Hamari Sister Didi: Evaluation Highlights

Key Findings from Preliminary Research in India: A Report to the Bill and Melinda Gates Foundation April 2015

A REPORT FROM Hollywood, Health & Society | The Norman Lear Center Annenberg School for Communication and Journalism University of Southern California

PREPARED BY Amy Henderson Riley, DrPH(c) Evaluation Consultant Drexel University School of Public Health

Erica L. Rosenthal, PhD Research Specialist Hollywood, Health & Society EXECUTIVE SUMMARY

An effort by Hollywood, Health & Society, The Third Eye – The Asian Center for Entertainment-Education, and other partners led to embedded entertainment-education messages about maternal and child health on the India television-based daily soap Hamari Sister Didi in October and November of 2014. This report outlines preliminary evaluation findings from research investigating the impact of these storylines among viewers of the program.

The study utilized a quantitative pre-test double post-test design with a panel of women aged 18 to 49 in Uttar Pradesh (UP), a priority state in India. Urban, peri-urban, and rural locations of Ghaziabad (West), Agra (Southwest), Varanasi (East), Lucknow (Central), and Gorakhpur (North East) from five sociocultural zones of UP were selected. The Center for Media Studies (CMS) (www.cmsindia.org), located in New Delhi, conducted three rounds of data collection: before the intervention (pre-test) and twice after the airing (post-tests), to measure shifts in knowledge and attitudes as a result of exposure to the show.

The University of Southern California and local CMS IRB approval was granted for the study. The panel consisted of 1,220 women aged 18 to 49, interviewed on all three occasions. Of these, 1,035 (84.8%) reported having ever watched Hamari Sister Didi by the time of the final post-test, and were retained in the final sample.

The results of this study suggest the program was associated with increases in knowledge and more supportive attitudes related to vaccination and family planning. Moreover, relative to rare viewers, regular viewers (those who watched at least once a week) had stronger outcomes related to the pentavalent vaccine. These preliminary findings should be explored in future programming.

2 INTRODUCTION

Background

Sony Entertainment Television launched Sony PAL, a satellite television channel for women in India, in September of 2014. Hamari Sister Didi was one of the first programs to air on the new channel. Since Hamari Sister Didi’s debut, the television soap opera has broadcast original, half-hour episodes six days a week (Monday through Saturday), with repeat telecasts multiple times every day (Figure 1).

Figure 1: Hamari Sister Didi advertisement on Sony PAL

An effort by Hollywood, Health & Society (HH&S), The Third Eye – The Asian Center for Entertainment-Education (ACEE), and other partners led to embedded entertainment- education messages about maternal and child health on the India television-based daily soap Hamari Sister Didi in October and November of 2014. HH&S oversaw the project from the United States, while ACEE in Mumbai built network partnerships and led the messaging in India. The primary audience for the messaging was women ages 18 to 49.

This report outlines preliminary evaluation findings from research investigating the short-term impact of the maternal and child health storylines among female viewers of the program ages 18 to 49.

Entertainment-Education

Entertainment-education (EE) is, “the process of designing and implementing a media message to both entertain and educate to increase audience members’ knowledge about an educational issue, create favorable attitudes, and change overt behavior.”1 The Hamari Sister Didi intervention is an example of short-term entertainment-education. Single messages were planned for a small number of episodes of the television serial in October and November of 2014. The amount of time for each message in the script varied. Messages related to both family planning and vaccines were each covered over two episodes, whereas most messages were covered in scenes from a single episode.

Figure 2 is an excerpt from the script of one episode of Hamari Sister Didi, which educated the audience about the pentavalent vaccine.

Figure 2: Excerpt from Hamari Sister Didi script

DR KARAN

We have come to speak to you about the pentavalent vaccine. This vaccine protects babies against five

different life threatening diseases. This vaccine is actually five vaccines in one and protects against diphtheria, pertussis, tetanus, hepatitis B, and haemophilus influenza type B.

EE is supported by decades of empirical research. Over time, many social and behavioral theories have been used to explain EE’s effectiveness.2 On a basic level, it is hypothesized that EE works by changing mediators, or process variables located on the pathway to behavior change such as knowledge and interpersonal communication (Figure 3). This is known as the indirect effects model.

