We are running a randomised controlled trial in West Africa to to measure directly the effect of a radio campaign on child survival.
We are running a five-year randomised controlled trial in Burkina Faso, funded by the Wellcome Trust and Planet Wheeler Foundation, to test the proposition that a radio campaign focused on child health can reduce under-five mortality. This is the most rigorous trial ever conducted of a mass media health intervention.
The trial uses radio broadcasts to change behaviours in order to improve child survival, covering a range of health issues, and is the largest, most rigorous evaluation ever conducted of a mass media intervention. It will generate a substantial body of further evidence for the impact of mass media campaigns on a range of behaviours, including those linked to demand for healthcare services, and on child mortality.
The trial involves fourteen geographical areas that were randomised and equally divided into an intervention group and a control group. Messages are being broadcast for 2.5 years in the seven geographical areas of the intervention group, but not in the control group. We predict that in Burkina Faso, where 101,000 children under five die every year, we will reduce under-five mortality by 15.7% at a cost per DALY of $8.49.
A controlled trial using radio would not normally work, due to the risk that people in ‘control’ areas would listen to radio stations broadcasting from ‘intervention’ areas. However, Burkina Faso has a very localised, radio-dominated media environment, so we can use local FM radio stations to broadcast our messages to intervention areas without ‘leaking’ into the control areas.
For 30 months we are broadcasting 60-second advertisements at least 10 times per day on seven radio stations (one in each intervention zone), in six languages. In addition, we are broadcasting two hours per night, five nights per week on each station. This represents a total of 70 hours per week of live radio.
The evaluation, led by LSHTM and Centre Muraz, includes a baseline mortality survey of 50,000 children under 5 years (with a two-year recall period), and a baseline behaviour survey of 5,000 households, before radio broadcasts began in March 2012. Broadcasts will stop in January 2015, and full results, based on an endline mortality survey of 100,000 children (with a one-year recall period), will be available in mid- to late-2015.
In April 2014 we published our midline results on behaviour change (based on a survey of 5,000 households). The results show that behaviours in the intervention zones have all improved (ranging from 9.3% to 25.5%). When changes in the control zones are subtracted from these results, the difference in difference is substantial (in the 8.5% to 23.3% range) in 6 out of 10 cases. This represents, even at this preliminary stage, the first randomised controlled trial to demonstrate that mass media can cause behaviour change. We expect the endline results to be stronger still.
To achieve these results, we use an approach called Saturation+.
Broadcast media messages several times per day
Our evidence base suggests a strong correlation between message frequency and impact. We broadcast radio and TV spots at least three times per day. This is particularly important when the target audience is not consuming media throughout the day at regular times. We also broadcast daily dramas, as well as using ‘concept placement’ to insert key health messages into existing, popular radio and TV programmes.
Use radio/TV networks that reach the target audience
Audience figures for radio and TV networks at national level are weak in many African countries. Sophisticated modelling is needed to generate a best estimate of audience numbers by network, especially in rural areas. A strategy that includes community radio stations will ensure strong rural coverage, but other networks often generate a higher return on investment.
Use modelling to maximise health impacts
Our mathematical model predicts the impact on child and maternal mortality of each media message in each country. In most African countries, a multi-issue radio/TV campaign can reduce under-five mortality by 16-23% and maternal mortality by 2-20%, at a cost of $2-10 per DALY. We can predict lives saved by disease, by behaviour, by message and by province. By focusing on the behaviours that are easiest to change and that also have the greatest impact on lives saved, we can maximise health impacts.
Measure outcomes and health impacts robustly
We can translate behaviour change outcomes into health impacts using our model, but first we need to measure behaviour change outcomes reliably, and to attribute them to our activities. We have developed quasi-experimental evaluation techniques that are rigorous, but can be feasibly integrated into a complex media campaign. These include dose-response analysis, triangulation of survey data with external data sources, time-series analysis and non-randomised control areas.
Understand the audience using qualitative research
We need to understand the values and motivations of our target audience. We send teams of researchers to conduct formative research (identifying barriers to behaviour change), to pre-test outputs for clarity and appeal with focus groups, and to conduct detailed post-broadcast feedback research (asking whether, how and why people who heard our messages changed their behaviours).
Generate content that changes behaviours effectively
Content that really changes behaviours must be simple, funny, and engaging, rather than didactic. We use drama to maximise emotional impact. Short, realistic dramas (including spots) work well if repeated often. We hire the best local talent using open competitions, and we use a proven creative and editorial process to generate ideas and select the best for broadcast.
Media Million Lives supports the following global maternal and child health initiatives: