DMI

Location Mental Health

Lumuno

Objective

Following consultations with mental health experts in Zambia, DMI identified significant need for an intervention on anxiety and depression. We piloted an evidence-based SBC radio campaign aiming to improve mental health outcomes amongst people aged 18-55, especially young adults, in a peri-urban area in Zambia. 

Locations

Zambia

Themes

Mental health – promoting awareness about self-help techniques and resources. 

Formats

26 x 90-second radio spots.

Scope

6 months broadcasting on two popular radio stations in Mazabuka town, 5 times in English and 10 times in Tonga every day. 

Estimated reach

82,000

Project at a glance

19.7%
reduction in depression scores over the campaign period
41%
of participants with depression at baseline achieved a clinically significant reduction in depression
54%
of participants with anxiety at baseline achieved a clinically significant reduction in anxiety

Our Approach

Science

Piloting new approaches to combatting mental health issues

In 2019, nearly one billion people globally suffered from a mental health condition, with depression and anxiety accounting for about half of these cases. In high income countries, there are over 60 mental health care workers per 100,000 people, whereas there are fewer than two workers per 100,000 in low-income countries (WHO, 2021). Low levels of health literacy about mental health and pervasive stigma can prevent people from seeking help for these conditions.  

Following consultations with WHO, StrongMinds, the Zambia National Public Health Institute, and the Zambian Ministry of Health, we identified a strong need for an intervention on mental health, with a particular focus on young adults. DMI worked with a Zambian psychiatrist, local mental health practitioners, community members and script writers to adapt the WHO’s Step-by-Step intervention from online to radio delivery.  Step-by-Step is a minimally guided self-help tool evidenced to reduce depressive symptoms in those with depression. The resultant Lumuno campaign was a carefully culturally adapted, evidence-based intervention promoting self-help techniques for behavioural activation and the improved giving and receiving of support.     

Stories

Engaging content based on self-help techniques

A team of Zambian scriptwriters used our in-depth formative research to create engaging and impactful content, delivering the campaign’s messages through stories involving characters that were recognisable and relatable to radio listeners. All scripts were reviewed by a Zambian psychiatrist and recorded spots were pre-tested with both male and female community members. The core campaign messages were: 

  1. Get support: If your mind is troubled by worries or everything in life feels difficult, talk about your feelings with a sympathetic, trusted friend or family member.
  2. Give supportasking and listening: When a friend or family member seems troubled and their behaviour changes, ask them if there is something troubling them and listen sympathetically and non-judgementally.
  3. Give supportencourage social interaction:  When a friend or family member seems troubled and withdrawn, try to help them spend less time alone.
  4. Get started: If you are feeling low or anxious, think of a few activities that made you feel good about yourself or that you enjoyed but have stopped doing, and then try to do more of those activities again.
  5. Breathing to manage stress: In moments of stress/anxiety or when experiencing an outburst of anger/frustration, pause and breathe slowly and regularly until you feel calmer.
  6. Breathing and relaxation to calm the mind: Find a few minutes every day to calm your thoughts by sitting quietly and focusing your mind on your breathing and relaxing your body.
A radio demonstrating the distribution mechanism used in this campaign

Saturation

6 months, 26 spots, 2 languages

We selected two radio stations with high daily listenership and low competition from other stations. Starting in September 2023, spots were played 15 times per day over a period of 6 months to ensure high reach and message retention among audiences. Each spot was broadcast 10 times per day in Tonga, with a further 5 spots per day in English in order to reach the high number of migrant workers residing in Mazabuka.  

Outputs

Project impact

Project Impact

Evaluation

We conducted a mixed-methods evaluation designed to quantitatively assess campaign impact on clinical measures of depression and anxiety using a pre-post panel design, alongside a qualitative exploration of whether and how listeners understood, interpreted and actioned the Lumuno core messages.  

The findings showed that there were important and statistically significant improvements in depression and anxiety scores between the start and end of the campaign.  

We saw a clinically significant reduction in depression among people who had common mental illness (CMI) at the start of the campaign, observing a 19.7% reduction in average depression scores between baseline and endline (effect size -0.65, p<0.001). The size and significance of this result is similar to that reported in a randomised controlled trial of the Step-by-Step intervention from which the campaign was adapted. 

Furthermore, among the 116 individuals with moderate or severe depression at the start of the campaign, 41.4% showed a clinically significant improvement in depression by the end of the campaign. 

We observed a 10.7% reduction in average anxiety scores among people who had CMI at the start of the campaign (p<0.05). Although only a modest proportion of the panel had moderate anxiety at baseline, over half of them (54%) showed a clinically significant improvement in anxiety at endline. 

Qualitative findings showed that Lumuno spots were generally well received, and listeners were able to recall key messages of the campaign. There were many instances of participants using and sharing the techniques with their friends and family, for example: 

“I shared it with my girlfriend … she was very worried, I told her to calm down and suggested to her to find a quiet place to be alone, and do breathing exercise, breathing in and out slowly to help a calm her mind.” (Male, aged 22) 

What I learned is that when I have problems, it doesn’t mean that’s the end of it all. When I am faced with challenges, I should find friends who can help me. A problem shared is a problem solved. It is not good to keep it to yourself, that can cause high blood pressure and stress …. (Female, 31) 

I used one of the messages in one drama which was talking about breathing exercise, where one is required to breathe in slowly and breathe out slowly too as it helps to relax and calm the mind… So, when I was sick, I did that exercise and it worked, it helped me. (Male, 21). 

Partners & Funders

We are grateful to Unorthodox Philanthropy, who co-funded this campaign alongside our unrestricted funders.

Unorthodox Philanthropy logo