Leeds Health Education Database 2015

Database entries with complete fields

2. Interventions to promote family planning and population education

2.1 General

2.2 Community-based programmes

2.3 Clinic- and hospital-based programmes

2.4 Mass media

2.5 Popular media and drama

2.6 Schools and youth

Click on the link for details of the Leeds Health Education Database 2015 Project, a complete listing of papers included and a listing of papers on family planning reviewed but not included in the database

2.1 General

Babalola,S., Vondrasek,C., Jane Brown,J. and Traoré,R. (2012) The Impact of a Regional Family Planning Service Promotion Initiative in Sub-Saharan Africa: Evidence From Cameroon. International Family Planning Perspectives 27, 186-193 and 216. Reference ID: 9093

Abstract: Target Group/Country Couples of child bearing age in Cameroon

Intervention Methodology In 1998-1999, the Gold Circle campaign--a regional initiative to promote and improve family planning service delivery sites--was launched in Cameroon. The main features of the campaign were mass-media coverage (including television and radio jingles), print materials (including posters, a comic strip and a logo featuring a smiling provider inside a gold circle), a Gold Circle advocacy tool and community mobilization activities. Campaign messages promoted GO clinics as quality clinics that offer a variety of contraceptive methods, shorter waiting times, and listening and caring providers. In addition to specifically promoting GO sites, the messages encouraged the audience to visit the family planning clinic nearest to them. Community participation was an aspect of the GO strategy. A team of providers and community representatives formed GO committees, which worked together to plan and implement their local campaign. These teams established a dialogue between the providers and the community, which gave community members a sense of ownership and helped empower them to demand that clinic improvements be maintained. The site-based launch typically lasted 2-5 days and included a formal ceremony presided over by a senior government official. The launch activities included concerts, football matches, traditional dances, speeches by various key community members and government officials, home visits and health talks by service providers. At varying intervals subsequent to the launch, service providers and other members of the GO committee organized community conferences. The campaign was launched nationally in May 1999. The national television station and two radio stations(one of which has national coverage broadcast campaign messages for a period of three months. Each participating radio station aired trhe messages at least three times a day while the national television broadcast the messages three times a week.

Evaluation Method During the last quarter of 1999, 571 women who had been interviewed during the 1998 Cameroon Demographic and Health Survey were re-interviewed regarding their exposure to the Gold Circle campaign and their perceptions on and use of contraceptives. Most questions in the follow-up were similar to those included in the 1998 DHS. In addition, the questionnaire included items that sought to assess exposure to the GO campaign The impact of the campaign was evaluated by assessing the panel data and by using an ideation model of behaviour change. In addition, service statistics from Gold Circle and non-Gold Circle family planning delivery sites were contrasted to assess the effects of the campaign on clinic performance. A total of 1,367 women were interviewed in the selected clusters during the DHS. During the follow-up survey, 1,150 women were successfully interviewed. Of these, 571 had been previously interviewed; thus, 42% of the women in the initial DHS sample were effectively re-interviewed during the follow-up between 18 and 22 months later. Many baseline respondents could not be re-interviewed because they were no longer at their place of residence or because they refused to further participate in the survey. The authors comment on this high rate of loss to follow-up could affect the validity of the findings

Impact Achieved More than one-third of the women surveyed reported exposure to the Gold Circle campaign, 52% of whom mentioned being exposed to the campaign through television. Those with primary or post primary education were four and six times as likely, respectively, as those with no education to have been exposed to the campaign. Exposure was associated with a significant increase in the level of family planning knowledge, as well as with an increased likelihood (p<0.05) of using a modern contraceptive method (80%). The service statistics indicate that the campaign led to a significant increase in the demand for family planning services at Gold Circle clinics. Campaign launch was associated with a six-fold increase in new client flow (p<0.01). There was an increase in use in non-GO sites but it was not significant. It is disappointing that the evaluation did not explore this relationship between the mass media and community-based activities. . Since everyone was exposed to the mass media, the higher impact on utilization in the GO site areas indicate the importance of the community mobilization component While the data would suggest that the community mobilization provided some added impetus to the programme, there remains the possibility – unproven by the data – that the mass media may have helped the community mobilization achieve its impact. The monitoring over time of uptake of family planning clinic use provides a good example of the use of dose response to evaluate programme impact.

Bertrand, J.T., Zelaya, J.D., Cisneros, R.J., and Morris, L. Evaluation of family planning communications in El Salvador. International Journal of Health Education 24(3):183-194, 1982.  Ref ID : 370

Target Group /Country Women of reproductive age in El Salvador

Intervention Methodology During the 1970s, El Salvador had one of the most active communication programmes for family planning (FP) of any Latin American country. Specific details of the IEC activities are not provided

Evaluation Method Questions to evaluate family planning IEC activities were incorporated into a contraceptive prevalence survey which used a two stage sampling method to select and interview 2.962 women aged 15-49 yrs during the period August and December 1978. There was no control and no baseline.

Impact Achieved Over 90% of women have been reached FP messages via mass or interpersonal channels. Levels of exposure were found to be relatively lower among women who live in rural areas, who work at home or not at all, who have little education, who are not married or live in union, and who are under 19 or over 40. While providing information on reach of IEC no information is provided on impact, which in any case would be difficult to ascribe to the IEC because of lack of baseline or controls.

