Impact of the Integrated Radio Communication Project in Nepal, 1994-1997

Published in the Journal of Health Communication, this 24-page report draws on multiple research sources that have examined the impact of a theory-based, multimedia reproductive health campaign launched in Nepal in 1995: The Radio Communication Project (RCP). In general, results of the integrated impact evaluation described here show that RCP had a significant impact on modern family planning, primarily through its effects on interpersonal communication about family planning with health workers and with one's spouse, and through its effects on ideation about family planning (particularly, attitudes about and perceived normative support for the practice of family planning).

Operating within what was then the twelfth economically poorest country in the world - with one of the highest infant mortality rates in Asia (70 deaths per 1,000 live births) - RCP used entertainment-education (EE) as a strategy for: (1) satisfying the unmet need for contraception, (2) improving the quality of services and service delivery (especially the interpersonal communication and counselling (IPC/C) skills of health workers), and (3) increasing use of services and contraception by enhancing the image and expectations of health workers and services by clients. The design was integrated in that it addressed both structural and individual factors affecting reproductive health behaviour. Components include radio serials (a soap opera for the general public called Cut Your Coat According to Your Cloth and a dramatised 6-month distance education serial for health workers called Service Brings Reward), in addition to radio spot advertisements and promotions and complementary print materials.

Conducted on behalf of the Government of Nepal Ministry of Health with funding from The United States Agency of International Development (USAID), the research detailed in this document draws on a variety of sources, including a pre-post panel survey of currently married women (N = 1905), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and two years of clinic service statistics.

Evidence is presented that indicates how the two radio dramas complemented each other and produced significant increases with regard to adoption and continued use of contraception. The study found increased health worker interpersonal interaction skills, improved quality of client-provider interactions, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilisation - all attributable to the RCP. The panel data allowed statistical control of the influence of predisposing factors before the campaign on post-campaign ideation and behaviour.

Specifically, effects of the two dramas on their respective audiences are described (categorised by source of data); to cite one specific example, Table 8 (page 288 within the paper), shows the results of a logistic regression analysis for individuals who were interviewed at two points in time: once in November 1994 before the RCP serials began, and again in January 1997. Data indicate that women who listened to the radio dramas were significantly more likely to have positive attitudes toward family planning, to have discussed family planning with a health worker, to have talked to their spouse and received approval, and to perceive that the majority in the community use family planning.

Evaluators attribute the success of the programme to the fact that:

• The programme design was developed "with unusual rigor and attention to theoretical explanations of effects" - specific behavioural objectives were defined from the outset, and formative research was conducted.
• Skilled Nepalese dramatists with sensitivity to the nuances of local arts and culture conducted the scripting and production of RCP materials.
• The two dramas, "while technically accurate, had higher production values and were less didactic than previous radio development projects..." This format appeared to have made the serial accessible, even popular, among both the general public and health workers.
• The fact that improvements in actual health worker performance through the distance education serial increased client-provider interaction may have had a reinforcing effect: Those who went to clinics were less likely to be disappointed, which may have reinforced attitudes and behaviours that were beginning to change.

Finally, implications for the design of like-minded integrated, multimedia, EE campaigns and integrated evaluation designs are discussed. Among the key suggestions:

• Take advantage of opportunities to link project components to achieve complementarity
• Match integrated programmes with integrated evaluation design.
• Look for opportunities to use an evaluation activity for multiple purposes.
• Involve research staff in project planning from the outset.
• Regard impact evaluation as the first step toward future efforts, not as the final stage of a project.