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Development action with informed and engaged societies
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Evidence: Impact of the Integrated Radio Communication Project in Nepal, 1994-1997

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Participating organisations in the Global Alliance for Social and Behaviour Change - Building Informed and Engaged Societies were asked to identify, in their opinion, the 5 most compelling research and evaluation studies that demonstrate the direct impact of this field of work on a major development issue. This was one of the nominees. For the full compiled list, please click here. For the compilation of the key impact data across all research evidence identified, please click here.

Editor's note: Click here for a summary of this evaluation on The CI site.

Title of paper, article, book (chapter), publication?:

Impact of the Integrated Radio Communication Project in Nepal, 1994-1997

Name(s) of author(s)?:

Douglas Storey, Marc Boulay, Yagya Karki, Karen Heckert, and Dibya Man Karmacharya

Who published this paper, article, book (chapter) or other publication?:

Journal of Health Communication, 4:4, 271-294, DOI: 10.1080/108107399126823

What are the best extracts that highlight the evidence for the impact of a communication for development, social change, behaviour change, public engagement, or informed citizen strategy on a development issue and priority?:

The Radio Communication Project (RCP) in Nepal consisted of two entertainment­ education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and community-based promotions, and complementary print materials. This paper examines impact data from a variety of sources, including a pre- and post-intervention panel survey (1994 & 1997) of currently married women (n=1905), three waves of clinic-based observations of client­ provider interactions (n=240 per wave, in November 1995 before the radio serials went on the air and before any IPC/C workshops had been conducted, in early April 1996 about midway through the distance education serial and after three of the four IPC/C workshops had been conducted, and in October 1996 about six months after the distance education serial ended) and client exit interviews (n=240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. The study found increased health worker interpersonal interaction skills and improved quality of client­ provider interactions associated with exposure of health workers to the distance education serial, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization, all attributable to the radio serioal for the general public. The panel data allowed statistical control of the influence of predisposing factors before the campaign on postcampaign ideation and behavior. The effect of the RCP on contraceptive behavior was largely indirect through its influence on ideation.

To which development issue does this evidence and impact data relate?:

Family health, family planning, spousal communication, ideational change

To which strategic approach(es) does the evidence and impact data relate?:

Entertainment-education, distance education of health workers using radio, interpersonal communication (client-provider communication and counseling)

What research methodology (ies) was/were used to produce this evidence and impact data?:

  1. Population-based panel survey of currently married women (n=1905) interviewed at two points in time (1994 and 1997) in four districts selected by the Ministry of Health.
  2. Three waves of clinic-based observations of client-provider interactions by trained observers using a checklist of desired IPC/C behaviors and techniques. The checklist was adapted for Nepal from Roter (1997) and Kim and Lettenmaier (1995). It included 24 service provider behaviors and 12 client behaviors. Each wave involved 40 observations of provider interactions with female clients at each of six selected service delivery sites chosen purposively to cover major geographical regions of two districts for a total of n=720 observed interactions.
  3. Client exit interviews (n=720) following each observed clinic-based interaction at each of six selected service delivery sites.
  4. Analysis of client flow data from rural sentinel health posts in the Dang District.

What is the URL to access this paper, article, book (chapter) or other publication?:

https://www.tandfonline.com/doi/abs/10.1080/108107399126823

Why was this research evidence found to be useful?:

Reviewers of the article and the editor of the journal noted that this is the first study to document population-level impact of an entertainment education radio serial. It documents the impact of separate, but complementary radio programs addressing both the demand and supply side of family health services. It provides strong causal inference about the impact of the project because four different sources of data corroborate that impact.

Further comments?:

Two other studies of this project produced additional evidence of how this impact was achieved:

  • Boulay M, Storey JD & Sood S. (2002). "Indirect Exposure to a Family Planning Mass Media Campaign in Nepal" Journal of Health Communication, 7(5): 379-399 collected interpersonal discussions network data from villages in Nepal and showed that women who did not listen to the radio serial, but who had talked to other women who were listeners, were just as likely to report adoption decisions as listeners. Editor's note: Click here for a summary of this evaluation on The CI site.
  • Gunther A & Storey JD. (2003). "The Influence of Presumed Influence." Journal of Communication, 53(2): 199-215 conducted additional analysis of the client-provider interaction data and found that clients who were aware of the distance education serial for health workers and who said they thought it was probably effective at improving health worker performance had better interactions with health workers and better outcomes of those interactions (FP adoption), even if the health worker had not received the distance education training, showing that the anticipation of communication impact on health workers affected client behaviors. Editor's note: Click here for a summary of this evaluation on The CI site.