1 Rogers E., & Singhal, A. (1999). Entertainment-education: A Community Strategy for Social Change. Mahwah, New Jersey: Lawrence Erlbaum Associates, Inc. 2 For more on the theory behind EE, see Sood, S., Menard, T., & Witte, K. (2004). The theory behind entertainment-education. In A. Singhal, M. J. Cody, E.M. Rogers, & M. Sabido (Eds.), Entertainment-education and Social Change. (pp. 117-149). Mahwah, New Jersey: Lawrence Erlbaum Associates, Inc.

Figure 3: Theoretical Understanding of EE

Knowledge Behavior Change Exposure (Short-term (Long-term Outcome) Outcome)

Short-term EE interventions require strategic and targeted message planning, especially in saturated environments. India, for example, has had a long history with maternal and child health communication by the government, national, and international organizations alike. The prevalence of health promotion messages such as breastfeeding and vaccination are nearly ubiquitous across the country. The ever-changing media landscape, meanwhile, means that more individuals than ever have access to hundreds of channels and media impressions both educational and otherwise.

5 METHODS

Evaluation Design

The study utilized a quantitative pre-test double post-test design with a panel of women aged 18 to 49 in Uttar Pradesh (UP), a priority state in India (Figure 4). Urban, peri-urban, and rural locations of Ghaziabad (West), Agra (Southwest), Varanasi (East), Lucknow (Central), and Gorakhpur (North East) from five sociocultural zones of UP were selected. Households from different socioeconomic categories with cable connections, specifically with access to Sony PAL, were listed in each district and this formed the sampling frame. Thirteen hundred women of reproductive age (18-49 years) who had continuous access to Sony PAL were recruited for the panel to ensure a comparable and statistically relevant sample to the end.

Figure 4: Geographic Location of Survey

6 The Center for Media Studies (CMS) (www.cmsindia.org), located in New Delhi, conducted three rounds of data collection: before the intervention (pre-test) and twice after the airing (post-tests), to measure shifts in knowledge and attitudes as a result of exposure to the show. At pre-test, the research team asked the women to watch the program and then respond to the survey two additional time points, following the airing of each relevant storyline. The University of Southern California and local CMS IRB approval was granted for the study.

The panel consisted of 1,220 women who were interviewed on all three occasions. Of these, 1,035 (84.8%) reported having ever watched Hamari Sister Didi by the time of the second post-test, and were retained in the final sample.

Measures

An identical, 90-question survey instrument was developed and administered to the same women on three occasions, at a pre-test and two post-tests, each approximately six weeks apart. Validated questions related to the key maternal and child health topics were posed. The tool also had questions on interpersonal communication and media habits. Questions were pretested with respondents prior to formal data collection. The instrument was translated, back translated, and administered in Hindi.

Inclusion Criteria

Women were selected for the panel according to the following inclusion criteria (Figure 5):

Figure 5: Inclusion Criteria

Panel Inclusion Criteria •Women, •Age 18-49, •Self-report watching DTH (direct to home/ cable) three times a week, •Access to Sony PAL, •Individual consent, and •Family consent (when/where appropriate)

7 RESULTS

Sample Characteristics

Table 1 enumerates the characteristics of the sample. The final sample consisted of 1,035 women interviewed on all three occasions who reported ever having watched Hamari Sister Didi at the time of the final post-test; 185 respondents who had never viewed the series were not analyzed.3

The median age was 27, and almost half of the respondents (47.1%) were between 20 and 29 years old. Slightly more than half of the overall sample (50.7%) resided in urban areas, while 29.5% resided in peri-urban areas, and 19.8% resided in rural areas. Approximately equivalent proportions of the sample came from four of the five districts, with the exception of Ghaziabad (5.8%). Almost all of the women (90.3%) were literate and 72.8% were currently married. A range of socioeconomic classification (SEC) was exhibited across the sample. SEC is a system of household classification using education and occupation developed by the Market Research Society of India (MRSI). A panel respondent is pictured with a CMS interviewer in Figure 6.

Figure 6: Hamari Sister Didi Panel Respondent (left) and CMS Interviewer (right)

3 Relative to non-viewers, viewers of Hamari Sister Didi were significantly younger (p = .019), less likely to have ever been married (p = .040), lower SEC (p < .001), and less likely to be from Ghaziabad (p < .001). All but two of the 185 non-viewers came from Ghaziabad. 8 Table 1 Sample Characteristics N 1035

Age 18-19 12.0% 20-29 47.1% 30-39 28.1% 40-49 12.9% Median Age 27.0

Area Urban 50.7% Peri-urban 29.5% Rural 19.8%

District Ghaziabad 5.8% Agra 23.4% Varanasi 23.6% Lucknow 23.4% Gorakhpur 23.9%

Literacy Yes 90.3% No 9.7%

Marital Status Currently Married 72.8% Divorced/Widowed 2.4% Never Married 24.8%

SEC B1 18.0% B2 15.8% C 24.3% D 22.0% R1 14.6% R2 5.3%

Note: Some percentages do not equal or exceed 100% due to rounding.

