Achieving impact: SATURATION+

DMI does not have a standard, one-size-fits-all method for designing and implementing mass media health campaigns. We do, however, build our campaigns on the basis of our proven Saturation+ methodology for achieving impact. This has three elements: saturation, science and stories. 
 


Summary
 

Saturation

       

Broadcast spots 8-12 times per day (radio), or 3 times (TV), and daily longer formats 

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Broadcast in languages which at least 75% of the target population can understand well 

Broadcast on stations viewed or heard at least weekly by at least 75% of the target population 

Science

       

Use mathematical modelling to estimate the impact of each message 

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Allocate airtime to each message based primarily on predicted impact

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Measure and attribute impact using robust evaluations 

Stories

       

Integrate formative research findings into the creative process

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Ensure emotional climax of dramas reflects key barriers to behaviour change 

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Test all materials before and after broadcast to check audience reaction, message clarity, impact 

 


Saturation
 

Broadcast spots 8-12 times per day (radio), or 3 times (TV), and daily longer formats 

Intensity is key to any commercial advertising strategy, but it has been an underrated element of public health campaigning. There is a strong correlation between the frequency and duration of broadcast of messages and their impact (as demonstrated by the midline results of our Burkina Faso RCT). Producing enough messages to enable a high-intensity broadcasting schedule is challenging. We believe that, if the aim is to change behaviours and improve people's lives, news and documentary formats are not very useful. These formats stress what is new and interesting, and are not based on repetition. Instead we place particular emphasis on two radio and TV formats: short advertising spots (based on drama, comedy or testimonial), which put across a basic message repeatedly, and longer dramas, which are useful for providing role models, demonstrating life-skills or allowing interactivity, but can still be produced cheaply and quickly enough to be broadcast every day, in many languages.

Broadcast in languages which at least 75% of the target population can understand well 

In some countries, it is possible to reach the majority of the population through one or two languages. However, in many countries (especially in Sub-Saharan Africa), tens if not hundreds of languages are spoken. It is not practical or affordable to broadcast in every dialect, but producing and broadcasting content in the most popular 5, 10 or 15 languages will have a much greater impact than broadcasting in the 'lingua franca' alone, especially when that language is only poorly understood by much of the population.

Broadcast on stations viewed or heard at least weekly by at least 75% of the target population

Intensity of broadcasting needs to be matched by scale. This can be achieved by working with the radio or TV networks with the greatest numbers of listeners or viewers among the target audience. Audiences in rural areas may listen to community radio stations that broadcast in local languages in preference to national networks, even if the signal of the national networks extends to those areas. A detailed economic and audience analysis will suggest the broadcasting strategy that generates the biggest return on investment, depending on the campaign’s objective and target audience. Reliable nationwide data on audience share by station is often unavailable, so detailed research and modelling is needed to provide the best strategy for maximising audience reach. 

 


Science
 

Use mathematical modelling to estimate the impact of each message 

For most target behaviours, there is some evidence of the extent to which they have been changed by mass media campaigns. By analysing this data, and combining it with data specific to the campaign that we are planning (country, audience reached, campaign intensity and so on), we can model the expected impact of the campaign on our target behaviours. In some cases, these behaviour change impacts can be converted into estimated health or social impacts. For example, we can use the Lived Saved Tool to estimate the expected number of lives that will be saved by media campaigns that have modelled impacts on a range of child survival behaviours. We can then estimate the cost-effectiveness of our campaigns, often in terms of cost per disability-adjusted life year (DALY).

Allocate airtime to each message based primarily on predicted impact

Wherever possible we message on multiple health issues and behaviours, because the economies of scale make it much more cost-effective than to set up and run a media campaign that is only focused on a vertical issue. One approach is generally to cover each behaviour for two weeks at a time, repeating key messages at certain points. The duration, frequency and relative weight attached to each message will vary depending on the expected behaviour change and health/social impact of each (for example, if messaging on malaria treatment was estimated to save twice as many children's lives as messaging on handwashing, we would weight the airtime given to each message in the same ratio). We also take into account the availability and quality of linked services and supplies, and seasonal or other time-related factors, such as periods of peak malaria transmission.

Measure and attribute impact using robust evaluations 

We need to be able to measure the degree of behaviour change robustly, and to attribute those changes to our campaign rather than to any other initiatives. The ideal evaluation design is a randomised controlled trial, but this is not feasible or affordable in most cases. We have therefore developed a set of techniques for measuring and attributing the health impacts of our campaigns using quasi-experimental evaluation designs. We use surveys to measure trends in knowledge, attitudes and practice, but wherever possible we triangulate survey data with external data sources, ideally clinic-level data, to minimise the risk of 'reporting bias' and other inaccuracies in survey responses. To enable us to attribute impact, we undertake regular surveys to allow us to conduct time-series analysis of impact; we also compare outcomes between intervention and control areas, and analyse dose-response relationships between behaviour change and target groups with low, medium and high exposure to the campaign.

 


Stories
 

Integrate formative research findings into the creative process

We cannot change behaviours if we do not understand the values, motivations and concerns of our target audience. We send teams of researchers to conduct detailed formative research, running focus groups with members of our target audience. These groups help us to identify barriers to behaviour change, and 'enablers' that can be used to motivate people to change behaviours. The formative research findings are condensed into a concise 'message brief’ for our scriptwriters.

Ensure emotional climax of dramas reflects key barriers to behaviour change 

Behaviour change campaigns in developing countries should be simple, funny, and engaging, so that they convince people to change their behaviours, rather than simply providing information. Short, realistic dramas are the best format for changing behaviours: short enough that rural audiences can find the time to listen regularly (often while they work); realistic because people prefer stories that are rooted in their everyday lives, performed by local actors; and dramas, because the human brain is hardwired to respond to emotion better than it responds to intellectual reflection, and dramas play on that emotion, influencing our choices and behaviours. The most important, but often most neglected, element is to recruit a team with the necessary talent, motivation, and organisational, intellectual and creative abilities, who understand the values and aspirations of the target audience. 

Test all materials before and after broadcast to check audience reaction, message clarity, impact 

Our researchers pre-test all of our materials with focus groups who are representative of our target audience, to judge clarity and appeal. Any materials that do not resonate with our audience are not used. After broadcast, we carry out audience feedback research, to ask whether and why people who heard our messages have changed their behaviours (or not). This gives us a more nuanced understanding of the impact of our campaigns that our quantitative impact evaluations, helping us to continuously improve the quality and impact of our campaigns.

 

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