Gray, R.H., Kambic, R.T., Lanctot, C.A., Martin, M.C., Wesley, R., and Cremins, R. Evaluation of natural family planning programmes in Liberia and Zambia. Journal of Biosocial Sciences 25:249-258, 1993. . Ref ID : Ref ID : 5831

Target Group /Country Couples in Zambia and Liberia

Intervention Methodology In Liberia natural family planning (NFP) was provided at 10 centres staffed by 66 trained teachers. And 3 supervisors. In Zambia 25 supervisors and 350 NFP teachers were trained and services were integrated with MCH services in Ministry of Health Clinics. The training programme was developed by WHO/British Life Assurance Trust. Details are not provided of the instructional process used with clients.

Evaluation Method Follow up of clients at 3 months intervals following initial training .'Acceptors' were defined as users who had managed to successfully follow their fertility signs for 1 month after instruction.

Impact Achieved   In Liberia 1277 women initiated the NFP learning and the numbers in the Zambian programme was much larger - 3701. A significantly higher (p<0.001) of women successfully completed the learning phase and progressed to autonomous use in Liberia (58%) compared with Zambia (35.3%). Rates of unplanned pregnancy were significantly higher in Zambia (8.9 per 100 woman years) than Liberia (4.3 per 100 woman years). The total 12 month discontinuation rates in Zambia were also significantly greater than in Liberia )28.8 and 21.2 per 100 woman years respectively) however interpretation of this should take into account that the majority of women were using NFP to space births so discontinuation was probably a result of an intended decision (but no information on this provided). Programme costs per couple-year protection  were lower in Zambia (US$25.7) than in Liberia (US$47.1).The main outcome of this study is the demonstration that NFP can be promoted in two African settings. However the study does not provide information on the long term effectiveness or the feasibility of scaling up the pilot study.

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

Ozgur,S., Bozkurt,A.I. and Ozcirpici,B. (2011)  The effects of family planning education provided to different gender groups.  British Journal of Obstetrics and Gynaecology  107, 1226-1232. Ref ID: 8783

Target Group /Country Married women aged 15-49 and their husbands in three villages in Gaziantep, Turkey

Intervention Methodology Family planning education was given only to women in the first village, only to men in the second village and to both women and their husbands in the third village. Family planning education was given a total of three times at one year intervals by staff of the health centers or health stations using standard methods and materials provided (details of the methods not given).

Evaluation Method A survey was carried out before the first education (total sample n=237 men, n=366 women) and two years later after the last family planning education (total sample n=155 men, n=322 women). Details of the data collection were not provided.

Impact Achieved The rate of any contraceptive use had not changed in all intervention groups. However the rate of effective contraception use had increased in was significantly increased in all intervention groups (p<0.05 for men only and women only group and p<0.01 for group where education delivered to both partners). The increase was greater in the group where family planning education was given to both sexes. The authors concluded that family planning education given to one of the couples may easily affect the other. The significance testing appears to have been use to establish the significance of the increases in all three groups - but not the significance of the apparent greater impact with education targeted at both couples. What is established from this study is that improvements in family planning can be achieved through targeting either men or women. 

Terefe, A. and Larson, C.P. (1993) Modern contraception use in Ethiopia: Does involving husbands make a difference? American Journal of Public Health 83, 1567-1571. Ref ID : 3623

Target Group /Country Husbands and wives in Ethiopia

Intervention Methodology Between August 1990 and January 1991 home visits by female health assistants accompanied by traditional birth attendants with and without husband participation. The sessions generally started with a discussion of the health of the family. Questions on the woman's reproductive history were then used as the entry point into the actual family planning education. The content  of the education focussed on the advantages of family planning for preventing pregnancy, birth-spacing and controlling family size. This was followed by a discussion of both traditional and modern contraceptive methods. A maximum of two visits were made, couples intending to initiate modern contraception were allowed their choice of method and provided with the contraceptive and appropriate information on follow-up.

Evaluation Method Home visits were conducted with 261 wives only (control) and with 266 husbands and wives (intervention). Subjects were questioned at baseline and 2 and 12 months about the reproductive history of the wives and the use of modern contraception

Impact Achieved 47% (n=125) of the experimental versus 33.0% (n=86) of the control women decided to start modern contraception ( relative risk RR 1.42, 95% confidence interval CI =1.15, 1.76) At 12 months almost twice as many experimental couples were using modern contraception as were control subjects (RR=1.90, 95% CI = 1.36,2.66). The majority 55.8% of these had initiated modern contraceptive use more than 2 mo after the intervention. Showing the existence of a sleeper effect.


2.2 Community-based programmes

DeBoer, C.N. and McNeil, M. Hospital outreach community-based health care: the case of Chogoria, Kenya. Social Science & Medicine 28(10):1007-1017, 1989. ). Ref ID : 2724 (Borderline for inclusion in database)

Target Group /Country Catchment population of Chogoria Hospital, Meru District, Kenya

Intervention Methodology Outreach program of Chogoria Hospital was established in 1969. Community involvement was increased through area health committees, a program of recruiting and training village health volunteers, as well as traditional birth attendants, and a youth education program. Family planning services provided health education, information and general services directed at entire extended families. A detailed description is provided of the educational methods.

Evaluation Method The impact of the program is illustrated with data from an extensive 1985 survey of 1879 women of child-bearing age (15-45 years).

