Editor’s Note: In a previous post, attention was brought to a study that highlighted misconceptions about HIV and AIDS among pregnant women in Nigeria, despite decades of mass media enlightenment campaigns. In this article, Ibrahim Abioye MD, summarizes synthesized evidence on the impact of mass media interventions on HIV-related behaviors in developing countries between 1986 and 2007. He summarizes that from current evidence, we do not know enough about the ideal model media campaign that can best affect HIV risk behavioral outcomes.
If you raise awareness about HIV infection and the high risk behaviors that are likely to contribute to its spread, while encouraging folks to desist from unsafe practices, there should be positive behavior change and subsequently reduction in occurrence of new infections. Makes sense, right?
Mass media interventions were conducted at some point, in almost every country as part of the AIDS response, usually alongside other interventions and policies. Three groups of researchers systematically reviewed mass media interventions aimed at changing HIV/AIDS related behaviors conducted in developing countries between 1986 and 2007.
These reviews identified about 100 primary studies, from Africa, and everywhere else. In the UK, US and Canada, the studies enrolled from among racial minorities and LGBT folks. They included a variety of study designs including serial cross-sectional studies, pre- and post-intervention studies, follow-up studies with comparison groups and randomized controlled trials. But they also included post-intervention assessments. They were interested in studies that led to changes in knowledge as well as behavior.
To achieve these, the investigators exposed participants to village theater group performances, radio shows and ads, film shows, comic books, posters, newsletters, and TV shows, at varying frequencies and duration, often up to 2 years. No meta-analysis was done. We therefore rely on the narrative review.
The overall picture is that mass media interventions led to remarkable changes in knowledge, and to a lesser extent, in HIV-related behaviors. Changes in condom use and knowledge of HIV transmission were the predominant outcomes reported on.
In almost all studies, participants’ knowledge increased. People’s perception of whether they may be at risk of infection increased, but not consistently in all studies. While many people were now able to convince themselves and their partners to use condoms, some were not. HIV became a topic that participants felt equipped to discuss with their partners. A slightly increased proportion of folks were now able to abstain from sex, and those who did not abstain had fewer casual encounters and sexual partners. Condom use also improved, but not remarkably across studies.
However, there were issues with the designs of some of the included studies. Too often, the studies did not make a satisfactory attempt to define which components of the media interventions were more effective. Thus, we do not know enough to create a model media campaign from what was reviewed.
What’s the way forward? More research. This is a critical question that everyone interested in global health would love to see resolved. Media campaigns need to employ effective campaign designs used in other programs.
We need to reliably understand the effectiveness of print versus electronic media, TV versus radio ads, dramas and soap operas versus commercials, messages that instill fear versus those that encourage action, use of multiple media versus print or electronic alone.
These days, we need to know if social media influences mass media outcomes. The evaluations need to be reliable and reproducible. Alternatively, statistical techniques such as meta-regression may be used to tease out the effects, limiting the systematic review and meta-analysis to primary studies evaluating sufficiently similar outcomes.