There is strong evidence that mass media, particularly entertainment broadcast media, have played a significant role in a number of countries in bringing about changes in reproductive behavior and in promoting adoption of other health measures.
Radio and television soap operas in Brazil, Ethiopia, India, Kenya, Mali, Mexico, Niger, Nigeria, Rwanda, St. Lucia, and Tanzania have been documented by independent researchers in their massive effects on audience attitudes and behavior with regard to HIV/AIDS avoidance and use of family planning.
One of the advantages of using serial dramas, as opposed to documentaries or single-episode dramas, is that they allow time for the audience to form bonds with the characters and allow characters to evolve in their thinking and behavior with regard to various issues at a gradual and believable pace in response to problems that have been well illustrated in the story line.
Just as important, entertainment programs forge emotional ties to audience members that influence values and behaviors more forcefully than the purely cognitive information provided in documentaries. As described in the social learning theory of Stanford University psychologist Albert Bandura, vicarious learning from others is a powerful teacher of attitudes and behavior. Next to peer and parental role models, role models from the mass media are of particular importance in shaping cultural attitudes and behavior.
Serial dramas to promote reproductive health have been remarkable in that they have attracted no serious opposition in any country. This stems, in part, from the thorough research that has been done prior to the development of the programs to measure audience attitudes and norms with regard to these issues. Characters for the serial dramas can then be developed who are very much like audience members, so that the show is in harmony with the culture. Through the gradual evolution of characters in response to problems that many in the audience also are facing, serial drama can show adoption of new, non-traditional behaviors in a way that generates no negative response from the audience.
Because of the bonds that have been formed by this stage between audience members and characters, and because of the commonality of problems between characters and the audience, audience members tend to accept these changes, even though they may challenge cultural traditions. Because they deal with issues that are as sensitive as sexual relationships and reproduction, it is especially important that such programs are designed not to build opposition or cause a backlash.
The most extensive evaluation of the effects of a social content serial drama occurred from 1993 to 1997 in Tanzania. There, Radio Tanzania broadcast a serial drama that attracted 58% of the population (age 15 to 45) in the broadcast areas. By design, in one region of the country, the area surrounding the city of Dodoma, a music program was heard instead of the serial drama during the first two years of the project. Then the serial drama was broadcast in its entirety in the Dodoma area.
Independent research by the University of New Mexico and the Population Family Life Education Programme of the Government of Tanzania measured the effects caused by the program with regard to such issues as AIDS prevention behavior, ideal age of marriage for women, and use of family planning. While the population of the Dodoma comparison area was more urban than the rest of the country, a multiple regression analysis eliminated the influence such differences might have accounted for. Nationwide random sample surveys of about 2,750 people were conducted before, during and after the broadcast of the program. Data was also collected from the AIDS Control Programme of the government, the Ministry of Health, and the Demographic and Health Survey, all of which reinforced the finding of dramatic impacts on attitudes and behavior.
Among the findings were a significant increase in the percentage of listeners in the broadcast areas who believed that they were vulnerable to HIV infection; an increase in the belief that audience members, rather than their deity or fate, can determine how many children they will have; an increase in the belief that children in small families have better lives than children in large families; and an increase in the percentage of respondents who approve of family planning.
The study also provided evidence that the Tanzanian radio serial stimulated important behavioral changes. Over half the population of the areas where the serial was broadcast identified themselves as listeners, with more men than women in the audience. One of the key characters in the serial drama was a truck driver with many girlfriends along the truck route. In the program he contracts HIV. Of the listeners surveyed, 88% said the program had caused them to change their own behavior to avoid HIV infection, through limiting the number of sexual partners and through condom use. Independent data from the AIDS control program of the government of Tanzania showed a 153% increase in condom distribution in the broadcast areas during the first year of the serial drama, while condom distribution in the Dodoma non-broadcast area increased only 16% in the same time period.
The program was also effective in promoting family planning. There was a strong positive relationship between listenership and the change in the percentage of men and women who were currently using any family planning method. The research also showed an increase in the percentage of Tanzanians in the areas of the broadcast who discussed family planning with their spouses.
In regions where the show was broadcast, the percentage of married women who reported they were currently using a family planning method increased 27% in the first two years of the program, while that percentage stayed flat in the Dodoma area where the program was not broadcast at that time. A parallel measurement showed that in regions where the program was broadcast, the average number of new family planning adopters per clinic (including men and women), in a sample of 21 clinics, increased by 32% from June 1993 (the month before the show began airing) to December 1994. Over the same period, the average number of new adopters at clinics in the Dodoma area remained essentially flat.
Independent data from Ministry of Health clinics showed that 41% of new adopters of family planning methods were influenced by the serial drama to seek family planning. This included 25% who cited the serial drama by name when asked why they had come to the clinic, and another 16% who cited “something on the radio” and then identified the serial drama when shown a list of programs currently on the air. Another family planning serial drama using a different methodology that was broadcast nationwide by Radio Tanzania at the same time was cited by just 11% of new family planning adopters at the same Ministry of Health clinics.
These data point to the importance of the methodology used in the design of the serial drama. Counting all of the costs of the radio serial, the cost per new adopter of family planning was about 34 cents (U.S.), a cost-effectiveness unmatched by any other known strategy.
Because entertainment programming (radio or television, depending on the coverage of each medium in any country) attracts the largest audiences, it is particularly important to utilize entertainment media for disseminating information about reproductive health issues. Along with that, many communications experts state that the most effective way of bringing about changes in attitudes and behavior with regard to any social issue is to utilize as many channels of communication simultaneously as possible, including print and broadcast, news and information, various formats of entertainment programs, and the communication activities of governmental and non-governmental organizations.
Examples of successful media campaigns that have utilized this strategy include the designated driver campaign of Harvard University and the smoking prevention campaign carried out by a coalition of organizations in the United States. It is logical to infer that people learn and change behaviors more quickly when they are hearing consistent information from a variety of sources.
For this reason, PMC works to develop comprehensive media campaigns in the countries where it is carrying out projects. Because of the strong evidence of their effectiveness, social-content serial dramas are, in most instances, a centerpiece of the strategy in any country. The strategy uses the best of what has been done in the past, and builds on it in each country with intensive broadcast and print coverage of issues related to sexual risk behavior. In this way, PMC intends to contribute to rapid change in the health-related behavior of people worldwide.
PMC provides people with entertainment and information to help them make informed decisions without telling them what to do. PMC’s approach emphasizes non-coercive, informed decision-making, tailored in each case to local needs and circumstances. Programs are designed to promote human health and dignity by providing education and examples of various alternatives and their consequences.
In any country, the values that the media strategy promotes are drawn from fundamental principles laid down in United Nations covenants and declarations, to which the country is a signatory, such as the Cairo Programme of Action on Population and Development. PMC’s work emphasizes local capacity building through providing technical assistance and promoting collaboration among developing countries that have different levels of experience with such media campaigns. The programs are written and produced by qualified local personnel with technical assistance from PMC.
Read the full article, “The Effectiveness of Entertainment Mass Media in Changing Behavior,” by William N. Ryerson.