Effects of an Entertainment-Education Radio Soap Opera on Family Planning and HIV Prevention in St
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ARTICLES Effects of an Entertainment-Education Radio Soap Opera on Family Planning And HIV Prevention in St. Lucia By Peter W. Vaughan, Alleyne Regis and Edwin St. Catherine Lucia, an entertainment-education radio Context: An entertainment-education radio soap opera, Apwe Plezi, was broadcast from Feb- soap opera, Apwe Plezi, was produced and ru a ry 1996 to September 1998 in St. Lucia. The program promoted family planning, HIV pre- b roadcast to promote the use of family vention and other social development themes. planning, the prevention of HIV and other Methods: The program’s effects were assessed through analyses of data from nationally rep- sexually transmitted diseases (STDs), gen- re s e n t a t i v e pretest and posttest surveys , foc u s - g roup discussions and other qualitative and quan- der equity and other social development titative sources. goals. (The name Apwe Plezi derives from R e s u l t s : Among 1,238 respondents to the posttest survey, 35% had listened to A p we Plezi, in- the Creole proverb “Apwe plezi c’est la cluding 12% who listened at least once per week. Multivar iate analyses show significant effec t s pain,” or “After the pleasure comes the 7 of both time and listenership category on seve ral know l e d g e, attitude and behavior va ri a bl e s. pa i n . ” ) The purpose of this article is to as- For example, 16% of posttest respondents knew a slang term for condoms that was coined for sess the program’s success in achieving its the radio program, and the proportions of respondents who considered it acceptable for hus- educational goals. bands to have sex partners outside their marriage declined from 27% in the pretest to 14% in the posttest survey. Compared with nonlisteners, regular listeners were more likely to trust fam - Context ily planning workers (83% vs. 72%) and considered a significantly lower number of children the St. Lucia’s population was about 136,000 ideal (2.5 vs. 2.9). Fou r teen percent of listeners reported having adopted a family planning method in 1990,8 and it grew by about 1.2% per as a result of listening to the program. year through 2000.9 The total fertility rate Co n cl u s i o n : Ap w e Plezi in fl uenced listeners to increase their awareness of contrac e p t i ve s , im- was 3.8 lifetime births per woman in 1980 pr o ve important attitudes about fidelity and family relations, and adopt family planning methods. but had declined to 2.6 by 1997.10 The con- Important lessons for entertainment-education programmers include that program reach, and traceptive prevalence rate re m a i n e d th e r e f ore effec t s , can be limited by competition with other programming, and that monitoring lis- roughly constant at about 55% from 1988 teners’ perceptions is essential to detect and correct misinterpretations of program messages. to 1997;11 some 62% of pregnancies were International Family Planning Perspectives, 2000, 26(4):148–157 unintended in 1988,1 2 and 21% of births we r e to women younger than 20 in 1991.13 Catholicism is the predominant rel i g i o n ntertainment-education is a com- ilar to themselves perform the task suc- in St. Lucia, but Seventh-Day Adventist munication strategy consisting of c e s s f u l l y. This makes entertainment- and evangelical Protestant churches rep - Ethe insertion of educational or education a suitable approach for efforts resent a growing minority. Many St. Lu- motivational information into entertain- to reduce unintended pregnancy and HIV cians choose not to marry, but instead co- ment media.1 Pr ograms are characterized infection, since self-efficacy is associated habit or enter visiting unions (in which the by an ongoing story line with several con- with contraceptive use among women at partners do not live together); as a res u l t , cu r r ent plots linked together by the char- risk of these events.3 85% of births occur out of wedlock.1 4 A acters’ personal relationships. Each Evaluations of entertainment-education 1994 report documented improved status episode ends with a hook, or cliffhanger, pr ograms have generally found that they for women in government, employment that creates interest in the next episode, have measurable effects on family plan- and education, but highlighted an increa s e and a brief epilogue that poses rhetorical ning knowledge, attitudes and practice, in reports of domestic violence against questions or provides information, such and are particularly important in stimu- as