. In the first phasein 1981  there were intensive TV and radio advertisements which sought to communicate the advantages of breast milk and dispel some of the myths that existed with messages such as "Breast feed for at least 6 months" and "weak milk does not exist "In the later phase Aug 1982 to Dec 1983 national celebrities were used to promote the messages and the campaign was longer. The international Code for Marketing Baby Milk Substitutes was introduced in 1981 but only in 1982 were stricter controls on marketing implemented. In the 3rd phase (Jan to Dec 1984)there was a concerted drive to train health personnel and set up mothers' groups and other groups began to campaign on breastfeeding.

Evaluation Method This paper reports the initial findings of an evaluation of the programme in Greater Sao Paulo that was carried out in 1987, 6 years after the programme started. The method employed was analogous to that used before the start of the programme in 1981. For this purpose, a representative sample of mothers who were attending child care services open to all income groups were interviewed, together with a number of health professionals. A total of 497 mothers with children aged 0-12 months were covered. A recall interview was also administered on the duration of breast-feeding for all children born to the mothers since 1981

Impact Achieved The mean duration of breast-feeding rose from 89.4 days to 127.5 days and of feeding only breast-milk from 43.2 days to 66.6 days. The proportion of previous children who were breast-fed for more than 6 months rose from 18.9% for those born in 1981-82 to 37.7% for those born in 1984, when the programme activities were at their highest, and slipped back again to 27.6% in 1985-86. Note that the campaign also included stricter controls on the promotion of infant milk substitutes. There were no controls but this paper does seek to relate breastfeeding to exposure to the campaign - however is not clearly stated how exposure was measured and the data is not clearly expressed.

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6 Promotion of oral rehydration

Kenya, P.R., Gatiti, S., Muthami, L.N., Agwanda, R., Mwenesi, H.A., Katsivo, M.N., Omondi-Odhiambo, Surrow, A., Juma, R., Ellison, R.H., and et a Oral rehydration therapy and social marketing in rural Kenya. Social Science & Medicine 31(9):979-987, 1990. Ref ID : 1886

Target Group/Country  Rural community in Kakamega Districtrural area in Western Kenya

Intervention Methodology  Knowledge behaviour and practice (KBP) surveys and focus group discussions were carried out as well as over the counter surveys of shops to design the social marketing intervention. Banana flavoured sachets of ORS standardised to be made up in commonly available 250 ml mugs were distributed through shops and clinics. A price was fixed to give some incentive  to shopkeepers who were also trained to give advice on how to makeup the ORS. The campaign started in January 1986 with a public rally ('baraza') in which officials and local chieftains prepared an ORS mixture and drank it publicly. A locally-produced film was shown by mobile cinemas, , posters, calendars, leaflets and packet instructions were prepared. In the control communities no major campaign inputs were made other than supply of the clinic with unflavoured ORS and the provision of basic instruction on its preparation and use.

Evaluation Design Two communities of similar population of about 17000 and health facilities (a single primary health care clinic) were selected as control and intervention community and the population enumerated for subsequent sampling. A baseline KBP survey using a standardised questionnaire  of 500 randomly selected mothers with three further KBP surveys of 500 mothers at 6 month intervals during the campaign. A request to prepare a sample of ORS was made to 100 mothers randomly selected from the 500 and samples of the prepared fluid were analysed for sodium content. Note it is not clearly stated what the sampling for the control community. However from the data presented it appears that the 500 figure for sample includes both control and intervention with the breakdown between the two not stated.

Impact Achieved  The 'ever administered ORS' increased from 18% to 54% in the experimental community and 9 t0 37% in the control community (p<0.05). There was an increasing trend by round for those obtaining sachets through commercial channels which was only significant in the experimental community were the advertising campaign was instituted (p0.05%). The uptake of ORS sachets through the primary care clinic was similar for both experimental and control communities, indicating that the increase in use by the experimental community was due to purchase from the shops. The mean ORS given per episode of diarrhoea was 2 litres in the experimental community compared to 1.5 litres in the control community (p<0.0001). 56% and 54%  of ORS in the experimental and control communities had safe and normal concentrations of sodium. (40-120mmol/l). However sodium concentrations above these clinically acceptable safe levels were found in 13% of both communities. The authors provide a good descriptions of methods and evaluation finds but do not provide any information on cost and sustainability of the social marketing programme.

Koul, P.B., Murali, M.V., Gupta, P. and Sharma, P.P. (1991) Evaluation of social marketing of oral rehydration therapy. Indian Pediatr. 28, 1013-1016.Ref ID : 8246 (Borderline for inclusion in database)

Target Group/Country  Urban poor in Delhi, India

Intervention Methodology  The Government of India (Ministry of |Health) with help from UNICEF has launched a mass media campaign to popularise ORT through television from 1989. Brief spots using popular TV personalities were shown in prime time viewing to convey simple and clear messages regarding ORT and WHO/ORS formula for ORT. Packets are freely available to the mothers through dispensaries and urban basic health services volunteers.,

Evaluation Design One hundred and eighty seven consecutive mothers appearing at a Diarrhoea treatment Unit of Paediatric Outpatient Department (38 excluded due to non use of ORT) were administered a pre-planned questionnaire to assess their socio-economic profile, educational status, concept of diarrhoea and correct use of ORT. Fifty nine mothers who watched these programmes on TV regularly formed the study group. These were compared with 90 mothers who had gained such knowledge from non-television sources including health workers at clinics.. There was no baseline

Impact Achieved  The correct knowledge of ORT and actual use of ORT was significantly better in the mothers who had seen the TV spots than the control group (P<0.01). When the sample was separated according to the level of education of the mothers, among the better educated mothers (n=58) there was a higher % of those who watched the TV spots who knew how to correctly prepare ORT (n=22, 81.5%) than those who had only received information from health staff (35%, n=11) could correctly prepare ORT (p<0.01). The authors use this to infer that mass media had more impact on educated women and that low education women were more influenced by clinic health workers. However, this raises the question of whether educational level of the mothers is a confounding variable of more importance than actual exposure to mass media [JH]

Miller, P. and Hirschhorn, N. The effect of a national control of diarrheal diseases program on mortality: the case of Egypt. Social Science & Medicine 40(10):S1-S30, 1995. Ref ID : 1157

Target Group/Country  Mass media programme in Egypt

Intervention Methodology  The National Control of Diarrhoeal Diseases Project (NCDDP) of Egypt began in 1981, became fully operational nation-wide by 1984, and concluded in 1991. The project was designed as a campaign to lower mortality from diarrhoeal disease in children under five by at least 25% within five years. The principal strategy employed was to improve case-management of diarrhoea through rehydration and better feeding: through assured production and distribution of oral rehydration salts, education of families through mass media and health workers through training programs, and rehydration corners throughout the established primary health care and hospital network. The educational component of the programme was mainly conveyed by mass media with TV spots by a well known motherly character actress., radio, articles in magazine and a campaign logo that appeared on all advertisements.

