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Randomized Control Trial - Media, Communication and Health - DMI in Burkina Faso

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Randomized Control Trial - Media, Communication and Health - DMI in Burkina Faso

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To: The Health Communication Network within The Communication Initiative Network

Randomized Control Trial - Media, Communication and Health - DMI in Burkina Faso

[We invite you to please ask questions about, comment on and critically review the RCT based research outlined below by either replying by email to this note or clicking the Read More link below and sharing a comment online (the paper is also attached to this post online).]

One criticism of the communication and media for development, social and behaviour change field of work is that there is little high quality evidence for its impact. In particular those outside this field of work ask us for evidence based on that supposed gold standard of research designs - the Randomized Control Trial (RCT). Of course we have a large amount of impact evidence using other quality research designs. But those with a narrower science perspective will always look for the three "magic" letters "RCT" as the basis for assessing whether the evidence presented is credible and reliable.

Well, now we have an RCT. Its mid-line results (the final results will be available in 2015) facilitated the researchers to make this statement: "There is a strong correlation between the intervention 'dose' (the number of weeks each message was broadcast) and the impact on behaviours…".

It is a four-year randomised controlled trial in Burkina Faso, with three years of broadcasting. The research tests the hypothesis that a radio campaign can reduce the large number of children dying before their fifth birthday. The RCT is directly measuring the impact of the radio campaign on child mortality, with a 50,000 sample size at baseline and 100,000 at endline.

Because of the nature of the Burkina Faso media there are unique media footprints for each of the 14 zones. These are community media stations. There is weak national media penetration. Consequently it is possible to broadcast in intervention zones with minimal risk of ‘contaminating’ the control zones.

Here are some examples of the ‘difference in difference’ (the additional behaviour change in the intervention zones compared with the control zones) as measured at mid-line (and adjusted for confounding variables):

  1. Parents taking children with diarrhoea to a health facility for treatment: 16.0 percentage points
  2. Children receiving antibiotics for pneumonia symptoms (fast or difficult breathing): 14.8 percentage points
  3. Mothers initiating breastfeeding within two hours of birth: 10.7 percentage points

For a full summary of the midline results please go to this link where there is also a link to the DMI summary paper.

This independent research is funded by the Wellcome Trust and Planet Wheeler Foundation. The radio campaign is being implemented by Development Media International (DMI), and the evaluation is being supervised by the London School of Hygiene and Tropical Medicine (LSHTM).

DMI wishes to stress that the research is a test of their strategy which is called "Saturation+". In Burkina Faso this involved, in the intervention zones, broadcasting 60-second radio adverts 10 times a day, seven days a week, in six languages on the major Burkina Faso health issues; and, two live radio dramas on health issues every weekday evening, as part of the prime time evening show on each station, since 2012

The mid-line results for each of these issues include:

a. Treatment for diarrhoea at a clinic - 16% improvement difference in intervention zones compared to control zones
b. Received ORT or increased liquids for diarrhoea - 23.3% improvement difference in intervention zones
c. Received antibiotics for pneumonia (fast/difficult breathing) - 14.8% improvement difference
d. Sought treatment for fever at a clinic - 9.1% improvement difference
e. Women sleeping under a bed net during pregnancy - 3.4% improvement difference
f. Household ownership of latrines - 2.3% improvement difference
g. Early initiation of breastfeeding (2 hours of birth) - 10.7% improvement difference
h. Exclusive breastfeeding aged 0 to 5 months - 1.8% negative difference in intervention zones compared to control zones
i. Gave birth in a health facility or with skilled attendant - no difference
j. Saved money for an emergency during pregnancy - 8.5% improvement difference in intervention zones compared to control zones

The DMI paper outlining these results can be accessed at the bottom of the online summary and is also attached to this post online.

The Board of DMI includes: Richard Horton - Editor-in-Chief, The Lancet; Joy Phumaphi - Executive Secretary, African Leaders Malaria Alliance; and, David Heymann - Chair, UK Health Protection Agency.