Impact Achieved The survey showed widespread general knowledge of modern contraceptive methods with 98% of respondents able to mention at least one modern method. 42.5% were using  a method of contraception (compared with national data from 1985 of 17.0%.  There has been a decline in fertility in the catchment area in recent years, from an average of 7.8 births to 5.2 births among women 40-44 years. The study is limited by the lack of any baseline data or controls or supplementary information to ascribe a causal impact to the programme in general or specific components

Katz,K.R., West,C.G., Doumbia,F. and Kane,F. (1998)  Increasing access to family planning services in rural Mali through community-based distribution.  International Family Planning Perspectives  24, 104-110. Ref ID 8705

Target/Country: Men and women of childbearing age in 8 villages of population of more than 800 in two subdistricts in rural Southern Mali

Intervention Methodology A community-based contraceptive distribution (CBD) programme was incorporated into an NGOs primary health care system  With the local Chief's support each village was asked to select a man and woman to be trained ass family planning promoters. They were trained to provide family planning through group talks and home visits, to sell contraceptives and keep tract of their stock of contraceptives and money received from sales. Trainers and nurses continued to provide family planning education in those villages and in two other districts used for comparison.

Evaluation Method The CBD program was incorporated into a nongovernmental organization's primary health care system in two sub-districts. In two other sub-districts, information and education alone were provided by primary health care workers. A fifth sub-district served as a control group. Contraceptive knowledge, attitudes and practices were measured prior to program implementation in a pre-test survey of 2,994 women and men. After 18 months, a post-test survey of 2,551 women and men was conducted.

Impact Achieved Women's knowledge of at least one modern contraceptive method was greater after the intervention than before for all three groups: 99% vs. 10% in the CBD group, 71% vs. 10% in the education-only group and 53% vs. 10% in the control group (all 3 groups p<0.001). Women's current use of a modern contraceptive method also increased, from 1% to 31% in the CBD group (p<0.001), from 1% to 10% in the education-only group (p<0.001), and from 2% to 14% in the control group (p<0.001). Oral contraceptives and spermicides were the most popular methods in the CBD group, while the pill accounted for almost all contraceptive use in the education-only and control groups. Similarly, men's ever-use of condoms increased from 9% to 35% in the CBD group (p<0.01) and from 7% to 16% in the education-only group (p<0.001), compared with use levels of 6% vs. 10% in the control group (n.s.).

Pineda, M.A., Bertrand, J.T., Santiso, R., and Guerra, S. Increasing the effectiveness of community workers through training of spouses: a family planning experiment in Guatemala. Public Health Rep. 98(3):273-277, 1983  Ref ID : 7832

Target Group /Country Rural communities in Guatemala

Intervention Methodology A family planning experiment in Guatemala using  community volunteers (called "distributors"). Spouses of volunteers were provided with a three day training course on family planning and contraceptives.

Evaluation Method Sales data were compared for the experimental group (33 distributors whose spouses received the training) and the control group (33 distributors whose spouses wanted to attend the training but could not because their primary occupation did not allow them to be absent) for periods of 6 months prior to and 6 months following the training

Impact Achieved The results indicated that sales among the experimental group increased  by 29% following training of spouses significantly higher (p<0.001) than controls whose sales did not increase. This higher level of sales was sustained for at least six months. This simple study provides a good example of how and evaluation can provide important information for future practice. The main limitation comes from the limitations of using contraceptive sales as a measure of impact on the community.


2.3 Clinic and hospital-based programmes

Bossyns,P., Miye,H. and vLerberghe,W. (2015) Supply-level measures to increase uptake of family planning services in Niger: the effectiveness of improving responsiveness. Tropical Medicine and International Health 7, 383-390. Ref ID: 9003

Target Group/Country Clients at rural health centres in a district in Nigeria.

Intervention Methodology Previously family planning was only offered to clients at specific family planning clinics operated by health centres. The intervention was set up in 1999 and involved a 4 day training session for staff to introduce the 3 measures: (1) family planning services were integrated , special family planning clinics were abolished and staff were instructed to make contraceptives available during any working session including curative consultations, under-fives clinics and post-natal care; (2) Health staff were asked to propose family planning to all eligible women rather than waiting until women initiated requests. There were also asked to improve communication; ((family planning procedures were made more flexible and the strict schedule for repeat visits no longer demanded with the message to come back whenever they felt necessary.

Evaluation Method The study measured in 3 health centres and whole district the number of new acceptors, number of oral contraceptive cycles and progesterone injections administered as well as the couple-years of protection before the measures were introduced and the year following the introduction. There was no control.

Impact Achieved In the year after the intervention the number of new acceptors increased by a factor of 4.5 in the 3 health centres and 3 times for the district as a whole. Staff were originally sceptical about the feasibility of the package of measures and wary of the extra workload but became enthusiastic only after the first positive results were obtained and also realized that this would stabilize as the pool of eligible new candidates for the contraception would diminish and that it is much less than the workload of training for and following-up that would be involved in a community-based distribution strategy. It is disappointing that information on coverage of potential target couples is not provided. The authors conclude service barriers are more important than cultural barriers which they feel are over-emphasized in the literature. That cultural barriers may still play a role is indicated by data presented on reasons for refusals recorded by the health workers which were: need for contraception was not felt as husband was away working (25%), preferred natural spacing through breast feeding (22%); women wanted to ask the opinion of their husband (19%), religious reasons and fear of side effects such as sterility (14%), assumed that husband would refuse (6%); lacked information about family planning (4%); reasons not given (10%). Unfortunately the number and proportion of refusals is not given. While improved communication was part of the package, training in communication skills did not appear to be in the training and the authors comment in their discussion that improvements in the quality of communication might increase the responsiveness of the services even further. The authors argue that improving the quality of existing services would be a cheaper and more feasible than launching community-based distribution programmes.

