Health effects of mass-media interventions
Authors: James Deane
Journal: The Lancet Global Health (2018)

We congratulate Sophie Sarrassat and colleagues (March issue)1Sarrassat S Meda N Badolo H et al.Effect of a mass radio campaign on a family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial.Lancet Glob Health. 2018; 6: e330-e341Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar for the rigour they applied in measuring the effects of a mass radio campaign on health behaviours. However, although their Article provides "some of the best evidence available that a mass media campaign alone can increase health facility utilisation for maternal and child health in a low-income, rural setting", what it does not do is show the best approach to health communications, or any effect of a mass-radio campaign on the original intent—to impact child mortality using media alone. We think the findings from this Article, its underlying theory of change, and its implications for future health-communication design and investment need to be carefully scrutinised. Like most other organisations that run health-communication programmes, we are sceptical that mass media alone is the most effective approach. We do believe that health communication can achieve a great deal as part of a mix of public health and other interventions. We see three problems with this study: first, the intervention locale and design appear to have been chosen because they provided the best conditions to do a randomised controlled study, not because mass communication was shown to be the most effective or relevant means of addressing the health needs of the communities concerned. This approach is not how most health-communication interventions are conceived or designed. Health communication is useful to address particular public health challenges—low demand for services (like vaccines), harmful norms that prevent healthy behaviours from being adopted (like husbands or mothers-in-law discouraging pregnant women to go for a check up), or non-health-seeking behaviours (like not using condoms to prevent HIV transmission). In some settings, those problems do not exist or are being tackled in different and more appropriate ways. Health communication is not considered by most of its practitioners to be the sole solution—this approach is just an important option that can be used to address certain public health challenges in some contexts. The second concern is the choice of a so-called saturation approach to health messaging, which was expected to affect quite a broad range of public health outcomes. Although ostensibly good reasons are given as a rationale for this type of health messaging, this approach is somewhat eccentric in the context of the rest of the sector, and belies much existing learning. Most health-communication practitioners root their approach in the specific drivers and characteristics of the health problem they are trying to solve, and tailor their approach to solving it. Practitioners seek to reach the relevant parts of a society through the channels that work best for the people concerned, and they generally try to make their intervention an integral part of the rest of the public health system. The idea of saturating the airwaves with health information would, for many of us, be expected to lead to a law of diminishing returns and is atypical of the rest of the sector. Third, it seems that it was difficult for the programme to be adaptive given that it was set up to prove (or disprove) one particular approach. Unless a programme adapts to shifting realities, it is highly likely to fail, especially given the fast-moving character of most information, communication, social and political environments, and public health challenges themselves. Evidence for the effectiveness of health-communication programmes has been accumulating over recent years, but the academic research underpinning the sector still has some way to go to enable practitioners like ourselves to be properly guided by not only what works or what does not, but also how, why (which is one reason we invest so heavily in our own research), and under what conditions these types of programmes work—answers to which we are left wanting after reading the study by Sarrassat and colleagues.1Sarrassat S Meda N Badolo H et al.Effect of a mass radio campaign on a family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial.Lancet Glob Health. 2018; 6: e330-e341Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar Although I have immense respect for the authors who have written this Article, I fear this study has not moved us on very much in this respect, and I agree with Tim Colbourn and Audrey Prost2Colbourn T Prost A Making waves: can radio reduce child mortality?.Lancet Glob Health. 2018; 6: e238-e239Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar who state in their accompanying Comment that this study provided an "elegant answer to the wrong question." Given the inherent challenges highlighted by this study that are involved in using a randomised approach to measuring health-communication outcomes, we need a better debate on how best to provide elegant answers to the right questions. BBC Media Action also does work using communication to advance public health and is donor-funded. BBC Media Action is the international development charity established by the BBC. My views as the Director of Policy and Research at BBC Media Action should not be taken to reflect those of the BBC itself. Effect of a mass radio campaign on family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trialA comprehensive radio campaign had no detectable effect on child mortality. Substantial decreases in child mortality were observed in both groups over the intervention period, reducing our ability to detect an effect. This, nevertheless, represents the first randomised controlled trial to show that mass media alone can change health-seeking behaviours. Full-Text PDF Open AccessHealth effects of mass-media interventions – Author's replyThat James Deane considers our study1 to be answering "the wrong question" is perplexing. Deane states the obvious, that media campaigns are just one part of the public health system. But we know of no other way to test whether these campaigns are a useful part of public health without the scientific method—isolating the variable in question, and comparing with unexposed controls. Imagining a more overdue question is also difficult. The first public health films were produced 100 years ago, yet since then, despite billions of dollars being spent, not a single randomised controlled trial (RCT) has confirmed that mass media can actually change behaviours. Full-Text PDF Open Access