Exposure & Recall Findings

Exposure to Hamari Sister Didi

In terms of exposure, at the time of the pre-test, 68.9% of women had heard of a new Sony channel, 71.5% had specifically heard of Sony PAL (Figure 7), 37.0% had watched Sony PAL, and 11.4% had watched Hamari Sister Didi. By the time of the first post-test, viewership had increased considerably, as indicated in Table 2.

Figure 7: Sony PAL logo

Table 2 Exposure to Hamari Sister Didi Pre-test Post-test 1 Post-test 2 N 1035 1035 1035 Heard of new Sony channel 68.9% 100.0% 100.0% Heard of Sony PAL 71.5% 100.0% 100.0%

Watched Sony PAL 37.0% 80.3% 100.0%

Watched Hamari Sister Didi 11.4% 72.9% 100.0% Note: Some percentages do not equal or exceed 100% due to rounding.

Frequency of Viewing

At each of the three time points, those who indicated they had ever watched Hamari Sister Didi were asked about their frequency of viewing: “How often do you watch Hamari Sister Didi?” (Table 3). The majority of viewers at pre-test and the first post-test reported watching only ‘rarely.’ By the second post-test, however, the balance had shifted, with 56.6% of viewers reporting that they watched ‘once a week’ or more.

Table 3 Frequency of Viewing Hamari Sister Didi Pre-test Post-test 1 Post-test 2 N 126 779 1035

How often do you watch Hamari Sister Didi? Rarely 57.9% 58.0% 43.4% Once a week 11.9% 12.3% 18.2% Almost every episode 19.0% 17.8% 35.1% All episodes/every day 11.1% 11.8% 3.4% Note: Some percentages do not equal or exceed 100% due to rounding.

Character Recall

Those who indicated they had ever watched Hamari Sister Didi at each of the three time points were also asked to spontaneously name characters from the show, such as the protagonist Amrita. At the time of the pre-test, viewers could only name 2.2 characters on average, but by the final post-test, they averaged 5.9 characters (Table 4). The results of this “recall” task are important for inferences regarding exposure.

Table 4 Spontaneous Character Recall Pre-test Post-test 1 Post-test 2 N 126 779 1035

Can you name some of the main characters from Hamari Sister Didi? Amrita 81.7% 97.3% 99.7% Bebe 25.4% 34.3% 35.3% Dr. Karan 21.4% 71.9% 83.5% Suraj 15.9% 43.9% 60.2% Dimple 14.3% 37.9% 74.7% Mean number of characters named 2.2 4.0 5.9 Note: Some percentages do not equal or exceed 100% due to rounding.

At each time point, there was a significant relationship between the number of characters recalled and viewing frequency; those who reported viewing Hamari Sister Didi regularly (at least once a week) were able to name more characters, on average, than those who reported viewing rarely (Figure 8).4 This relationship was especially pronounced at pre-test and post-test 1, and suggests more frequent viewers had a higher level of involvement with the program.

4 Pre-test: t(69.6) = -4.97, p < .001; Post-test 1: t(592.7) = -10.89, p < .001; Post-test 2: t(1020.1) = -2.40, p = .017. 12 Figure 8: Number of Characters Named, by Viewing Frequency

Mean Number of Characters Named 7 6.04 Rarely 5.72 6 Regularly 4.90 5

4 3.42 3.09 3

2 1.59

0 Pre-Test Post-Test 1 Post-Test 2

Key Findings

In this section, findings are reported for the 1,035 respondents who reported having ever viewed Hamari Sister Didi at the time of the final post-test. It is unknown whether these individuals viewed any of the specific episodes containing maternal and child health messages. Findings are reported for messages that were explicitly addressed as part of the storyline (pentavalent vaccine, birth spacing, and contraception methods).