The Scientific Advisors include: Simon Cousens - Professor of Epidemiology, London School of Hygiene and Tropical Medicine (LHSTM); Cesar Victora - Professor of Epidemiology, Federal University of Pelotas; Bocar Kouyaté - Technical Advisor to the Minister of Health, Burkina Faso; and Anne Mills - Professor of Health Economics and Policy, LSHTM.

Please share your questions and analysis of the research outlined above. We would much welcome your comments and questions on this research.

What do you think?

What questions do you have on the results?

What questions do you have about the methodology?

We will encourage and support DMI to respond.

Best wishes,

Warren Feek Executive Director The Communication Initiative

A randomized trial in social

To: The Health Communication Network within The Communication Initiative Network

Eric Lugada - Axios Foundation International Country Director for Sudan and Nigeria. with questions on the Randomized Control Trial - Media, Communication and Health by DMI and LSHTM in Burkina Faso

A randomized trial in social and behavior change is a great initiatives many thanks to the team. I have a couple of questions which would help us definitively establish a causal relationship between media messaging and observed health seeking behavioral change.

  1. There exits a considerable variation in the target behaviors between the control zones (CZ) and the intervention zones (IZ) at baseline. Could the authors explain why?
  2. Where the CZ and IZ truly comparable at baseline such that each community had an equal chance of being either in the control or the intervention group with the group to eventually belong to not being predictable?
  3. How were the CZ and IZ groups chosen? Was it through a random allocation process thus reducing the potential for confounders?
  4. As it were now give the vast variations in target behaviors at baseline, its difficult to attribute with certainty the observed behavioral changes at midterm to the radio messaging interventions.

Proper randomization could have prevented bias and assume that both the CZ and IZ groups do not differ in anat systematic way which could have influenced and biased the observed results.

Its possible that:

a) The CZ could have had prior health awareness raising intervention thus the vast differences target behaviors at baseline
b) The CZ groups were affluent, with better education levels thus had already achieved maximum behavior change associated with literacy by the time of the study
c) possibly the CZ had more high household income dwellers thus easily access health care
d) possibly the CZ group had more urban dwellers as opposed to rural dwellers compared to the IZ group?

The authors need to explain to us in detail the methods used, particularly the constitution and selection process of the CZ and IZ groups for us to be able to establish existence of a true causal/effect relationship between interventions and observed behavioral changes.

Eric Lugada - Axios Foundation International Country Director for Sudan and Nigeria.

Reply from DMI to qestions from Erica Lugada

To: The Health Communication Network within The Communication Initiative Network

Will Snell from DMI responds to the questions posed by Eric Lugada - Axios Foundation International Country Director for Sudan and Nigeria. about the methodology of the Randomized Control Trial - Media, Communication and Health conducted by DMI and LSHTM in Burkina Faso

Dear Eric

Thanks for posting this comment. You are of course right about the difference in behaviours (and mortality) at baseline between intervention and control clusters. Unfortunately the small number of clusters (seven in each group) limited the extent to which we could avoid this during the randomisation process. As a result, mortality levels were higher, and behaviour coverage levels lower, in our intervention zones; there are also twice as many health centres in the control zones as in the intervention zones. We dealt with this discrepancy at midline by adjusting those midline results that related to facility-dependent behaviours for distance to a health facility. This adjustment was not necessary for household behaviours. Our endline results will be adjusted for all potential confounders. In the meantime, LSHTM will be publishing a detailed technical report on the midline results later this year (timings are dependent on the peer review process).

Best wishes - Will Snell - DMI

*To add your questions, observations and comments on this RCT research either reply by email to this note or click Read More below and post online. Thank you for engaging.