Omu, A.E., Weir, S.S., Janowitz, B., Covington, D.L., Lamptey, P.R. and Burton, N.N. (1989) The effect of counseling on sterilization acceptance by high-parity women in Nigeria. International Family Planning Perspectives 15, 66-71. Ref ID : 6809

Target Group /Country Women with four or more children at ante-natal clinics

Intervention Methodology University of Benin Teaching Hospital launched a family planning and education program for pregnant women who had had 4 or more previous deliveries. This consisted of 4 individualized counselling sessions on family planning methods and the health risks associated with high parity.

Evaluation Method  ore than 1000 high-parity women ( 4or more children) admitted for prenatal care during a 19-month period were randomly allocated either to a treatment group exposed to the education or to a control group that received only the standard family planning information provided at the prenatal clinic. More than 99% of the women were interviewed at admission and almost 90% were interviewed at six weeks post-partum.

Impact Achieved   Overall, 71% of the women in the treatment group were using an effective method of birth control at 6 weeks postpartum, compared with 51% of the women in the control group (p<0.001). About 40% of women in both groups had indicated at admission that they did not want more children, but women in the treatment group were significantly more likely to choose female sterilization as their postpartum contraceptive method than women in the control group--13%, compared with 3% (p<0.001). At admission, only 45% of the women in the study had heard of sterilization and most of them did not fully understand it. At 6 weeks post partum, however all of the treatment patients said that they had heard of sterilization and women who had had the operation were the most informed. 6% of women in the treatment group who had 4 living children underwent sterilization, compared with 46% of those with 7 or more living children. Among control patients, the proportions were 0 and 5%, respectively. This study provides both a demonstration of the impact of counselling as well as evidence for the achievement of informed consent

Ward, W.B., Sam, M., Nicholas, D.D., and Pappoe, M.E. Impact of family planning information on acceptance at a Ghanaian rural health post. International Journal of Health Education 21(4):273-281, 1978.  Ref ID : 543

Target Group /Country Communities in Rural Southern Ghana.

Intervention Methodology A clinic-based educational programme by health education assistants to groups of women at a family planning clinic. The family planning presentation took about 10 minutes and was followed by a question and answer period. There were between thee to  four presentations per session. At the beginning of each session the HEAs were given the results of the previous session's interviews so that they could improve on their practice.

Evaluation Method  The study was limited to female clinic attendees aged 15-44. Ten sessions were investigated  in the study, five with family planning information (N=210) and a control group of five sessions (N=236) with educational session on nutrition. Health clinic attendees were directed to interviewers after they had been seen by the nurse and were waiting to receive their medication

Impact Achieved   There were significantly more (p<0.005) acceptors on days when family planning information was offered. In general, it would appear that family planning education provided in a health facility adjacent to a family planning clinic can have a significant impact on initial adoption of family planning methods.


2.4  Mass Media

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.

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 educational talks to groups of between 12 and several hundred men in mines, farms factories and villag, 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.


2.5 Popular media and drama

Babalola, S. Mobile family planning drama. Promotion et Education Spec No:42-45, 1993. Ref ID : 5880 (Borderline for inclusion in database)

Target/Country Rural Yoruba communities in Ogun State, Nigeria

Intervention Methodology Focus group discussions were used to develop dramas on family planning  which were performed by local artists between November 1988 and April 1989. The project staff visited the locations before to prepare the community and meet with leaders. The performances took place the day before the market when persons from surrounding villages would also be present. The plays ended with a visit to the local clinic by the actors and a public forum where the community were invited to participate and ask questions.                                       

Evaluation Method 20 men and women aged between 15 and 49 yrs. from 20 locations were given a structured questionnaire before and after performances. Data from 10 clinics were monitored six months before and 6 months after drama to determine the number of new acceptors, revisits, total visits and numbers of referrals. No controls were used but questions were asked at clinic about sources of information and reason for coming.

Impact Achieved %of respondents who could name at least two contraceptive methods increased from 44% to 100% . Less than a quarter of sample could name three contraceptive methods before drama and 99% could afterwards (raw numbers or significance tests not provided). Average number of new acceptors at a family planning clinic increased from 107 in pre-performance period to 232. The stated reason for this increase was the drama. Raw data on survey not provided in report... It is stated that drama-s were well attended with an audience on one occasion being over 2011. However, Information is not provided on total numbers of persons reached or costs 

Kinkaid,D.L., Elias,J.R.J., Coleman,P. and Seguara,F. (1988)  Getting the message: the communication for young people project. A.I.D. evaluation special study no. 56,  Washington:  United States Agency for International Development. Ref ID 8742

Target Group /Country Young people aged 10-19 in Mexico and other Latin American Countries

Intervention Methodology The primary message promoted was the need for sexual responsibility. The secondary message was to postpone sex until they were more mature. The media products were released in 1986 and consisted of: two songs )"Cuando estemos juntos" and "Detente") ; two music videos; four television commercials; four radio spots; 11,000 45-rpm records; 11,000 two-sided, full-colour posters and record jackets; one press kit with black and white photographs, coour slides and a brochure; and 7 press bulletins. The songs were selected as the best out of 30 entries to a comptition and the singers were two popular young singers Tatiana and Johnny.