In each table, responses from the same individuals are compared over time from pre-test (column A) to post-test 1 (column B) to post-test 2 (column C). Columns D, E, and F indicate whether changes over time were statistically significant (results from McNemar Test). The rows provide comparisons between all viewers (row 1), rare viewers (row 2), and regular viewers (row 3) within each time point. Regular viewers are defined as those who indicated watching the show at least once per week at the time of the final post-test. Row 4 indicates whether the difference between rare and regular viewers was significant (results from Chi- Square Test of Independence at each time point).5

5 The results of significance tests are designated as follows: * p < .05, ** p < .01, *** p < .001. 14

Vaccination

Have you ever heard of the pentavalent vaccine?

As shown in Table 5 and Figure 9, overall, awareness of the pentavalent vaccine increased over time from 2.9% at pre-test to 11.5% at post-test 1 to 14.7% at post-test 2. This increase was evident among both rare and regular viewers. At pre-test, there were no significant differences between regular and rare viewers. At each post-test, however, regular viewers’ awareness of the pentavalent vaccine significantly surpassed that of rare viewers.

Table 5 Have you ever heard of the pentavalent vaccine? (“yes”) (A) (B) (C) (D) (E) (F)

Pre Post1 Post2 Pre v. Post1 Pre v. Post2 Post1 v. Post2 Overall 30 119 152 (1) *** *** ** (N = 1035) (2.9%) (11.5%) (14.7%)

Rarely 8 40 46 (2) *** *** (N = 449) (1.8%) (8.9%) (10.2%)

Regularly 22 79 106 (3) *** *** ** (N = 586) (3.8%) (13.5%) (18.1%)

(4) Rare v. Reg * **

Figure 9: Percentage Heard of Pentavalent Vaccine, by Viewing Frequency

Heard of Pentavalent Vaccine (% Yes) 20% 18.1% Rarely Regularly 15% 13.5%

10.2% 10% 8.9%

5% 3.8% 1.8%

0% Pre-Test Post-Test 1 Post-Test 2

15 What are the diseases or conditions that the pentavalent vaccine protects against?

Respondents were asked to spontaneously recall the diseases or conditions against which the pentavalent vaccine protects. Table 6 and Figure 10 show the number and percentage that were able to correctly name at least one of the five.6 Overall, there was a significant increase in the percentage of respondents who could name at least one disease, from 0.9% at pre-test to 8.4% at post-test 1 to 11.1% at post-test 2. This increase was evident among both rare and regular viewers. Once again, there was no significant difference at pre-test, but at both post-tests, regular viewers significantly exceeded rare viewers in the likelihood of naming at least one correct disease.

Table 6 What are the diseases or conditions that the pentavalent vaccine protects against? (at least one correct) (A) (B) (C) (D) (E) (F)

Pre Post1 Post2 Pre v. Post1 Pre v. Post2 Post1 v. Post2 Overall 9 87 115 (1) *** *** * (N = 1035) (0.9%) (8.4%) (11.1%) Rarely 1 19 27 (2) *** *** (N = 449) (0.2%) (4.2%) (6.0%) Regularly 8 68 88 (3) *** *** * (N = 586) (1.4%) (11.6%) (15.0%)

(4) Rare v. Reg *** ***

Figure 10: Percentage Named at Least One Correct Disease, by Viewing Frequency

Diseases Pentavalent Vaccine Protects Against 20% (% at Least 1 Correct) Rarely 15.0% 15% Regularly 11.6%

10% 6.0% 4.2% 5% 1.4% 0.2% 0% Pre-Test Post-Test 1 Post-Test 2

6 Meningitis, pneumonia, ear infection/otitis, and throat infection, all of which are possible complications of Haemophilus/Influenza B, were counted as correct answers. 16 In your opinion, how important or not important is it that a child receives the pentavalent vaccine?

As shown in Table 7 and Figure 11, overall, perceived importance of the pentavalent vaccine increased from pre-test (10.7%) to post-test 1 (14.9%). There was no significant change from post-test 1 to post-test 2. Moreover, the increase was evident among regular viewers only. At pre-test, there were no significant differences between regular and rare viewers. At each post-test, however, regular viewers attributed greater importance to the pentavalent vaccine than rare viewers.

