The Role of Interpersonal Communication in Reducing Structural Disparities and Psychosocial Deficiencies: Experience From the Malawi BRIDGE Project

This journal article examines research on interpersonal communication as it functions in the Malawi BRIDGE Project, a health communication intervention designed to promote HIV prevention behaviours through the use of mass media, interpersonal channels, and community mobilisation efforts. This study was made to determine the extent to which the socio-normative environment and interpersonal communication patterns influenced individual-level knowledge and behaviours, including HIV testing, condom use, and condom use intentions. The article suggests that "the effect of campaign exposure on knowledge and HIV testing was heightened by interpersonal discussion. Interpersonal communication also heightened the effect of community norms on condom use, suggesting that interventions can garner greater effects and reduce disparities if they promote interpersonal discussion."

The Malawi BRIDGE Project, implemented in the northern, central, and southern regions of Malawi, with the southern region hardest hit by the HIV epidemic, built the campaign on the basis of the formative research findings to promote HIV-prevention behaviours by enhancing self-efficacy through the use of the tag line Nditha, which means "I can" in Chichewa, the primary language in Malawi.

In terms of behaviours and message dissemination, the BRIDGE campaign promoted HIV testing, condom use, and remaining faithful to one's partner, through mass media (national and local radio, targeted billboards, brochures, and booklets), interpersonal channels (religious leaders, village chiefs, community organisers, and other influential people), and community mobilisation efforts (women's groups, youth groups, and faith-based organisations).

The key strategy was promoting open discussion about sexuality, HIV/AIDS, and prevention behaviours, and the study findings show that discussion does matter. "The data showed that interpersonal communication was positively associated with study outcomes, but more importantly, it heightened the influence of other predictors, particularly the socio-normative environment, on important intervention outcomes." There was a positive association between community-level variables and their corresponding individual-level outcomes across all the outcomes, including knowledge, HIV testing, condom use, and intention to use condoms. "Those who lived in communities with higher knowledge and greater rates of HIV testing, for example, were themselves likely to be more knowledgeable and more likely to get tested for HIV. Similarly, individual condom use and intention to use condoms were higher in communities with higher condom use and higher condom use intentions, respectively."

The findings show that individuals' behaviour and outlook are shaped, to some extent, by their surroundings, and they point to "the need for interventions to incorporate the social and environmental milieu into intervention design....Both campaign exposure and interpersonal discussion, for example, were independently, and positively, associated with HIV testing and self-efficacy to use condoms. This highlights the fact that the intervention appears to have promoted both outcomes with some success and that conversations also played a positive role." Researchers found that the association between interpersonal discussion and condom use was not significant if the community norm around condom use was weak. The results on the two variables, exposure and discussion, signify a multiplicative effect.

The article concludes that "the greater the interpersonal discussion in a community, the stronger the norm–behaviour relationship. This likely reflected the ritualistic, as well as the instrumental, function of communication: Rituals reinforced norms that were transmitted interpersonally in a community. Interpersonal discussion also moderated the relationship between exposure to the BRIDGE campaign and the campaign's outcomes. In particular, those who were minimally exposed to the intervention appeared to have benefited most from interpersonal discussions."