Come Gather Around Together: An Examination of Radio Listening Groups in Fulbari, Nepa

This article examines the relationship between exposure to a family planning radio initiative, membership in radio listening groups, and family planning outcomes - measured in terms of knowledge, attitudes and practice. The study attempts to evaluate how mass media communication is related to positive contraceptive behaviour, and what role audience involvement might play in reinforcing this behaviour. It compares how people who are members of listening groups differ in their family planning behaviour from those who are only exposed to a radio programme and those who are exposed to neither. The authors seek to answer the following research question: "Do members of listening groups have higher levels of correct knowledge, approval, intention to practice, current use and personal advocacy related to family planning compared to those who are not members of the listening groups?" In general, evidence from their research in Nepal reveals that they do.

Background

The authors suggest that behaviour changes that are triggered by entertainment-education messages occur in stages, and they begin the paper with a discussion of a number of theoretical frameworks have been used in previous research to explain how individuals proceed from one stage to the other. The approach that this particular study utilises is the 'ideation' or 'social interaction' model. The ideation model is based on the understanding that communication directly influences some members of an audience to change their behaviour. Communication can also indirectly influence behaviour by enhancing knowledge, shifting attitudes and fostering discussion of new behaviours with family and friends. It is much more likely that an individual will adopt a new behaviour when they have, "gained sufficient knowledge about it, developed a positive attitude toward it, talked to others about it and feels right about doing it."

The Radio Communication Project (RCP) Nepal is an integrated mass media entertainment-education campaign that was designed to generate demand for family planning services and improve service-provider quality. The RCP employed a combination of mass media messages, distance education and interpersonal communication and counselling (IPC/C) training programmes. The mass media component included a dramatic radio serial entitled Cut Your Coat According to Your Cloth, which is the source of the mass media messages for this study. A comprehensive discussion of the RCP project and a history of radio listening group initiatives similar to the one being studied is included in the article.

In April 2000, the residents of the Fulbari VDC (a VDC is a type of Nepalese administrative unit encompassing several villages) signalled their interest in forming listening groups around the ongoing RCP. An information package consisting of materials related to behaviour change communications and instruments for monitoring behaviour change was distributed to about 40 participants who acted as facilitators for the community project. Female community health volunteers were trained in interpersonal communication and counselling skills and moderated the listening groups in their wards. A typical radio listening group met in an open area or local schools on Saturday evenings. The radio programme was aired for 15 minutes beginning at 5:30 and afterwards the participants in the group discussed the episode they had heard in terms of both its entertainment and educational aspects.

The authors believe that this project was promising for several reasons:

1. The radio listening groups represented a unique opportunity to extend the reach of the RCP,
2. They were a means to promote interpersonal communication regarding health issues, and,
3. By reinforcing the messages of the RCP, they could result in a shift of community norms, and create an enabling environment for social change.

Methodology

The data used in this study came from an evaluation survey conducted in the Parbatipur and Fulbari VDCs in Chitwan district of Nepal. There were 408 respondents to the survey equally divided between the VDCs of Fulbari and Parbatipur. All respondents who were members of listeners groups were residents of Fulbari VDC, while the residents of Parbatipur were used as a control group. The goal of the researchers in this study was to compare participants of radio listening groups with the people exposed to the radio campaign only and those who were totally unexposed to the campaign. The groups were divided as follows:

• Group 1: Respondents who are exposed to both the radio programme and the listening groups (N = 204).
• Group 2: Respondents who are exposed only to the radio programme (N = 73).
• Group 3: Respondents not exposed to either the radio programme or the listening groups (N = 131).

In addition to the different groups as the main independent variable, the researchers controlled for a variety of socio-demographic characteristics including sex, caste, education, occupation, and the number of surviving sons and daughters. This last measurement was thought to be important because of a strong preference for sons in rural Nepalese society and the suspected effect that it might have on contraceptive usage.

There were six sets of dependent variables:

1. Family planning method knowledge is measured by a dichotomous variable indicating spontaneous recall of at least five modern methods of contraception and a variety of specific methods.
2. Contraceptive use is dichotomised to indicate current use of any modern method of family planning.
3. A dichotomised variable is used to indicate whether the respondent has ever recommended to others the method that he or she is currently using.
4. Two variables related to future use: anytime in the future, and within the next 12 months.
5. Interpersonal communication, whether the respondent had discussed family planning with spouse, and/or friends, neighbours or relatives within the last 10 months.
6. And finally, to assess attitude toward family planning in general, respondents were asked whether they approved of couples using family planning.