Table 7 In your opinion, how important or not important is it that a child receives the pentavalent vaccine? (“very important” or “important”) (A) (B) (C) (D) (E) (F)

Pre Post1 Post2 Pre v. Post1 Pre v. Post2 Post1 v. Post2 Overall 111 146 154 (1) ** ** (N = 1035) (10.7%) (14.1%) (14.9%) Rarely 41 46 49 (2) (N = 449) (9.1%) (10.2%) (10.9%) Regularly 70 100 105 (3) ** ** (N = 586) (11.9%) (17.1%) (17.9%)

(4) Rare v. Reg ** **

Figure 11: Percentage Rating Pentavalent Vaccine Important or Very Important, by Viewing Frequency

Importance of Child Receiving Pentavalent Vaccine (% Very Important/Important) 20% 17.9% Rarely 17.1%

15% Regularly 11.9% 10.2% 10.9% 9.1% 10%

0% Pre-Test Post-Test 1 Post-Test 2 17

Contraception

Please name all the ways or methods that a couple can use to delay or avoid having a baby (male condom)

Table 8 and Figure 12 show the number and percentage of respondents that were able to spontaneously name male condoms as a way to delay or avoid having a baby. Overall, there was a significant increase in the percentage of respondents who could name condoms, from 38.9% at pre-test to 73.7% at post-test 1 to 84.6% at post-test 2. This increase was evident among both rare and regular viewers, though there was no change from post-test 1 to post- test 2 among rare viewers.

Table 8 Please name all the ways or methods that a couple can use to delay or avoid having a baby (spontaneously named male condom) (A) (B) (C) (D) (E) (F)

Pre Post1 Post2 Pre v. Post1 Pre v. Post2 Post1 v. Post2 Overall 403 763 876 (1) *** *** *** (N = 1035) (38.9%) (73.7%) (84.6%)

Rarely 156 348 350 (2) *** *** (N = 449) (34.7%) (77.5%) (78.0%)

Regularly 247 415 526 (3) *** *** *** (N = 586) (42.2%) (70.8%) (89.8%)

(4) Rare v. Reg ** **a *** a The significant difference was in the opposite of the expected direction.

Figure 12: Percentage Spontaneously Naming Male Condoms, by Viewing Frequency

Ways a Couple can Delay or Avoid Having a Baby (% Named Male Condom) 100% Rarely 89.8% Regularly 77.5% 78.0% 70.8% 75%

42.2% 50% 34.7%

25%

0% Pre-Test Post-Test 1 Post-Test 2

18 Please name all the ways or methods that a couple can use to delay or avoid having a baby (birth control pills)

Table 9 and Figure 13 show the number and percentage of respondents that were able to spontaneously name birth control pills as a way to delay or avoid having a baby. Despite a high starting point of 82.8% at pre-test, there was a significant increase overall in the percentage of respondents who could name birth control pills, to 90.8% at post-test 1 and 97.2% at post-test 2. This increase was evident among both rare and regular viewers; rare viewers shifted between pre-test to post-test 1, whereas regular viewers shifted between post-test 1 and post-test 2.

Table 9 Please name all the ways or methods that a couple can use to delay or avoid having a baby (spontaneously named birth control pills) (A) (B) (C) (D) (E) (F)

Pre Post1 Post2 Pre v. Post1 Pre v. Post2 Post1 v. Post2 Overall 857 940 1006 (1) *** *** *** (N = 1035) (82.8%) (90.8%) (97.2%)

Rarely 359 426 434 (2) *** *** (N = 449) (80.0%) (94.9%) (96.7%)

Regularly 498 514 572 (3) *** *** (N = 586) (85.0%) (87.7%) (97.6%)

(4) Rare v. Reg * ***a a The significant difference was in the opposite of the expected direction.

Figure 13: Percentage Spontaneously Naming Birth Control Pills, by Viewing Frequency

Ways a Couple can Delay or Avoid Having a Baby (% Named Birth Control) Rarely Regularly 94.9% 96.7% 97.6% 100% 85.0% 87.7% 80.0% 75%

50%

25%

0% Pre-Test Post-Test 1 Post-Test 2

Birth Spacing

I personally approve of using family planning to delay/space births

As shown in Table 10 and Figure 14, overall, approval of the use of family planning to delay or space births increased from pre-test (78.0%) to post-test 1 (86.6%). There was no significant change from post-test 1 to post-test 2. This increase was evident among both rare and regular viewers. The only significant difference between regular and rare viewers was at pre- test; regular viewers had higher approval ratings of family planning than rare viewers.