Proving the impact of media on behaviour change

To the Health Communication Network within The Communication Initiative Network

Sharing a blog with observations and questions - eg Full data? Theory of change? Dose response? Design? - from Kavita Abraham Dowsing and Leonie Hoijtink at BBC Media Action on the Randomized Control Trial - Media, Communication and Health by DMI and LSHTM in Burkina Faso. [To join this conversation critically reviewing this research either reply by email or click Read More below and add your comments and questions online - thank you]

The expectations and excitement levels among our research and learning team here at BBC Media Action were high. The largest single study using a randomised control trial (RCT) to investigate media impact has published midline results online last month. Had the company behind the trial, Development Media International, cracked the Holy Grail and isolated the impact of media on behaviour change? Could these results from their trial in Burkino Faso begin to answer the questions of attribution which trouble the impact evaluation of health communications while resonating through the halls of our donors? Our team couldn’t wait to jump into the detail of the data and explore the initial results.

But while DMI’s conclusion of the findings is exciting - that this is "the first randomised controlled trial to demonstrate that mass media can cause behaviour change" - their three-page report and one-page summary left us wanting more.

While neatly summarised for a policy level audience, we couldn’t help but ask, where are the technical appendices, where is the data, where are the standard errors and, ultimately, what does all this mean for us as a sector? This is why we contacted DMI and their research partners at the London School of Hygiene and Tropical Medicine. We are pleased to learn a more detailed technical report is being finalised and to be published in the upcoming months.

A rare condition for a unique study

In DMI’s film about the study, they state that there are few countries and media environments around the world that would provide the necessary conditions for this type of study. A principal issue is 'contamination', where some people who are not supposed to hear the broadcast (the 'control group') are, in fact, exposed to it.

The limited number of suitable countries to work in is in keeping with findings on impact evaluation approaches in health communication from scholars in the sector, such as Jane Bertrand and Robert Hornik. They have underscored the need for alternative study designs to randomised trials as the optimal means of evaluating full coverage mass-media programming. It is largely seen not to be viable to assign subjects randomly to treatment groups when the intervention consists of a full coverage campaign aiming to reach the largest possible audience.

This highlights the uniqueness of their Burkino Faso study and why the results - positive or negative –have such potentially large implications for our sector’s evidence base.

Up until now, the media for development sector has focused on less robust evaluation methods to explore how mass media contributes to improved knowledge and behaviour. And while all evaluations, qualitative and quantitative, build towards a more informed answer, the Burkina Faso trial is pushing the envelope by applying an, in our sector, untried research methodology that should give us more conclusive results.

But to be able to learn the most from DMI’s trial in Burkina Faso and interpret its results correctly, it is vital we get more information on the following aspects, which we hope would be addressed in the upcoming publication.

Theory of change

An important issue where we would like to gain more insight is the Theory of Change that underlies DMI’s intervention in Burkino Faso.

How are their short, high-intensity broadcasts expected to impact behaviour, and more importantly lower child mortality rates?

From the list of outcomes targeted it appears that the trial focused on curative, one-off behaviours and less on those that are underpinned by social norms. People will have more incentive to alter their behaviour if their child is sick, but will be less inclined to change if they feel their family or community would disapprove.

It would also be interesting to learn more about the quality and nature of the programmes: how similar or different are they, what are the editorial values, has any assessment of quality been done? Knowing the Theory of Change and relevant programme information would help us to look beyond the results and understand not only if we see impact, but why.

Dose response

Similar questions apply to the presented dose response results. 'Dose response' refers to the period of time each message was broadcasted and the possible relation this has with behaviour outcomes, ie do behaviours that aired for more weeks show more change?

Only a selection of outcomes is taken to present the effect of dose response and a diverse set at that. This affects the interpretability of the results.

Another way of presenting the dose response would have been to group those behaviours that are similar together. It is safe to say, that it is easier for people to take Oral Rehydration Solution (ORS) against diarrhoea than to install a latrine in their house; we expect to see higher differences in one outcome than the other.

Breaking the dose response down according to type of behaviour could have resolved that and provided more insight. Though these midline results give an indication, based on what is currently presented it is difficult to say what the real influence of dose response is.

Research design

Without further technical insight or Theory of Change to turn to, the midline report leaves us with some questions about the study design.

