[this message was sent also to HIFA, Healthcare Information For All]

Below is the citation, abstract and selected extracts of the latest paper on the Burkina Faso study, in Global Health: Policy and Practice. The paper describes in detail the methodology and the approach used. For me, it demonstrates how challenging it is to undertake impact evaluation. The current evaluation involves surveys, interviews and focus group discussions with thousands of mothers, fathers, grandparents, co-wives, as well as 'individual interviews with key informants such as religious leaders, district medical chiefs, health center staff, midwives, and community health workers'.

The evaluation is being undertaken against a broad theory of change or causal pathway by which the authors hypothesized that the Burkina Faso campaign would achieve impact, illustrated here: www.ghspjournal.org/content/3/4/544/F1.expansion.html

CITATION: The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso
Joanna Murray, Pieter Remes, Rita Ilboudo, Mireille Belem, Souleymane Salouka, Will Snell, Cathryn Wood, Matthew Lavoie, Laurent Deboise, Roy Head
www.ghspjournal.org/content/3/4/544

'This randomized radio campaign focused on the 3 principles of the Saturation+ approach to behavior change: (1) saturation (high exposure to messages), (2) science (basing design on data and modeling), and (3) creative storytelling. Locally developed short spots and longer dramas targeted multiple child survival-related behaviors and were delivered entirely by local radio stations. Innovative partnerships with radio stations provided free airtime in return for training, equipment, and investment in solar power.'

ABSTRACT
A 35-month cluster randomized controlled trial was conducted in Burkina Faso to test whether a radio campaign focused on child health, broadcast between March 2012 and January 2015, could reduce under-5 mortality. This paper describes the design and implementation of the mass media intervention in detail, including the Saturation+ principles that underpinned the approach, the creative process, the lessons learned, and recommendations for implementing this intervention at scale. The Saturation+ approach focuses on the 3 core principles of saturation (ensuring high exposure to campaign messages), science (basing campaign design on data and modeling), and stories (focusing the dramatic climax on the target behavior) to maximize the impact of behavior change campaigns. In Burkina Faso, creative partnerships with local radio stations helped us obtain free airtime in exchange for training and investing in alternative energy supplies to solve frequent energy problems faced by the stations. The campaign used both short spots and longer drama formats, but we consider the short spots as a higher priority to retain during scale-up, as they are more cost-effective than longer formats and have the potential to ensure higher exposure of the population to the messages. The implementation research synthesized in this paper is designed to enable the effective adoption and integration of evidence-based behavior change communication interventions into health care policy and practice.

EXTRACTS (selected by myself)

'So how does exposure lead to behavior change? There are several theories about the mechanisms or pathways by which high exposure drives behavior change, summarized by Bob Hornik, including:
- Learning. People listen to the radio at different times each day and vary in their susceptibility or inclination to respond to a message. The more times a message is repeated, the more opportunities there are for people to hear and learn from the message when they are receptive to it.
- Priming. Repeated exposure to a message affects its pertinence, so a stronger weight is attributed to the message when deciding whether to adopt the behavior.13
- Creating social norms. Repeated exposure to messages can create social expectations about behaviors. Such social norm pressures may persuade people to adopt behaviors.
- Diffusion effect. As more people are exposed to messages, more people will discuss these messages within their wider social networks, including people who have not seen or heard the media campaign.
- Indirect impact on policy. High exposure may alert policy makers to issues that are of public concern and thereby result in legislation or the implementation of policies that promote behavior change.'

'The independent evaluation of our campaign included a baseline and a midline (as well as an endline) behavioral survey of 5,000 mothers of a child less than 5 years old, after 20 months of broadcasting.'

'We employed a team of in-house qualitative researchers, who conducted formative research at the start of our campaign. The research consisted of semi-structured individual interviews and focus group discussions with mothers and fathers of young children and influential members of their entourage (spouses, grandparents, co-wives), as well as individual interviews with key informants such as religious leaders, district medical chiefs, health center staff, midwives, and community health workers.'
--

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare knowledge - Join HIFA: www.hifa2015.org
HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and co-director of the Global Healthcare Information Network. He is also currently chair of the Dgroups Foundation (www.dgroups.info), a partnership of 18 international development organisations promoting dialogue for international health and development. He started his career as a hospital doctor in the UK, and has clinical experience as an isolated health worker in rural Ecuador and Peru. For the last 20 years he has been committed to the global challenge of improving the availability and use of relevant, reliable healthcare information for health workers and citizens in low- and middle-income countries. He is also interested in the wider potential of inclusive, interdisciplinary communication platforms to help address global health and international development challenges. He has worked with the World Health Organization, the Wellcome Trust, Medicine Digest and INASP (International Network for the Availability of Scientific Publications). He is based near Oxford, UK. www.hifa2015.org Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil.pakenham-walsh AT ghi-net.org