Prepared by Africa's Voices Foundation (AVF) for the Health section at the United Nations Children's Fund (UNICEF) Somalia, this report shares findings from interactive radio programmes on immunisation that aired during October 2016. As part of a communication for development and social research initiative, in 2015, AVF conducted an 8-week pilot project with UNICEF Somalia that recruited interactive radio as a research tool to understand socio-cultural beliefs related to polio and routine immunisations, as well as child and maternal health. (See Related Summaries, below.) The present study builds upon the pilot study in 2015, as well as AVF's growing analysis assets from a sustained radio series over 2016 and early 2017.
Somalia has been polio-free since 2014. Yet challenges endure, and overall rates of immunisation coverage remain low. To maintain progress and reduce vaccine-preventable illness and mortality in a country with some of the worst health indicators in the world, AVF and UNICEF felt that more research was needed to better understand Somali people's beliefs, including the barriers and obstacles, that facilitate or prevent the successful uptake of immunisation programmes. The hope was that such research would provide insights to inform behaviour change interventions, ensuring that they are evidence-based, tailored to socio-cultural realities of intended populations, and effective in boosting demand for and uptake of immunisation campaigns. However, because of poor infrastructure and political insecurity in Somalia, traditional, on-the-ground qualitative research is difficult to undertake and costly to reproduce at scale in the country. AVF has a growing track record of overcoming such obstacles by leveraging the popularity of radio and mobile phones in Somalia.
AVF worked with the UNICEF Somalia to devise the following three research questions: (i) What are the differences (in terms of beliefs and demographic characteristics) between parents who bring their child to complete the full schedule of immunisation and those who do not (ii) What are the differences between parents (in terms of beliefs and demographic characteristics) who discriminate by gender in regards to immunisation uptake and those who do not (iii) How are different structures of household decision-making associated with uptake of immunisation These research questions guided a series of questions - e.g., Do you believe that boys and girls should always receive the same level of immunisation Yes or No Why - to be broadcast to radio audiences, as part of the radio programmes, and through SMS (short message service, or text message) questionnaires.
In partnership with MediaINK, AVF's Hargeisa-based media partner, AVF deployed interactive radio programmes across a network of 26 FM radio stations covering all three zones of Somalia. AVF's estimates put this range to be 49% of Somali territory and 70% of the population. Ahead of the radio shows, the radio questions were broadcast in short promos on all of the radio stations. Two 30-minute shows incorporated audience responses to these questions and were broadcast on October 14 and October 21 2016. To those who participated, AVF sent follow-up SMS questions using UNICEF's RapidPro platform. A total of 6,981 people participated in the radio shows around immunisation, sending a total of 12,317 text messages that could be used for analysis.
AVF's research allows it to gain insights from conversations held in local languages and on a scale otherwise difficult for qualitative methods. AVF achieves this scope and depth of research through using a mixed method approach combining qualitative and quantitative approaches, which is detailed in the report. To analyse messages about beliefs sent in response to the radio questions, AVF carried out a thematic analysis of the responses. Based on this, it developed a coding frame that helped categorise the relevant beliefs into themes and subthemes.
Key findings include:
Finding 1: Most parents responded positively to whether parents should complete the full schedule of immunisation (826 responded positively and 104 negatively). The most common reason given for not completing the full immunisation schedule was that it is bad for health, but there were also ideas that children were protected by God, too young in their first year to receive vaccinations and that vaccination was a foreign idea.
- Recommendation 1: UNICEF's communication campaigning should be based on a careful study of the beliefs that are not supportive of completing a full immunisation schedule in order to develop tailored messages to shift such beliefs towards more positive ones.Finding 1.1: A number of participants said that their children did not need a full schedule of immunisation because a mother's milk was believed to act as a natural protection against diseases. This potentially dangerous misconception has likely emerged from campaigning around breastfeeding and child nutrition that has unintentionally sparked this belief.
- Recommendation 1.1: UNICEF communications campaigning should be planned in an integrated way across different sectors. Behaviour change initiatives need to be carefully considered and tested for unintended consequences outside of the sector in which they are planned.
Finding 2: While we might expect boys to be more immunised then girls, it is girls who are more immunised because they are perceived as more vulnerable to diseases and, as a result, they require more immunisation to protect them.
- Recommendation 2: Future messaging can stress that there is no inherent difference in the susceptibility of boys and girls to vaccine-preventable diseases, include calls for gender equality, and feature supportive religious beliefs.
AVF concludes that, "[w]hen deployed in a robust manner, research via interactive radio can track social change over time. Research can be designed in a way that it assesses progress amongst and between socio-demographic groups, changes in their practices, and associations between beliefs and practices. As the group of engaged radio audience members grows over time, these changes can be assessed using follow up SMS surveys, independent of radio shows, providing a channel to interact with hard-to-reach populations across Somalia."
AVF website, February 7 2018, and email from Joshua Holmes to The Communication Initiative on February 9 2018. Image caption/credit: UNICEF Measles campaign in Mogadishu, UNICEF Somalia/2015/Riccardo