Evaluation Method The programme was evaluated in Mexico by: 1) interviews with survey of young people aged 10-19 of equal mixture of sexes from Mexico Coty (n=657), Guadalajara (n=673) and Ciduad Juarez (n=412). Respondents were asked to recall, unaided , their favourite popular songs from 1987 and then from 1986; they were asked if they remembered any songs from a list that included the two songs and further questions probed their recall of the songs and the messages; 2)focus group discussions with six groups of 10 teenagers each; 3) analysis of a random sample of 1000 letters of the thousands of letters received. There was no baseline study or controls.

Impact Achieved Both songs made the top 20 in the countries where they were released and were no. 1 in Mexico and Peru. The record company reported that the album they released containing the songs became one of their all time best sellers. It was estimated that the songs and discussions about them received over 1 million hours of air time. One song was recalled unaided by 20-25% of the sample and the other by 10%. When presented with a list, the numbers recalling the song increased to 98% and 78% for the two songs. There was a high degree of correct interpretation of the messages. On a 7 point scale, the songs were rated very highly between 5 and 6. Half the respondents said that they talked to their female friends about the songs, and 32% said that they talked to their male friends about them. About 34% said that they had talked to their mothers about the songs and 16% said that they had talked to their fathers, and 7% that they had talked to their teachers. The authors suggest that the project was less successful in channelling young people to family planning centres for advice on contraception but no data are presented on this. Note that raw data or significance tests are not presented in this report - only summary charts.

Valente, T.W., Poppe, P.R., Alva, M.E., Vera de Briceño, R., and Cases, D. (1994). Street theatre as a tool to reduce family planning misinformation. International Quarterly of Community Health Education 15(3):279-289, . Ref ID : 7383

Target Group/Country Public in open air outside parks and health clinics in urban Peru

Educational Method A street theatre play 'Ms Rumours' was designed to dispel rumours about modern contraceptive methods. The misconceptions targeted included: the pill promotes cancer, the pill affects the foetus and the IUD promotes abortions. Each performance lasted about 20 minutes and was followed by a group question-and-answer counselling session. The play was performed in parks and squares and also outside hospitals and clinics to people waiting for services.  It involved four characters Ms. Rumours, a couple in love and a pharmacist. The street theatre showed how Ms. Rumours promotes misconceptions, negative attitudes and shows the pharmacist dispelling those rumours..

Evaluation Design Pre-test/Post-test design.. Approximately four persons per performance were interviewed before and after 17 performances making a total of 102 respondents. The interview asked them whether they agreed or disagreed with 11 knowledge and attitude questions before and after the drama using a likert scale. There were no controls.

Impact Achieved From April 1992 to July 1994 the play was performed about 200 times to an estimated total audience of about 61,000 and an estimated 4,500 attending follow-up face-to-face counselling sessions. All the item scores decreased between pre- and post-test measures. Knowledge statements such as "the pill produces cancer," the pill affects the fetus", the pill affects the nerves" and the condom is uncomfortable" changed the most (p<0.01). Attitudinal statements "The pill is easy to use," ""The pill produces abortions" and "the condom is easy to use" changed little. The authors claim that the street theatre significantly reduced misinformation but did not have a significant impact on the attitude questions. There was a greater impact on women rather than men and among educated rather than less educated respondents. However, the distinction between questions about attitude and misinformation is not very clear-cut and the conclusions about a differential effect on knowledge and attitudes is not justified


2.6 Schools and youth

Agha,S. 2013 A Quasi-Experimental Study to Assess the Impact of Four Adolescent Sexual Health Interventions in Sub-Saharan Africa International Family Planning Perspectives 28(2)67-117.Ref ID: 9073

Target Group/Country Adolescents in Cameroon, Botswana, South Africa and Guinea

Intervention Methodology All four social marketing programs in in 1994-1998
interventions evaluated in this study were nested within national social marketing programs. The national programs sold subsidized, branded condoms to traditional outlets, such as pharmacies and clinics, and to nontraditional outlets, such as supermarkets, kiosks and street vendors. They promoted the use of their brand to sexually active adults through mass media advertising and through information, education and communication tools such as billboard messages about condom use and point-of-sales materials (stickers and posters) at condom outlets. Design of the educational intervention was based on the Health Belief Model.
In Cameroon The 13-month intervention included peer education, youth clubs, mass media advertising and the distribution of informational and educational materials. Twenty-eight adolescents (16 males and 12 females) were trained as peer educators to promote behavior change and motivate adolescents to use the contraceptive products available through the social marketing program. They led discussion groups about a wide range of topics-for example, abstinence, pregnancy prevention, HIV and AIDS, other sexually transmitted diseases and how to communicate about sexual issues- and sold subsidized condoms to discussion-group participants. Members of the youth clubs wore promotional items such as T-shirts and caps carrying messages about contraceptive use.
In South Africa, the 11-month intervention in Soweto included campaigns promoting safer sex, which were broadcast on the community's new radio station. On live weekly talk shows, project staff held discussions with guest experts (e.g., family planning providers and counselors) on topics such as ways to prevent pregnancy, HIV and other sexually transmitted infections; dating; relationships; sexual violence; contraception; and how to resist peer pressure to have sex.9 Seventy adolescent volunteers were trained to participate in media development, condom distribution and peer education. (Twelve of these young people later became paid marketing assistants for the project and promoted or sold condoms to adolescents in their communities for a commission.) In addition, 300 new condom outlets that sold the program's condoms were opened in Soweto.
In Botwana, the 8 month intervention sampling process. The mass media component included radio messages and information campaigns directed at parents, teachers and young people, and a radio call-in show on which adolescents could discuss issues related to AIDS, family planning and contraceptive use. However, because the same radio station reached both Lobatse and Francistown, adolescents in the comparison area were also exposed to these radio shows and messages. Peer educators who were part of the intervention were given standardized training and refresher courses. 13 Because of the relatively small population of Lobatse, a substantial proportion of adolescents (70%) were exposed to the intervention.
In Guinea, 28 male and 28 female volunteer peer educators were trained on issues related to HIV and AIDS, family planning and communication techniques. During the intervention period (about six months in Kankan and 8-9 months in Conakry), they held discussions about reproductive health with young adults and organized educational theater, .lm presentations on reproductive health, and dances and athletic events during which presentations reproductive health issues (including condom use demonstrations) were made. Most of these events were conducted at locations frequented by adolescents, such as schools, sports .elds and video clubs. Peer educators distributed .yers on family planning, HIV and AIDS, and promotional items (T-shirts, stickers, badges and caps) carrying messages about contraceptive use. They also distributed free contraceptives to adolescents. Young people developed a logo proclaiming "My Future First," which was used to identify youth-friendly retail outlets where young people could purchase condoms and other contraceptives. Because each city included intervention and comparison areas, the intervention did not use mass media communication specifically targeted at adolescents.