Results

The following selected attitudes and fertility intentions of respondents are presented by exposure level:

Knowledge: At least five modern methods (spontaneous recall)

• Group 1 - 55.9%
• Group 2 - 49.3%
• Group 3 - 16.0%

Approval of Family Planning: Both self and spouse

• Group 1 - 93.6%
• Group 2 - 95.9%
• Group 3 - 88.5%

Discussed family planning: with either spouse or others

• Group 1 - 92.2%
• Group 2 - 84.9%
• Group 3 - 72.5%

Current Use: Any modern method

• Group 1 - 80.9%
• Group 2 - 74.0%
• Group 3 - 67.2%

Current Use: Male sterilisation (this was the most common method of all respondents)

• Group 1 - 53.4%
• Group 2 - 50.7%
• Group 3 - 55.0%

Recommended family planning to others

• Group 1 - 91.2%
• Group 2 - 90.9%
• Group 3 - 86.5%

In addition to the above univariate analysis, the authors performed several bivariate crosstabs and derived the following findings (in all cases the reference category is the group exposed to neither radio programmes nor listener groups):

• Group 2 respondents were five times more likely, and Group 1 respondents over six times more likely to spontaneously recall at least five modern methods of contraception.
• Group 1 respondents were significantly more likely to know about all the individual methods except male sterilisation.
• Men and women who were exposed to both the radio programme and the listening groups (Group 1) were twice as likely to currently use a modern method of contraception.
• Intention to use contraception in the future did not vary by level of intervention (though the authors observe that this is to expected given the higher current usage rate in intervention communities).
• Group 1 respondents were also most likely to discuss contraception with their spouse as well as with friends, relatives and neighbours.

The authors also performed several multivariate regressions on the data and determined the following with regards to knowledge, higher current use, and positive attitudes toward family planning methods, while controlling for other relevant demographic and socio-economic variables in the model.

• Knowledge: Exposure to the radio programmes and to listening groups was positively related to knowledge about modern methods of family planning. Group 2 respondents were 3.5 times more likely and Group 1 respondents over 8 times more likely than those who were exposed to neither to spontaneously recall at least five modern methods of family planning. Women and those engaged in agricultural occupations were somewhat less likely.
• Approval: Overall, approval was very high in all study groups (97.8%), and thus intervention exposure was unrelated. However, the authors found that having more male offspring was significantly associated with a positive attitude toward family planning.
• Interpersonal Communication: The authors' results suggest that exposure to the radio programme is positively associated with discussion about family planning with one's spouse only when it is combined with listening groups. Group 1 respondents were over three times more likely to discuss family planning methods with their spouses, and were most likely to discuss with friends and/or relatives. Schooling was also relevant with respect to the likelihood of having discussions with others.
• Current Use: This was significant only for exposure to a combination of radio programme and listening groups, suggesting that media exposure alone is not significantly connected with current use of modern contraceptives. Persons who had at least one or more surviving sons were significantly more likely to use a modern method of contraception.

The authors believe that these findings suggest that media exposure and interpersonal communication are correlates of behavioural change that results in the adoption of modern methods of family planning. The combination of radio programmes with listening groups appears to be associated with higher levels of knowledge, current usage and discussion about contraceptive methods, and are significant even after age, gender, education, caste and gender composition of surviving offspring are taken into account. The evidence on contraceptive usage is further supported by a small survey of service statistics from clinics in the Fulbari VDC (Group 1) that show increased consumption of contraceptives during and after the campaign.

Conclusions

The authors argue that this study strengthens the understanding of the theories of mediated human behaviour change. In this case, radio listening groups in Fulbari serve as examples of a radio programme audience that have, "taken it upon themselves to establish a formal forum for interpersonal communication after being inspired by a media campaign," and provide evidence of the blurring between mass media and interpersonal communication. The authors believe that this helps to validate the theorised overlap and mutual interaction of mediated and interpersonal communication. And while the authors' goal was not to flesh out causal paths, the evidence suggests that change associated with family planning is expected to begin with improved knowledge, positive attitude, increased discussions and a motivation to adopt a new method.

The programmatic implications of these findings are that it is likely that as audience involvement increases, campaigns can build a relationship of trust and commitment with audiences and harness their assets and aspirations to act as catalysts for sustained family planning-related behaviour change at the societal level, despite prevailing social norms. They conclude by arguing that in order to achieve sustainable change in behaviour, "audience members need to be viewed more as collaborators than as passive receptors of expert information and advice."