Entertainment-education Radio Serial Drama and Outcomes Related to HIV Testing in Botswana

This article, published in the Global Health Sciences Literature Digest, shares findings of an evaluation to assess preliminary data on the effectiveness, particularly on HIV testing behaviours, of an entertainment-education radio serial drama, Makgabaneng. The Makgabaneng radio serial drama broadcast from 2001 to 2007 as part of a government communications strategy for behaviour change based on the Modeling and Reinforcement to Combat HIV (MARCH) approach. Grounded in behavioural change theory, the MARCH strategy builds on two fundamental principles of behaviour change: showing people how to change through role models (modelling) and supporting efforts to change primarily through interpersonal communication and normative change (reinforcement). The authors concluded that the popularity of Makgabaneng combined with preliminary evidence of its effects on intermediate outcomes related to HIV testing suggest that the radio serial drama is a promising medium to facilitate behaviour change in Botswana.

The cross-sectional study began 18 months after the initial radio broadcast. Data was collected between February and May 2003 in face-to-face interviews by using a structured questionnaire in a multistage-sampling approach. The study sought to explore different aspects of audience involvement in the radio programme and identification with the characters. Four measures of exposure to the programme were assessed: a) how often respondents listened ("frequency"); b) how long they had listened ("duration"); c) whether they had spoken with anyone about Makgabaneng in the previous 3 months ("discussion"); and d) whether they were attentive to and engaged with key characters in story lines related to HIV testing ("identification").

The research found that nearly one half (46%, 243) of sexually active respondents reported listening to Makgabaneng one or more times each week, 15% (76) reported listening for 1 year or longer, and 19% (100) reported talking with someone about Makgabaneng in the past 3 months. In addition, 23% (122) of the respondents attended to the story line (i.e., spontaneously named any relevant character) and 9% (50) attended to and identified with relevant characters (i.e., spontaneously named one or more relevant characters and identified a relevant character as a favourite).

Greater levels of exposure to Makgabaneng, including more frequent listening, longer-term listening, and attentiveness to and identification with the characters, were associated with lower levels of stigmatising attitudes. Overall, the mean score for stigma was 2.11 on a scale of 5 which reflects low levels of stigmatising attitudes.

The article explains that 22% of those surveyed had been tested since December 2001. Of the 326 respondents who had never been tested, 27% reported no intention to test in the next 3 months, and 29% reported being extremely likely to test. Both frequency and duration of listening were significantly related to a respondent's intention to test in the next 3 months. Respondents who reported listening to Makgabaneng one or more times each week were almost twice as likely as less frequent listeners and non-listeners to have stronger intentions to have HIV testing. Likewise, compared with those who listened for less than 1 year or not at all, longer term listeners were twice as likely to have stronger intentions to be tested in the next 3 months.

Among the measures of exposure tested, only duration of listening had a statistically significant association with talking about HIV testing. Respondents who listened for 1 year or longer were more than twice as likely as those who listened less than 1 year, or not at all, to report talking to their partner about HIV testing.

The report states that the findings show that a programme such as Makgabaneng can capture and maintain the attention, on a weekly basis, of a large audience at risk for HIV, and that the programme had broad reach and appeal for the intended audience. Having an audience who consistently tunes in to a programme provides public health practitioners with a regular opportunity to communicate with the audience, to introduce relevant information, to promote available services, to address emerging problems, and to model new behaviours and norms.