Can the mass media cause changes in an audience’s knowledge, attitudes and intention to practice behaviors? At BBC Media Action, we have just successfully conducted a randomized control trial (RCT) to investigate this chain of causality in a prime time health TV drama in Bangladesh.
This is the first blog in a two-part series on BBC Media Action’s Bangladesh RCT, read more about the methodology underpinning the study in the second blog.
Do BBC Media Action programmes cause changes in our audiences? Do our television and radio shows increase knowledge, make people think differently or change their actual behaviour? In short, what is happening as a direct result of our programmes?
The answer is: we could never be sure. Our research has long shown that our audiences become more knowledgeable, change their attitudes and take different courses of action. However, we weren’t previously able to scientifically prove that our shows caused these changes. Yet now we definitively know our programmes made the difference – thanks to the use of a‘randomised control trial’ (RCT).
Why use an RCT to answer this question? To explain, an RCT is an experimental research design, in which people are assigned, at random, to groups. One set of people, the ‘treatment’ group, receives the intervention, while a second set, the ‘control’ group, gets a placebo. All other conditions are held constant so that the only difference between the groups is whether or not they receive the intervention. Only using this tightly controlled research methodology can we be certain whether or not the intervention caused the desired outcome.
What does that look like when you are studying the media? Our RCT was interested in investigating how watching our Bangladeshi health programmes affects the ‘key drivers’ of healthy behaviour among women of childbearing age. We consider key drivers to be precursors of behaviour, like people’sknowledge of antenatal and early newborn care, their attitudes and beliefs around, for example, what to feed a newborn baby, and their intention to do things such as attending antenatal care sessions.
In Bangladesh, we are currently airing a health-based drama called Ujan Ganger Naiya (UGN) (Sailing Against The Tide). This programme resembles many prime time family dramas, with storylines around the themes of falling in love, marriage and the important role that mothers-in-law play in Bangladeshi marriages. But the production team also weaves key elements of health knowledge into the dramatic arc, such as the recommendation that four antenatal child care visits are ideal for a pregnant mother. UGN is closely linked to a follow-up discussion show called Natoker Pore (NP) (After The Drama), in which some of the characters from the show, a medical expert and a real-life contributor review some of the key issues explored in the episode.
So one treatment group watched UGN while the control group watched another show produced by the BBC Media Action team in Bangladesh with an educational focus. This helped ensure that production values were consistent. A second treatment group was also included in the study to investigate whether watching the discussion show alongside this drama has more of an effect than just watching the drama on its own. In short, our research questions were focussed around the short term impacts caused by watching the drama alone vs. watching it together with the discussion programme.
The results from BBC Media Action’s first-ever RCT are very encouraging:
- Women who watched the drama – particularly those who saw the drama and factual discussion programme – showed significantly higher levels of knowledge across all of our measures of antenatal and early newborn care than the control group.
- Women in both treatment groups (i.e. all those who watched either one or both of the health programmes) reported improved attitudes on several of the reproductive and maternal health statements we asked them about.
- Women who watched both programmes reported higher levels of ‘efficacy’– in other words, they had greater self-belief in their ability or capacity to do something – than those who watched the drama alone, who in turn reported higher levels of self-efficacy than those in the control group.
- When women who watched the drama were asked about a hypothetical future pregnancy, they were more likely to say they intended to pursue a number of healthy behaviours than those in the control group. Women who also watched the factual show responded positively to even more intended behaviours than those who only saw the drama.
- In order to be effective, the clarity and consistency of messaging across the two programmes needs to be carefully managed. Programmes were less successful at shifting negative attitudes and increasing self-efficacy regarding certain antenatal and early newborn care practices such as attending at least four antenatal care sessions and exclusively feeding breast milk to a new-born.
So, why does all of this matter?
From a methodological standpoint, the RCT constitutes an important piece of evidence for isolating the impact that media and communication can have within the development sector. In this particular instance, we can now say that our health programme caused positive change in the short-term knowledge, confidence, behavioural intent and attitudes of women of child-bearing age in Bangladesh – precisely the audience we are trying to reach. We also now have evidence that watching the health programme alongside a closely related discussion programme has further positive effects – an important learning for production teams.
As BBC Media Action’s Senior Health Advisor Sophia Wilkinsonnotes:
“Often, there is a lack of funding to enable really strong study designs that tell a clear story. So it’s really exciting to have this evidence from Bangladesh that shows that entertaining television drama can indeed increase people’s knowledge and their intention to do something. Even more exciting, is that we seem to have proved our theory that exposure to more than one format will have a greater effect than just one programme! This all helps to strengthen the case for communication for development.”
The BBC Media Action Research and Learning team manages a global cohort of more than 100 researchers around the world who inform, evaluate and generate evidence on BBC Media Action projects across the countries in which we work. Former BBC Media Action Quantitative Research Manager Paul Bouanchaud was a key contributor to this piece.