Effects of an Entertainment-Education Radio Soap Opera on Family Planning and HIV Prevention in St

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):148Ð157 unintended in 1988,12 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. samples were small, especially in the 1998 ap p r opriate analytic method, given the im- The characters in entertainment-educa- s u r v e y, and regular listenership to A p w e possibility of implementing an experi- tion programs serve as positive, negative Pl e z i was not high, detection of statistical- mental design for a mass media interven- or transitional behavioral role models, and ly significant changes is problematic. To tion in a small country that is completely 17 their fates provide vicarious learning ex- im p r ove the power of our statistical tests, co v e r ed by a single radio transmitter. periences to demonstrate the consequences we combined the 1997 and 1998 surveys Causation may be inferred from listen- of alternative behaviors. Positive charac- into a single posttest sample, and we con- ers’ “self-attribution” that their changes ters embody positive values and are re- ducted all statistical tests on this combined in knowledge, attitudes and behaviors re- † wa r ded. In Apwe Plezi, for example, Leona sample of 1,238 men and women. sulted from listening to Apwe Plezi, al- is a well-educated woman of 23 who wants The independent (control) variables though such self-attribution may be over- to delay childbearing until she is fin a n- used in the study are listed in Table 1 (page stated because of the leading nature of the cially secure. Leona suspects that her 150), and the dependent variables are questions req u i r ed to elicit the res p o n s e s . boyfriend, Marcus, has other sexual part- identified in Table 2 (page 152). Using The personal interview questionnaire ners, and she decides to break up with him multivariate logistic re g ression analysis minimized this effect by asking un- because of her fear of contracting HIV from (for categorical dependent variables) and p rompted (open-ended) questions first, him. Leona eventually takes a job and mar- multivariate general factorial analysis of and then prompted questions. To prov i d e ries Marcus, after he ref o r m s . variance (for continuous dependent vari- conservative estimates of the radio pro- Negative characters embody negative ables), we examined the data in two ways. First, we tested for changes in the depen- *The production and evaluation of Apwe Plezi involved values and are punished. The Apwe Plezi a collaboration between the RARE Center, a non- character Tony has multiple partners and dent variables across time, from pretest to governmental organization based in Philadelphia, PA , c h i l d ren by two of them. He refuses to posttest. Any association between a de- USA, that is dedicated to the preservation of island bio- support his children, he rapes a woman pendent variable and time may have been diversity; the St. Lucia Planned Parenthood Association; on a date and ultimately he contracts HIV. caused by some factor that was unrel a t e d the National Population Unit of the Ministry of Planning; to but occurred contemporaneously with the St. Lucian Ministry of Health; and Population Com- Transitional characters are torn between munications International, a nongovernmental org a n i- the positive and the negative values, but the broadcast of Apwe Plezi. However, to zation based in New York. Airtime was donated by the eventually choose the positive values and the best of our knowledge, there were no government-owned Radio St. Lucia. a re re w a rded. For example, Georgie is a new development initiatives in St. Lucia † We compared the 1997 and 1998 samples on the same young man who becomes a drug user and between 1995 and 1998 that might explain 15 independent variables employed in the subsequent unintentionally impregnates his 16-year- the changes observed in this study. analyses, using chi-square tests for categorical variables Second, we tested for diffe r ences in the and t-tests for continuous variables. There was no sta- old girlfriend, but who later enters a drug tistical diffe r ence between the 1997 and 1998 data on nine rehabilitation program and tries to be- dependent variables by listenership cat- of these variables. Compared with respondents in the come more sexually responsible. egory in the posttest sample, which we de- 1998 sample, those surveyed in 1997 were more urban, The RARE Center and the St. Lucia termined in the following way: We asked about two years younger, more likely to own radios, more likely to listen to the FM station Radio Helen 100 and to Planned Parenthood Association (SLPPA) all participants if they had ever listened to Apwe Plezi on the radio; if they said yes, Apwe Plezi, and less likely to listen regularly to the soap collaborated on several other activities to opera. We concluded that combining the two samples augment the effects of the radio soap we asked how often they listened to it. The into a single posttest sample is an acceptable analytic latter question had three response options: strategy.

Volume 26, Number 4, December 2000 149 Effects of an Entertainment-Education Radio Soap Opera

Table 1. Percentage of survey respondents with selected characteristics, or mean value of se- reported being casual listeners and 12% † lected measures, by timing of survey and Apwe Plezi listenership category, St. Lucia we r e regular listeners. Several signiﬁca n t di ff e r ences emerged among listenership Characteristic Timing Listenership categories (Table 1). Respondents who lis- Pretest Posttest Non- Casual Regular tened to Apwe Plezi regularly were the listener listener listener most likely to live in urban areas, own a (N=753) (N=1,238) (N=799) (N=288) (N=151) radio, be female and be regular listeners Urban residence 18 25* 23 29 31* to Radio St. Lucia; they also had the large s t £primary school education 45 42* 46 29 45* Own a radio 96 92* 90 95 95* families. Casual listeners were the least Live in town with condoms available 91 80* 78 86 83* likely to have no more than a primary ed- Live in town with family planning available 83 70* 68 74 73 ucation, and nonlisteners were the least Catholic 71 63* 63 59 65 likely to live in a town where condoms Speak Creole at home 54 67* 69 63 66 w e re available. Because of these diff e r- In union 36 44* 45 44 42 Male 48 49 54 44 33* ences, the ﬁrst 13 independent variables Mean parity (and standard error) 1.6 (0.1) 1.6 (0.1) 1.7 (0.1) 1.3 (0.1) 1.9 (0.2)* in the table were used as controls in all sta- Listen to Radio St. Lucia often or most often 38 39 34 44 57* tistical tests of the effect of Apwe Plezi on Mean age (and standard error) 29.3 (0.4) 28.7 (0.3) 28.9 (0.3) 27.8 (0.5) 29.4 (0.8) our dependent variables.‡ Listen to Radio Helen 100 often We measured eight dependent variables or most often na 65 63 69 66 Regular or casual listener to Apwe Plezi na 35 na 100 100 related to knowledge about family Regular listener to Apwe Plezi na 12 na 0 100 planning and STD prevention, 14 related