Evaluation Design Change in the population was monitored over time through periodic knowledge-and-practice surveys, successive national household surveys before and  after the summer diarrhoea season, review of the national civil register and local area controlled trials, the national Demographic and Health Surveys.

Impact Achieved  By its own terms, the NCDDP appears to have succeeded in improving case management; by several local and national mortality surveys, overall infant and childhood mortality fell by at least one-third with the majority proportion in diarrhoeal deaths. The declines coincided with the peak of NCDDP activities and results in improved case-management. The detailed analyses of their monograph provides evidence to demonstrate that: (a) the mortality decline and the diarrhoeal mortality decline in particular were actual events; (b) that case-management improved with plausible sufficiency to account for most of the diarrhoeal mortality reduction; and (c) that changes in other proximate determinants to lowered mortality, such as host resistance or diarrhoeal incidence, do not plausibly account for the magnitude of the reductions seen. Data are also presented on general socio-economic changes in the decade of the Project.  The impact of the mass media campaign is inferred by the findings from Knowledge-and practice studies that after 1985 nearly 100% of mothers knew about ORS and dehydration. One survey found that in 1988 nearly 90% of mothers could mix ORS correctly.

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7. Immunization programmes

Berry, D.J., Yach, D. and Hennink, M.H.J. (1991) An evaluation of the national measles vaccination campaign in the new shanty areas of Khayelitsha. S. Afr. Med. J. 79, 433-436.Ref ID : 6856

Target Group/Country A community undergoing rapid urbanisation near Cape Town, South Africa

Intervention Methodology The 3 week intensive campaign used stickers, pamphlets, posters, radio, newspapers and enlisted the help of community leaders. Actual vaccination activity was divided into two phases. The first involved all available staff based at fixed clinics and in the community using two mobile units equipped with loud hailers. If no "Road to Health Card" was available, a new, specially coloured card was issued. Any child between the age of 6 months and 5 years without documentation of vaccination was given measles and/or polio vaccine. Community health workers, student nurses and health inspectors all contributed to this phase. A  second campaign was planned but low staff moral due to the increased workload of doing the campaign and immunizing children together with the rainy season led to a lower key "mopping up operation" details of which are not provided.

Evaluation Method Four serial cross-sectional cluster samples were used. The 1st (n=206) was before the campaign, the 2nd (n=175) following the 3 week campaign, the 3rd (n=350) was 2 months after the campaign and the 4th (n=205) was 6 months after the campaign. The proportion of the children vaccinated at the time of the campaign was estimated by defining a campaign vaccination as one given either during the dates of the official campaign or having the abbreviated date stamp of the campaign.

Impact Achieved Proven vaccination coverage before the campaign was 55,8%% (95% confidence interval (CI) 46-66%), immediately afterwards it was 71.1% (95% CI 65-77%) and 6 months later 73.6% (95% CI 67-80%). In surveys 2 and 3 the proportion of the children fulfilling the criteria of being vaccinated during the campaign was 25.8% (95% CI 29.3%). By survey 4 this proportion had fallen to 6.8 (9.5% CI 3.9-9.8%). Significant determinants of vaccination coverage were: place of birth (chi squared = 9.7; 2df; p=0.008; CI 1.2 -4%; and home birth (OR 3.21; 95%CI 1.2-8.4%). A group that posed a particular problem for sustaining vaccination levels was the incoming Transkei-born children, The authors discuss their findings in the light of debates concerning the value of campaigns versus routine services.

Duque, L.F., de Bello, P.V., Bejarano, J., Ruiz, A., Rodriguez, W., Silva, E., Jaramillo, G., Munoz, A.L., Gacharna, M., Pacheco, C. and Rivera, L. (1984) Ref ID : 8381The national vaccination crusade in Colombia. Assignment Children 65/68, 159-178. Ref ID 8381 (Borderline for inclusion in database)

Target Group/Country Parents in Colombia

Intervention Methodology The National Vaccination Crusades in Colombia involved three intensive vaccination days ( 23rd June, 28th July and 25th August 1984) with an aim to vaccinate nearly a million children against diptheria, whooping cough, tetanus, poliomyelitis and measles. carried out throughout the country. The programme had the strong official endorsement of the Crusade by the Head of State, the existence of a political will and exceptional media support (press, television and radio), all sectors of society, both public and private, joined forces and cooperated and 10,000 vaccination posts throughout the country were mobilized The programme provides a good example of the use of the campaign and social mobilisation approach involving schools, churches and many other sectors..

Evaluation Method Details on vaccinations given were recorded by the health information system (no information provided in this report)

Impact Achieved In three vaccination days it was possible to vaccinate nearly a million children (over 90%) of the target against five communicable diseases: diphteria, whooping cough, tetanus, poliomyelitis and measles. On 23rd June and 28th July the numbers of children vaccinated were 804,053 and 854,570 respectively. The Colombian programme was the first ever use of such intensive one day campaigns at which three vaccines were simultaneously administered throughout a country. While demonstrating the ability of one day intensive programmes to immunize children, it would have been useful to have had some information on the costs involved, potential spin-offs and some discussion of the sustainability of such intensive campaigns. While presenting data on immunization coverage, this report provides little information on the source of the data and other supporting information on the effectiveness of programme inputs.

