Indirect Exposure to a Family Planning Mass Media Campaign in Nepal

This study examines the dispersion and strength of indirect exposure to mass media family planning (FP) campaigns. The authors suggests that individuals discuss the messages and information received from mass media campaigns with others and that some of the knowledge, attitudes, and behaviour (KAB) associated with a campaign can be transmitted in this indirect manner, thus it is possible that normally tabulated coverage rates are underestimated. They are seeking to strengthen this argument by assessing the transmission patterns in several rural villages in the Dang district of Nepal. The findings support this position, with an overall increase in the reach of the programme messages from 50% to 75%.

Background

The study sought to evaluate villager interaction and knowledge with the Radio Communication Project (RCP), a national health communication campaign designed to address unmet need for FP in Nepal. The components of the project included several radio dramas, and these were the main indicators of direct exposure and formed the basis for questions concerning indirect exposure, most importantly, KAB with regards to the notion of the "well-planned family." An important part of the study was also evaluating whether interpersonal communication (IPC) helped to overcome the ethnic stratification that is common to much of Nepal. Members of the Tharu ethnic/caste group are generally less educated, poorer, and less likely to speak Nepali (the language of the RCP), and made up slightly more than half of the population of the Dang district. The community groups against which participation was measured were those organised by Backward Society Education (BASE), a predominantly Tharu organisation in Western Nepal.

Methodology

Previous research cited by the authors has demonstrated that direct exposure to FP campaigns can be limited by a number of access factors including income, literacy, and language/ethnic group. Indirect exposure to messages through interpersonal communication (IPC) with other women may be able to overcome these barriers. The first Research Question (RQ) is:

RQ1 - To what extent can IPC extend the reach of a mass media programme’s messages about FP?

The authors believe that community groups extend the scope of a mass media message, and may increase the chance that women who were unexposed to the direct message may discuss FP with another woman. This led to:

RQ2 – (a) Are members of community groups more likely than non-members to become indirectly exposed, and (b) are non-members living in communities with a higher level of participation in community groups more likely than non-members in low participation communities to become indirectly exposed?

Finally, the authors sought to test the association between IPC and contraceptive use. It is believed that IPC helps women to relate FP messages to their own context more so than does mass media channels. This generated the question:

RQ3 – (a) Are women indirectly exposed to FP messages more likely to use a contraceptive than those not exposed to the programme's messages, or (b) those only directly exposed to the programme's messages?

Data was collected using a structured questionnaire in 6 randomly selected villages in the region in which BASE operates. The RCP programme broadcasts nationally, and all villages are within receiving range of radio transmitters. All currently married women aged 15 to 45 years in each of the villages were included in the study, with n = 667, a 99.1% response rate. The main variables for analysis included:

• Membership in a community group;
• Interpersonal communication (IPC) about FP;
• Exposure to the RCP; and
• FP knowledge, attitudes, and behaviour (KAB).

Details of the coding techniques are discussed in the article but will not be reproduced here other than to say that RCP exposure was measured as: (1) no exposure, (2) direct exposure only, (3) indirect exposure only, (4) direct and indirect exposure.

Results

The authors observed the following phenomenon:

• More than half the respondents recalled hearing at least one component of the radio campaign, and 55% had talked to someone who had either heard the campaign herself had talked to someone who had heard the campaign (twice removed).
• Among women not directly exposed to the RCP campaign, more than 40% could be considered indirectly exposed to the programme messages. When considering both direct and indirect measures of exposure, the RCP message reached 73% of women in the sample, a 40% increase over direct exposure alone.
• There were substantial differences in direct exposure between villages; three factors were correlated with these differences, the percentage of the population that was Tharu (negative), the number of radios in the village (positive), and the percentage of the population in a community group (positive).
• Household radio ownership ranged from 44% to 62.5%.
• Direct exposure was relatively high (52%-60%) in all three villages with high levels of group membership (group membership of 25%-38%), and lower (43%) in the other villages (group membership of 3%-8%), with the exception of the village with the highest level of radio ownership (53% directly exposed).
• The relationship between indirect exposure and group membership was, however, undermined by the finding that the village with the highest participation had an indirect exposure rate comparable to those villages with the lowest participation rates. This was also a village with a higher proportion of upper caste groups. The authors are without an explanation for this finding.
• Overall, 20% more group members were directly exposed to the FP campaign, and demonstrated consistently higher rates of discussing FP.
• The multivariate regression analysis revealed that those belonging to a community group are 4.6 times more likely to be indirectly exposed to FP messages, while they are 7.6 times more likely to receive direct and indirect exposure (p .001).
• Knowledge of FP increased substantially through exposure, with the % aware of more than five modern methods increasing in a linear fashion between no exposure (44.3%), indirect (47.8%), direct (70.6%), and direct and indirect (78.6%).
• Attitudes towards FP were largely unresponsive, with the most substantial improvement being reduced child gender bias among women who had direct and indirect exposure.
• Behaviours were substantially affected by indirect exposure, of which 44% were currently using FP, compared to only 22% with no exposure, and 26% with direct exposure. 50% of those who had received both indirect and direct exposure were currently using FP. Contraceptive use appears to be more influenced by indirect, interpersonal exposure than direct exposure.

Conclusions

Overall, the authors believe that indirect exposure to a mass media campaign's messages can be extensive and that the effect is substantial. Interpersonal communications can have a positive and reinforcing effect on mass media messages; possibly in part because of the nature of entertainment-education programmeming in that it is able to create culturally appropriate narratives that are more likely to have daily import in the lives of women. Nowhere is this more apparent than the finding that the usage of contraceptives is substantially more likely to occur as a result of IPC rather than media messages. The authors note that if indirect exposure is ignored, estimates of usage of contraceptives among those not exposed would be inflated and the impact of campaigns would be underestimated.

The findings also suggest that women’s groups may increase the reach of FP media messages through at least two mechanisms: first, group members were more likely to report hearing the programme, possibly as a result of greater discussion about the programme, and an increased likelihood of then listening to the programme at a later date. Secondly, community groups promote indirect exposure to a programme's message, as groups tend to be diverse and cut across some of the ethnic, language, and economic barriers between individuals.

In conclusion, the authors believe that this study reinforces the need to view and develop communication campaigns as an "integrated set of processes occurring at several levels." Exposure to mass media programme stimulates and informs interpersonal communication, which subsequently influences behaviour and additional exposure to the mass media messages.