One of the best resources for social and behaviour change (SBC) and designing better sexual and reproductive health interventions is the High Impact Practices in Family Planning (HIPs).

According to the HIPs, mass media is one of several proven  practices recommended for  widespread implementation as part of a comprehensive family planning strategy, provided that there is monitoring of coverage, quality, and cost as well as implementation research to strengthen impact. Mass media can reach a large audiences with consistent, high-quality messages, primarily through TV and radio (e.g., public service announcements or advertisements, talk shows, or serial dramas) (High Impact Practices in Family Planning (HIPs), 2017).

Mass media and entertainment education  are popular intervention mediums, and there are several findings in the literature about the role they play in improving SRH outcomes:

• Young women who were exposed to mass media had higher odds of negotiating for safer sex compared with those who had no exposure (Aboagye et al., 2021; Somefun et al., 2019).
• Longer-format content, such as mini-series that are compelling and tap into storylines and emotions, can have an impact on the audience’s health-related behaviours (Massey et al., 2022).
• Social influence is a powerful tool for spreading knowledge, norms, and practices through an entertainment education strategy using storytelling techniques. Online communities can be leveraged to stimulate meaningful engagement around prosocial topics (Lutkenhaus et al., 2020).
• Adolescent viewers of a Mexican drama were more likely to seek out information about contraception, unhealthy romantic relationships, use contraception other than condoms or dual contraception compared to non-viewers. Parental viewing was associated with increased likelihood of talking with their children about SRH topics including contraceptive methods such as condoms and abstinence compared to non-viewers (Montoya et al., 2022).
• Entertainment education narratives have been found to have small but significant effects for three sexual behaviours: reducing the number of sexual partners, reducing unprotected sex, and increasing testing and management of STIs. Entertainment education had medium-size effects on knowledge outcomes. Individuals exposed to entertainment education narratives were more likely than comparison participants to engage in safer sexual practices (Banerjee et al., 2019; Orozco-Olvera et al., 2019).

Digital SBC using technologies such as social media, mobile phones, computers, or tablets to convey information and messages as part of an evidence-based multichannel SBC strategy is seen as a promising area of practice (HIPs, 2018).

Evaluations of the specific mechanisms through which digital SBC and various social media platforms work for behaviour change is still very limited, even though we have evidence of high engagement rates (Raftree, 2019).

Some of the most interesting work I came across was conducted by Emmanuel Olamijuwon who runs experiments on Facebook to better understand its effectiveness for SBC in the area of SRH. I’ll highlight briefly some findings from his studies below (Olamijuwon et al., 2021; Olamijuwon & Odimegwu, 2022).

• Young people were more likely to engage superficially with peer-generated sexual health messages using reactions than leaving comments or sharing messages with those in their network.
• Young adults may be less likely to interact with sensitive topics such as SRH information to circumvent monitoring by parents and friends.
• Messages using multimedia and storytelling formats were significantly associated with higher levels of engagement, propagation, comprehension, recall, retention rate compared with messages without multimedia or stories.
• Young adults were more likely to interact with messages telling a story or sharing an experience. When asked for their opinions, young adults were also more likely to comment. This approach may be useful in getting young adults’ perspectives about issues of importance.
• Young adults would use and interact with sexual health information on social media if such use and interaction align with the way young people interact with other issues.
• Young people reported that they would access and interact with sexual health information on social media if such use improves their awareness of SRHR, is free of effort, and aligns with the way they interact with other information on social media.

While it seems that digital SBC through social media platforms fill a much-needed gap for young people (Waldman & Amazon-Brown, 2017), there are also a few things that intervention designers should be aware of:

• It is imperative to increase the involvement of parents, religious leaders, and other influential persons in sexual health communication as this would likely help minimize some of the stigma associated with interacting with sexual health information and ultimately boost interaction with sexuality information on social media. Facilitating conditions such as training programs can shape attitudes towards technology (Dwivedi et al., 2019).
• A Nigerian study (Nwaogwugwu & Isara, 2022) found that only 35% of respondents utilized digital media for SRH information. Furthermore, there are concerns about correct use, as only 30% had good utilisation of digital media for SRH information. The majority relied on parents to meet financial needs which could affect frequency/duration of internet use.
• Even if behavioural interventions can influence through informing, reminding, teaching skills and supporting people by linking them to health services, this might not be sufficient to achieve condom use, where access to condoms is a problem or power imbalances between partners are too stark (Berendes et al., 2021).
• The meaningful involvement of young people is crucial for effective SRH programming (HCD Exchange, 2023). Human-Cantered Design approaches/tools used across projects stimulate creativity among both young people/adults when co-designing solutions.

