University of Southern California (Chatterjee, Frank, Murphy); BBC World Service Trust (Bhanot, Power)
This paper employs structural equation modeling to test a series of hypotheses about the relationship between exposure to a television drama and shifts in knowedge, attitudes and practices (KAP). Analysing the use of the education entertainment (EE) strategy as part of a particular effort to address HIV/AIDS in India, the authors ask: Is the KAP model adequate to capture behaviour change processes, or is its explanatory power improved by the addition of measures of HIV/AIDS-related self-efficacy and interpersonal communication?
In the opening sections of the report, the authors provide a working definition of EE: "the process of purposely designing and implementing a media message that both entertains and educates, in order to increase audience members knowledge about a particular issue, create favorable attitudes, shift social norms, and change overt behavior." This strategy characterised Jasoos Vijay, a weekly crime drama produced from 2002 to 2007 by the BBC World Service Trust (BBC WST) and telecast on the national TV channel on Sunday nights at primetime. The fast-paced detective show was created to appeal to sexually active men between 18 and 34 years of age. Jasoos Vijay was developed as part of a larger HIV/AIDS awareness multi-media campaign that was funded by the British government's Department for International Development (DFID) and implemented in partnership with India's national broadcaster Doordarshan and the National AIDS Control Organization (NACO).
Data show that access to this EE effort was considerable: The show aired 130 episodes over the course of 5 years. By the end of the campaign, Jasoos Vijay was among the top 10 most watched programmes on television in India. During its final year, Jasoos Vijay was estimated to have reached a weekly audience of up to 15 million; over the course of the year, it reached 70 million viewers.
But, like most evaluators, those analysing the impact of Jasoos Vijay want to know more than just how many people it reached; they want to know its impact on the intended audience. Thus, the evaluators extended a set of hypotheses, as follows:
H1a: Exposure to JV predicts increased HIV/AIDS-related knowledge.
H1b: Exposure to JV predicts more positive HIV/AIDS-related attitudes.
H1c: Exposure to JV predicts increased HIV/AIDS-prevention behaviour (practices).
H2: HIV/AIDS-related knowledge predicts more positive attitudes toward HIV/AIDS.
H3: HIV/AIDS-related attitudes predict increased HIV/AIDS prevention behaviour.
As highlighted in the report, one of the key communication challenges of HIV/AIDS-related campaigns in India is the taboo nature of the issue: traditionally, social and religious beliefs have played a strong role in keeping public discourse on issues of sexuality at a minimum. Furthermore, prevalent gender norms are such that (among heterosexual couples) men typically have the power to initiate discussions and implement decisions regarding sexual matters. Because of the context in which interpersonal communication occurs, in light of evidence that interpersonal discussion can accelerate behaviour change, and for other reasons described in the report, the following research questions were added:
RQ1. Does perceived self-efficacy with respect to HIV/AIDS prevention measures influence the relationship between exposure and knowledge, attitudes, and behaviour?
RQ2: Does interpersonal discussion with respect to HIV/AIDS-prevention measures influence the relationship between exposure and knowledge, attitudes, and behaviour?
Noting that not everyone in the Jasoos Vijay audience or in India more generally is personally at elevated risk of contracting HIV/AIDS, the researchers surmised that focusing exclusively on whether or not viewers personally engage in safer sex behaviours may underestimate the true impact of the programme. Thus, they also examined the extent to which viewers recommend HIV/AIDS prevention behaviours to their friends and relatives, as follows:
H4a: Engaging in interpersonal discussion with respect to HIV/AIDS-prevention measures predicts making HIV/AIDS-prevention recommendations to others.
H4b: Engaging in HIV/AIDS-prevention behaviour predicts making HIV/AIDS-prevention recommendations to others.
The study investigates not only if young sexually active male viewers discussed these sensitive topics, but with whom and to what effect, as follows:
RQ3: Does it matter with whom the viewers discuss HIV/AIDS prevention methods?
Taken together, the 4 hypotheses and 3 research questions yield a conceptual model that researchers used in an analysis of 834 sexually active young men.
Excerpts from the Discussion and Conclusion sections of the report follow:
"...In short, exposure to Jasoos Vijay predicted increased HIV/AIDS-related knowledge, attitudes, and practices, supporting all components of Hypothesis 1. Moreover, knowledge of HIV transmission routes and methods of prevention significantly predicted more positive attitudes, supporting Hypothesis 2. Likewise, having more enlightened attitudes about HIV directly predicted engaging in HIV/AIDS prevention behaviors, supporting Hypothesis 3.
Further iterations of the model that incorporated self-efficacy help to illuminate the relationship between HIV/AIDS-related attitudes and behaviors. More specifically, in Model 2, which added self-efficacy to the basic KAP model, attitudes significantly predicted viewers' self-efficacy with respect to performing the eight HIV-prevention methods incorporated into the Jasoos Vijay narrative. Elevated self-efficacy was, in turn, related to actually engaging in these behaviors. In fact, the inclusion of self-efficacy within the model made the direct relationship between attitudes and behavior insignificant. Thus, self-efficacy fully mediates the relationship between attitudes and behaviors. This suggests that more enlightened HIV attitudes may serve to make individuals more confident that they can successfully perform these various HIV/AIDS-related behaviors, and this self confidence, in turn, increases the likelihood that they actually do engage in these safer sex practices...
Similarly, the addition of interpersonal discussion...to the model does not modify the majority of the relationships among exposure, knowledge, attitude, self efficacy, and behavior, but it does increase our ability to predict relevant knowledge, attitudes, and behavior....In other words, the relationship between exposure and attitudes is better explained by their relationships with interpersonal communication....[I]t is particularly important to note that the effects of exposure on attitudes in this campaign all occurred through interpersonal communication...
...As predicted in Hypothesis 4, both interpersonal discussion and engaging in safer sex behavior themselves increased the likelihood that the young sexually active men in our sample recommended HIV/AIDS-prevention behaviors to others...
Our final research question asked whether the interlocutor with whom one discussed the safer sex practices depicted in the Jasoos Vijay series mattered. Linear regression analyses revealed...[that] speaking with one's spouse about the eight HIV prevention behaviors was significantly related to actually performing those behaviors. To a lesser extent, talking to one's immediate and extended family also predicted behavior....In short, it appears that viewers were more likely to talk either to their family or to their friends about HIV prevention; and those who talked to their family were more likely to follow through in terms of their own safer sex behavior....For EE campaign producers and researchers, this indicates the need to pay more nuanced attention not only to integrating elements that spark discussion in the audience, but also to whom the individuals talk to better account for effects on different topics and in different contexts.
...[O]ur study clearly demonstrates that more attention needs to be focused on the complex way in which interpersonal communication works, impacting not only behavior, but also related aspects of knowledge, attitude, and self-efficacy. Focusing on interpersonal communication as a mediating variable may also enable us to theoretically explore the complex interaction between individual-level (micro) behavioral change and community-level (meso/macro) social change....Further, our analysis suggests the potential for EE programs to role model a variety of interpersonal communication scenarios in order to optimize the behavior change outcomes...
...There now exists a wide array of EE projects that differ in terms of message, medium, audience, length, complexity, and innumerable other dimensions. What is lacking is a serious attempt to step back and make sense of this burgeoning field by contextualizing and extricating the differences in EE programs and their associated effects....This study sheds light on EE interventions that use a serial drama format on television. Further research is likewise necessary to verify the value of the inclusion of self-efficacy and interpersonal discussion as key components in models of behavioral change and to begin to parse out how and when these variables are most effective with other EE formats."
International Journal of Communication, Vol 3 (2009), pps. 607-634.