Perez-Cuevas,R., Reyes,H., Pego,U., Tome,P., Ceja,K., Flores,S. and Gutierrez,G. (1999)  Immunization promotion activities: are they effective in encouraging mothers to immunize their children?  Soc. Sci. Med.  49, 921-932. Ref ID8721

Target Group/Country Mothers of pre-school children in Mexico

Intervention Methodology The National Vaccination Council (CONAVA) launches three immunization campaigns for mostly polio and measles every year. This study refers to the Second National Health Week (SNHW).Vaccines are provided at health facilities, temporary health posts and through home visits and this is combined with distribution of Vitamin A, albendazole and oral rehydration salts. Messages targeted at both adults and children are broadcast on radio and television. Most of the messages are based on popular children's songs or slogans. TV spots use cartoons or animated clay figures. In addition posters, flyers, newspaper ads and announcements are distributed through communities in key public places. Private companies, NGOs and schools participate in the campaign - notifying parents of the campaign. Face-to-face motivation of mothers was also given by health workers or volunteers at the immunization posts or during home visits

Evaluation Method A probability sample of 935 mothers living in the metropolitan area of Mexico City and having at least one child under five years old was selected for the study. Mothers were interviewed one month after the campaign  to determine four outcome variables: (1) mothers' knowledge about the SNHW; (2) mothers' comprehension indicating how well they understood the campaign messages (aware, partly aware and unaware) Mothers who remembered that the campaign aimed to provide either polio or measles vaccine or both were defined as 'aware'; (3) mothers' motivation, i.e. whether or not they sought out immunizations for their children under the age of five and (4) mothers' opinion of how well they liked the messages. There were no controls or baseline

Impact Achieved 601 (64.3%) were knew that the campaign aimed to provide immunizations and were defined as 'aware'.  224 (24%) knew about the campaign but not that it was about immunization  - 'partially aware'. 110 (11.75%) did not know about the campaign - 'unaware'. Among those aware mothers, 526 (87.5%) of their children received immunizations, 379 (72.1%) voluntarily and 147 (27.9%) through face-to-face motivation. Of the unaware mothers' group, fewer (80, 72.7%) of their children received immunizations; of those fewer (50, 62.5%) of the mothers took their children or their own accord and a higher proportion (30 - 37.5%) - acted because of face-to-face motivation. The proportion of 'unaware' mothers not taking their children for immunization was significantly higher (p<0.05) and more than double (30 - 27.3% of 110 ) that of 'aware' mothers (75 -12.5% of 601). The campaign had more impact on mothers of lower socio-economic level which may be because higher socio-economic mothers made more use of private health services for immunization.

Quaiyum, A., Tunon, C., Baqui, A.H., Quayyum, Z. and Khatun, J. (1998) Impact of national immunization days on polio-related knowledge and practice of urban women in Bangladesh. Health Policy and Planning 12, 363-371.Ref ID : 7246

Target Group/Country Women in Dhaka, Bangladesh

Intervention Methodology  National lmmunization Days (NIDs) from 1995 as part of the country's goal to eradicate poliomyelitis by the tum of the century. The NIDs brought together government agencies, the media, voluntary organisations and individual volunteers in social mobilization and service delivery activities

Target Group/Country Data were collected through pre- and post-NID cross-sectional surveys in a sample of one area of Dhaka city which included slum and non-slum households. Knowledge data were collected from 525 women with at least one child aged less than five years. The oral polio vaccine (OPV) coverage during NIDs was obtained from 720 children

Impact Achieved Knowledge of polio as a vaccine preventable disease increased after NIDs among both slum and non-slum women (p<0.05). The knowledge gap between the slum and non-slum dwelling groups of women was significantly reduced. Field workers, who regularly visit women at their homes to promote health and family planning services, were the main source of information for the slum women while television was cited as the most important source of information by non-slum women (p<0.005). The study revealed that 88% of children under five years received at least one dose of oral polio vaccine (OPV) during NIDs, and 67% received two stipulated doses with no significant differences between slum (65%) and non-slum (69%) groups. In addition, 68% of the children contacted during the NIDs were given vitamin A supplementation. This shows the benefits of linking other interventions such as Vitamin A with immunization programmes. The differential access to communication also shows the need to target communication strategies to the specific needs of target groups.

Risi, J.B. (1984) Nation-wide mass polio immunization in Brazil. Assignment Children 65/68, 137-157.Ref ID : 8382 (Borderline for inclusion in database)

Target Group/Country Parents in Brazil

Intervention Methodology In response to the lack of success of routine immunization, mass immunization programmes based two  one-day immunization campaigns per year were launched in 1980. A strong political determination, large-scale community involvement of all sectors of society, the assistance of over 450,000 volunteers, a national distribution of tasks and efficient coordination at all levels were identified as some of the crucial components

Evaluation Method Data on immunizations carried out during the one day campaigns were collected for the 8 days from 1980 to 1983. There were no controls.

Impact Achieved Nearly 20 million children were immunized at each one-day campaign. Between 1975 and 1980 an average of almost 2330 cases of poliomyelitis were reported annually in Brazil representing a rate of 2.1 cases per 100,000 inhabitants. In 1981 only 122 cases were registered giving an incidence of 0.1 cases per 100,000. Whilst provided striking information on the benefit that can result from such a campaign, a weakness of this report is the lack of any research which ascribes the importance of specific programme inputs and any discussion on issues of sustainability and cost.

Shepard, D.S., Robertson, R.L., Cameron, C.S.,3d, Saturno, P., Pollack, M., Manceau, J., Martinez, P., Meissner, P., and Perrone, J. Cost-effectiveness of routine and campaign vaccination strategies in Ecuador. Bull.World Health Organ. 67(6):649-662, 1989. Ref ID : 5848

Target Group/Country Children in Ecuador

Intervention Methodology  A major purpose of the campaigns was to complement the routine services and to accelerate immunization activities. Details are not provided of the content, timing and other programmatic details for the campaigns described.

Evaluation Method A national household coverage survey of 3697 Ecuadorean children, carried out in July 1986, provided an opportunity for a cost-effectiveness analysis of (1) routine vaccination services based in fixed facilities and (2) mass immunization campaigns.

Impact Achieved The campaigns, though less cost-effective than routine services, significantly improved the vaccination coverage of younger children who had been missed by the routine services. The costs per fully vaccinated child of both the campaign and the routine services compare favourably with the Program for Reduction of Maternal and Childhood Illness (PREMI) and earlier campaigns increased the proportion of children under 5 years who were fully vaccinated from 43% to 64%. In one year, the PREMI campaign was responsible for fully vaccinating 11% of children under one year, 21% of 1-2-year-old children, and 13% of all children under 5 years. The campaign also helped ensure that vaccinations were completed when children were still very young and at greatest risk. The average cost per vaccination dose (in 1985 US$ prices) was approximately $0.29 for fixed facilities and $0.83 for the PREMI campaign. Total national costs were $675,000 and $1,665,000 for routine and campaign services respectively. The cost per fully vaccinated child (FVC) was $4.39 for routine vaccination services and $8.60 for the campaign. The cost per death averted was about $1900 for routine vaccination services, $4200 for the PREMI campaign, and $3200 for the combined programme.