Table 10 I personally approve of using family planning to delay/space births (“strongly agree” or “agree”) (A) (B) (C) (D) (E) (F)

Pre Post1 Post2 Pre v. Post1 Pre v. Post2 Post1 v. Post2 Overall 807 896 919 (1) *** *** (N = 1035) (78.0%) (86.6%) (88.8%)

Rarely 337 379 396 (2) *** *** * (N = 449) (75.1%) (84.4%) (88.2%)

Regularly 470 517 523 (3) *** *** (N = 586) (80.2%) (88.2%) (89.2%)

(4) Rare v. Reg *

Figure 14: Percentage Agreeing or Strongly Agreeing with Personal Approval of Family Planning, by Viewing Frequency

Approval of Family Planning to Delay/Space Births (% Strongly Agree/Agree) Rarely

100% Regularly 89.2% 84.4% 88.2% 88.2% 80.2% 75.1% 75%

50%

25%

0% Pre-Test Post-Test 1 Post-Test 2

20 In your opinion, how important or not important is it that a couple space/time births?

As shown in Table 11 and Figure 15, overall, the perceived importance of birth spacing increased over time. At pre-test, only 3% did NOT indicate birth spacing was “important” or “very important.” Despite this low starting point, the percentage decreased to 1.8% at post- test 1 and 0.2% at post-test 2. This change was evident among both rare and regular viewers. At the first post-test, regular viewers significantly exceeded rare viewers in the perceived importance of birth spacing.

Table 11 In your opinion, how important or not important is it that a couple space/time births? (NOT “very important” or “important”) (A) (B) (C) (D) (E) (F)

Pre Post1 Post2 Pre v. Post1 Pre v. Post2 Post1 v. Post2 Overall 31 10 2 (1) ** *** * (N = 1035) (3.0%) (1.0%) (0.2%)

Rarely 14 8 1 (2) ** * (N = 449) (3.1%) (1.8%) (0.2%)

Regularly 17 2 1 (3) ** *** (N = 586) (2.9%) (0.3%) (0.2%)

(4) Rare v. Reg *

Figure 15: Percentage NOT Rating Birth Spacing Important or Very Important, by Viewing Frequency

Importance of Birth Spacing (% NOT Very Important/Important) 5% Rarely Regularly 4% 3.1% 2.9% 3%

1.8% 2%

1% 0.3% 0.2% 0.2% 0% Pre-Test Post-Test 1 Post-Test 2

21 DISCUSSION

The results of this study suggest viewing Hamari Sister Didi was associated with changes in knowledge and attitudes regarding vaccination and family planning. The relationship between exposure and outcomes was assessed by examining both changes over time (from pre-test to post-test 1 to post-test 2) and differences in degree of exposure (rare versus regular viewers).

For the majority of outcomes addressed, there were significant increases over time, as well as positive associations with viewing frequency. This was true of the number of characters participants could name, awareness of the pentavalent vaccine, ability to name at least once disease the vaccine prevents against, and perceived importance of the pentavalent vaccine. For the outcomes related to family planning, the results were more mixed. There were significant increases over time in participants’ ability to name condoms and birth control pills as ways to delay or avoid having a baby, personal approval of birth spacing, and the perceived importance of birth spacing. For these variables, however, differences between rare and regular viewers were inconsistent.

The results of this evaluation must be considered in light of some limitations. First, while the choice of a panel design following identical individuals over time was a strong choice for claims of causality, the threat of history still remains. That is, parallel forces other than the Hamari Sister Didi intervention may have influenced outcomes. Similarly, it is possible that due to repeated testing, respondents became more aware of some of the concepts addressed, or responded in a manner consistent with expectations. On many variables, regular viewers exceeded rare viewers even at pre-test, suggesting some degree of selection bias.

Despite attempts by the research team to encourage watching, not all participants reported viewing the program. As a result, the analysis was limited to those who did watch. Of the 185 non-viewers, all but two came from a single district (Ghaziabad). The reason for this extreme disparity in attrition is unknown. Moreover, the study did not assess whether respondents viewed the specific episodes that constituted the intervention; this can only be inferred indirectly from degree of exposure. Finally, the results of this study may not be generalizable to the Indian population as a whole. While this evaluation used both purposive and random selection techniques within one priority state, this preliminary research was unable to utilize population-based sampling methods across the country due to time and financial constraints.

22 Despite these limitations, the results of this intervention are promising. Indian media are highly saturated with messages related to family planning and vaccination. This is evident in the fact that participants already exhibited very high levels of knowledge (e.g., birth control pills) and supportive attitudes toward birth spacing at pre-test. Despite the strong potential for ceiling effects, every concept discussed within the target episodes saw significant increases over time. This finding suggests that although the intervention was brief, the messages (particularly those pertaining to vaccination) were strong enough to break through the informational “clutter.”

