ViewpointCan mass media interventions reduce child mortality?
Section snippets
Child mortality and the case for a focus on demand
Logic suggests that however much money is spent on health services, they will only work effectively if people use those services and behave in life-protecting ways. UNICEF's “Facts for Life”1 is based on this concept. Reflecting on the limited progress made towards reducing child mortality by two-thirds by 2015, the 2012 Countdown to 2015 report2 suggested that, although supply-side investments have worked well in many countries, “Interventions…requiring behaviour change (early initiation of
An epidemiological approach to mass media campaigns
Why is evidence for the importance of demand missing? Why do most of the data either fall short of the standards required to impress policy makers, or show negative results? The most comprehensive attempt to answer this question is provided by Bob Hornik,3 in Public Health Communication, Evidence for Behaviour Change. Hornik looks carefully at the evidence from controlled trials of health communications campaigns. The few major trials that have taken place “have shown either ambiguous or no
The intervention: the Saturation+ method
Concluding his analysis of whether public health communication can change behaviours, Hornik3 asks whether the dominant literature6, 20, 23, 24 has missed something important:
“Most of the innovative work in public health has focused on the problem of developing high quality messages reflecting particular evidence about the underpinnings of health behaviour. This has been a good thing. At the same time there has been less attention to the problem of exposure to those messages and how to
Modelling the effect of comprehensive campaigns
To estimate the potential effect of a comprehensive campaign, we gathered evidence from previous multiple-issue media campaigns to predict how much they could increase coverage of key interventions (such as breastfeeding, or seeking treatment for pneumonia). We adjusted our predictions for service provision and media penetration in each country. We then analysed the effect on mortality of these increases in intervention coverage in a range of sub-Saharan African countries using the Lives Saved
Putting these predictions to the test
We are currently running a 35 month cluster-randomised trial in Burkina Faso, funded by the Wellcome Trust and Planet Wheeler Foundation, to evaluate the effect of a comprehensive mass media campaign on child mortality (ClinicalTrials.gov, number NCT01517230). The trial is, to our knowledge, the largest, most rigorous evaluation ever conducted of a mass media intervention in a low-income setting.
We have been able to solve, exceptionally, the problem of randomising a mass media intervention by
Implications of our work
If the trial yields results that are broadly consistent with the predictions of our model, the implications for the public health community will be substantial. Our model predicts that if comprehensive campaigns are implemented in ten African countries for 5 years, one million lives of children younger than 5 years should be saved. If this claim is sustained by the trial, saturation-based media campaigns should belong in the mainstream of public health interventions and a priority for
References (27)
- et al.
Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: a systematic review
Am J Prev Med
(2004) - et al.
Impact of health education on active trachoma in hyperendemic rural communities in Ethiopia
Ophthalmology
(2006) - et al.
Development of a smoking prevention mass media program using diagnostic and formative research
Prev Med
(1988) - et al.
Use of mass media campaigns to change health behaviour
Lancet
(2010) - et al.
Advancement of global health: key messages from the Disease Control Priorities Project
Lancet
(2006) Facts for life
(2010)Fulfilling the health agenda for women and children: the 2012 report
Public health communication: making sense of contradictory evidence
- et al.
AIDS in The Netherlands: the effects of several years of campaigning
Int J STD AIDS
(1990) - et al.
Increased condom use without other major changes in sexual behavior among the general population in Switzerland
Am J Public Health
(1997)
Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippines experience
Mass media interventions: effects on health services utilisation
Cochrane Database Syst Rev
Mass media interventions for smoking cessation in adults
Cochrane Database Syst Rev
Cited by (24)
Mass media exposure and maternal healthcare utilization in South Asia
2020, SSM - Population HealthCitation Excerpt :Media can disseminate information to large audiences in the form of public service announcements, entertainment, advertisement, or short drama quickly and at relatively low costs (Sarrassat et al., 2015). Mass media has contributed to other demographic processes, especially regarding methods and motivations for family planning (Barber & Axinn, 2004) and health promotion and preventing disease (Head et al., 2015). Mass media campaigns have the potential to raise awareness about maternal health globally by transmitting maternal healthcare-related information between countries through international news broadcasts, television programming, new technologies, film, and music (Matos, 2012; Randolph & Viswanath, 2004; Sarrassat et al., 2015).
Health effects of mass-media interventions – Author's reply
2018, The Lancet Global HealthEffect of a mass radio campaign on family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial
2018, The Lancet Global HealthCitation Excerpt :To our knowledge, there have been no attempts to do a randomised controlled trial to test the effect of mass media on any health outcome in a low-income country. From March, 2012, to January, 2015, Development Media International (DMI) implemented a comprehensive radio campaign to address key family behaviours for improving under-5 child survival in Burkina Faso.8 In 2010, Burkina Faso ranked 161 of 169 countries in United Nations Development Programme's Human Development Index with 44% of the population living below the poverty line and 77% living in rural areas.9
Promoting meal planning through mass media: Awareness of a nutrition campaign among Canadian parents
2019, Public Health NutritionHealth communication fundamentals: Planning, implementation, and evaluation in public health
2023, Health Communication Fundamentals: Planning, Implementation, and Evaluation in Public Health