Communication Impact: Rural Communication Activities Increase Net Use in Tanzania

This two-page document provides an evaluation of the Communication and Malaria Initiative in Tanzania (COMMIT), a four year project funded by USAID and the President’s Malaria Initiative (PMI). The John's Hopkins Bloomberg School of Public Health Centre for Communication Programmes (CCP) leads COMMIT in partnership with Jhpiego, Population Services International (PSI), the Research Triangle Institute (RTI), PMI, and the Tanzania Ministry of Health and National Malaria Control Programme (NMCP). The programme is implementing a comprehensive strategy for behaviour change and communication in the prevention and case management of malaria in mainland Tanzania. According to the report, the activities are reaching wide sectors of the population, increasing perceived threat and self-efficacy in terms of preventing malaria.

COMMIT supports the NMCP Communication Strategy objectives of influencing positive behaviour change among audiences through: a comprehensive approach; improving the flow of information to key audiences; and advocacy to raise the profile of malaria. The programme conducts activities throughout the country with intensive community-based interpersonal communication activities in 11 of the most endemic regions in Tanzania. COMMIT integrates mass media and community-based activities to increase individual's perceptions of the threat posed by malaria as well as their confidence in their ability to take actions that effectively counter this threat. Through these perceptions, the project aims to persuade households to obtain and use insecticide treated nets (ITNs). Specific activities included roadshows, mass media campaigns, and community engagement via community change agents.

The evaluation showed that since 2008, COMMIT has directly reached more than three million people through a variety of community mobilisation and outreach activities. All activities are focused on the main malaria messages of sleeping under ITNs, malaria in pregnancy, and under-five case management. Since the 2009 survey, more than 1,000 village-based respected community members have been trained as community change agents (CCAs).

Initial survey data was collected from two regions in 2009, one year following the start of the community-based activities. The survey showed that individuals who were exposed to community-level activities had greater perceptions of the threat of malaria and were more confident in their ability to obtain and use ITNs than those who were not exposed (71% vs. 35%). The team also found that households exposed to the project roadshows were more than twice as likely to have all of their children under five sleeping under an ITN than those who were not exposed (76.6% versus 34.6%).

The report explains that Witte’s Expanded Parallel Process Model posits that individuals with high perception of threat as well as high confidence will be more likely to take action to counter the threat than will individuals with high perception of threat and low confidence. Individuals who perceive low threat do not process the message any further. Consistent with theoretical predictions, perceived threat was positively associated with ITN use among individuals with high confidence and negatively associated with ITN use among individuals with low confidence. The study found that low-efficacy households use nets less as their perceived threat of malaria increases – they are stymied by the threat and unable to act. For the high-efficacy households, their net use increases as their perception of the threat increases, but only up to a certain point.

According to the report, to measure the impact of their mass media campaign and village-level communication activities, a second survey will be fielded in 2010, one year following the previous survey. It will assess the combined effects of mass media and community- based activities on perceptions and use of ITNs, and offer further lessons in message development and channel selection for other malaria prevention programmes.