Douglas Storey

Impact of the integrated Radio Communication Project in Nepal, 1994-1997.

The Radio Communication Project (RCP) in Nepal is an ongoing, theory-based, multimedia reproductive health campaign which began in 1995. It consists of two entertainment-education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and promotions, and complementary print materials. This paper examines impact data from a variety of sources, including a pre- and postpanel survey of currently married women (N = 1905), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. The study found increased health worker interpersonal interaction skills, improved quality of client-provider interactions, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization, all attributable to the RCP. The panel data allowed statistical control of the influence of predisposing factors before the campaign on postcampaign ideation and behavior. The effect of the RCP on contraceptive behavior was largely indirect through its influence on ideation. Implications for the design of integrated, multimedia, entertainment-education campaigns and integrated evaluation designs are discussed.

Using Health Education Theories to Explain Behavior Change: A Cross-Country Analysis:

Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four theories provide an excellent fit to the data, but that certain variables within them may have particular value for understanding specific aspects of behavior change. Recommendations for the selection of theories to use as guidelines in the design and evaluation of reproductive health programs are provided.

Increasing equity, affirming the power of narrative and expanding dialogue: the evolution of entertainment education over two decades

Abstract This article provides a critical summary and review of the presentations and discussions that took place during the Fifth International Conference on Entertainment Education (EE) in New Delhi, India, in November 2011, in an attempt to understand what it tells us about the state of the field and where it is going. This gathering of EE scholars, practitioners, activists, donors, government policymakers, media producers, artists, writers and performers from 31 countries represented a broad spectrum of contemporary work and perspectives on EE, reflecting its topical, geographic, conceptual, technological and methodological diversity. Key themes that shape EE discourse today are identified, including a focus on increasing equity, affirming the power of narrative and storytelling for social change, and expanding opportunities for transformative dialogue. The review also identified several key challenges facing the field of EE going forward, including how to work effectively with donor agencies and the private sector, how to balance the imperatives of research and practice, and how to maintain a creative dynamic between art/entertainment and science/education. The researchers argue that the fundamental principles embodied in EE practice may facilitate how the field responds to these challenges, as EE looks to a future of expanding scale, increasing demand, decentralisation of access and diversification of technology.

What is health communication and how does it affect the HIV/AIDS continuum of care? A brief primer and case study from New York City

Abstract:This article responds to key questions related to health communication that are commonly asked in the HIV/AIDS arena: “What is health communication?”; “What is its role beyond HIV prevention?”; and “How can it be used to achieve better HIV/AIDS outcomes?” We review how communication scientists think about their own discipline and build on a basic definition of communication as a fundamental human process without which most individual, group, organizational, and societal activities could not happen, including how people think about and respond to health issues such as HIV and AIDS. Diverse factors and processes that drive human behavior are reviewed, including the concept of ideation (what people know, think, and feel about particular behaviors) and the influence of communication at multiple levels of a social ecological system. Four main functions of communication—information seeking and delivery, persuasion, social connection and structural/cultural expression and maintenance—are linked to a modified version of the Department of Health and Human Services Continuum of Care and are used to conceptualize ways in which communication can achieve better HIV/AIDS outcomes. The article provides examples of how communication complements other types of interventions across the HIV/AIDS continuum of care and has effects on HIV-related knowledge, attitudes, social norms, risk perceptions, service delivery quality, and behavioral decisions that affect if and when the virus is transmitted, when and where testing and care are sought, and how well adherence to antiretroviral therapy is maintained. We illustrate this approach with a case study of HIV/AIDS communication conducted by the New York City Health Department during 2005–2013.

The Integrated Gateway Model: A catalytic approach to behavior change

To develop and test an Integrated Gateway Model of behaviors and factors leading to subsequent positive reproductive, maternal, and child health behaviors.

Healthcare-seeking behaviors for acute respiratory illness in two communities of Java, Indonesia: a cross-sectional survey.

Understanding healthcare-seeking patterns for respiratory illness can help improve estimations of disease burden and inform public health interventions to control acute respiratory disease in Indonesia. The objectives of this study were to describe healthcare-seeking behaviors for respiratory illnesses in one rural and one urban community in Western Java, and to explore the factors that affect care seeking. From February 8, 2012 to March 1, 2012, a survey was conducted in 2520 households in the East Jakarta and Bogor districts to identify reported recent respiratory illnesses, as well as all hospitalizations from the previous 12-month period. We found that 4% (10% of those less than 5 years) of people had respiratory disease resulting in a visit to a healthcare provider in the past 2 weeks; these episodes were most commonly treated at government (33%) or private (44%) clinics. Forty-five people (0.4% of those surveyed) had respiratory hospitalizations in the past year, and just over half of these (24/45, 53%) occurred at a public hospital. Public health programs targeting respiratory disease in this region should account for care at private hospitals and clinics, as well as illnesses that are treated at home, in order to capture the true burden of illness in these communities.

Framed, Interactive Theory-Driven Texting: Effects of Message Framing on Health Behavior Change for Weight Loss

More approaches to support weight control are needed, especially among racial minorities who shoulder a disproportionate obesity burden. Using an approach influenced by regulatory fit theory, we conducted a 28-day, 4-arm experimental trial with 89 obese adults recruited from urban, predominantly African American churches to ascertain the efficacy of framed text messages to motivate behaviors conducive to weight loss. Participants were assigned to receive message framing that was matched versus mismatched to their motivational orientation. Results were mixed overall; however, matched texts elicited greater motivation to change eating and exercise behavior, suggesting promise in using motivational approaches to tailor messages.

Poor Knowledge and Nonuse of Long-Acting/Permanent Methods of Contraceptives in Six Districts in Indonesia:

This analysis aimed at examining the association between the level of knowledge about long-acting/permanent methods of contraceptives (LAPM) and nonuse of LAPM among currently married, nonpregnant, and fecund women aged 15 to 49 years intending to limit childbearing. Data were derived from a cross-sectional study in Tuban, Kediri, and Lumajang District (East Java Province) and Lombok Barat, Lombok Timur, and Sumbawa District (Nusa Tenggara Barat Province) in June 2012. Information was obtained from 4323 respondents. Using multivariate logistic regression, we found that women with moderate levels of LAPM knowledge were less likely to use LAPM than women with high levels of knowledge (adjusted odds ratio [aOR] = 2.01, 95% CI = 1.51-2.68). Women with low level of LAPM knowledge were less likely to use LAPM than women with high levels of knowledge (aOR = 4.25, 95% CI = 3.37-5.36). Efforts to strengthen counseling services and increased provider knowledge and counselling skills are important to improve women’s knowledge about and use of LAPM.