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FoME Symposium 2015 | Workshop 9: Story-telling and other New Methods of Evaluation | Sally Gowland: Influencing Prdouction through Insight: Development of Bangladesh Maternal and Child Health TV Programming
- 1. Influencing Production through Insight: Development of Bangladesh Maternal and Child Health TV Programming BBC Media Action Research and Learning September 2015
- 2. ► BBC’s international development NGO ► We aim to transform lives through media by giving people a voice and access to information ► We work through the BBC World Service and 500 local partners Who we are Governance and Rights Health Resilience & Humanitarian Response Governance & Rights Health Resilience & Humanitarian Response Who we are
- 3. Audiences sits at the heart of everything we doAudiences are at the heart of everything we do
- 4. TV drama Ujan Ganger Naiya – increasing the uptake of healthier reproductive, maternal and neonatal health
- 5. Home Birth Preparedness Behaviours Discussion (helpful ) Women’s Supportive Attitudes Agency (Physical) Barriers to Medical Care - Access Self-efficacy for future pregnancies Supportive Social Norms Knowledge What are the key ‘predictors’ of the intended outcomes of birth preparedness behaviours among Bangladeshi mothers?
- 6. Complex analysis vs telling the story Birth preparedness practice Total effects Direct effects Indirect effects Discussion .208 .196 .012 Barriers -.064 - -.064 Agency (physical) .039 - .039 Social norms .180 .128 .052* Knowledge .295 .286 .009* Attitudes .083 .083 -
- 7. 7 Housewife Busy with Household Chores & Harvesting I’m Maya. I have a five month old baby Read till Class 7 Brother in Law Husband Father in law Sister in Law Mother in law Married at 17 Farmer Age 19
- 8. 8 I saw Rashid bhai saving money for the delivery. Knowledge leads to positive attitudes and practice: I knew what preparations are important and so I felt ready to take action Yes, you know I think if we start taking preparations early it will be good for us. Do you think we need to start taking preparations now as well? During Last pregnancy
- 9. 9 Discussion also leads to positive attitudes and practice: I discussed the preparations needed with my husband and mother in law During Last pregnancy
- 10. 10 no scope for discussion shy to talk about delivery less confident to talk fear of the reaction of husband or MiL do not know what to discuss about But in my old village I didn’t see other women discussing birth preparations within their family because:“I couldn’t plan as we had financial problems. I wanted to bring pain killer injection at home for labour pain but couldn’t. When I talked to my husband he said there is no money. So whom should I discuss with?’’
- 11. Conclusions • Translating complex analysis into a relatable format for our key audience ensured our research was used • Research partnerships are crucial • Our grounding for evaluation is stronger
Editor's Notes
- BBC Media Action, the BBC’s international development organisation, uses the power of media and communication to support people to shape their own lives. Working with broadcasters, governments, other organisations and donors, we provide information and stimulate positive change in the areas of governance, health, resilience and humanitarian response. This broad reach helps us to inform, connect and empower people around the world. We are independent from the BBC, but share the BBC’s fundamental values and have partnerships with the BBC World Service and national broadcasters that reach millions of people in developing countries. In addition, we train journalists and reach audiences with local broadcast partners.
- Research is embedded across our project life cycle. Findings inform our work, bridging theory and practice to provide an evidence base for both our own programmes and for anyone working in media and development worldwide. At the beginning of each project we conduct formative research in order to understand our key target audiences – their lives, motivations, barriers, media habits depending upon thematic area. We conduct content development research – testing formats, characters, storylines throughout the project lifecycle in order to continually feedback audience reaction and engagement with our work, and finally, evaluative research is conducted at the end of each project to measure and understand the impact of our projects.
- In Bangladesh our health project uses TV drama and factual programming in order to influence and shift key behavioural outcomes around maternal and child health. Ujan Ganger Naiya, the TV drama funded by the UK Department for International Development in Bangladesh aims to support improved reproductive, maternal and neonatal health by increasing the uptake of healthier reproductive, maternal and neonatal health behaviours and practices, particularly amongst women of reproductive age (15-49 years), their partners and older women who influence decision making around RMNH. One of these outcomes is being prepared for birth – and what we mean by this is having emergency contact numbers, emergency transport ready and saving money for the birth in case anything goes wrong at home. Lets take a look at the drama…..
