Preliminary Findings from Cambodia MCH Campaign

This 18-slide presentation was offered by the British Broadcasting Corporation (BBC) World Service Trust at a December 2005 meeting of The Communication Initiative (CI)'s Partners, who gather annually to guide the strategic direction of the organisation. The second day of the 2005 meeting featured a number of presentations from CI Partners on the theme of "measuring communication impact" (click here for additional background, and to access all the presentations from that meeting).

This particular presentation begins with a brief look at the Trust's Research & Learning Group (R&L), which was established in January 2005 to carry out qualitative and quantitative research across all Trust interventions, such as the Cambodia Maternal and Child Health (MCH) Campaign. The Trust's work in this country is part of a larger Department for International Development (DfID) country strategy which aims to strengthen health sector development by increasing access to high-quality essential health services, especially for economically poor mothers and children. The need for these services is highlighted by various figures presented here, such as the fact that diarrhoea and acute respiratory tract (ARI) infection cause half of child mortality. Yet in Cambodia there is limited access to improved sanitation (in urban areas: 56%; in rural areas: 26%). In response, the Trust sought to spur behaviour change by reaching out to mothers, caretakers, and pregnant women in Cambodia with messages related to diarrhoea, ARI/immunisation, child nutrition, and pre- and post-natal care.

Components of the behaviour change communication (BCC) campaign included:

• Television: 60 episodes of the 30-minute television drama Taste of Life (a second series of 40 episodes is underway) and 21 TV spots (one of which featured a handwashing song designed to spur behaviour change to prevent diarrhoea)
• Printed materials: 5 editions printed out of 8 total of the magazine Taste of Life
• Radio: 61 episodes of the 60-minute radio call-in show First Steps and 21 radio spots

The R&L Group carried out household-based, population-based, cross-sectional surveys to evaluate the MCH campaign: a baseline study in April/May 2004 (2274 respondents) and a midline study in April/May 2005 (2280 respondents) involving face-to-face interviews by trained interviewers. Here is a summary of selected findings:

Access: At midline, evaluators found that 26% named Taste of Life when asked in general what TV shows they watched; 51% said they had watched the drama when shown a picture of the cast. Half or more respondents said they had seen 5 TV spots, which aired 2,167 times by the end of August 2005; 65% recognised one spot in particular (Srey Touch). Twenty-two percent recalled (unprompted) the radio spots, which aired 14,336 times by the end of August 2005.

Knowledge Shifts:

General MCH Knowledge: Respondents were asked about specific things people can do caring for a baby or a young child (less than 5 years old) to help the baby or child be healthy. To cite one example of a result detailed here, at baseline, 12% knew that washing hands is one such action; at midline, 25% of those unexposed to the campaign vs. 31% of those exposed knew this.

ARI Awareness: At baseline, 20% had heard of ARI; at midline, 60% of those unexposed to the campaign vs. 81% of those exposed had heard of it. Knowledge levels of specific symptoms of ARI are compared here.

Oral Rehydration Awareness: At baseline, 81% had heard of Oralit/SRO (an oral rice-based rehydration solution); at midline, 82% of those unexposed to the campaign vs. 96% of those exposed had heard of it. Knowledge levels about how to make the solution are compared here.

Behaviour Change:

Diarrhoea Prevention: Respondents were asked, "Have you done anything in the past 6 months to prevent diarrhoea in your children? What have you done?" In general, at baseline, 73% had done something; at midline, 74% of those unexposed to the campaign vs. 84% of those exposed had done something. Specific findings are shared here; to cite one example, at baseline, 60% had boiled water; whereas this figure remained the same for those unexposed at midline, 68% of those exposed to the campaign had boiled water.

Diarrhoea Treatment: Respondents were asked, "Has your child ever had diarrhoea?
If yes, what did you do last time your child had diarrhoea?" For example, at baseline, 18% gave Oralit; at midline, this figure had dropped to 15% among those unexposed to the campaign and increased to 29% among those exposed.

In conclusion, the author offers several strategic considerations to those seeking to evaluate similar BCC campaigns:

• Develop a practical field-based model of impact that acknowledges the complexity of
  social change and behaviour change on the ground, considering cost, time, intended audience, etc.
• Create customised interventions (content and format) that are designed to deliver
  impact to a variety of audiences with varying objectives, possibly facilitated by an index or taxonomy of impact.
• Invest in understanding how impact occurs, not only substantiating that it does, perhaps conducting post-intervention diagnostic assessment with individuals.
• Recognise that information interventions can have a stabilising/reinforcing effect as
  well as a change effect, and define impact accordingly.
• Identify intervention as part of broader donor strategy, encouraging strategy-wide impact assessment.