Mass Media Campaign to Help Eliminate TB in Brazil: Final Report

"The literature of health communications is replete with examples of campaigns which impact on knowledge and attitudes without making an impact on behaviour. It is the contention of DMI that health campaigns must contain more than simply information: they must be motivating and entertaining, and tested on their target audience if they are to stir people into action."

This 31-page report includes a description and evaluation of a national media campaign that Development Media International (DMI) conducted in April 2006 to promote treatment of tuberculosis (TB) in Brazil, in partnership with the Ministry of Health of Brazil, the World Health Organization (WHO), and the United States Agency for International Development (USAID). The campaign included 3 television spots and 10 radio spots broadcast over a 30-day period. While the campaign aimed to further improve knowledge and attitude indicators, the ultimate goal of the campaign was to change behaviour: to increase the number of people presenting themselves for tests, and thus to improve the rate of case detection. Organisers felt that this could be accomplished by creating a campaign which motivated people to take action through messages that were optimistic in tone, that featured visual depictions of patients in a non-stigmatised way, and that included images of patients being observed by another person during treatment (thus complying with the DOTS strategy).

In addition to involving TB experts in the development of the spots, organisers sought the participation of the audience they were aiming to address and then adapted the scripts to better suit the preferences and gaps in understanding that were indicated by the research. For instance, when focus group members felt that the initial storyboards did not reflect enough family support for patients undergoing treatment, the "Neighbours" script was significantly changed. Organisers also strategised about how to engage those who would communicate the messages. For example, attractive designs for the CD covers of the final versions of the spots were developed based "on the simple principle that radio DJs prefer to work with visually attractive materials, and it is often the decisions of DJs (rather than radio station owners) which are decisive in achieving a high number of broadcasts."

As detailed in the document, data collected by Instituto Ethos de Pesquisa Aplicada Ltda indicate that the campaign reached 43% of the males and females aged 20-50 in socio-economic classes C, D and E. This may be due in part to the DMI model of media campaigning, which involves working in partnership with national TV and radio stations. In this case, the TV and radio spots were broadcast 8000 times on 13 TV stations in Brazil, as well as on 2326 radio stations; 37 of the largest radio networks sent back reports showing more than 7000 airings (an average of 194 broadcasts per station).The total amount of airtime donated free of charge was US$12.3 million (the total cost of the project was US$316,000). In addition, all 3 spots were broadcast every 2 minutes on 20 plasma TV screens in one of the busiest railway stations in São Paulo - Brás Station, where 300,000 people pass through every day.

The results show that, of 1000 people interviewed in May 2006 after the campaign (representative of people aged 20-50 from social classes C, D and E), 4% went to a health centre as a result of the campaign to get a persistent cough checked for TB. "Given that the vast majority of people will not have had a persistent cough during this period, this is a significant result. Projecting this 4% finding to the target population of Brazil would indicate a very large number of additional examinations." The improvement in knowledge and attitudes was less dramatic. Knowledge that TB is curable and that the drugs are available free of charge were already at levels greater than 90% of the population. Significant shifts did occur and are detailed in the report, but the authors suggest that earlier government campaigns were very successful in informing the population about the facts about TB, and that this campaign served to push audiences towards the next level: acting on that knowledge, and seeking treatment.

In conclusion, the authors ask, "Should further TB campaigns be mounted? There is strong evidence that repeated campaigns have a far stronger impact than individual campaigns, and that the conversion from knowledge to behaviour change takes time to build and become established Moreover, anecdotal evidence suggests that the impact of repeated campaigns is strongest when phases are spaced 6-12 months apart. It should also be noted that campaigns based on the DMI model (leveraging private sector resources) are entirely dependent on the strength of the DMI's relationships with broadcasters..."

To request a copy of the full evaluation in MS Word format via email, please see contact details below.