Zimicki, S., Hornik, R.C., Verzosa, C.C., Hernandez, J.R., de-Guzman, E., Dayrit, M., Fausto, A., Lee, M.B. and Abad, M. (1994) Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience. Bull. World Health Organ. 72, 409-422. Ref ID : 2132

McDivitt,J.A., Zimicki,S. and Hornik,R.C. (1997) Explaining the impact of a communication campaign to change vaccination knowledge and coverage in the Philippines. Health Communication 9, 95-118. Ref ID: 8942

Target Group/Country National programme in Philippines

Intervention Methodology The Philippine Department of Health conducted national mass media communication campaign during the period March-September 1990 to support routine vaccination services. City mayors, health officers and clinic staff primed  for campaign ( conferences, meetings etc.). Mass media campaign, four television and four radio advertisements broadcast. Messages: the danger of measles and its complications, recommendation that infants 9-12 months to be taken to health centre for vaccination. Advertisements printed in newspapers with the message that Wednesdays were free vaccination days. Other promotional materials: posters, welcome streamers, stickers, T-shirts. Materials emphasised that vaccinations were free and available on Wednesday at health centres. Campaign slogan "Protect your baby from measles".

Target Group/Country A two phase communication campaign (pilot and intervention) with pre and post campaign surveys (1989 and 1990). :    1)A post campaign survey was conducted 5 months after start of the campaign using a structured  questionnaire and multistage cluster sampling (cluster size 10, sample restricted to less well  off people). Families included those with children < 2 years. Coverage estimates based on carers reports and vaccination cards. 2)Simultaneous health centre survey: Structured interviews with staff of 60 health centres, observation of 10 children attending a subset of 20 health centres on vaccination days and exit interviews of adults in same health centres

Target Group/Country There was a significant increase in knowledge of measles vaccination (P<0.01) and some increase regarding other vaccinations. However, the relationship between knowledge and practice remained the same between 1989 and 1990. There was "little evidence for changes" in the way that vaccination sessions were held in the health centre. While the proportion of exit interviewees saying that "someone explained about vaccination" increased from 18.4% (1989) to 75.5% (1990) this was not paralleled by an increase in their knowledge.  Percentage of fully vaccinated children increased from 54% (1989) to 65% (1990),  P < 0.0001.  Percentage of children < 4 months who had at least one vaccination increased from 43.3% 1989 to 55.6% 1990 (Rate difference 12.3%, 95% CI 1.5-19.0).  Percentage of children ages 2-8 months with at least four vaccination increased (47.7% 1989 to 56.2% 1990 (Rate difference 8.5%, 95% CI 0-17.1). Percentage of children aged 9-11 months who had all vaccinations increased (32.2% 1989 to 56.2% 1990. rate difference 24.0, 95% CI 12.2-35.8). Factors contributing to the success of the campaign: good public access to the media (radio 73%, television 60%, both 50%), the development of high quality radio and television spot and a routine system ready to serve the increase in demand the campaign generated.

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10 Nutrition Education

Can,G., Ökten,A. and Green,J. (2012) The role of local mass media in promoting the consumption of iodized table salt. Health Educ. Res. 16, 603-607. Ref ID: 8940

Target Group/Country Married Women >19yrs in Trabzon region of Turkey

Intervention Methodology During the period between February and May 1999 there were 2 TV programmes, each running for 3hrs in the late evening between 21.00 and 24.00, and one live morning radio broadcast, which was transmitted from 10.00 to 12.00. The programme used a pnone-in format and were subsequently repeated twice at prime time between 20.00 and 23.00. The key messages about Iodine deficiency disorder, its control and the role of iodized salt were reinforced by the researchers 3 and 4 times during subsequent day-time slots scheduled to run at various times of day. These daytime slots each lasted 2-3 hrs

Evaluation Method Face to face interviewing using a structured questionnaire of a sample of 672 married women >19 yrs in February 1999 before the campaign and 768 women in May 1999 after the campaign. There were no controls. The sample obtained through a two stage random sample method - the first stage being the identification of provincial family centers and the second that of women from families registered at those centres. There were no controls.

Impact Achieved Prior to the intervention, the prevalence of reported iodized salt consumption was 54.5%. Following the 3-month education program it increased to 62.4% (p = 0.00237). Those who were aware of campaign (not stated how 'awareness' was verified) were more likely to use iodized salt (p=0.1324). Women of higher educational level were more likely to use iodized salt (p=0.022) It is disappointing that no information is provided on the actual availability of iodized salt in the community. Also it is not clear whether any checks were carried out to determine the validity of self-reported use of iodized salt e.g. observed presence in the home

Cerqueira, M.T. and et al A comparison of mass media techniques and a direct method for nutrition education in rural Mexico. J Nutr Ed 11:133-137, 1979.  Ref ID : 907

Target Group/Country Communities in Rural Mexico

Intervention Methodology Three different geographical areas were chosen: in one area mass media techniques including radio, posters and leaflets were used; in a second area teachers used a direct method of nutrition education involving six two hours sessions over three weeks of theory alternating with demonstrations sessions. The educational sessions were deliberately kept didactic with little interaction; and the third served as a control group. Note the control group were in a position to receive the radio spots (but did not have leaflets or posters. It is not clear whether the face-to-face education group were in a position to receive radio broadcasts.

Evaluation Method The impact of the programme was compared on a sample of mothers of children under 5 yrs in the control area (n=976), face-to-face education(n=1083) and mass media (n=959). A dietary survey was carried out with the three samples of mothers to determine the dietary intake habits and frequency of food intake. A questionnaire was administered in 20 minute interviews during the initial evaluation to detect the mother's knowledge of nutrition concepts. The same questionnaire was modified to change the question order and given immediately following the educational programme, 3 months and 12months later

Impact Achieved It was found that nutrition concepts were learned equally well using the direct method of education as with mass media. The face-to-face education group showed a 53 % increase (p<0.001) in their learning scores. In this group, the mothers increased their knowledge of infant nutritional needs by more than 70%. With the mass media techniques the increment in their final learning scores was 54 % (p<0.001). The knowledge of the control group also increased but at a lower level of significance (p<0.05). An increase in the self-reported intake of fish, vegetables, and fruits was observed in both the mass media and direct education groups (p<0.001). The control group increased their consumption of popular but low nutritive value foods. It is suggested that the slight increase in knowledge of the control groups was due to their exposure to the radio spots.

