For International Radio Day on February 13th this year, we are reprising a great blog by contributer Brad Hurley exploring the work of Development Media International. To read about DMI's work since Brad's blog first appeared (9/2016), see our DMI Information Page as well as this article just published in The Lancet.
The first episode of the television series Mad Men, set in the Madison Avenue advertising district of New York City in 1960, opens in a smoky bar. It proceeds to scenes in smoky bedrooms, smoky offices, smoky restaurants, and even a smoky doctor’s examination room. None of this would have seemed unusual if you were watching in 1960: More than 40 percent of American adults smoked, and smoking was permitted nearly everywhere.
Today, smokers account for less than 17 percent of the American adult population. Ironically, the reduction is in large part due to the media—the same media that the New York advertising agencies used to boost cigarette sales in the 1960s.
According to a summary in the National Cancer Institute’s 2008 report on The Role of the Media in Promoting and Reducing Tobacco Use, media campaigns that discourage smoking can change attitudes about tobacco use, reduce the number of people who start smoking, and encourage smokers to quit. It’s probably safe to say that mass media anti-smoking campaigns have prevented hundreds of thousands of early deaths in America.
Media campaigns are just one of many anti-smoking forces Americans have been exposed to during the past five decades. In 1971, the U.S. government banned cigarette advertisements from television and radio, and in the late 1990’s most states banned advertising of cigarettes on billboards and public transit. Tax and price increases have reduced the affordability of cigarettes. All of these factors have affected behavior, making it difficult to estimate the number of lives saved by any one alone. But it’s clear that television, radio, magazines, newspapers, and now social media, have played important roles in smoking’s decline.
Measuring the effectiveness of media campaigns
The story of the media’s influence on smoking trends in America illustrates the potential of mass media campaigns to address other public health risks. Mass media campaigns can be extraordinarily cost-effective, reaching millions of people for a relatively modest investment. This makes media campaigns an attractive option for donors who want to accomplish the most good with their giving. But as the example of smoking trends in America shows, it’s not easy to assess the effectiveness of media campaigns as a public health intervention. How do you demonstrate cause-and-effect relationships in the real world, where people may be exposed to information and influences from multiple sources? And how do you determine which approaches will be most effective in bringing about real, lasting changes in behavior?
These are exactly the questions that Development Media International (DMI), one of The Life You Can Save’s recommended charities, aims to answer. DMI designs and runs radio, television, and mobile campaigns to change behaviors and improve lives in developing countries, using innovative methods to evaluate the impact of those campaigns. The most effective campaigns then get scaled up to reach millions of people.
Roy Head created DMI in 2005. Before launching the organization, he was a former television producer for the BBC and the United Nations, who ran large-scale public health media campaigns in 16 countries for the BBC World Service Trust. His objective for DMI was to bring a scientific approach to mass media campaigning. DMI developed an evidence-backed methodology for its media campaigns, called Saturation+, and runs rigorous evaluations and randomized controlled trials (where feasible) to determine impact. It uses surveys to measure trends in knowledge, attitudes, and practices in areas where it has run media campaigns, and “triangulates” those results with those of other data sources to minimize biases.
Working with epidemiologists at the London School of Hygiene and Tropical Medicine, DMI has also developed a model that predicts how many lives can be saved by media campaigns. The model suggests that mass media campaigns aimed to improve children’s health in sub-Saharan Africa can reduce mortality of children under five by up to 10 percent, at an estimated cost of around $20 per disability-adjusted life year, which translates to a cost per life saved of around $600. This would make mass media campaigns one of the most cost-effective ways of saving lives currently available.
Testing the predictions
The first test of DMI’s model predictions was a randomized controlled trial of a mass media campaign in Burkina Faso from 2011–2015. The trial, whose final results will be reported in late 2016, used radio broadcasts to reduce mortality of children under five by influencing the behavior of their parents and caregivers. Randomized controlled trials of media campaigns aren’t feasible in most countries, due to the possibility that people in a control group might be exposed to broadcasts intended for the intervention group, but many areas of Burkina Faso receive radio only from small local stations with limited reach. This allowed the researchers to establish geographically separated intervention and control groups.
Every week, the study broadcasted 70 hours of radio advertisements and live drama shows, in six languages, for 30 months. The researchers collected baseline data on under-five mortality and behavior and then ran surveys at the middle and end of the trial to compare behaviors and mortality rates between the intervention and control groups. The midpoint results showed clear improvements in behavior among the intervention group. While DMI has not yet published its final findings, GiveWell reported that the preliminary end-of-trial survey results on behaviors and under-five mortality were inconclusive. However, data collected from health facilities showed a significant increase in the numbers of children who were taken for treatment for malaria, pneumonia, and diarrhea in intervention zones, compared with control zones. DMI is currently running another three-year randomized controlled study in Burkina Faso to test the impact of radio campaigns on family planning.
One of the challenges faced by DMI in its randomized controlled trials is that—just as in American smoking trends—there are other influences at play. Child mortality in Burkina Faso has been declining across the country in recent years, and a number of organizations have been providing interventions (e.g., health worker training and anti-malaria bednet distributions) that could be contributing to that trend.
Building the evidence base
The Burkina Faso studies are only two of DMI’s many efforts to test the effectiveness of media campaigns. Regardless of the outcomes of these projects, what’s important is that DMI is bringing the same kind of rigorous analysis to mass media campaigns that is being used to assess the effectiveness of other public health interventions such as anti-malarial nets, deworming, and salt iodization. Ultimately, this information will help donors and charity evaluators compare a wider range of options to determine where their giving can do the most good.