These preliminary findings should be explored in future programming. Hamari Sister Didi is a successful daily soap opera on the new Sony PAL network and the program is a good platform for embedding short messages within a television serial. While the extent to which outcomes can be directly attributed to this short-term intervention is unclear, this program produced significant lessons learned. In particular, in an ever-growing media and health promotion landscape, future short-term mass media interventions must be even more strategic in their approach to disseminating essential health information for individuals and communities alike.

23 CONTRIBUTING ORGANIZATIONS

Hollywood, Health & Society (HH&S)

Hollywood, Health & Society (HH&S) is a program of the Norman Lear Center at the University of Southern California’s Annenberg School for Communication and Journalism. Established in 2001, HH&S provides entertainment industry professionals with accurate and up-to-date information for health and climate change storylines, through expert consultations and briefings, panel discussions and online tip sheets (www.hollywoodhealthandsociety.org). Funded by the Centers for Disease Control and Prevention and several other agencies and foundations, the program recognizes the profound impact that entertainment has on behavior. Between 2009 and 2014, HH&S’ goal of improving the accuracy of health storylines on TV shows and films resulted in more than 700 aired storylines across 91 shows from 35 networks.

Under the Creative Alliance for Global Health & Sustainability, and through a grant from the Bill & Melinda Gates Foundation, HH&S launched joint projects in the creative capitals of India and Nigeria to use the power of entertainment to improve the lives of millions of TV and film viewers. Creative Alliance centers—The Third Eye in India and Nollywood Workshops (Gist) in Nigeria—draw on the resources of HH&S, and both conduct a program of outreach in Bollywood, Nollywood and beyond to increase the accuracy and frequency of health and sustainability topics in television, film and new media.

HH&S led the impact evaluation of Hamari Sister Didi, including primary responsibility for the design of the study and development of the survey instrument, oversight of data collection by CMS, data analysis, and preparation of this report.

Asian Center for Entertainment Education (ACEE) / The Third Eye

The Asian Center for Entertainment Education (ACEE) was established in 2012 and The Third Eye, its flagship program providing free, on-demand information to creative communities in the industries of media and entertainment in India, was launched in 2013 in partnership with HH&S.

The Third Eye has worked with producers, writers, directors, journalists, medical specialists and development experts, and created a platform for inter-disciplinary interactions through meetings, briefings, events, conclaves and digital interaction (www.acee-thethirdeye.org). 24 The program has worked with several films, documentaries, television serials and digital properties to bring accuracy to the discourse on health, sustainable development, environment and gender issues as and when addressed in popular and mainstream media and entertainment. The program is also involved in creating concepts and content for television, and for publishing on the web in the form of articles on the website and as newsletters to development, media and entertainment professionals. In collaboration with partner organizations, ACEE conducts research to measure the impact of media based interventions for the spectrum of traditional and new forms of media, and evolves strategies to maximize their effect.

ACEE/The Third Eye was responsible for developing entertainment industry partnerships in India, leading to the inclusion of maternal and child health messages in Hamari Sister Didi.

Centre for Media Studies (CMS)

Centre for Media Studies (CMS) is a multidisciplinary, not for profit, think tank engaged in developing and discussing policy alternatives on a wide-range of issues of local and global significance through Research and Advocacy. Key areas of CMS research and advocacy are in the sectors of Communication and Media, Social Development, Environment and Governance. The fundamental objective of CMS is to influence formulation of policies or programs relevant to contemporary challenges in India with a vision for building an equitable and responsible nation (www.cmsindia.org).

The CMS Communication Team has been engaged in studying and analyzing the communication and media environment with an aim to make strategic use of Information Communication Technology (ICT) tools for effective implementation of development policies and programs. This process takes the form of independent research, technological diffusion & ICT use studies, concurrent monitoring and evaluation, publications, policy consultations and creating platforms for experts and stakeholder interactions. Using innovative, qualitative and quantitative research methodologies, CMS has also been successfully documenting the impact of Entertainment Education (EE) endeavors in India.

CMS managed the impact evaluation of Hamari Sister Didi in the field, including training interviewers, three rounds of data collection, data entry and providing a cleaned data set to HH&S for analysis. CMS also consulted with HH&S on study design and survey development, and translated the survey instrument into Hindi.