*Difference between surveys or between listeners and nonlisteners is statistically significant at p£.05. Note: na=not applicable. to attitudes about family planning and gender equity, and eight pertaining to behaviors reg a r ding family planning and gram’s effects, we report responses to un- A hot line for telephone consultations was STD prevention. Those variables that prompted questions when possible. established in collaboration with SLPPA showed an effect of Apwe Plezi— f o u r In addition to the personal interviews, in October 1996. We conducted content knowledge, nine attitudinal and seven 44 focus-group interviews were conduct- analyses on the re c o rded messages to be h a v i o r a l — a r e included in our analyses.§ ed at intervals throughout the bro a d c a s t gather anecdotal information about indi- period to monitor listeners’ responses to vidual listeners’ responses to the prog r a m . Results the program. Interview guides evolved Perceptions of Apwe Plezi f rom asking about listeners’ perc e p t i o n s Sample Characteristics Ac c o r ding to results from our 1997 survey, of characters and story lines in the early Ac c o r ding to results of chi-square testing Apwe Plezi was the second most popular focus groups to asking about education- and analyses of variance, the pretest and pr ogram on Radio St. Lucia that year, and al issues and personal involvement with posttest samples were significantly dif- the fourth most popular program on any the radio program in later ones. fe r ent with respect to several independent radio station in the country, competing To assess trends in the use of family variables (Table 1). Members of the favorably with other programs of various planning services, we monitored SLPPA posttest sample were more likely than par- g e n res (e.g., news, sports and music). clinics for the number of patient visits ticipants in the pretest to live in urban Findings from the combined posttest f rom 1994 to 1999. In addition, the gov- a reas, speak Creole at home and be in a sample shed some light on listeners’ per- ernment Statistics Department provided sexual union; they were less likely to have ceptions of the program and its characters. data on contraceptive imports and the a low educational level, own a radio, say The audience, especially regular lis- numbers of births to adult and teenage that condoms were available in their town, teners, generally viewed positive charac- women from 1990 to 1999. say that family planning was available ters as such. For example, Leona (the We had one final source of information and be Catholic. Because of these diff e r- young woman who wanted to delay for measuring the program’s effects. The ences, 12 independent variables were used childbearing and who broke up with her RARE Center established a telephone as controls in all statistical tests of the re- boyfriend rather than risk contracting number with a rec o r ding machine for lis- lationship between time (pretest vs. HIV) was viewed as being “morally good” teners to call with comments on the radio posttest) and our dependent variables.* by 25% of all listeners in 1997 and by 28% pr ogram; the telephone number was reg - S i x t y - five percent of the posttest sam- in 1998; among regular listeners, 56% in ularly provided in Apwe Plezi’s epilogues. ple did not listen to Apwe Plezi, while 23% 1998 viewed her as being morally good.

*The control variables are all of the independent variables samples were included as controls because sometimes a §The knowledge variables that showed no effect were in Table 1 except listenership to Radio Helen 100 (which variable becomes significant in multivariate analyses; fur- the belief that it is possible to space births, awareness of was not asked about in 1995) and the two variables re- thermore, certain variables, such as parity, have associ- t u b e c t o m y, family planning users’ knowledge of radio g a rding listenership to Apwe Plezi. Many of the diff e r- ations with family planning use in other countries, and as an information source and knowledge that HIV is ences between the pretest and posttest samples are like- it was theref o r e reasonable to examine their effects here. s p read by heterosexual intercourse (which was known ly attributable to sampling error. However, variation in by 99% of respondents in 1995). The attitude variables urban residence likely stems from a change in the way †Casual listenership was higher in 1998 (33%) than in with no effect were approval of family planning, feeling this variable was determined: At the pretest, res p o n d e n t s 1997 (17%), but regular listenership was about the same about going to a family planning clinic, desire to have were asked to describe their place of residence, while at in both years. the posttest, enumerators were asked to classify each another child, believing that using family planning would household. The decline in the proportion of Catholic re- ‡Most of the diff e rences between listeners and nonlis- make respondents feel they were doing something good spondents may be partly attributable to the growing in- teners are likely the result of self-selection to the radio and believing that men have the right to beat their part- fluence of several Protestant churches. Variables that were pr ogram, or the fact that the radio program was more ap- ner if she disobeys them. Ever-use of family planning was not associated with significant differences between the pealing or accessible to some individuals than to others. the only behavioral variable that had no effect.

150 International Family Planning Perspectives Listeners’ opinions of transitional char- Figure 1. Perc e n t a ge of regular listeners to Apwe Plezi, by self-reports of the prog r a m ’ s effec t s acters improved over time if the charac- on their knowledge and attitudes, according to theme ters’ behavior improved. For example, when Marcus (Leona’s boyfriend, who Theme had multiple sexual partners) re f o r m e d his behavior, the proportion of regular listeners who considered him morally good rose from 31% to 44%, while the proportion who viewed him as morally bad declined from 23% to 9%. As might be expected, there is more ambivalence about transitional characters who had not fully resolved their behavioral problems at the time of the 1998 survey. For example, reg - ular listeners were evenly divided as to whether Georgie, who at one point fails in his effort to stop using drugs and be celibate with his girlfriend, was morally good (31%) or morally bad (26%). S u r p r i s i n g l y, listeners’ opinions also we r e divided about one of the main negative characters, To n y, who had been ac- cused of date rape, led an irresponsible sexual life and was infected with HIV. Some 17% of all listeners viewed him as being morally good, while only 12% viewed him as being morally bad. Some regular listeners also considered him morally good (38%), and women were more likely than men to view him in a positive light (19% vs. Learned about 15%). This is an example of the so-called Changed attitude “a lot” Ar chie Bunker effect, in which some audience members interpret a negative character as being positive.18

Knowledge Variables Regular listeners to Apwe Plezi we r e high- % ly cognizant of its educational content. In No t e : Percentages for knowledge changes reflect unprompted responses; percentages for attitude changes reflect prompted responses. response to an unprompted question asking listeners what topics they had learned about from the program, 52–60% of re g- however, were not significant.* While knowledge that HIV is spread by ular listeners cited HIV or AIDS, teenage RARE Center staff coined the term “cat- homosexual intercourse with an infected pr egnancy or drug abuse (Figure 1). Other apult” as a new slang term for condoms, and person was high in 1995 (90%), it increa s e d salient themes were spousal abuse, mar- characters in the soap opera began using it (to 93%) by the time of the posttest; the riage, discussion of family planning and in episode 140, prior to the 1997 survey. In multivariate result (odds ratio, 1.6) was rape (cited by 42–48%). Only 16% of reg- 1997, 16% of all survey respondents, 22% of statistically significant. Listeners and non- ular listeners reported learning nothing listeners and 13% of nonlisteners knew the listeners did not differ on this variable. from the radio soap opera. term (not shown). At this time, the only way Belief that HIV can be contracted by car- F o c u s - g roup participants were also one could have learned the term was by lis- ing for an AIDS patient increased fro m aw a r e of the educational content of Ap w e tening to Apwe Plezi or by talking to an Ap w e 24% of respondents at pretest to 37% at Pl e z i , as the following comment indicates:19 Pl e z i li s t e n e r . By contrast, in 1998, knowledge posttest. However, the proportion hold- “V ery interesting, and I learn a lot of dif- about the term “catapult” remained at 16% ing this view was about equal among lis- f e rent things, such as how diff e rent per- of all respondents, but was about equal be- teners and nonlisteners, suggesting that sons deal with diff e rent kinds of pro b- tween listeners and nonlisteners. This find - the rumor was widespread in St. Lucia. lems.…”—38-year-old man ing may refl ect that in December 1997, The proportion of survey respondents SL P P A began selling Catapult-brand con- Attitude Variables who were aware of contraceptive pills do m s , 20 and these were being sold in nine Listeners were asked whether listening to i n c reased from 77% to 83% between the out of 10 districts in the country by the time Apwe Plezi had caused them to change pr etest and the posttest, and the odds ratio of the later survey. In the combined posttest their attitude about 11 educational themes f rom the multivariate analysis (1.6) was sample, 14% of nonlisteners, 17% of casual statistically significant (Table 2, page 152). listeners and 26% of regular listeners knew *Results for other variables that were significant in the D i ff e rences in awareness of oral contra- what “catapult” meant, and the diffe re n c e multivariate analyses are described in the appendix (page ceptives among listenership categories, was statistically significant (odds ratio, 2.2). 156).