Evaluation Method A quasi-experimental design was used to evaluate the impact of adolescent sexual health interventions conducted by. The same statistical models, using data from baseline and post-intervention surveys, were employed to study each intervention; the results are presented within the framework of the Health Belief Model. Cameroon The 1996 baseline survey included a random sample of 1,606 respondents (805 in the intervention city and 801 in the comparison location), and the 1997 follow-up survey contained data on 1,633 respondents (811 and 822, respectively). South Africa - the baseline survey was conducted in 1996 among 118 young people in Soweto and 103 in the comparison location; the post-intervention survey took place in 1997, and included 101 respondents in Soweto and 103 in the comparison town. Botswana -for the 1994 baseline survey, 1,002 adolescents were selected. For the follow-up, in 1995, the sample was
increased to 2,396. Guinea -for the 1997 baseline survey, the sample consisted of 2,016 respondents; for the 1998 follow-up, 2,005 respondents.

Impact Achieved The interventions were associated with improvements in a variety of health perceptions among women in Cameroon, including perceptions of benefits of and barriers to protective behavior for women (p<0.01), the interventions also had positive impacts on contraceptive use for both men and women in both Cameroon and Guinea (p<0.01) . Effects were much more limited among men but reached p<0.01 for health perceptions in Cameroon. Evidence from Cameroon and Botswana suggests that men were less likely after the intervention than before to have multiple or casual partners (p<0.01). The Cameroon intervention, the most successful of the four, used multiple communications media (including radio and peer education) and reached nine in 10 adolescents; the Botswana program also reached a high proportion of the target audience. In South Africa and Guinea, however, the programs were less intensive and had a more limited reach and may have been attended by persons from the control communities. The programme in Guinea relied primarily on sponsored events such as soccer games and concerts which young women were less likely to reach. The programme in South Africa used a newly established community radio station which only reached a small fraction of the population. authors conclude that Interventions targeted at adolescents can be effective in changing attitudes and sexual behavior if they include multiple channels of communication, reach a substantial proportion of young adults and make contraceptives widely available. However it should be noted that significant evidence for impact was only reached in the Cameroon intervention, raising queries on the validity of the conclusions for the other three locations.

Eggleston,E., Jackson,J., Rountree,W. and Pan,Z. (2011)  Evaluation of a sexuality education program for young adolescents in Jamaica.  Revista Panamerica de Salud Publica  7, 102-112. Ref ID: 8892 (Borderline for inclusion in database)
Target Group /Country School children in 7th grade (aged 11-14) in Jamaica

Intervention Methodology A Grade 7 project initiated in 10  schools across Jamaica in 1995-1997. It was designed to delay initiation of sexual activity and promote  use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Female educator-counselors employed by the project conducted Grade 7 project sessions once per week throughout the 9 month academic year. Sessions were coeducational, lasted 45 minutes and had calls sizes from 30-60. The sessions included classroom lectures supported by visual aids and question-and-answer sessions. Small group discussions were held during some sessions.

Evaluation Method 5 intervention schools were compared with 5 schools with the standard sex education curriculum.  945(490 girls, 455 boys) completed a baseline self-completed  questionnaire in Sept 1995 and 75% of these completed the post test questionnaire in June 1996 (short-term ) and in June 1997 (long term).  The questionnaire was pre-tested, revised and the final version was pre-tested again as considerable changes were required to ensure that the questions could be answered by students who could not read and write very well.

Impact Achieved   Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P = .08) by adolescents who reported first intercourse during the study period (n=91); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. Note the short term impact on use of contraception is encouraging but the p value is greater than the standard value of acceptability of p<0.05 which can be attributed to the small sample of 91 children who had their first intercourse during the study. Note that lack of significant impact on the project on initiation of intercourse can be consider a positive outcome reinforcing various reviews that have argued that sex education does not lead to early experimentation.