the number of a telephone hot line. lating interpersonal communication about Peter W. Vaughan is re s e a rch consultant to Population The entertainment-education strategy family planning and increasing self- Communications International, New York, and visiting assistant pro f e s s o r, Macalester College, St. Paul, MN, is based on Bandura’s social cognitive the- e fficacy with respect to the use of family USA; Alleyne Regis is program officer at the RARE Cen- 4 o r y, which posits that individuals learn planning methods and HIV prevention. ter, Castries, St. Lucia; and Edwin St. Catherine is direc- new behaviors by observing and imitat- Ho w e v e r , one study found limited effe c t s tor of statistics, Government of St. Lucia, Castries. Fund- ing the behavior of others, who serve as of an entertainment-education pro g r a m ing for this work was provided by the RARE Center and role models.2 Another underlying princi- on HIV and AIDS pre v e n t i o n ,5 and an- by Population Communications International. The au- thors thank Audrey George, executive director of the St. ple is that individuals may increase their other criticized some previous studies for Lucia Planned Parenthood Association, for making clin- 6 s e l f - e ff i c a c y, or sense of their ability to lacking rigor in design and analysis. ic data available and Everett M. Rogers for his comments carry out a task, by seeing individuals sim- In the Caribbean island-nation of St. on an earlier draft of this article. 148 International Family Planning Perspectives w o m e n .1 5 The per capita gross national opera, including a street theater produc- once a week or more, less than once a pr oduct was about US $3,370 in 1997.16 tion that used Apwe Plezi characters and week and not at all. We categorized re- was performed 21 times in 1998 and spondents choosing the first option as reg - The Program viewed by about 1,500 people. Apwe Plezi ular listeners, those giving the second an- The entertainment-education radio soap story updates were regularly published swer as casual listeners and the rest as opera Apwe Plezi was designed to addres s in the local press, and posters, bumper nonlisteners. In these analyses, any asso- 37 educational issues identified in forma- stickers and billboards were used to ad- ciation between the dependent variables tive re s e a rch. These issues included vertise the radio program. and listenership category may be the re- knowledge, attitudes and behavior rel a t - sult of self-selection to the audience by ed to family planning, HIV pre v e n t i o n , Methods people who already agreed with the ed- gender equity, relationship fidelity and do- Data and Analyses ucational themes being promoted by the mestic violence. Our principal source of information about radio program. During the program’s first phase, from the program’s effects was a pret e s t - p o s t t e s t Since both of our analytic appro a c h e s February 1996 to May 1997, 260 episodes survey conducted through personal in- have validity threats caused by the corre- we r e broadcast from 5:15 to 5:30 P.M.Tue s - terviews. A January 1995 survey of 753 lational nature of the analyses, it is diffi- day through Friday (with a repeat of Fri- men and women provided baseline data. cult to infer causal effect. We adjusted for day’s episode on Monday) on Radio St. Posttest surveys were conducted in June these validity threats by controlling for 13 Lucia.* There followed a period of sever- 1997 (among 741 respondents) and in Sep- variables refl ecting demographic charac- al months when selected episodes fro m tember 1998 (with 497 respondents). Each teristics, socioeconomic status, mass media the initial phase were rebroadcast with a survey included an independent quota access and family planning availability narrator to bridge the gap in the story line. sample that was rep r esentative of the coun- (the first 13 variables in Table 1, added to For the second phase, 105 episodes were try’s sexually active population aged 15–54 our models through forward stepwise like- b roadcast from July 1997 to September (a c c o r ding to the 1991 census) in terms of lihood-ratio selection). Although the use 1998; two new 15-minute episodes each geographic re p resentation of the 10 dis- of such statistical controls is only a partial a i red three times every week. The 400th tricts of St. Lucia, sex ratio, age distribution solution to the validity threats inherent to episode of Apwe Plezi was broadcast dur- and socioeconomic status. Because the all nonexperimental designs, it is the most ing the third phase, in July 2000.