Volume 26, Number 4, December 2000 151 Effects of an Entertainment-Education Radio Soap Opera

Tab le 2. Perc e n t a ge of respondents, or mean val u e , by knowl e d g e, attitude and behavior mea- women to have multiple sexual partners sures addressed by Apwe Plezi, according to timing of survey and listenership category; and be f o r e marriage was unchanged over time, mul t i v ariate results from analysis of relationship between timing of surve y or listenership cat- but regular listeners were less likely than egory and measure nonlisteners to consider this behavior ac- Measure Timing Listenership ceptable (19% vs. 30%). The proportion who agreed that a Pretest Posttest Multi- Non- Casual Regular Multi- variate listener listener listener variate woman needs her husband’s consent to result result work outside the home declined signifi- Knowledge cantly between the pretest (84%) and the Are aware of the pill 77 83 1.6** 84 82 80 ns posttest (71%), but this measure was un- Know that Catapult is a type of condom na 16 na 14 17 26 2.2** a ffected by listenership category. Belief Know that HIV is spread that parents should “impose” their will on by homosexual intercourse 90 93 1.6** 93 93 90 ns their children declined over time (fro m Believe that HIV is spread by caring for AIDS patient 24 37 1.9** 37 38 36 ns 75% to 68%), and listeners were significantly less likely to agree with this state- Attitude ment (63% of both regular and casual lis- Believe it is possible to determine one’s family size 60 62 1.5** 60 68 60 ns teners) than nonlisteners (71%). Mean ideal age for women’s Among nonusers of family planning first birth (and standard error)† 23.4 (0.2) 22.6 (0.1) Ð0.8** 22.7 (0.2) 22.4 (0.2) 23.0 (0.4) ns Mean ideal number of children methods, 47% of the pretest sample in- (and standard error)‡ 2.7 (0.1) 2.8 (0.1) ns 2.9 (0.1) 2.8 (0.1) 2.5 (0.1) Ð0.4** tended to use a method, compared with Believe men can have other 39% of those in the posttest; the multi- sexual partners after marriage 27 14 0.5** 16 12 10 ns Believe women can have more variate findings indicate a significant de- than one sexual partner cline (odds ratio, 0.7). Casual listeners ap- before marriage 33 29 ns 30 33 19 0.5** Believe a wife needs her pe a r ed to be more likely to report that they husband’s consent to work 84 71 0.4** 71 74 62 ns intended to use family planning than ei- Believe parents should impose ther nonlisteners or regular listeners; how- their will on children 75 68 0.7** 71 63 63 0.8* Intend to use family planning¤ 47 39 0.7* 37 46 35 ns e v e r, this diff e rence was not signific a n t , Believe that you can trust staff and the number of regular listeners who at family planning clinics 84 75 ns 72 78 83 1.5* we r e not currently using family planning Behavior was small (83). Talked to spouse/partner about Finally, while belief in the trustworthi- family planning 77 67 0.6** 65 72 65 ns Talked to same-sex friend about ness of family planning staff did not family planning 69 57 0.6** 52 69 57 1.9** change over time, listeners were more like- Talked to a family planning worker 37 27 0.6** 26 27 30 ns ly than nonlisteners to trust family plan- Currently use modern method of family planning†† 53 54 ns 55 58 47 ns ning clinic staff (78–83% vs. 72%), and the Currently use condoms‡‡ 21 24 ns 24 20 31 ns odds ratio from the multivariate analysis Pregnant/partner is pregnant 6 7 ns 7 7 6 ns indicates that the effect was significant. Cite STD prevention as the main reason for using family planning¤¤ 9 13 ns 12 14 10 ns Behavior Variables *p£.05. **p£.01. †Based on respondents who gave numeric responses: 466 respondents in the pretest and 686 (429 nonlisteners, 165 casual listeners and 92 regular listeners) in the posttest. ‡Based on respondents who gave num e r ic responses: 493 respondents in the Listeners were asked the unpro m p t e d pretest and 755 (463 nonlisteners, 190 casual listeners and 102 regular listeners) in the posttest. ¤Based on nonusers: 380 respon- question “What, if anything, did you do dents in the pretest and 661 (433 nonlisteners, 145 casual listeners and 83 regular listeners) in the posttest. ††Based on women in union: 146 respondents in the pretest and 270 (170 nonlisteners, 62 casual listeners and 38 regular listeners) in the posttest. ‡‡Based as a result of listening to Apwe Plezi?” with on men in union: 120 respondents in the pretest and 277 (186 nonlisteners, 65 casual listeners and 26 regular listeners) in the posttest. ¤¤Based on users: 318 respondents in the pretest and 542 (340 nonlisteners, 139 casual listeners and 63 regular listeners) in the posttest. six coded responses. Eighteen percent of No t e s : Mu l t i va r iate results for categorical vari a b les are odds ratios from logistic regression and for continuous vari a b les are coeffici e n t s men and women who listened re g u l a r l y from analyses of va ri a n c e. na=not applicabl e. ns=not statistically significant. For results of mul t i va r iate analysis using other independent variables, see appendix (page 156). to Apwe Plezi reported that they had talked about its family planning content, and 14% reported that they had adopted a “a lot, a little, or not at all.” On average, cant effect of time. These variables did not family planning method. Six percent of the proportions reporting substantial differ among listenership categories. regular listeners reported that they had attitude change are 10 percentage points T h e re was no significant change be- called a hot line or gone somewhere to ob- lower than (or about 80% of) the levels re- tween the pretest and the posttest in ideal tain counseling. Twenty-nine percent had porting having learned about the themes, family size, but there was a significant dif- not changed their behavior as a result of but the patterns are similar. For example, f e rence among listenership categories. listening to the program. The self-rep o r t - the highest levels of self-reported learn- Apwe Plezi regular listeners had a smaller ed behavior changes were, on average, ing and attitude change were for HIV and mean ideal family size (2.5 children) than about 45% of the reported attitude change. AIDS, teenage pregnancy and drug abuse. nonlisteners (2.9). In 1998, 35% of listeners said they talked Between the pretest and the posttest, re- Posttest respondents were significa n t - to a friend and 19% reported talking to spondents’ level of belief about individ- ly less likely than pretest participants to be- their spouse as a result of listening to Ap w e uals’ ability to determine their family size lieve that it is acceptable for married men P l e z i. Of those who talked to someone, increased from 60% to 62%, and their no- to have other sexual partners than their 32% reported discussing the characters, tion of the ideal age for a woman to fir s t wives (27% vs. 14%); diffe r ences among lis- 18% discussed how the radio program re- give birth declined 0.8 years; the odds ra- tenership categories were not significa n t . lated to their own lives and 15% talked tios for these changes indicated a signifi- By contrast, belief that it is acceptable for about the radio program’s family plan-

