Health effects of mass-media interventions – Author's reply
Authors: Roy Head
Journal: The Lancet Global Health (2018)

That James Deane considers our study1Sarrassat S Meda N Badolo H et al.Effect of a mass radio campaign on 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 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.2Hornik RC Public health communication: making sense of contradictory evidence.in: Hornik RC Public health communication: evidence for behaviour change. Lawrence Erlbaum, Mahwah2002: 1-22Google Scholar There is a high burden of proof on the health communications sector to show that its interventions work, particularly its most expensive component, mass media. Every dollar spent on media could be spent on drugs, doctors, or bednets, all of which are more obviously linked to public health, and all of which are scientifically supported. Policy makers rely primarily on data that is rigorous and comparable to other health interventions. In the absence of such data, mass media has remained at the periphery of public health. Deane considers our Saturation+ approach3Head R Murray J Sarrassat S et al.Can mass media interventions reduce child mortality?.Lancet. 2015; 386: 97-100Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar to be eccentric; this remark is also surprising. Within commercial advertising, few would question the importance of the intensity and volume of broadcasting. Of course we would have preferred to have tested different output combinations as part of our trial, but with just 14 clusters, this was impossible statistically. We therefore tested a method that worked consistently well in previous campaigns,3Head R Murray J Sarrassat S et al.Can mass media interventions reduce child mortality?.Lancet. 2015; 386: 97-100Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar has served as the backbone of the advertising industry since the 1920s, and was identified as the crucial missing link in Hornik's seminal evaluation of previous, failed RCTs.2Hornik RC Public health communication: making sense of contradictory evidence.in: Hornik RC Public health communication: evidence for behaviour change. Lawrence Erlbaum, Mahwah2002: 1-22Google Scholar Deane raises several other concerns, none of which stand up to scrutiny. He suggests that our method prevented us from designing the most appropriate intervention, selecting the best channels, tailoring outputs to specific drivers, adapting to change, and integrating with the public health system. In fact, as documented previously,4Murray J Remes P Ilboudo MJR et al.Implementing a mass media campaign to reduce child mortality in Burkina Faso: the Saturation+ approach.Glob Health Sci Pract. 2015; 3: 544-556Crossref PubMed Scopus (19) Google Scholar our method incorporated all these features. We used local radio, by far the most powerful medium in Burkina Faso, reaching 82% of all women in our intervention clusters. No other medium (including national radio or television) reaches more than 20% of the population, and to imagine a more cost-effective design is difficult. To identify specific barriers and beliefs, and to test the clarity of our messages, we conducted 4024 qualitative interviews in 150 villages over 3 years. We also used post-broadcast focus groups to understand why some behaviours remained unchanged. New specifically tailored outputs were produced every week. Our team also liaised weekly with the Minister of Health's most senior advisor to ensure that all messages were based on disease burden, taking into account seasonality and the availability of services. In two further papers reporting the same trial, we present diagnostic-specific data that show significant improvements in parents taking their child for treatment:5Murray J, Head R, Sarrassat S, et al. Modelling the effect of a mass radio campaign on child mortality using facility utilisation data and the Lives Saved Tool (LiST): findings from a cluster randomised trial in Burkina Faso. BMJ Glob Health (in press).Google Scholar a 56% increase compared with controls in the case of malaria (p<0·001), a 39% increase for pneumonia (p<0·001), and a 76% increase for diarrhoea (p<0·001). Economic analyses6Kasteng F, Murray J, Cousens S, et al. Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso. BMJ Glob Health (in press).Google Scholar also show mass media is one of the most cost-effective health interventions available. Our hope is that these studies will establish mass-media campaigns as a scientifically validated intervention that should benefit the whole sector. I report grants from Planet Wheeler Foundation and from The Wellcome Trust. I am the CEO of Development Media International, which implemented the intervention in the original study. 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 interventionsWe congratulate Sophie Sarrassat and colleagues (March issue)1 for the rigour they applied in measuring the effects of a mass radio campaign on health behaviours. Full-Text PDF Open Access