These pertain for instance to technical issues like confidence intervals and the powering of the samples. Perhaps more pressing though is to what extent the control and intervention zones are comparable on various socio-economic, demographic, cultural and/or geographical factors? Based on the presented data, baseline equivalence is questionable.

Reported differences on behaviour outcomes could therefore be caused not by exposure, but by important underlying characteristics of the selected areas. The research methodology of RCTs should balance such differences, but when a relatively small number of areas are selected, this is unlikely to happen. Adjusting only for distance to a health centre, ie keeping its effect constant, is then insufficient to assess the actual impact of the intervention.

A Theory of Change could provide an important rationale for determining which characteristics to control for when analysing the data. So we look forward to seeing the endline results where adjustment for possible confounders is said to take place.

Statistical detail

From a research perspective, assessing the impact of an intervention becomes complicated when a succinct summary leaves out certain statistical information; sample sizes for outcomes which have been measured at the cluster level, and the accompanying standard errors are important for external researchers to be able to correctly interpret results.

A more technical report should provide that information to provide transparency about the study. It would also help us understand why strong relationships between the intervention and outcomes are reported, while p-values (probability values) in many cases are not significant. Could differences be the result of chance or is the study design making it difficult to detect significant change?

Interpretation and going forward

So far, the results seem to be mixed. For certain one-off behaviours, such as seeking treatment for diarrhoea at a clinic, there appears to be an impact, but for many others, and especially those like exclusive breastfeeding which are underpinned by social norms, the intervention does not appear to have had an effect. Though again, this is interpretation without technical information or qualitative data to inform us further.

The fact that these are midline results may also be a cause for the mixed results. It will take time to change people’s attitudes and perhaps three years is just too short. Endline results may be more conclusive. We would encourage future initiatives to evaluate interventions past their running time. After broadcasts have finished, do people fall back into old behaviours or has the change been sustainable? Is there any enduring impact we can bring about with mass communications?

A final note of caution is that it is important to realise this RCT is just one study, conducted under difficult, imperfect conditions. Even if we were able to conclusively interpret the current results, one swallow does not make a summer. We need to contextualise the results in the broader field of what we know media can and cannot do. Some smaller scale links that we at BBC Media Action are trying to establish are explored in a few of our recent research papers, a report examining the role of factual debate and discussion programming on political participation in Nepal and a paper which reviews field experiments in the media and political development sector.

This is an exciting moment for our sector. Our appetites have been whetted. We look forward to learning and understanding more from DMI and the London School of Hygiene and Tropical Medicine on the findings from the trial - and would love to be part of the conversation as the findings move from midline to endline over the next one and a half years.

It is a great opportunity for us all to learn about the impact of these findings of this unique trial which will affect us all.

Kavita Abraham Dowsing and Leonie Hoijtink

Will Snell from DMI responds to the BBC Media Action Qs

To the Health Communication Network within The Communication Initiative Network

Kavita Abraham Dowsing and Leonie Hoijtink at *BBC Media Action commented on the Randomized Control Trial - Media, Communication and Health in Burkina Faso.

Will Snell from DMI provides a response below. To join this conversation critically reviewing this research either reply by email or click Read More below and add your comments and questions online - thank you

Dear Kavita and Leonie

Thanks for re-posting this blog post. We welcome your interest and agree with many of your comments. As you point out, LSHTM will be publishing a detailed technical report on the midline results later this year (timings are dependent on the peer review process), and we hope that this report will deal with many if not all of the points that you raise. Ultimately, however, we agree with your comment that the real 'proof of the pudding' is in the endline results next year...

Best wishes

Will Snell DMI

RCT (media, communication, health) in Burkina Faso

To: The Health Communication Network within The Communication Initiative Network

Jane Sherman - from the Nutrition Education Team in FAO with questions on the Randomized Control Trial - Media, Communication and Health by DMI and LSHTM in Burkina Faso

Very exciting reading, and the results look promising. I'd like to follow up BBC Media's question about the theory of change, but focusing mainly on the how. One account mentioned 1-minute radio ads 10 times a day every day, with messages, plus 2 radio dramas per week. Another mentions radio phone-ins as well (how often?).