Ramadasmurthy, V., Rao, D.H., Clarence, I.D., and Balasubramanian, S.C. Nutrition education and SITE telecasts. International Journal of Health Education 21(3):168-173, 1978. Ref ID : 511 (Borderline for inclusion in database)

Target Group/Country Women in four rural villages in Hyderabad District, Andhra Pradesh State, India

Intervention Methodology Television programmes were broadcasted through satellites to rural villages. The programmes investigated in this study covered "Supplementary food for babies", cooking of rice" and "importance of greens". The first telecase was between 6.20 and 7pm and a second telecast was at a later time in the evening from 8.30-9pm.

Evaluation Method Pre-test survey was carried out of all women of child-bearing age in four villages (n=373). After the first broadcasts 200 of these women could be contacted for a follow-up survey and 289 after the second broadcast.

Impact Achieved Only 29 of 220 women contacted viewed the first telecast and 7 out 289 viewed the second. Among those who did view comprehension of main points was poor. Low viewing figures for women was attributed to their high workload and cultural norms within the rural villages. This simple evaualtion study highlighted some the problems faced when introducing a new communication technology to a community without adequate initial research and pre-testing.  The evaluation is very limited but it is of interest for historical reasons and for showing the problems that can occur when using new communication technologies in a community.

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11 Infectious and tropical diseases

Gordon, A.J. Mixed strategies in health education and community participation: an evaluation of dengue control in the Dominican Republic. Health Education Research: Theory and Practice 3(4):399-419, 1988.  Ref ID : 4381

Gordon, A.J., Rojas, Z., and Tidwell, M. Cultural factors in Aedes aegypti and dengue control in Latin America: A case study from the Dominican Republic. International Quarterly of Community Health Education 10(3):193-211, 1989. Ref ID : 3717

Target Group/Country Communities in the lower middle class urban barrio (population 6000) of Buenos Aires in the Dominican Republic

Intervention Methodology Four levels of intervention of increasing effort were explored for dengue and Aedes aegypti control were used. Level I was in a separate barrio (Los Salados) relied on the existing mass media (radio. Television and newspapers) and health programme effort; Level II relied on a multiplier effect of diffusion from the communities exposed to the intensive Level III and IV; Level III involved the inspection of breeding sites and motivation of the community to remove breeding sources; Level IV involved direct face-to-face education by heath workers with half of the community receiving larvivorous fish. The education involved intensive effort using two sessions lecture-discussion format over two days using local community health workers along with workers from the National Malaria Eradication Service. Families receiving fish were also given a 2-5 individual talk reinforcing the education and specific instructions about caring for the fish. Large quantities of pamphlets on Dengue were left in grocery stores, beauty salons, clinics and other stores throughout the barrio in order to support the intended multiplier effect.

Evaluation Method Pre-test-post test design with interval of one month; Level I (pre-test n=135, post-test n=134); Level II (pre-test n=133, post-test n=109), Level III (n=65), Level IV (fish-receiving group n=61, education-only group n=60). A core interview testing knowledge lasting 10 minutes was given to all groups and household water receptacles  in Level III and IV were examined for A. aegypti larvae

Impact Achieved Increases in knowledge of the seriousness of dengue and general preventive measures took place even in low intensity Level I and improved with increased intensity of effort (p values between 0.01 to 0.05). However, problems were encountered with communicating specific preventive measures especially keeping the lid on tanks and the risks from household water containers. Inspection visits on their own were found to increase knowledge of the importance of covering of tanks. There was a 17%decline in untopped tanks (50% à 33% p=0.15) in the enducation only group Level IV  Only a partial success was achieved in using the fish with 20 houses out of 72 still having live fish (thought not in all of their tanks). This very detailed report is of interest for its discussion of the difficulties of communicating specific concepts such as 'stagnant water' and the distinction between culex (breeding in garbage) and aedes mosquito (breeding in stagnant water). It is also of interest for the evidence presented to support the information diffusion process and an approach involving mutually-reinforcing mass media and interpersonal approaches in a cost-effective way.

Cheriyan, C.S. and Roopkumar, K.S. A study about the billboards on leprosy displayed in the Pallavan transport corporation buses at Madras City. Indian J.Lepr. 56:151-157, 1984. Ref ID : 909

Target Group/Country General public in Madras, India

Intervention Methodology Billboards with the message ‘Leprosy is curable’ were placed on the entire fleet of city buses in Madras city (2500 total, 1,000 in English and 1,500 in Tamil).

Evaluation Method 500 interviews were done at major bus stands, terminals and busy traffic junctions - persons interviewed included college students (30%), factory workers (20%), office goers (30%), businessmen (15%) and housewives (5%).

Impact Achieved All the respondents had seen the posters and could correctly describe the message it displayed. On being asked to give their opinion of the message 75% (361) made positive comments - 36% said that as leprosy was curable, persons should go for treatment. 34% felt encouraged by the information that leprosy was curable and that this message should be spread.6% felt that the message dispelled the stigma attached to the disease.52.8% (264) persons indicated that they would like to know more about leprosy.

Navon, L. Beyond Constructionism and pessimism: theoretical implications of leprosy destigmatisation Campaigns in Thailand. Sociology of Health and Illness 18(2):258-276, 1996.  Ref ID : 5474

Target Group/Country General population in Thailand

Intervention Methodology In the 1970s an intensive educational programme was launched in Thailand to remove the stigma from leprosy and encourage persons to come for treatment. The means mobilised include radio and television broadcasts, press reports, dissemination centres where educational material can be obtained free of charge, information exhibits, visits to treatment institutions, lectures to students, soldiers, community leaders and so forth, open discussions for the general public, slides and films presented even in large department stores, posters, pamphlets and booklets distributed in schools, universities and heath centres, slogans about leprosy printed on various products such as calendars contests in writing songs, essays and slogans on leprosy and finally, lectures given and posters hung in public places in villages during case-finding activities. On International Leprosy Day - commemorated annually on 16th November - particularly widespread activities were held including radio interviews with the Minister of Public Health, press conferences with leprosy experts and exhibitions and lectures throughout the country.

Evaluation Method The author draws on data fromKAP questionnaires conducted by the Leprosy Division of Thailands Ministry of Public Health between 1978 and 1983 in Mahosaarakam province (n=1,655) and Khon Kaen Province (n=1,091). No details are provided of the studies and the author herself comments on their lack of definition of the terms used and lack of statistical analysis.

Impact Achieved The surveys indicated that despite the educational campaign many people did not understand that the disease was curable and the fear and stigma persisted. The implications of this failure are discussed in terms of sociological theory. The author suggests that such campaigns are likely to fail due to their tendency to transmit a normalizing message, & because of the stigma associated with metaphorical uses of the term leprosy in spoken language Also, educational efforts have also increased the risk of stigmatization. A critique is given of the assumptions of knowledge & power in constructionism's analysis of destigmatization. A call is made to move beyond such constructionist views.

