Entertainment-education radio serial drama and outcomes related to HIV testing in Botswana.

Makgabaneng is an entertainment-education radio serial drama written and produced in Botswana to promote prevention of HIV. This effort is part of the national response to HIV/AIDS. Broadcast of the serial drama began in August 2001, and two new 15-minute episodes air each week. We examined associations between exposure to Makgabaneng and outcomes related to HIV testing, including stigmatizing attitudes, intention to be tested, talking with a partner about testing, and testing for HIV, among 555 sexually active respondents. The four measures of exposure to Makgabaneng were frequency of listening, duration of listening, talking about the program, and attentiveness to and identification with relevant characters. Data were collected approximately 18 months after the drama began airing. We found positive associations between exposure to the program and intermediate outcomes, including lower level of stigmatizing attitudes, stronger intention to have HIV testing, and talking to a partner about testing. Although associations were identified with all four measures of exposure, increased duration of listening was associated with more positive outcomes than the other measures. This finding suggests that longer term exposure to entertainment-education programming may be important for behavior change.

Radio role models for the prevention of mother-to-child transmission of HIV and HIV testing among pregnant women in Botswana.

Although Botswana supports a program for the prevention of mother-to-child-transmission of HIV (PMTCT), many women initially did not take advantage of the program. Using data from a 2003 survey of 504 pregnant and post-partum women, we assessed associations between exposure to a long-running radio serial drama that encourages use of the PMTCT program and HIV testing during pregnancy. Controlling for demographic, pregnancy and other variables, women who spontaneously named a PMTCT character in the serial drama as their favorite character were nearly twice as likely to test for HIV during pregnancy as those who did not. Additionally, multiparity, knowing a pregnant woman taking AZT, having a partner who tested, higher education and PMTCT knowledge were associated with HIV testing during pregnancy. Identification with characters in the radio serial drama is associated with testing during pregnancy. Coupled with other supporting elements, serial dramas could contribute to HIV prevention, treatment and care initiatives.

Applying behavioral science to behavior change communication: the pathways to change tools.

Entertainment-education (EE) is a popular vehicle for behavior change communication (BCC) in many areas of public health, especially in the developing world where soap operas and other serial drama formats play a central role in encouraging people to avoid risky behavior. Yet BCC/EE developers have been largely unable to integrate behavioral theory and research systematically into storylines and scripts, depending instead on external, technical oversight of what should be an essentially local, creative process. This article describes how the Modeling and Reinforcement to Combat HIV/AIDS project at the Centers for Disease Control and Prevention has developed a set of tools through which creative writers can exercise greater control over the behavioral content of their stories. The Pathways to Change tools both guide scriptwriters as they write BCC/EE storylines and help project managers monitor BCC/EE products for theoretical fidelity and sensitivity to research.

"One day I might find myself HIV-positive like her": audience involvement and identification with role models in an entertainment-education radio drama in Botswana.

Entertainment-education programs promote health and development goals throughout the world. This study looks specifically at a radio serial drama designed to provide behavioral role models for HIV prevention and reproductive health in Botswana as part of the behavior-change strategy, Modeling and Reinforcement to Combat HIV/AIDS (MARCH). The purpose of this qualitative study is to elucidate regular listeners' involvement and identification with three different types of fictional characters in the drama. Regular listeners were interviewed using a semi-structured guide; 31 interviews were analyzed to assess respondents' reactions to three female characters. The findings suggest that characters designed to be "negative," "positive," and "transitional" (i.e., moving from negative to positive) role models were generally perceived as such and that the type of behavior modeled influenced whether a character was perceived to be transitional or positive. Audience members discussed the implications of specific behaviors by contrasting the different character types. Although characters modeled behaviors within distinct but interrelated storylines, the respondents spontaneously compared characters' ways of confronting similar dilemmas across storylines, suggesting that listeners perceived the drama as a unified whole rather than as a series of parallel stories. The use of more than one transitional character for each behavioral objective might be beneficial for improving audience identification with agents of behavior change by providing several models to which the audience can relate.