Martiniuk,A.L., O'Connor,K.S., & King,W.D. 2013, A cluster randomized trial of a sex education programme in Belize, Central America, International Journal of Epidemiology, 32(6)131-136. Ref ID: 9067

Target Group/Country Adolescents aged 13-19 years in schools in Belize, Central America

Intervention Methodology A responsible sexuality education programme (RSP) based on Bandura's Social Learning Theory and using modeling, role playing and shaping techniques. The 3 hour scripted responsible sexuality education programme sought to provide a framework for adolescents for decision making in relationships and unbiased information about sex and sexuality. Very little information is provided on the actual sessions, who taught them and what activities took place.

Evaluation Method A cluster randomized design. Seven high schools in Belize City were selected; 8 classrooms were randomized to the intervention arm and 11 classrooms to the control arm (N = 399). Data were colleted using a 79-item questionnaire. Parts One and Two examined attitudes and behavioural intent rated on a five-point Likert scale. Part Three examined knowledge using 20 true/false,don't know questions.

Impact Achieved Greater changes in knowledge were observed in the intervention group than in the control group following the intervention. The intervention was associated with two more correct answers on the post-test (difference score was 2.22 points, 95% CI = 0.53, 3.91) after adjusting for gender and previous sexual experience. Changes were not observed for the attitude or behavioural intent domains. After controlling for gender and previous sexual experience, the intervention was associated with no change in the attitudes (0.06, 95% CI: -2.89, 2.82) or behavioural intent domains (0.84, 95% CI: -1.12, 2.46). The authors discuss possible errors introduced by the randomization process which was at the class room level. While they feel that there was unlikely to be contamination between control and intervention classes in the same school, the randomization resulted in inbalances in gender and previous sexual experience. Given that the input was only for three hours a lack of impact on behaviour is unsurprising. However, It is disappointing that no information is provided on the actual quality of the educational inputs.

Mbizvo, M.T., Kasule, J., Gupta, V., Rusakaniko, S., Kinoti, S.N., Mpanju-Shumbushu, W., Sebina-Zziwa, A.J., Mwateba, R. and Padayachy, J. (1997) Effects of a randomized health education intervention on aspects of reproductive health knowledge and reported behaviour among adolescents in Zimbabwe. Social Science & Medicine 44, 573-577. Ref ID : 6736

Rusakaniko, S., Mbizvo, M.T., Kasule, J., Gupta, V., Kinoti, S.N., Mpanju-Shumbushu, W., Sebina-Zziwa, J., Mwateba, R. and Padayachy, J. (1997) Trends in reproductive health knowledge following a health education intervention among adolescents in Zimbabwe. Central African Journal of Medicine 43, 1-6..Ref ID : 6868

Target Group/Country Secondary school pupils from 11 schools mainly from rural areas of in Zimbabwe

Intervention Methodology An educational programme on male and female reproductive function, female anatomy, STDs, AIDS, human sexuality and responsible behaviour. Lectures supported by videos, leaflets, pamphlets and posters were given on reproductive biology, STD/HIV/AIDS, unwanted pregnancy and contraception, human sexuality and responsible behaviour. Details of the duration of the educational sessions not provided.

Evaluation Method  A randomized controlled study on reproductive health knowledge and behaviour was undertaken among adolescent pupils drawn from a multi-stage random cluster sample with 30 selected from each of forms 1-6 with a sample of 180 per rural schools. The schools included one Catholic and two Salvation Army Schools. A self-administered questionnaire was used to assess aspects of reproductive health knowledge and behaviour at baseline and five and nine months after the health education intervention. Results are based on 1689 responses made up of 1159 intervention and 530 control respondents mean age 14.6+/- 3.1yrs. Details are not given how the controls were selected.

Impact Achieved   There was a significant increase in correct knowledge about aspects of menstruation in intervention as compared with control schools [odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.4-6.1). Significantly, (OR = 2.0, 95%CI = 1.1-3.9) more pupils from intervention than control schools scored knowledge of correct practice relating to menstruation. Knowledge of wet dreams increased by 11.7% in intervention group and 1.3% in controls (p<0.01) Pupils from intervention schools were more likely (P < 0.001) to know that a boy between 13-19 years could make a girl pregnant and that a girl could get pregnant at her first sexual intercourse (OR = 1.4, 95%CI = 1.1-1.9). Understanding of family planning increased in intervention schools from 24.6% at baseline to 51.4% at 5 mo. (p<0.01) and in controls from 18.8% to 43.1% Knowledge of specific family methods increased (odds ration 1.4. 9.5% CI 1.1-1.7). Improvements were sustained over time. Note: increases in the level of knowledge of controls indicated that pupils are exposed to sources of health education on family planning outside of schools

Russel-Browne, P., Rice, J.C., Hector, O. and Bertrand, J.T. (1992) The effect of sex education on teenagers in St Kitts and Nevis. Bull. Pan. Am. Health. Organ. 26, 67-78.Ref ID : 6513

Target/Country 12-15 year old school children from all six government high schools in St Kitts Nevis, Caribbean

Intervention method A syllabus covering human reproduction, growth and development, emotional development and issues and values in adolescent sexuality was developed for 12-15 age group  to be delivered through two 40-minute sessions for 26 weeks in St Kitts and Nevis in the mid 1980s. The 12 participating teachers received a four week training course in sex education.

Evaluation Method Evaluation was carried out using a before and after self-administered questionnaire of 2,202 children in experimental (six schools) and 1,321 children in control schools.  Follow-up questionnaires were given 10 months and one year after baseline. Questionnaires for follow-up consisted of The evaluation focused on four areas of knowledge: changes at puberty, reproductive anatomy and physiology, intercourse and pregnancy and contraception. Questions also asked about level of sexual activity and use of contraceptives on last sexual encounter.