152 International Family Planning Perspectives ning content. The following exchange be- being in a regular sexual union have a Tab le 3. Volume of imports of condoms and of tween two women in a 1998 focus group much higher rate of condom use than men chemical contraceptives, and number of new illustrates the role of Apwe Pleziin stimu- in a union (39% vs. 21% in 1995—not fa m i l y planning acceptors at SLPPA clinics, by lating interpersonal discussions:21 shown), possibly because they were using year 32-year-old woman: “Well, we used to condoms with casual partners to avoid Measure No. talk about [Apwe Plezi].” contracting an STD. Regular listeners were Condom imports (kg) 28 - y e a r -old woman: “You mean argu e . the most likely to report using condoms 1995 1,791 Those women were always arguing about (31%), but the difference was not signifi- 1996 1,884 who was right or wrong.” cant, perhaps because of the small sample 1997 2,008 1998 2,904 32 - y e a r -old woman: “I think it made us of male listeners. 1999 7,043 think and talk a lot. I even used to tell my Fi n a l l y , although the proportion of fam- Chemical methods imports (kg)† cousin to listen to [Georgie, a transition- ily planning users who cited pro t e c t i o n 1995 676 al character] on the program.” fr om STDs as their primary reason for use 1996 617 The proportion of respondents who re- i n c reased slightly from pretest (9%) to 1997 1,225 1998 1,197 ported talking to their spouse or partner posttest (13%), this change was not sig- 1999 1,292 about family planning declined from 77% nificant and occurred about equally New acceptors in the pretest to 67% in the posttest (odds among listeners and nonlisteners. 1994 879 ratio, 0.6), and the change was statistical- 1995 887 ly significant (Table 2). Diffe r ences among Service Statistics 1996 932 1997 1,053 listenership categories were not signifi- Condom importation increased modest- 1998 1,107 cant. Between the pretest and the posttest, ly between 1995 and 1997, and then ro s e 1999 1,175 th e r e were also statistically significant de- 45% in 1998 and 143%, reaching 7,043 kg, †Hormonal and spermicidal methods. clines in the proportions of re s p o n d e n t s in 1999 (Table 3). By contrast, imports of who reported discussing family planning chemical contraceptives (hormonal and with a same-sex friend (69% vs. 57%; odds spermicidal methods) decreased 9% from vious fertility declines, but it accelerated ratio, 0.6) and with a family planning 1995 to 1996, roughly doubled in 1997 and after 1995. The proportion of all births that worker (37% vs. 27%; odds ratio, 0.6). Ca- fluctuated at about 1,200 kg through 1999. w e re to teenagers declined from 21% in sual listeners reported more discussion The number of new family planning ac- 1990 to 16% in 1999.§ with friends than nonlisteners (odds ratio, ceptors at SLPPA clinics increased each These changes in fertility corre s p o n d 1.9), and listeners generally reported more year from 1995 to 1999;* although the in- with the broadcast of Apwe Plezi, and are discussions with friends and family plan- crease was small (1–6%) in most years, it consistent with an effect of the radio soap ning workers than nonlisteners, although reached 13% in 1997. The generally larg- opera on fertility in St. Lucia. But it is dif- most of these relationships were not sta- er increases in contraceptive imports and ficult to establish a causal relationship be- tistically significant. new method users after 1996 are consis- cause of the correlational nature of the C u r rent use of family planning meth- tent with the hypothesis that Apwe Plezi analyses and the small number of years ods was slightly but nonsignificantly high- would positively affect service demand, available for reg r ession analysis. Also, the er at the posttest (54%) than at the pret e s t and SLPPA attributes much of the increa s e declines in both overall births and those (53%). Given the level of regular listener- to the radio program.22 occurring among teenagers began some- ship among women (16%) and the self- A p p roximately 40,630 women aged what sooner than might be expected, reported adoption of family planning 15–54 resided in St. Lucia in 1997.† Si x t e e n given the necessary nine-month lag be- among regular female listeners (15%), one p e rcent of women in our survey were tween a change in contraceptive behav- would expect an increase of two perce n t - regular listeners to Apwe Plezi, and 4% ior and any decline in births. age points (0.16 x 0.15=0.02), rather than of regular listeners had gone to an SLPPA one point. There f o re, our unpro m p t e d clinic because of Apwe Plezi; together, these *Of women who were using a family planning method in se l f - r eports may not be overstated, and are findings suggest that the program should 1995, 28% reported receiving their method from an SLPPA clinic, 25% from a Ministry of Health clinic, 40% from pri- consistent with the hypothesis of a small have motivated 260 women nationwide vate doctors and 7% from other sources. Many people pre- Apwe Plezi ef fect on women’s family plan- to attend an SLPPA clinic. This estimate fer private doctors so as to avoid any embarrassment that ning adoption. Similarly, casual listeners is approximately 60% of the actual might be associated with being seen going to a family plan- seemed somewhat more likely than non- cumulative increase in new acceptors ning clinic. Our service statistics do not include either Min- istry of Health clinics or private physician visits. listeners or regular listeners to be curren t at SLPPA clinics (431) between 1995 users, but these differences were not sta- and 1998.‡ †This estimate is derived from the 1991 census and is based on the government’s revised population estimate tistically significant. However, these re- for 1992 of 36,981 women in this age range and on an an- sults are based on very small numbers of Fertility Trends nual rate of natural increase of 1.9%. listeners; in analyses based on all res p o n - Between 1990 and 1995, the total number ‡The cumulative increase was obtained by calculating dents in 1998, listeners were significa n t l y of births to St. Lucian women was ap- the difference between the number of new acceptors in mo r e likely than nonlisteners to be curren t p roximately constant, at an average of 1995 and each subsequent year, and then adding the dif- users of a family planning method (52% 3,673 births per year, but for the period ferences together. vs. 43%; odds ratio, 1.6). 1996–1999, the annual number dro p p e d §For births overall, the slope of a linear re g ression of Among men who were in a sexual 13% to an average of 3,183 (Figure 2, page births vs. years for 1990–1995 is not significantly differ- union, the proportion currently using con- 154). Births to teenagers have been de- ent from zero; the slope of a linear re g ression of births vs. years for 1995–1999 is –180 births per year (R2= . 7 7 , doms was 21% at pretest and 24% at clining steadily since at least 1990; this de- p=.06). For births to teenagers, the slopes are –26 (R2=. 9 0 , posttest, but this increase was not statis- cline may be partly attributable to the p<.01) for the earlier period and –44 (R2=.85, p=.03) for tically significant. Men who reported not aging of the population as a result of pre- the later years.