I would like to know a lot about this - e.g. How and why did you choose this mix? What do people ask in the phone-ins? What is the media competition? (Are there other things to listen to in BF?)

Of course the three kinds of communication reinforce each other but is there any way of differentiating between their impacts? How much attention did each topic get? And then (re sustainability) Are there plans to monitor beyond the 4-year saturation campaign to see how long the effects last? And how much does it cost (in some places radio is expensive).

I guess this will all be made clear in the final report, but it would be nice to have a little information about the communication strategy in the meantime.

Jane Sherman
Nutrition Education Team
FAO

Please share your questions and observations about this research by either replying to this email and/or clicking the **Read More link below and posting on the platform - thank you

Response from DMI

To: The Health Communication Network within The Communication Initiative Network

Will Snell from DMI responds to questions posed by Jane Sherman from FAO requesting more information about the communication strategy related to the Randomized Control Trial - Media, Communication and Health research initiative. Please review and join this dialogue at this thread or just reply by email to this note.

Dear Jane,

Many thanks for your interest and questions.

On outputs: we are broadcasting one-minute radio adverts 10 times per day, and two radio dramas EVERY evening - each about 10 minutes long and generally followed by a phone-in discussion. These form part of the primetime evening show, which lasts for two hours and also includes music, news and other features. All this is happening on seven different community radio stations, in six languages. We chose this mix to maximise impact: the repetition and simple call to action of the spots, and the opportunity to examine underlying social issues and barriers in greater detail in the dramas, with the opportunities for audience interaction afforded by the phone-in discussions. For an example of both the dramas and the spots, see the clips at this link.

There isn't a huge amount of media competition in Burkina Faso. In each intervention zone, our partner radio station tends to be the dominant station; and we are priority a lot of their content.

We would love to be able to differentiate between the relative impacts of the spots and the dramas. Unfortunately this is beyond the scope of the current trial, since there is only so much that we can measure at one time. However, our ongoing qualitative research is throwing up some interesting clues: see for example our research reports at this link and here. We would like to do more research on this question in the future.

On sustainability, we are not currently funded to come back and measure behaviours 1/2/3 years after the end of the campaign. We may be able to secure funding to allow us to do this.

On cost: the RCT is very expensive because of the complexity involved in the randomisation and the size and nature of the evaluation, so is not a good guide to cost-effectiveness for scaling up at national level. For more on cost-effectiveness, see this link.

Best wishes,

[Will Snell]((http://networks.comminit.com/user/35542)
Director of Public Engagement & Development
DMI

Burkina Faso RCT: Comment from Sue Goldstein - Soul City

To: The Health Communication Network within The Communication Initiative Network

Sue Goldstein - from Soul City (South Africa) with an observation on the Randomized Control Trial - Media, Communication and Health by DMI and LSHTM in Burkina Faso

Hi Warren this is indeed great.

I would love to see more of the methodology particularly how they randomised the communities. I am a sceptic when it comes to community randomisation and it seems in the study that the control communities had consistently higher baselines which may (though I don’t know) mean that it is harder to change than coming off a lower base, or it may mean that the communities’ had some systematic difference.

Despite this the results seem very promising.

Best

Sue

Dr Sue Goldstein
Programme Director
Soul City: Institute for Health & Development Communication

To review this thread and to submit your own comments and observations please click on the Read More Link below or just reply by email - thank you

RCT Research - DMI - Baseline diffs and randomizing communities

Will Snell from DMI responds to questions posed by Sue Goldstein from Soul City about baseline differences and randomizing communities in the Randomized Control Trial - Media, Communication and Health research initiative. Please review and join this dialogue at this thread or just reply by email to this note.

Dear Sue

Many thanks for your comment. You are right about the difference in behaviours (and mortality) at baseline between intervention and control clusters. Unfortunately the small number of clusters (seven in each group) limited the extent to which we could avoid this during the randomisation process. As a result, mortality levels were higher, and behaviour coverage levels lower, in our intervention zones; there are also twice as many health centres in the control zones as in the intervention zones.

