A Staged Model of Communication Effects: Evidence from an Entertainment-Education Radio Soap Opera in Tanzania

Published in the Journal of Health Communication in 2000, this study develops a theoretical model of health communication through an analysis of the impacts of an entertainment-education radio soap opera on family planning practices in Tanzania. The authors synthesise a "staged mode" of health communication effects by drawing on existing theories of behaviour change: the hierarchy-of-effects (HOE) model; the stages-of-change (SOC) model, social learning theory, and the diffusion of innovations (DOI). A staged model of communication effects posits that an individual's exposure to mass-media health messages sets in motion - in stages - cognitive, affective, role-modeling, or interpersonal communication processes. The authors propose six specific stages:

1. Precontemplation: Through media message exposure, an individual (a) gains awareness/knowledge of a health practice, and (b) perceives, through an affective process of identification, that the message is relevant to him/her;
2. Contemplation: Role-modeling of the consequences of a new behaviour and parasocial interactions with role models (e.g., radio soap characters) persuade an individual that a new health behaviour is beneficial to him/her;
3. Preparation: An individual develops a belief in the merits of a new health behaviour and a sense of self-efficacy to adopt the new behaviour;
4. Validation: An individual with an intention to adopt a new behaviour validates his/her intention with a spouse/partner through interpersonal communication and negotiation;
5. Action: An individual communicates with a service provider to obtain needed materials and specific information. Mass communication messages can stimulate interpersonal communication between an individual and service providers by providing models of such discussion; and
6. Maintenance: Mass media provide role models of satisfied users of a new health behaviour for audience members to observe and emulate.

Evaluation/Research Methodologies:

The six stages of communication effects were empirically explored by analysing the impacts of the radio soap opera project in Tanzania, Twende na Wakati. This project promoted contraceptive use through various techniques: entertaining and highly emotional plots; characters, scenes, and circumstances that the audience members could easily identify with; positive, negative, and transitional role models; rewards for positive behaviours and punishments for negative behaviours. The programme has been broadcast twice a week since 1993 throughout the country, except in the Dodoma area, where the broadcasts began only in the mid-1995.

Nationwide audience surveys were conducted in 1993 (prebroadcast), 1994, 1995, 1996, and 1997. The Dodoma area served as the control area; the delayed start of the broadcasts in Dodoma allowed a comparison of the communication effects in the area with those in the rest of the country.



Key Findings/Impact:

The Twende na Wakati broadcasts reached a significant portion of Tanzanians. In 1995, 53% of people in the treatment area listened to Twende na Wakati at least once, and 61% of these individuals listened to the radio programme at least once per week. By 1997, 58% of the people in the treatment area and 75% of the people in comparison area (the Dodoma area) had listened to Twende na Wakati at least once.

The effects of the entertainment-education radio broadcasts within each behaviour change stage were reported through the findings from an earlier study (Rogers, et al., 1999):

1. Precontemplation: Very few respondents were classified as being in this stage because of the widespread awareness of contraceptives even prior to the broadcasts in 1993. Among those who lacked contraceptive knowledge, 97% of these individuals reported in 1995 that they had learned about family planning from listening to the radio soap opera. In addition, letters written to Radio Tanzania from the audience members indicated that they were highly involved with the main characters in the radio programme, suggesting that the radio broadcasts induced the affective process of identification with characters.
2. Contemplation: Audience members' identification with negative role models had declined between 1993-1997, while the identification with positive role models (e.g., women taking charge and gaining self-efficacy of family planning) had increased in this period.
3. Preparation: Attitudes toward family planning were very favourable even prior to the beginning of the broadcasts, but the percentage of individuals approving family planning in the treatment area increased from 80% in 1993 to 83% in 1995, and to 85% in 1997. In the comparison area, the approval of family planning declined from 90% in1993 to 84% in 1995 (no broadcasts of Twende na Wakati in 1993-1995 in the comparison area), but it increased to 90% in 1997. The indicator of self-efficacy for family planning also increased during the radio soap broadcasts. In the treatment area, the indicator increased from 52% points in 1993 to 63% points in 1995, and to 70% points in 1997.
4. Validation: Spousal communication and joint decision making were emphasised in 63% of the 205 episodes of Twende na Wakati during the first two years of broadcasts. The percentage of married respondents who reported talking to their spouse about family planning increased from 72% in 1993 to 76% in 1995 in the treatment area, while it increased from 75% to 77% in the comparison area.
5. Action: Neither the treatment nor comparison area showed discernable effects of the radio soap opera broadcasts.
6. Maintenance: The maintenance stage was the largest category in number of respondents for any stage. In 1995, 22% of the respondents reported that they adopted family planning as a result of listening to the radio soap opera. The percentage of married women who reported using a family planning method increased from 29% in 1993 to 39% in 1995, and to 41% in 1997 in the treatment area. In the comparison area, the percentage decreased from 65% in 1993 to 54% in 1995 but then increased to 70% in 1997. The percentage of sexually active men who reported using a family planning method increased from 14% in 1993 to 21% in 1995, and to 23% in 1997 in the treatment area. In the comparison area, the percentage decreased from 29% in 1993 to 19% in 1995, but then increased to 47% in 1997.

An analysis of the changes among the six behaviour adoption stages indicated that the radio soap opera helped people to move from lower stages (i.e., precontemplation, contemplation) to advanced stages (i.e., action, maintenance) between 1993 and 1997 in the treatment area, and between 1995 and 1997 in the comparison area. However, the authors note that the staged model of behaviour change is not strictly linear or hierarchical, citing evidence of cycling between stages among some respondents. For example, 45% of married women reported in 1995 that they had ever used a family planning method, while 38% reported that they were current users of family planning. The authors also found that listenership to Twende na Wakati was much greater for individuals at the model's advanced stages. The percentage of survey respondents who listened to the broadcasts in each stage was: 10% in precontemplation stage, 21% in contemplation stage, 44% in preparation stage, 47% in validation stage, 50% in action stage, and 66% in maintenance stage.

The authors conclude that mass media messages can be designed to influence people at the precontemplation, contemplation, preparation, validation, action, and maintenance stages, rather than mainly at the knowledge stage. The model contrasts with the KAP gap hypothesis, which posits that mass media messages have stronger effects on knowledge (K) / attitude (A) but effects are weaker on people's overt behaviour and practice (P). The findings from the present study indicate that entertainment-education programmes may influence people at later stages in the process by providing role models and motivation to change, rather than just affecting an individual's knowledge.