Volume 26, Number 4, December 2000 153 Effects of an Entertainment-Education Radio Soap Opera

Figure 2. Number of births to all women and teenage women in St. Lucia, 1990Ð1999 spoke the language that we know.”—35- year-old woman No. of births “I would continue to listen [to Apwe Plezi] because it really bringing the messages out 4,000 in a good way. I know that is what they doing, you know...they using the soap opera to send messages. Only one thing I want is 3,600 for them to let Tony [a negative character] su f fer more. ” — 37-year-old woman 3,200 We speculate that the nonpre s c r i p t i v e n a t u re of the entertainment-education 2,800 strategy increases its acceptability among All diverse audiences. Teenagers The radio program is likely to have the 2,400 s t rongest inﬂuence on those individuals who listen most re g u l a r l y, less inﬂu e n c e 2,000 on those who listen infrequently and even less on those who are not directly exposed to the program. Our self-report data sup- 1,600 port this relationship: Regular listeners indicated that they learned more, changed 1,200 their attitude more and changed their behavior more than casual listeners. This re-

800 lationship is also supported by our survey data: For those variables that show a relationship among listenership categories, 400 the response is generally larger for regular listeners than for nonlisteners. 0 An upper bound on the magnitude of expected effects among the general pop- 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 ulation is imposed by the size of the audience, especially for regular listeners. For Listeners’ Responses population of St. Lucia. Similar enter- example, in a controlled ﬁeld study of an About 10 people called the Apwe Plezi ho t tainment-education radio programs have entertainment-education radio soap opera line each week. Some offe r ed advice to the had listenerships of 23% in Tan z a n i a 23 an d in Tanzania, the magnitude of change in characters (e.g., suggesting that one char- 6% in Uttar Pradesh, India.2 4 E x p o s u re several dependent variables was corre- acter put her child up for adoption); oth- levels are likely the result of a mixed lated with the magnitude of the audience ers gave compelling testimony about how e ffect of access to radio and competition in different geographic areas, and a pop- they had suffe r ed similar fates to those of with other media programs, including ulation-level increase of 10 perc e n t a g e the characters, including beatings and television programs. Listenership to Ap w e points in the current use of a family plan- rape by their partner. One unidentified Pl e z i was probably reduced somewhat by ning method by married women in the caller said: “He has been beating me, abus- two sources of competition: a very popu- treatment area was associated with a lis- ing me and harassing me. I went to the po- lar television soap opera, The Young and the tenership to the soap opera of 53% in the lice, they say they coming, but they R e s t l e s s, that aired at the same time as treatment area.26 haven’t done that.…It has been about 10 Apwe Plezi during part of each year; and Fu r t h e r , it must be assumed that some months since he has been beating me.…I a very popular FM commercial radio portion of the audience will know about, don’t know what to do.…Call me.” station, Helen 100, which began bro a d- a g ree with or practice the intended be- In response to callers’ apparent need for casting after 1995. Because a program’s haviors prior to the intervention, and counseling, SLPPA established a counsel- e ffects are proportional to its audience th e re f o r e will not be persuaded by the pro- ing telephone line in October 1996. The size, producers of entertainment-educa- gram. A program is most likely to inﬂu- counseling telephone line received 6–10 calls tion programs must be very careful to ence regular listeners who do not alrea d y per day, for a total of 1,200 calls as of August select media, channels and time slots that ag r ee with or practice the promoted edu- 1997. These calls can have been stimulated will maximize exposure to the intended cational themes. In the pretest sample, 53% only by the radio soap opera, since it was audience. of adult women who were in a sexual the only place the telephone line was ad- Comments made during focus groups union were practicing family planning. In vertised, and they rep r esent about 2% of the illustrate that the appeal of the radio pro- the posttest, 16% of women were reg u l a r total adult population of St. Lucia (assum- gram lay in both its local nature and its listeners. If one assumes that 53% of Ap w e ing they include no repeat callers). educational content:25 P l e z i’s regular female listeners were al- “I think it is local, and that is what ready practicing family planning before Discussion I liked the most. It really is St. Lucian. the program began broadcasting, and if Ex p o s u r e to Apwe Plezi was high, and the When you look at programs both on TV one assumes that all nonusers who listened p rogram developed a loyal audience of and radio, they are all foreign. I think it regularly to Apwe Plezi adopted family regular listeners of about 12% of the adult was good to have a local program that planning between the pretest and posttest

154 International Family Planning Perspectives surveys, then the maximum change in con- regular listeners. Thus, an important lim- cluding approximately 300 per month in traceptive use that we might have ob- itation of our study is that the sample sizes one district where the demand for con- served among women in union in the gen- used in the quantitative surveys lacked the doms had been near zero previously.31 eral population would be about eight statistical power to detect changes of a This rather unusual form of social mar- pe r centage points, or from 53% to 61%. magnitude that it would be reasonable to keting influenced both new demand for We observed much less change (one expect, given the size of the audience and condoms and brand-switching, as SLPPA percentage point). This is not surprising, the baseline levels of many dependent noted a decline in demand for other types since it is unreasonable to assume that any variables. Nonetheless, our multivariate of condoms in exchange for Catapult. Con- program could have 100% efficiency. On analyses show a positive association of dom imports increased dramatically from the basis of the self-reports that 14% of reg - time with six dependent variables and a 1998 to 1999, more than demand for chem- ular female listeners adopted family plan- positive association of listenership cate- ical contraceptives or visits to SLPPA clin- ning because of listening to Apwe Plezi, we gory with six dependent variables while ics, likely re flecting the dual function of have shown that we might have expect- co n t r olling for relevant independent vari- condoms in preventing unwanted pre g- ed an increase of about two perc e n t a g e ables, supporting the hypothesis that nancy and STDs. Users seemed satisfie d points among women in union in the gen- Apwe Plezi influenced these dependent that Catapult condoms met their needs, eral population. For a statistical test to variables. The evidence is strongest that even though the condoms were substan- have an 80% chance of detecting a five- Apwe Plezi influenced awareness of the tially the same as the ones that the SLPPA point diff e rence between two samples term “catapult,” ideal number of children , had distributed prev i o u s l y . One man said would re q u i re a sample size of appro x i- the unacceptability of married men’s hav- in an interview, “I feel more secure when mately 1,600 in each year, as opposed to ing multiple sex partners, the unaccept- I use it, I know it will not burst.” Another our sample sizes of 753 and 1,238; to reli- ability of women’s having multiple sex said, “I prefer Catapult to other brands.” ably detect a smaller change would re- partners before marriage, the proportion Ample evidence indicates that A p w e quire an even larger sample.27 of people who feel that a wife needs her Pl e z i stimulated a great deal of discussion, Although our survey data show neither husband’s consent to work, the prop o r t i o n which is an important mechanism of be- a significant increase in current use of fam- of people who feel that parents should im- havior change for entertainment-educa- ily planning methods nor a decline in the pose their will on children and trust of tion pro g r a m s .3 2 We found that twice as proportion of women who were current- family planning clinic workers. many people had heard of Apwe Plezi a s ly pregnant, clinic data indicate that con- Listeners’ own reports of an effect of had actually listened to it (which could be traceptive demand and attendance at Apwe Plezi show a classic hierarchy of ef- a result of advertising), 13% of nonlisten- SL P P A clinics have risen, and national sta- fects: The program has its greatest impact ers knew the definition of “catapult” in tistics reveal fertility declines. On the basis on knowledge, less impact on attitude 1997 and many listeners in both the sur- of the population estimates we used ear- change and even less impact on behavior veys and the focus groups said they talked l i e r, the numbers of births shown in Fig- ch a n g e . 28 This hierarchy is consistent with about the radio program and its educa- u re 2 and the 75% chance that a woman other findings,2 9 although the degree of tional content.* It is surprising that the giving birth in any year would be pre g- decline between levels of the hierarchy is p roportions of respondents who re p o r t- nant at the time of a survey, we calculate less than is anticipated in some other stud- ed talking to their spouse or partner, same- that the proportion of women who have ie s . 30 By comparing our self-reports for be- sex friends and family planning workers indicated that they were pregnant at the havior change with other independent es- about family planning declined, given ev- time of a survey should have declined timates for the same behavior change (e.g., idence that Apwe Plezi stimulated such dis- f rom about 7.1% in 1995 to 5.9% in the change in family planning use by cussions among listeners. These declines 1997–1998. Our surveys’ failure to detect women from pretest to posttest, and the remain unexplained. this decline is likely attributable to a lack number of new acceptors at SLPPA clin- The problem of listener ambivalence of statistical power to be able to measure ics), we find that the self-reports are about some of the negative characters such small changes. roughly equal to the independent esti- (e.g., Tony and Chester) was identified In t e re s t i n g l y , if the one-point incre a s e mates, suggesting that the self-reports are early in the monitoring focus groups. In in current use of a family planning not consistently overstated and may, in response, the scriptwriter exaggerated the method that we measured is accurate fact, understate some effects. negative aspects of these characters and (even though it is not statistically signifi- Among knowledge variables, it is clear ultimately punished them by giving Ton y cant), it corresponds with the decline of that Apwe Plezi’s use of the term “catapult” HIV and having Chester be stabbed to 1.2 percentage points in the proportion of played an important role in the early dif- death while in prison, but this did not di- women one would expect to be preg n a n t fusion of awareness of the new condom. minish the listeners’ opinions of them. The at the time of a survey. Further, given St. Part of this diffusion occurred via inter- ambivalence about these characters’ moral Lucia’s historically high rate of unplanned personal communication about this term. s t a t u re may re flect strong conflict about p regnancy and moderately high rate of However, by the time of the 1998 survey, the nature of gender and sexual relations contraceptive prevalence, a declining fer- other mechanisms of diffusion, including in St. Lucia, which is illustrated by these tility rate is possible without a concomi- the displaying of 1,000 posters, may have two quotes from focus-group participants tant increase in contraceptive prev a l e n c e played a role, since listeners and nonlis- asked about Chester’s rape scene:33 if use is increasingly consistent, effective teners were equally likely to know what or correct. “catapult” meant. Surprisingly, overall *In fact, the diffusion of knowledge about Catapult con- The lack of statistical power caused by aw a r eness of the term did not increase sig- doms in 1997 suggests that listeners must have talked to nonlisteners about the program content. This diffu s i o n small sample sizes is particularly impor- ni fi cantly from 1997 to 1998. Between De- may have contaminated our statistical comparisons of tant in our comparisons of listenership cat- cember 1997 and the end of 1998, about listenership categories, but it is difficult to know how large egories, since only 151 participants were 10,000 Catapult condoms were sold, in- this effect may have been for other dependent variables.