We dealt with this discrepancy at midline by adjusting those midline results that related to facility-dependent behaviours for distance to a health facility. This adjustment was not necessary for household behaviours. Our endline results will be adjusted for all potential confounders; and the technical paper on the midline results will discuss this issue in more detail. In short, it is a complicating factor but it won't detract in a significant way from the validity of the results.

Best wishes,

Will Snell
Director of Public Engagement & Development
DMI

In addition to radio? Plus Philippines and Nicaragua data

To: The Health Communication Network within The Communication Initiative Network

Mike Favin from The Manoff Group comments on the Randomized Control Trial - Media, Communication and Health by DMI and LSHTM in Burkina Faso. Please add your voice and experience to this critical analysis - reply be email or click the Read More Link below and comment online.

My immediate reaction to this summary was, "this looks too good to be true" if the only program action was the radio broadcasts.

My main question is, what, if any, OTHER actions the program took besides radio? (Of course I'd also like to know about any formative research that was the basis for the radio materials.) Raising people's knowledge regarding appropriate service utilization is rarely the only step needed. Commonly, there are barriers of access, convenience, reliability, quality and friendliness of services. It’s hard to believe that utilization would increase significantly without addressing some or all of these factors.

One final point is that the summary itself does not indicate decreases in under-5 mortality. I assume that information is in the full report, or perhaps it's just assumed, but if that's the case, it probably shouldn't be.

It occurs to me that it may be interesting to remind or inform the network that similar projects have been implemented at least since the mid-1970s. Below, I’ll paste in the summary of a USAID-funded radio communication project from the mid-1970s. An important difference between this project and the one in Burkina Faso is that the behavior changes in the former project were ones that mothers or families could carry out in their own homes with no new resources or service improvements required. The summary does remind us of the serious challenge of sustaining the positive changes that strategic communications can support. Clearly we can’t maintain intense communications year and after year, so we must come up with workable strategies for maintenance of the gains. The citation for the full document is: Manoff International, Inc. Radio Advertising Techniques and Nutrition Education: A Summary of a Field Experiment in the Philippines and Nicaragua. Final Report. December 1977.

Health and nutrition education messages patterned after the reach-and-frequency technique of commercial advertising have led to significant gains in knowledge, increases in positive attitudes, and changes in behavior. The messages were broadcast over local stations for up to one year without the support of more conventional education methods, other than those going on before the project began.

The experiment was funded by the Agency for International Development and carried out in the Philippines and Nicaragua. The themes and messages were developed in consultation with local health and nutrition authorities, recorded using professional talent from local radio stations, tested with representatives of the target audience before airing them, redrafted, and aired according to the listening habits of the target group.

In the Philippines, the messages were directed to mothers of children under 12 months. A dialogue between a young mother and her mother presented how to enrich a 6-month-old child’s rice porridge with oil, fish, and vegetables for calories, protein, and vitamins.

In Nicaragua, the messages were directed to mothers of children 5 years old and under. In six separate messages, a doctor and a village wise woman, Doña Carmen, instructed mothers how best to care for their children with diarrhea. The instructions included a recipe and dosage for a homemade rehydration fluid, Super Limonada; the proper food for a child with diarrhea; warnings about giving purges; and the necessity of seeking medical help for serious cases.

The messages were broadcast for approximately one year in each country. Evaluation data were gathered through questionnaires administered to mother in their homes in baseline studies, 6 months after broadcasts began, and 23 months after the baseline. One thousand mothers were interviewed in each wave of interviews. In the Philippines, the interviews were divided – 700 in the test group and 300 in the control group. A control group was not possible in Nicaragua. Interviews in both countries were supplemented by self-administered questionnaires to doctors, teachers, and other community workers.

RESULTS

In the Philippines, 24% of mothers of infants 6-12 months old reported enriching their child’s rice porridge with oil after 12 months of broadcasts, where none did at the baseline (N = 140).