Impact Achieved Despite some non-equivalence of the experimental and control group for age and a drop-out from the original sample in the follow-up questionnaire, the programme is claimed to have an impact of knowledge in the four domains (raw data and % given, statistical tests were reported to have been carried out but no p values given). The programme did not appear to influence contraceptive practices. There was no increase in sexual activity among the intervention group. No significant gender differences were found on the impact of the intervention on knowledge.

Turner, R. (1994) Sex education gains strength in Mexican public schools. International Family Planning Perspectives 20, 73-74.  Ref ID : 6787

Target/Country Schools in 72 secondary schools in 30 states in Mexico

Intervention method The evaluation of a sex education course Planning Your Life was used to develop a further course Adolescence and Development which combine factual and psychosocial elements and involve extensive role playing.

Evaluation Method The evaluation of Planning your life involved 1076 students who took the course and 556 as controls. Students were interviewed at baseline and again post-intervention. The evaluation of Adolescence and development involved giving 2011 pupils  a questionnaire at baseline and 1945 at follow-up . Also 1795 were given an opinion survey at the end of the course. 10% of teachers were given "tests" of attitudes and knowledge and 82 were also given an "opinion survey" at the end of the year. Details of sampling or measuring instruments are not provided.

Evaluation impact Unfortunately this publication only gives a brief account of the programme with no raw data or statistical analysis. The courses are claimed to have earned praise from parents and students despite fears from researchers that sex education would be rejected by Roman Catholics. In an evaluation of "Planning Your Life" performed in 1988-89 at 2 Mexican schools, it was found that exposure to this course led a significantly larger portion of the students who were having sex to use contraceptives. Evaluation of "Adolescence and Development" was undertaken to determine the attitudes of teachers, school authorities, parents, and students toward sex education. The teachers are claimed to have reported attitudes of other teachers, parents, and students as being either very positive (51-63%) or positive (33-45%). Attitude and knowledge scores of the students were reported to have  improved by the course, and most students liked the course a lot. 87% of parents were in favour of continuing the course, and 68% felt it should be required. By the time that newspaper advertisements appeared demanding that the course be stopped, it had gained sufficient support that its creator, the Instituto Mexicano de Investigacion de Familia y Poblacion (IMIFAP), was asked to develop more educational programs. By July 1993, the Mexican Congress passed a General Education Law which encourages sex and family education.

Vadies, E. and Clark, J. Comprehensive adolescent fertility project in urban Jamaica. Hygie 9(2):21-26, 1990. Ref ID : 538

Target Grou;p/Country Youth in 8 communities (total population 100,000)  in Jamaica, Caribbean

Intervention MethodologyThe Duhaney Park Youth Project and Health Centre in Jamaica is aimed at providing counseling, family life education, health, family planning and STD treatment, recreation and sports for youth. Activities included counselling, training of peer counselling, 3 day special topic youth workshops and an evening youth clinic. The project provided a central local point for activities through a new youth centre. There were four full time youth project staff who received 750 hours training.

Evaluation Method  Evaluation was through monitoring clinic attendances during the first year of operation. There were no controls or baseline

Impact Achieved   Over 12 months from April 1985 there were 419 visits to the youth clinic by a total of 285 patients. 120 (29)% were for family planning and 102 (24%) for STD consultations. Attendance was slow for nine months (35 per months) then increased by 100% in the 4th quarter of the year. Clinic users were predominantly female (1 male for every 9 women and 71% were aged 19+ years.  The main significance of this study is that it demonstrates that young people will use youth clinics  - however it does not seemed to have reached the young people 18 years and under. No information is provided on long term sustainability of the programme.

Wong, T. and Travers, K. (1997) Evaluation of a peer health education project in the Gambia, West Africa. International Quarterly of Community Health Education 17, 43-56. Ref ID : 7258

Target/Country Secondary school pupils in10 high schools in the Gambia

Intervention method A peer health education program among high school students. A variety of methods were used including group-work, lectures and distribution of leaflets on AIDS, drugs, stress, nutrition, alcohol, environmental health, family planning and STDs. No information is provided on selection, training, supervision of peers or the specific activities that they were supposed to undertake. From information presented in the discussion of the results it looks as if peer educators were supposed to give presentation in classes.

Evaluation Method Two of the ten high schools targeted by the program (one urban end one rural) were selected for evaluation. A total of eighty respondents, forty from each school. were randomly selected for participation. A self-completed questionnaire with both open and closed-ended questions was the data collection instrument which was subjected to qualitative content analysis and quantitative descriptive analysis. 74 participants completed the questionnaire for a response rate of 92  percent. The questionnaire was applied to one school after the project had run for 8 months and for 11 months in the other school. There was no baseline or control.

Impact Achieved 98% of respondents were aware of the existence of the peer education programme and 67% of those who were aware had received information from youth sources. 94% of respondents indicated that they had applied the information learned from peer education to their lives. Content analysis of their responses indicated that 67.7% of those had applied it to behaviour change in their own lives and 22.4% indicated that increased awareness of health issues was informing anticipated future choices. This evaluation is severely limited by the lack of specific information on the actual peer education programme, the nature and extent of peer education activities, the views of the peer educators themselves and the vagueness of the data on the impact on pupils.


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