Jaramillo,E. (2012)  The impact of media-based health education on tuberculosis diagnosis in Cali, Colombia.  Health Policy and Planning  16, 68-73.Ref ID: 8878

Target Group/Country General public in  Cali, Colombia

Intervention Methodology A mass media health education campaign for TB control in. The campaign aimed at increasing case finding and reducing levels of prejudice against people with TB. The media campaign was implemented for 6 weeks A[ro;/May 1993 and had 3 components; the television and radio components consisted of public service announcements and chat shows involving people with tuberculosis, doctors and heath educators; the printed component consisted of flyers inserted in a Sunday issue of two local newspapers and two feature articles in one broadsheet and two tabloid newspapers

Evaluation Method The programme was evaluated by counting the total number of smears examined by the laboratory network in Cali and a control population  Risaralda 200 km north which did not  receive the educational inputs.

Impact Achieved There was a sudden increase by 64%  in the number of direct smears processed by the laboratories and an increase of 52% in the number of new cases of positive pulmonary TB, with respect to the previous period. This was not shown in the control areas (no statistical tests carried out on . The effect of the campaign was lost once the radio and television public services announcements stopped raising questions about the sustainability of programmes relying on short-term mass media campaigns. It is unfortunate that no data is presented of the coverage of the campaign or impact on targeted knowledge and attitudes.

Garfield, R.M. and Vermund, S.H. Health education and community participation in mass drug administration for malaria in Nicaragua. Social Science & Medicine 22(8):869-877, 1986.  Ref ID : 3395

Target Group/Country Mass programmes in Nicaragua

Intervention Methodology A campaign approach which used a cascade model to eventually train 73,000 volunteers to mobilise the population to take a three dose chloroquine regime. Educational activities made extensive use of media including newspapers, TV and radio as well as meetings at schools with parents, in the workplace, murals/posters, street megaphones and hanging of cloth signs outside houses.

Evaluation Method Monitoring of distribution of chloroquine and surveillance for malaria

Impact Achieved About 70% of the population received anti-malarials in November, 1981 . The malaria incidence reduced for four months following the campaign and but improvements were not sustained. This programme can be seen as a classic example of a campaign approach which met short-term objectives.

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12 Oral (dental) health

Bian, J.Y., Zhang, B.X. and Rong, W.S. (1995) Evaluating the social impact and effectiveness of four-year "Love Teeth Day" campaign in China. Advances in Dental Research 9, 130-133.. Ref ID : 4178 (Borderline for inclusion in database)

Target Group/Country Mass campaign in China covering 600m people

Intervention Methodology A campaign on "Love Teeth Day" (LTD) carried out each year in China since 1989. The main activities were planned and conducted by the National Committee for Oral Health. It aims to motivate the people's awareness of dental self-care, participation, and to promote community involvement in oral health education programs. The main methods used include radio, television, newspapers, lectures/symposia, posters, pamphlets and face-to-face consultations. Detailed information on campaign including timing, content and formats are not provided though messages are listed.

Evaluation Method For feedback, two types of questionnaires were designed and sent to the public and the organizers, respectively, after each campaign, and then returned to the office for data processing. 79 forms from organizers were received in 1989 and 47 in 1992. 345 forms were received from the public in 1989 and 321 forms in 1992. Details of the methods used to obtain information on oral health knowledge not provided. There were no controls

Impact Achieved The findings from a four-year study indicated that: (1) The activities started from three municipalities, 29 capitals of provinces, and some large cities (1989), and spread to most cities in the urban area, and about 300 counties in the rural area (1992); (2) 14,000 dental professionals and health workers participated in 1989 as information providers, and increased to 40,000 in 1992; (3) oral health knowledge has increased to 76.2% (1992) from 37% (1989); 94) % of people reporting to brush teeth twice a day increased from 50% in 1989 to 69.3% in 1989; (4) The % of people who reported never visiting a dentist was 17.35% in 1989 and 18.28%in 1992. - raw data or significance tests not provided.. While this study report is of interest because of the large-scale nature of the campaign lack of controls and details of the measuring instruments and raw data reduces the value of the report.

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14 Environmental health and hygiene education

Montazeri, A. and McEwen, J. (1998) Health education campaign on environmental health: a pilot study. International Journal of Environmental Health Research 8, 35-41.Ref ID : 8489

Target Group/Country Residents in Teheran, Iran

Intervention Methodology Health education campaign on environmental health (no details provided on actual campaign). The campaign consisted of billboard (no number provided of numbers/locations) with three illustrations asking people to (1) keep away flies from foods, (2) to use a dustbin with a lid and (3) to chlorinate vegetables and fruits.

Evaluation Method A sample of 183 adults aged 18 to 56 years participated in the study. Each respondent was shown a picture related to the campaign (illustrating keeping flies away from foodstuffs, using dustbins with lids, and chlorinating vegetables and fruits), and then filled in a short questionnaire. The main objective of the study was to measure recall rates.

Impact Achieved The results showed that recalls were high (73%), 53% of respondents were either "very positive" or "positive" about the campaign, and almost all participants perceived the main idea of the campaign correctly. The study findings showed that there were some significant associations between demographic variables, recall and perception of the campaign. The study concludes that health education campaigns are useful tools for launching environmental health related topics and the focus should be on getting the attention of as many of the target population as possible

Murthy, G.V., Goswami, A., Narayanan, S., and Amar, S.  (1990) Effect of educational intervention on defaecation habits in an Indian urban slum. Journal of Tropical Medicine & Hygiene 93(3):189-193. Ref ID : 3018

Target Group/Country Urban slum populations during cholera epidemic, India

Intervention Methodology A community latrine facility was constructed in this area in February 1988. Later that year there was a cholera epidemic during which there was an intensive educational campaign using radio, television newspapers, scooter-rickshaws fitted with audio-equipment broadcasting audio-cassettes and group talks.

Evaluation Method The defaecation habits of 172 adults before and 170 of the same respondents seven months later after the educational campagn and cholera epidemic. There was no baseline of latrine use before construction of public latrines.

Impact Achieved There was no significant difference in the numbers using the latrine facility before th education (105) and afterwards ( 116 ).  Cost and distance were the main reasons cited for non-utilization of latrines. 91.4% of respondents stated that they had faced some problem in using latrines. Most children were found to be defaecating in the open around the dwelling units at both rounds of the investigation.