Volume 26, Number 4, December 2000 155 Effects of an Entertainment-Education Radio Soap Opera

“I don’t understand how they arres t e d religion (1.2, p=.04), speak Creole at home (0.8, gion (1.2, p=.01), sexual union (0.8, p<.01), family the man for demanding sex from his p=.01); by listenership category: religion (1.3, planning availability (0.8, p<.01), condom avail- p= . 0 2 ) . Believe HIV is spread by caring for AIDS ability (0.8, p<.01), speak Creole at home (0.9, woman.”—27-year-old man p a t i e n t —over time: religion (0.9, p=.01), family p=.01), age (1.0, p<.01), radio ownership (0.8, “I remember when a fella rape a girl by planning availability (0.9, p= .02), urban res i d e n c e p=.01); by listenership category: religion (1.3, the beach. That brought one argument be- (0.7, p<.01); by listenership category: urban resi- p<.01), family planning availability (0.7, p<.01), tween me and my boyfriend.”—1 9 - y e a r - dence (0.7, p<.01), primary education (0.8, p=.03), radio ownership (0.8, p=.02), gender (0.9, p=.01). old woman listen to Radio Helen (0.9, p=.03). Believe it is pos- Talked to a family planning worker—over time: sible to determine one’s family size—over time: religion (1.2, p<.01), sexual union (0.7, p<.01), fam- R e g a rdless, the issue of oppositional family planning availability (0.7, p<.01), speak ily planning availability (0.7, p<.01), parity (1.1, reading of characters provides a lesson on C reole at home (0.8, p<.01), age (1.0, p<.01), pri- p=.02), speak Creole at home (1.1, p=.04), urban the importance of monitoring listener per- mary education (0.7, p<.01), radio ownership (0.7, residence (1.2, p=.02), rural residence (0.8, p=.04), ceptions of characters and making ad- p<.01); by listenership category: family planning gender (0.7, p<.01); by listenership category: rel i - availability (0.7, p<.01), speak Creole at home (0.8, gion (1.2, p=.02), sexual union (0.7, p<.01), family justments to the scripts to limit the po- p<.01), age (1.0, p<.01), primary education (0.7, planning availability (0.7, p<.01), parity (1.1, p=.01), tential negative effects of misperce p t i o n s p<.01), radio ownership (0.7, p<.01). Ideal age for rural residence (0.8, p<.01), gender (0.7, p<.01). Us e among listeners. w o m e n ’s first birth—over time: sexual union modern family planning method—over time: The strength of this study lies not in any (–0.2, p=.05), speak Creole at home (–0.3, p<.01), condom availability (0.6, p<.01), age (1.0, p=.03), one analysis, since each of our data urban residence (0.3, p=.05), rural residence (–0.6, secondary education (1.8, p<.01); by listenership p<.01), primary education (–0.4, p=.02), gender category: condom availability (0.6, p<.01), sec- s o u rces and analyses suffers from some (–0.2, p=.05), parity (–0.1, p<.01); by listenership ondary education (2.2, p<.01). Pr e g n a n t / p a r t n e r serious validity threat, but in the conflu- category: speak Creole at home (–0.4, p<.01), par- pr e g n a n t — over time: sexual union (0.5, p<.01), age ence of the majority of our findings, which ity (–0.1, p<.01), rural residence (–0.6, p<.01). Id e a l (1.0, p=.01), gender (1.3, p<.01), listen to Radio tend to re i n f o rce each other. Self-re p o r t s number of children—over time: sexual union (0.1, Helen (1.3, p=.02); by listenership category: sexu- p=.05), speak Creole at home (0.1, p=.04), gender al union (0.6, p<.01), gender (1.3, p=.04), listen to of family planning adoption by listeners; (0.2, p<.01), listen to Radio St. Lucia (–0.2, p=.02), Radio Helen (1.3, p=.05). STD prevention is main a slight, although nonsignificant, increa s e listen to Radio Helen (0.2, p=.04), parity (0.2, reason for using family planning—over time: sex- in the use of contraceptives by women in p<.01); by listenership category: sexual union (0.2, ual union (1.8, p<.01), parity (0.8, p=.02), primary our surveys; increases in the importation p=.03), speak Creole at home (0.2, p=.04), gender education (1.9, p<.01), gender (1.5, p<.01), listen of contraceptives, especially condoms; in- (0.3, p<.01), sexual union (0.2, p=.03), listen to to Radio St. Lucia (1.6, p<.01); by listenership cat- Radio St. Lucia (–0.2, p=.03), listen to Radio Helen egory: sexual union (1.7, p<.01), primary educa- c reases in the number of visits to SLPPA (0.2, p=.04), parity (0.2, p<.01), age (0.1, p=.04). Be - tion (1.7, p<.01), gender (1.5, p<.01), listen to Radio clinics; and a decline in the number of lieve married men can have other sexual part- St. Lucia (1.6, p<.01), age (1.0, p=.03). births—all are consistent with an A p w e ne r s — over time: condom availability (0.7, p<.01), P l e z i e ffect on family planning behavior gender (1.4, p<.01); by listenership category: con- References dom availability (0.7, p=.02), gender (1.6, p<.01), 1 . Nariman HN, Soap Operas for Social Change: Toward a in St. Lucia. The lack of alternative expla- speak Creole at home (1.4, p<.01), parity (1.1, Methodology for Entertainment-Education Tel e v i s i o n , Wes t - nations for these changes, such as other p<.01). Believe women can have multiple sexu- port, CT, USA: Praeger, 1993; Piotrow PT et al., F a m i l y al partners before marriage—over time: rel i g i o n intervention initiatives during the period Planning Communication: Lessons for Public Health, New (1.4, p<.01), rural