- But in order to inform programming and evidence evaluation it is important for us to systematically understand what the drivers or ’key predictors’ of birth preparedness are in Bangladesh. We know that media for development interventions are often built on ideas around diffusion of information or social interpretations of ideas. These less direct paths of effect have important implications for designs of media programming and their subsequent evaluations. Causal pathways that require networks to discuss and share ideas in order to influence, for example social norms, need an evaluation approach that does not just compare those exposed with those not exposed, because people may be indirectly exposed via their social networks. Understanding how media and communication are intended to work will affect how we can sensibly evaluate them. The use of pathway analysis or social network analysis as methodologies to understand these causal chains hold promise for evaluation in the field. However, to date, they have been used sparingly by a small number of practitioners. Greater collaboration between academia and practitioners in this area could support innovative evidence creation in the future. And this is exactly what we did in Bangladesh. BBC Media Action Research and Learning department collaborated with Dr Lauren Frank from Portland State University to analyse a nationally representative quantitative baseline survey in early 2014, with a representative sample of 3000 mothers. Using structural equation modelling which aims to analyze what are the drivers that influence ensuring birth preparedness are and how much they drive that practice. It can show what the drivers are, how much of an effect they have on the practice being analyzed (birth preparedness – known as ‘direct effects’ and ‘indirect effects’) influence practice and how they relate to each other. By understanding the drivers of birth preparedness this would help our production team think through how storylines, characters and issues were going to be portrayed throughout the drama. However, we wanted to provide our production team with a full picture not only of the enablers to good birth preparedness but the barriers too – this is where in depth qualitative research with pregnant women, mothers of young children and key influencers such as mothers in law and husbands was integrated into our story. And of course, this type and level of analysis will be useful for our evaluation following programming to understand how such a pathway interplays with exposure to programing.
- However we also wanted to convey the insights of the enablers and barriers to birth preparedness in a format which would be understood and relatable for our audience. So, our local research team in Bangladesh took the findings of the structural equation modelling and contextualized these with qualitative research with audiences to come up with a typical target audience members story of her journey through pregnancy – and the key insights from the structural equation modelling, contextualised with in depth qualitative research with families in Bangladesh. Because for a producer or scriptwriter the story of one woman would make more sense than a table of ‘direct’ and indirect’ effect sizes. This was Maya’s story.
- I wont talk through the whole story we came up with but just a couple of the critical insights we conveyed through her story which we relayed to the producers and scriptwriters. We gave her a background first of all – so this is Maya - she is 19 years old who married when she was 17 after leaving school. She lives in a rural village with her husband, parents-in-law, sister-in-law and brother-in-law. She has a 5 month old baby and is a housewife. She is busy all day doing household chores. Her husband is a farmer. And she tells us through her story what her journey through pregnancy was like in terms of being prepared for birth, this aimed to give the production team what the key drivers and the strength of those drivers are in terms of birth preparedness and we had Maya reflect on how families were different in her old village (her parents village) to give a flavour of the key barriers which prevent birth prepareation.
- So for example one part of her story (which related back to the model) was knowledge is the biggest driver of birth preparedness – but has more of an effect through attitudes. So, we said that Maya’s knows what are the preparations her family need to take and that they need to take them early. She knows that even though they are planning for a home delivery she needs to prepare in case anything does not go to plan and she may need transport, money or to go to a hospital. This good knowledge means she feels the importance of being prepared and means she has a good and positive attitude towards the need to be prepared.
- Our second key insight was that discussion was the second biggest driver of birth preparedness – so – we described how Maya also discussed preparations needed with her family members.
- And then we conveyed the barriers by describing how Maya found some women in other villages who can not discuss these issues with their husband or MiL. Because sometimes there is no scope of discussion, they feel shy to talk about delivery, they do not know what they need to be talking about, they fear of the reaction of husband or MiL and they are less confident to talk about birth preparedness.
- So, that was just a flavour of how we used storytelling to convey complex research findings. But importantly what were the results and what did we learn? Well first of all, by boiling down our key insights – knowledge is the biggest predictor, discussion is the second this helped the project understand they were on the right track – this evidence underpins their existing theory of change. Secondly it helped them pin point the driving influences to birth preparedness practice and reflect on how they should be showcased in programming. As we speak, the third series of Ujan Ganger Naiya is being filmed on location in Bangladesh and further episodes scripts being written with the script writers reflecting and thinking about how they are going to showcase and model more discussion within and outside the home amongst mothers, families and others in order to drive birth preparedness practice. Secondly, research partnerships were critical for this work to be conducted, they helped us to undertake this more complex analysis (but we ensured that such analysis was grounded in other data and our local Bangladeshi researchers’ understanding of the context. Thirdly, this work of course has informed our project and production but importantly it provides solid grounding for our future evaluation of understanding how exposure to Ujan Ganger Naiya affects this pathway and our behavioural outcomes. This analysis as it stands it due to be published imminently through an academic journal, but we also plan to repeat this analysis on our endline data next year. Hopefully this has given you food for thought for how complex research can be broken down and communciated to non research audiences and how understanding the pathway of change and media’s role in it. Do ask any questions or if you are interested in finding out more come and speak to me offline. Many thanks.