Curtis,V., Kanki,B., Cousens,S., Diallo,I., Kpozehouen,A., Sangare,M. and Nikiema,M. (2012)  Evidence of behaviour change following a hygiene promotion programme in Burkina Faso.  Bulletin of the  World Health Organization.  79, 518-527. REF ID 8859

Target Group/Country Carers of small children in rural communities in Burkino Faso

Intervention Methodology The programme was designed following an extensive research on local practices, motivation and facilities. Using both qualitative and quantitative methods. Monthly house-to-house visits and community meetings were carried out by community volunteers . Health centre staff were trained in participatory discussion and gave talks at health centres. A youth theatre group performed each week a comic play about cleanliness and the need to dispose of stools. A series of 12 comic radio spots with an evolving story was developed, tested and broadcast in local languages and French at local radio stations. A curriculum and materials for six primary school hygiene lessons were developed, teachers trained and provided with lesson guides, 6 posters and a box of soap and buckets.

Evaluation Method There were no controls (because mass media used) and a time series approach was used for evaluation . Two population surveys recorded the coverage of the programme among target audiences (mothers of children aged 0-35 months). Four surveys were carried out: three prior to the programme and one in 1998 (after the programme had been running for 3 years). , using structured observation of hygiene behaviours of young children and their carers using a pre-coded form recorded over a 3 hour period

Impact Achieved After the programme had run for 3 years, three- quarters of the mothers targeted had had contact with programme activities. Half could cite the two main messages of the programme correctly. Although the safe disposal of children's stools changed little between 1995 and 1998 (80% pre-intervention, 84% post- intervention), hand-washing with soap after cleaning a child's bottom rose from 13% to 31%(p<0.01). The proportion of mothers who washed their hands with soap after using the latrine increased from 1% to 17% (p<0.001). Lack of a control is the main limit to the validity of this study. Even with the tree pre-test studies the authors conclude that it is not possible to show from the data  state that the change in washing hands after using the latrine was a change from the underlying trend. It is unfortunate that the data on coverage was not related to the impact - to show a relative take-up of behaviours by those persons who reported hearing the messages from radio or volunteers.

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15 Chronic disease, disability, mental health and substance abuse

Wessels,C., Van Kradenberg,J., Mbanga,I., Emsley,R.A. and Stein,D.J. (1999)  Television as a medium for psycho-education in South Africa: analysis of calls to a mental health information centre after screening of a TV series on psychiatric disorders.  Cent. Afr. J. Med.  45, 1-3. Ref ID: 8584 (Borderline for inclusion in database)

Target Group/Country General public in South Africa

Intervention Methodology The South African Broadcasting Corporation (SABC) recently screened a TV series in 1996/7that focused on the signs and symptoms of the main psychiatric disorders.The TV series "Improve Your Frames of Mind" was developed by an independent producer in collaboration with the Society of Psychiatrists of South Africa, and was screened by the SABC. At the end of each show, the telephone number of our Mental Health Information Centre was given to viewers.

Evaluation Method All calls to the centre were received by three psychiatric nurses at the Mental Health Information Centre who completed a questionnaire during the conversation with the caller and entered the information onto a database for analysis.

Impact Achieved Almost 3,000 calls were taken. Calls related to each of the major psychiatric disorders, particularly the mood and anxiety disorders. Callers expressed satisfaction with the information that they received from the Centre. Callers were particularly interested in anxiety and mood disorders. This evaluation showed that a television programme can encourage people to call in for help.

Bach, J.F., Chalons, S., Forier, E., Elana, G., Jouanelle, J., Kayemba, S., Delbois, D., Mosser, A., Saint-Aime, C., and Berchel, C. 10-year educational programme aimed at rheumatic fever in two French Caribbean islands. Lancet 347:644-648, 1996.  Ref ID : 4095 (Borderline for inclusion indatabase)

Target Group/Country Health workers and general public in French Caribbean islands Martinique and Guadeloupe

Intervention Methodology The 10-year programme  was based in the community and in clinics and hospitals and was directed at the public and at health-care workers to reduce the incidence of rheumatic fever. The educational part of the programme targeted the public and health- care workers, including doctors, with written information distributed in schools or via radio and television broadcasts or videotapes. Pamphlets describing the clinical features and origin of cardiac complications of rheumatic fever were distributed to school children's parents and patients attending hospital clinics. Posters were produced in French and Creole and placed in schools and hospitals. A 30 min film was produced to shown to teachers, parents and pupils in schools. The public television channel gave regular time for advertisements and messages were regularly broadcast in public and private radio channels. In the content of the messages, the benign clinical presentation of the initial streptococcal infection was contrasted with the severity of later heart disease.

Evaluation Method The programme established a registry of all cases of primary and secondary rheumatic fever (diagnosed by Jones' modified criteria), with systematic hospital admission of children. They graded carditis as severe, mild, or subclinical, and acute glomerulonephritis was defined by oedema, proteinuria, and haematuria for less than 3 months. 1982 as the baseline year and data was collected up to 1992.

Impact Achieved  The first months of the programme led to a 10-20% increase in the number of rheumatic fever cases admitted to hospital, because of the renewed attention paid to the disease. .1982-83 the incidence of rheumatic fever was 19.6 per 100 000 inhabitants aged under 20 in Martinique. Disease frequency was highest in the poorest areas and families, a finding that persisted over time. The programme was associated with a progressive decline in the frequency of rheumatic fever: final reduction of 78% in Martinique and 74% in Guadeloupe. The frequency of carditis also fell. Apart from two outbreaks in one hospital, the frequency of acute glomerulonephritis also declined; 31% of cases had had sore throat, while 56% had skin infections. The cost of the programme during the 4 most intensive years was FFr 250 000 (US$ 44 500) in each island. The cost of childhood rheumatic fever, excluding late sequelae, was initially (in 1982) about FFr 7.8 million (US$ 1426 000). The cost fell to an average of Ffr 550 000 (US$ 100 000) per year in 1991-92.

The main limitations of this study are the lack of controls and the difficulty of ascribing importance to the different programme inputs.

Dowse, G.K., Gareeboo, H., Alberti, K.G.M.M., Zimmet, P., Tuomilehto, J., Purran, A., Fareed, D., Chitson, P., Collins, V.R. and Hemraj, F. (1995) Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius. British Medical Journal Clinical Research edition 311, 1255-1259. Ref ID : 6536 (Borderline for inclusion in database)


Target Group/Country General public in the island of Mauritius

Intervention Methodology Changes in the prevalence of risk factors for cardiovascular disease were examined following a 5-year population-wide ion

Evaluation Method intervention programme promoting a healthy lifestyle in Mauritius. Little information is provided on the intervention which included use of the mass media, fiscal and legislative measures and widespread community, school and workplace health education activities to promote healthy nutrition, increased exercise, smoking cessation and reduction in alcohol intake.