residence (1.2, p<.01), primary of study, strengthens the assertion that York: Praeger, 1997; and Singhal A and Rogers EM, En- education (0.8, p=.01), gender (1.2, p<.01); by lis- Apwe Plezi had an effect. We conclude that tertainment-Education: A Communication Strategy for So- tenership category: religion (1.5, p<.01), gender cial Change, Mahwah, NJ, USA: Lawrence Erlbaum As- entertainment-education programs can (1.2, p=.02), listen to Radio Helen (0.9, p=.04). Be - sociates, 1999. play an important role in motivating in- lieve a wife needs her husband’s consent to dividuals to plan their families in a nation w o r k —over time: parity (1.1, p<.01), condom 2. Bandura A, Social Learning Theory, New York: Pren t i c e - such as St. Lucia, but that expectations for availability (0.8, p=.03), rural residence (1.2, p=.02), Hall, 1977; and Bandura A, S e l f - E f ficacy: The Exercise of primary education (1.3, p<.01), gender (1.4, p<.01), Control, New York: Freeman, 1977. such programs must be based on rea l i s t i c listen to Radio St. Lucia (1.2, p<.01); by listener- 3 . Galavotti C et al., Validation of measures of condom projections of audience size. ship category: parity (1.1, p<.01), condom avail- and other contraceptive use among women at high risk ability (0.8, p=.04), gender (1.4, p<.01), listen to for HIV infection and unintended preg n a n c y , Health Psy- Radio St. Lucia (1.2, p<.01). Believe parents Appendix: Multivariate Results chology, 1995, 14(6):570–578. Table 2 presents the findings of our multivariate should impose their will on children—over time: logistic reg r ession results for the key independent sexual union (0.8, p<.01), age (1.0, p<.01), prima- 4 . P i o t row PT et al., Mass media family planning pro- variables, time and listenership category. Here , ry education (1.3, p<.01), gender (0.9, p=.05); by motion in three Nigerian cities, Studies in Family Planning, we present results for control variables (odds listenership category: sexual union (0.8, p<.01), 1990, 21(5):265–274; Rogers EM et al., Effects of an en- ratios and coefficients from analyses of variance, age (1.0, p<.01). Intend to use family planning— tertainment-education radio soap opera on family plan- res p e c t i v e l y , for categorical and continuous vari- over time: religion (1.3, p<.01), condom avail- ning behavior in Tanzania, Studies in Family Planning, ables) that also had significant effects. Dichoto- ability (0.7, p<.01), family planning availability 1999, 30(3):193–211; Singhal A and Rogers EM, 1999, op. mo u s variables were coded 1 if the following char- (0.7, p<.01), rural residence (0.7, p<.01), age (0.9, cit. (see ref e r ence 1); Valente TW et al., Radio prom o t i o n acteristics were present and –1 otherwise: p<.01); by listenership category: religion (1.3, of family planning in the Gambia, International Family Catholic; not in union; family planning not avail- p<.01), condom availability (0.6, p<.01), family Planning Perspectives, 1994, 20(3):96–100; and Va u g h a n able; condoms not available; speak Creole at planning availability (0.7, p<.01), rural res i d e n c e PW et al., Entertainment-education and HIV/AIDS pre- home; urban residence (vs. suburban); rural res- (0.7, p=.01), age (0.9, p<.01), primary education vention: a field experiment in Tanzania, Journal of Health idence (vs. suburban); primary education or less; (0.7, p=.02). Trust staff at family planning clin- Communication, 2000, 5(Supplement):81–100. ic s — over time: religion (1.3, p<.01), listen to Radio secondary education; no radio; male; does not lis- 5. Yoder PS, Hornik R and Chirwa BC, Evaluating the pro- Helen (0.8, p<.01), family planning availability ten to Radio St. Lucia often; does not listen to gram effects of a radio drama about AIDS in Zambia, (0.8, p=.01); by listenership category: sexual union Radio Helen 100 often. Studies in Family Planning, 1996, 27(4):188–203. Pill awareness—over time: religion (1.2, p=.02), (0.8, p<.01), listen to Radio Helen (0.8, p=.04), fam- sexual union (0.9, p=.03), parity (1.1, p<.01), family planning availability (0.7, p<.01). Talked to 6 . Sherry JL, Prosocial soap operas for development: a ily planning availability (0.7, p<.01), condom spouse/partner about family planning—o v e r review of res e a r ch and theory, Journal of International Com- availability (0.7, p<.01); by listenership category: time: religion (1.2, p<.01), sexual union (0.6, p<.01), munication, 1997, 4(2):75–101. religion (1.2, p=.04), family planning availability family planning availability (0.6, p<.01), prima- 7. Regis A and Butler P, RESPONSIBILITY 6: Research- (0.8, p<.01), condom availability (0.7, p<.01), age ry education (0.7, p<.01); by listenership catego- ing and evaluating St. Lucia’s population “problem” of- (1.0, p<.01). Know the term “catapult”—by lis- ry: religion (1.2, p=.01), sexual union (0.6, p<.01), fers new solutions in broadcasting on lifestyle issues for tenership category: primary education (0.6, p<.01), family planning availability (0.6, p<.01), prima- today’s youth, Castries, St. Lucia: RARE Center, 1997. listen to Radio Helen (1.2, p=.01). Know HIV is ry education (0.7, p<.01). Talked to same-sex spread by homosexual intercourse—over time: friend about family planning—over time: re l i- 8. Registrar of Civil Status and Statistics Department, 19 9 1