Do you have experience working with mass media, entertainment education or digital SBC? Share your insights in the comments!

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References

Aboagye, R. G., Ahinkorah, B. O., Seidu, A. A., Adu, C., Hagan, J. E., Amu, H., & Yaya, S. (2021). Mass media exposure and safer sex negotiation among women in sexual unions in sub-saharan africa: Analysis of demographic and health survey data. Behavioral Sciences, 11(5). https://doi.org/10.3390/bs11050063

Banerjee, A., La Ferrara, E., & Orozco-Olvera, V. H. (2019). THE ENTERTAINING WAY TO BEHAVIORAL CHANGE: FIGHTING HIV WITH MTV. http://www.nber.org/papers/w26096

Berendes, S., Gubijev, A., McCarthy, O. L., Palmer, M. J., Wilson, E., & Free, C. (2021). Sexual health interventions delivered to participants by mobile technology: A systematic review and meta-analysis of randomised controlled trials. Sexually Transmitted Infections, 97(3), 190–200. https://doi.org/10.1136/sextrans-2020-054853

Dwivedi, Y. K., Rana, N. P., Jeyaraj, A., Clement, M., & Williams, M. D. (2019). Re-examining the Unified Theory of Acceptance and Use of Technology (UTAUT): Towards a Revised Theoretical Model. Information Systems Frontiers, 21(3), 719–734. https://doi.org/10.1007/s10796-017-9774-y

HCD Exchange. (2023). How has Human-Centered Design Contributed to Youth Engagement in Adolescent Sexual and Reproductive Health Programming ? April.

High Impact Practices in Family Planning (HIPs). (2017). What is the proven high impact practice in family planning for social and behavior change? http://www.fphighimpactpractices.org/overview/.

High Impact Practices in Family Planning (HIPs). (2018). Digital Health for Social and Behavior Change: New technologies, new ways to reach people. Family Planning High Impact Practices.

Lutkenhaus, R. O., Jansz, J., & Bouman, M. P. A. (2020). Toward spreadable entertainment-education: Leveraging social influence in online networks. Health Promotion International, 35(5), 1241–1250. https://doi.org/10.1093/heapro/daz104

Massey, P. M., Kearney, M. D., Rideau, A., Peterson, A., Gipson, J. D., Nianogo, R. A., Bornstein, M., Prelip, M. L., & Glik, D. C. (2022). Measuring impact of storyline engagement on health knowledge, attitudes, and norms: A digital evaluation of an online health-focused serial drama in West Africa. Journal of Global Health, 12, 1–10. https://doi.org/10.7189/jogh.12.04039

Montoya, J. A., Plant, A., Creech, D. N., Orvañanos, C., & Barker, K. (2022). entertainment education to impact adolescent sexual and reproductive health and parent ‑ child communication in Mexico. 1–12. https://doi.org/10.1186/s12889-022-14853-8

Nwaogwugwu, J. C., & Isara, A. R. (2022). Utilization of Digital Media for Sexual and Reproductive Health Information among  In-School Adolescents in Benin City, Nigeria. West African Journal of Medicine, 39(9), 949–957.

Olamijuwon, E., Clifford, O., & Adjiwanou, V. (2021). Understanding how young African adults interact with peer-generated sexual health information on Facebook and uncovering strategies for successful organic engagement. 1–15.

Olamijuwon, E., & Odimegwu, C. (2022). Sexuality Education in the Digital Age: Modelling the Predictors of Acceptance and Behavioural Intention to Access and Interact with Sexuality Information on Social Media. Sexuality Research and Social Policy, 19(3), 1241–1254. https://doi.org/10.1007/s13178-021-00619-1

Orozco-Olvera, V., Shen, F., & Cluver, L. (2019). The effectiveness of using entertainment education narratives to promote safer sexual behaviors of youth : A meta-analysis , 1985-. 1–14.

Raftree, L. (2019). Digital and social media for social and behavior change communication. March, 1–52.

Somefun, O. D., Wandera, S. O., & Odimegwu, C. (2019). Media Exposure and HIV Testing Among Youth in Sub-Saharan Africa : Evidence From Demographic and Health Surveys ( DHS ). https://doi.org/10.1177/2158244019851551

Waldman, L., & Amazon-Brown, I. (2017). New Digital Ways of Delivering Sex Education: A Practice Perspective. In IDS Bulletin (Vol. 48, Issue 1, pp. 1–6). https://doi.org/10.19088/1968-2017.10