Impact Achieved All adults (25-74 years old) residing in 11 geographically defined clusters were surveyed in 1987 (n=5892) and 1992 (n=5770). Response rates were 86.2% in 1987 and 89.5% in 1992. Subjects underwent a 2-h oral glucose (75 g) tolerance test. Body mass index, waist-hip ratio, serum lipid concentrations and blood pressure were examined and a lifestyle questionnaire was completed. There were significant decreases in the prevalence of hypertension (15.0 to 12.1% in men and 12.4 to 10.9% in women); tobacco smoking (58.2 to 47.2% and 6.9 to 3.7%, respectively); and heavy alcohol consumption (38.2 to 14.4% and 2.6 to 0.6%, respectively). Moderate leisure physical activity increased from 16.9 to 22.1% in men and from 1.3 to 2.7% in women. Mean population serum total cholesterol concentration decreased (5.5 to 4.7 mmol/litre; P<0.001). The prevalence of overweight or obesity increased. The rate of glucose intolerance was similar. The prevalence of cholesterol concentrations ?6.5 mmol/litre and triacylglycerol concentrations of ?2.0 mmol/litre decreased. The mean concentrations of fasting triacylglycerols, total cholesterol and uric acid decreased (P<0.001) and HDL cholesterol increased (P<0.001). The main limitations of this study is the lack of information on the interventions, the lack of a control and the fact that some of the change may be due to the government substituting coconut oil for soybean oil in the government issued ration oil.

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16. Miscellaneous health topics including primary health care, patient education/use of medicines

Brown ,J. and Cody,M.J. (1991) Effects of a prosocial television soap opera in promoting women's status. Human Communication Research 18, 114-142. Ref ID: 8945

Target Group/Country General population in India

Intervention Methodology "Hum Log," India's first long-running television soap opera. The soap opera is intended to promote prosocial beliefs about the role of women in India.The proucers created positive and negative role models to demonstrate the prosocial behaviours. At he end of ech episode a famous Indian film actor gave a 30 to 50 second epilogue in which he summarised the main points.

Evaluation Method a survey of 1170 respondents from three geographic areas. A structural equation model was developed to measure the impact of awareness, involvement, and television dependency on personal beliefs.

Impact Achieved The programme became the most popular television programme in the history of Indian television with audience ratings of 90% in North India and 40% in the non-Hindi speaking South India. The programme was financially successful for its sponsors. Viewers who were most exposed to "Hum Log" were more involved with its characters and more dependent on Indian television for education and entertainment, but were no more aware than their less exposed counterparts of the prosocial beliefs promoted by the soap opera. There was no significant association between viewers' involvement with the characters and their beliefs about women's equality, freedom of choice, or family planning. Moreover, viewers who were more dependent on television did not exhibit significantly stronger beliefs about these issues. There was a significant association between awareness of the prosocial messages promoted in "Hum Log" and viewer beliefs in freedom of choice and family planning (p<0.05). Overall, it appears that, while "Hum Log" enjoys a large and dedicated audience, its messages regarding women's equality are not being assimilated on a large scale. An analysis of the female characters in the soap opera reveals that, in many cases, the self-sufficient, career-oriented women experienced negative social consequences, while characters who pursued more traditional female roles were rewarded. This evaluation provides an important lesson on the limitations of mass media soap opera for changing deeply entrenched norms in a society. It is a remarkable but salutory lesson that a programme can be entertaining yet at the same time not able to fulfil its (admittedly ambitious) objectives

Chalker,J. (1998)  Improving quality of care in Hai Phong Province.  Essential Drugs Monitor 15-17. Ref ID 8691 Ref ID8691

Target Group/Country
1.6 million people in twelve districts of Vietnam

Intervention methodology Following workshops with community members and health workers an IEC programme was developed which included the following messages: 1) Never use injections if tablets will do. Injections can be dangerous and are usually not necessary.2) If you need antibiotics, you must use a full dose. Not finishing the dose means that the next time you need them they may be less effective.3) When you are ill do not self-prescribe, ask your local expert. Use your commune health station. 4)The media used included: two posters - --five distributed to every Community Health Stations (CHS); four radio programmemes (short, five-minute p plays of five minutes) and four 30 -second radio spots broadcast on district and regional radio and also distributed as cassettes to be broadcast through commune loudspeaker systems; four 5-minuteTV programmesmes each 5 minutes long and one -minute TV spots were broadcast on provincial TV; newspaper advertisements; a leaflet was given to every householder in five communes. The content of the educational programmemes was closely matched to the messages above.

Evaluation Method Two hundred 200 households were randomly selected from each of five 5 communes and interviewed. Forty 40 CHSs were randomly chosen and data obtained from the outpatients book, the drug cabinet, the accounting books and some interviews were carried out. The last thirty 30 treatments in the outpatient books of for each CHS wereas examined.

Impact Achieved  89% of households could repeat some IEC message, 75% claimed to have had a change in knowledge or practice. Respondents claimed to have heard messages from the following sources: commune public address system (67%); TV (52%, note TV ownership is 51%), CHS staff (53%), newspapers (7.5%), posters (15%), leaflet (37%). The following improvements were noted between August 1994 and December 1995: patients given vitamins (75% à8%); percentage% of patients given injections (33%à7%); patients given antibiotics (69%à46%); patients given correct doses of antibiotics (29%à91%). Follow-up data in September 1`996 showed that improvements were sustained. By using local resources the additional costs came to a total of $2,200.   This case study was included because it is one of the rare examples showing from developing countries of use of mass media for public education on drugs in a developing country. Its evaluation data have limitations in In showing an impact for the educational component, their evaluation data has limitations. While they demonstrated that their campaign was received, their impact data highlighted was health worker practices. From the data, iIt is difficult to establish from the data whether or not the improvements are a result of the training of of health workers iin improved prescribing or the educational component. However, even if the change is mainly due to improved prescribing, it is important that this is acceptable to patients. It is possible, but not proven by their data, that the educational campaign also contributed although there is but no evidence is available to support this.. While cost data is welcome, it should be noted that this is the additional costs but routine operational costs, research and supervision do not seem have been factored into the costing.


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