156 International Family Planning Perspectives Census, Volume 3: Living Arrangements and Fertility, Cas- Resumen de los oyentes para detectar y corregir los tries, St. Lucia: Government of St. Lucia, 1994. C o n t e x t o : Desde febre ro de 1996 a septiem- posibles erro res de interpretación de los 9. Population Reference Bureau (PRB), 2000 World Pop- bre de 1998, se difundió en la isla caribeña de mensajes. ulation Data Sheet, Washington, DC: PRB, 2000. Santa Lucía una novela radial de entre t e n i- 10 . Statistics Department, Vital Statistics Report, 1992, Ca s - miento, y a la vez educativa, titulada A p w e Résumé tries, St. Lucia: Government of St. Lucia, 1993; and PRB, P l e z i. Este programa promovía la planific a- C o n t e x t e : Un feuilleton radiophonique World Population Data Sheet, 1997, Washington, DC: PRB, 1997. ción familiar, la prevención del virus que causa mélodramatique à dessein éducatif, A p w e el SIDA y otros temas de desarrollo social. Plezi, a été diffusé, de février 1996 à septem- 11. Jagdeo TP, Contraceptive prevalence in Saint Lucia, Castries, St. Lucia: International Planned Parenthood Fed- M é t o d o s : El impacto del programa fue eva- br e 1998, à Sainte-Lucie. Le programme met- eration, 1990; and PRB, 1997, op. cit. (see reference 10). luado mediante análisis de datos re p re s e n t a- tait l’accent sur le planning familial et la pré- 12. Jagdeo TP, 1990, op. cit. (see reference 11). tivos a nivel nacional de encuestas de pre- p r u e - vention du VIH, entre autres thèmes de ba y post-prueba, y mediante discusiones de développement social. 13. Statistics Department, Vital Statistics Report, 1993, Ca s - tries, St. Lucia: Government of St. Lucia, 1994. grupos focales y otras fuentes de datos cuali- Méthodes: Les effets du programme ont été tativos y cuantitativos. évalués par l’analyse des données re c u e i l l i e s 14. Ebanks GE, Mortality, Fertility and Family Planning in Dominica and Saint Lucia, London, Ontario, Canada: Re s u l t a d o s : En t r e los 1,238 entrevistados en dans le cadre d’enquêtes préalables et posté- University of Western Ontario, 1985. la encuesta de post-prueba, el 35% habían r i e u res à l’essai, de discussions de groupe et 15. Ministry of Legal Affairs and Women’s Affairs, Na- escuchado el programa Apwe Plezi, y dentro d’ a u t r es sources qualitatives et quantitatives. tional report on the status of women, United Nations de este grupo, el 12% lo había escuchado por R é s u l t a t s : Des 753 répondants à l’enquête Fourth Conference on Women, Beijing, China, Castries, lo menos una vez a la semana. Los análisis de p o s t é r i e u re à l’essai, 36% avaient écouté St. Lucia: Government of St. Lucia, 1994. multivariables indican que las variables sobre Apwe Plezi, et 12% l’avait écouté au moins 16. PRB, 1997, op. cit. (see reference 10). conocimiento, actitud y comportamiento, une fois par semaine. Les analyses multiva- 17. Bertrand JT, Magnani RJ and Rutenberg N, Evaluat- v a r i a ron significativamente con el tiempo riées révèlent l’effet significatif des facteurs ing Family Planning Programs: With Adaptations for Re- ( p re-prueba contra post-prueba) y según la temps et catégorie d’auditeurs sur plusieurs productive Health, Chapel Hill, NC, USA: Carolina Pop- fr ecuencia de audición al programa. Por ejem- variables de connaissance, de perception et de ulation Center, 1996. plo, el 16% de los entrevistados en la encues- comportement. Ainsi, 16% des répondants à 18 . Vidmar N and Rokeach M, Archie Bunker’s bigotry: ta de post-prueba conocían un término en jerga l’enquête postérieure connaissaient un terme a study in selective perception and exposure, Journal of Communication, 1974, 24(1):36–47. popular para denominar al condón, el cual d’ a r got créé spécifiquement pour le feuilleton, fue acuñado para el programa radial; y el pour désigner le préservatif, et les prop o r t i o n s 19. Regis A and Butler P, 1997, op. cit. (see reference 7). porcentaje de entrevistados que consideraron de répondants qui jugeaient acceptables les rap- 20. Regis A and Butler P, RESPONSIBILITY 9: research- aceptable que los hombres casados tuvieran ports sexuels des maris en dehors de leur union ing and evaluating St. Lucia’s population “problem” of- fers new solutions in broadcasting on lifestyle issues for relaciones sexuales fuera del matrimonio conjugale avaient diminué, de 27% avant today’s youth, Castries, St. Lucia: RARE Center, 1999. declinó del 27% en la pre-prueba al 14% en l’essai à 14% lors de l’enquête postérieure. Par 21. Ibid. la post-prueba. Al comparar a las personas rapport aux non-auditeurs, les auditeurs ré- que no habían escuchado el programa con guliers étaient plus susceptibles de faire 22. George A, executive director, St. Lucia Planned Par- enthood Association, personal communication, July 1998. los oyentes re g u l a res, estos últimos eran confiance aux prestataires du planning fami- más proclives a confiar en los trabajadores lial (83% par rapport à 72%) et considéraient 23. Rogers EM et al., 1999, op. cit. (see reference 4). de planificación familiar (83% contra 72%) comme idéal un nombre d’enfants significa t i - 24. Law S and Singhal A, Efficacy in letter-writing to an y era más bajo el número de hijos que éstos vement moindre (2,5 par rapport à 2,9). Qua- entertainment-education radio serial, Gazette, 1 9 9 9 , 61(5):355–372. consideraban ideal (2,5 contra 2,9). El 14% torze pour cent des auditeurs avaient adopté de los oyentes adoptaron un método de une méthode de planning familial sous l’effet 25. Regis A and Butler P, 1997, op. cit. (see reference 7). pl a n i fi cación familiar como resultado del pro- du feuilleton. 26. Rogers EM et al., 1999, op. cit. (see reference 4). grama radial. Co n c l u s i o n : Apwe Plezi a influencé les au- 2 7 . Sokal RR and Rohlf FJ, Biometry: The Principles and C o n c l u s i o n e s : Apwe Plezi influyó en diteurs en termes d’’a c c r oissement de leur sen- Practice of Statistics in Biological Research , second ed., New que los oyentes adquirieran una mayor sibilisation à la contraception, d’amélioration York: W.H. Freeman, 1980. conciencia con respecto a los métodos anti- de leurs perceptions de la fidélité et des re l a- 28 . Mc G u i r e WJ, Theoretical foundations of campaigns, conceptivos, en que mejoren sus actitudes tions familiales et de l’adoption de méthodes in: Rice RE and Atkin CK, eds., Public Communication Campaigns, Newbury Park, CA, USA: Sage, 1989. con respecto a la fidelidad y a las relaciones de planning familial. Les importantes leçons fa m i l i a r es, y que adopten un método anticon- à tirer par les réalisateurs de programmes de 29. Lettenmaier C et al., Africa: using radio soap operas to promote family planning, Hygie, 1993, 12(1):5–10. ceptivo. Entre las lecciones importantes divertissement éducatif incluent le fait que la obtenidas para los productores de programas portée du programme, et donc ses effets, peu- 30. Sherry JL, 1997, op. cit. (see reference 6). de entretenimiento y educación, se incluyen vent être limités par la concurrence d’autre s 31. George A, executive director, St. Lucia Planned Par- que el alcance que tenga el pro g r a m a — émissions, et que le contrôle des perc e p t i o n s enthood Association, personal communication, July 1998. y asimismo su impacto—pueden verse des auditeurs est essentiel à la détection et à 32. Rogers EM et al., 1999, op. cit. (see reference 4). limitado por la competencia con otros proga- la rectification des interprétations parfois er- 33. Regis A and Butler P, 1997, op. cit. (see reference 7). mas, y que es esencial vigilar las perce p c i o n e s ronées des messages diffusés.

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