Twenty-seven per cent reported adding chopped fish when 17% did before, and increase of 10% (N = 136):

Seventeen per cent reported adding vegetables where 5% had before, an increase of 12% (N = 136).

Positive attitudes toward putting oil in lugaw (rice porridge) increased from 15% (N = 700) at the baseline to 74% (N = 660) after one year; toward adding fish, from 48% to 81%; and toward adding vegetables, from 49% to 79%.

Knowledge of why oil was good for the baby increased from 4% to 25% after one year of broadcast, an increase of 21%.

Seventy-five per cent of all mothers could recall correctly at least one message element, although radio ownership is only 48%.

Most of the changes occurred in the first 6 months of the broadcasts, after which a plateau was maintained. The leveling off is attributed to a marked decrease in exposure to the messages, especially from the most popular stations, and possible message fatigue.

In Nicaragua, after one year, 25% (N = 940) of mothers with children under 5 report using Super Limonada for their child’s last case of diarrhea, where 2% had been giving lemonade before.

The incidence of feeding during diarrhea increased by about 10%.

Eighty-nine per cent of all respondents knew the purpose of Super Limonada, 55% knew the important ingredients in the correct amounts, and 41% volunteered the correct dosage.

Sixty-five per cent of the respondents could correctly recall at least one element of the messages.

The practice of giving purges, a common detrimental custom, does not seem to have changed.

The implications of the experiment are that the reach-and-frequency technique provides a discipline that can render broadcasting to unorganized audiences, the most inexpensive use of radio, effective in bringing about behavior change as well as attitude and knowledge change. It appears that the project development approach may also be useful for planning and implementing other forms of nutrition and health education, including longer radio programs, posters, pamphlets, etc. Creative talent and management support are available in most countries, although the impetus for developing the programs and initial technical assistance may have to come from outside.

Mike Favin
The Manoff Group

Response to Mike Favin questions on the RCT from Will Snell -DMI

To the Health Communication Network within The Communication Initiative Network

Will Snell from DMI responds below to the questions posed by Mike Favin from The Manoff Group about the Randomized Control Trial - Media, Communication and Health research initiative. Please review and join this dialogue at this thread or just reply by email to this note.

Dear Mike

Many thanks for your detailed comments.

This RCT is measuring the impact of a radio campaign ALONE. Of course, we are focusing on convincing people to change behaviours, not just on increasing knowledge. And we are ensuring that our messages take account of supply-side constraints. But we are not doing anything to tackle the 'supply-side aspects' of demand-side barriers such as service quality or accessibility (other than convincing people that, for example, it really is worth saving up so that a pregnant woman can give birth in a health facility).

On mortality reduction, we are not assuming anything; the midline survey only looked at behaviour change. We will be measuring mortality reduction at endline (100,000 sample size).

Thank you for sharing details of the USAID-funded projects in the Philippines and Nicaragua - very interesting. It is worth pointing out that we are also broadcasting messages on 'household' behaviours alongside 'service uptake' behaviours.

Best wishes,

Will Snell
Director of Public Engagement & Development
DMI

Springboard from Mike Favin's post: CI summary of report

Hello,

With great interest, I read the July 30th post by Mike Favin and was inspired to correspond with him about a report he referenced in that post. I wanted to let you know that you can now find impact data from that report - "Radio Advertising Techniques and Nutrition Education: A Summary of a Field Experiment in the Philippines and Nicaragua Final Report" - summarised here: http://www.comminit.com/children/content/impact-data-radio-advertising-techniques-and-nutrition-education In addition, the summary includes a link (within the Source section) to the full, original, 114-page paper, which makes for some good reading, indeed.

Though 1977 may seem like a long time ago, many of the insights shared here - e.g., about the methodology of the "reach and frequency technique" and the impacts that these projects saw in the Philippines and Nicaragua - seem to me to still offer gems.

It would be valuable to hear what others have learned in using this technique and/or your reaction upon reading about it (and the evaluation of it), based on your experience as a researcher or your work in another communication capacity.

~ Kier

Health Communication
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