Asia's population and family planning programmes: leaders in strategic communication.

PIP: Countries in Asia played a key a role in identifying problems related to population growth and high fertility and in developing strategies to address these problems. Despite the economic problems experienced by some, they continue to lead the world in designing and implementing programs in the areas of reproductive and family health using a strategic communication approach. This modern strategic communication program has the following characteristics: science and research-based, client-centered, benefit-oriented, service-linked, entertainment-education focused, professionally developed, and programmatically sustainable. This paper describes several outstanding Asian family planning communication programs in 5 countries that clearly illustrate these 7 elements. Overall, these Asian countries have shown that strategic communication can be the steering wheel for modern family planning and health promotion programs. The article concludes by giving future directions for strategic communication programs to address new emerging health and population concerns in the region.^ieng

"Enter-educate." Reaching youth with messages of sexual responsibility.

PIP: Messages about sexual relationships, the prevention of pregnancy and disease, education, the empowerment of women, and concern for the environment are increasingly being disseminated to audiences of all ages through the use of entertainment. Ideas are presented in this Enter-Educate approach through popular, enjoyable entertainment in the form of songs, dramas, soap operas, variety shows, and other folk media. This approach can be adapted to be acceptable and effective in all cultures. Yafaman is one such example. It is a drama written and acted by high school students in Cote d'Ivoire which depicts the story of a school girl who learns that her older, married boyfriend is no longer interested in her when she becomes pregnant. After winning the annual national drama contest, Yafaman was televised and broadcast widely in schools and on national networks in francophone Africa. The video has also been dubbed in English for wider use. Popular music has delivered effective messages of sexual responsibility to young adults in Latin America and the Philippines. The US Agency for International Development-funded Population Communication Services project at the Johns Hopkins University supports 36 major Enter-Educate television series and specials, nine radio dramas, three songs, and nine music videos. Other organizations are expanding or experimenting with work in this area. The authors discuss the theoretical basis for Enter-Educate projects and explain that the approach works because it is pervasive, popular, personal, passionate, persuasive, practical, profitable, and proven effective.^ieng

Improving the quality of service delivery in Nigeria.

This study evaluates the effect of a nurse training program in family planning counseling skills on the quality of service delivery at the clinic level, as well as its impact on client compliance with prearranged appointments. The study used a quasi-experimental design to compare certified nurses who received six weeks of family planning technical training with certified nurses who, in addition to the technical training course, received a three-day course in counseling skills. Data were collected through client exit interviews, expert observation, and inspection of medical record abstracts. Trained nurses performed better than their untrained counterparts in the quality-of-care areas investigated--interpersonal relations, information giving, counseling, and mechanisms for encouraging continuity. The likelihood that clients will attend follow-up visits was also found to improve when they were attended by trained professionals. Short-term counseling training can significantly improve the quality of care provided by family planning workers, as well as client compliance with follow-up appointments.

PIP: In 1989, researchers evaluated the impact of a 3 day course in counseling and interpersonal communication skills for family planning nurses in Ogun State, Nigeria on quality of service delivery and on client compliance with follow up appointments. They interviewed 480 clients, observed 39 nurses, and examined the medical records of 1001 clients who visited the 8 clinics. 97% of clients who spoke to a trained nurse felt the nurse earnestly listened whereas only 66% of those who spoke with an untrained nurse felt this (p.001). Further clients tended to be more comfortable with trained nurses than with untrained nurses (97% vs. 76%; p.001). Moreover trained nurses provided clear explanations to 94% of clients while untrained nurses did so to only 76% of clients (p.001). In addition, trained nurses were better at demonstrating the use of a contraceptive (p.001), repeating instructions for methods (p.05), asking if clients had more questions (p.05), and referring to booklets or leaflets about methods (p.05). They intended to schedule a follow up visit with clients who used a method for the 1st time (96% vs. 78%; p.001). In fact, clients of trained nurses were 2 times as likely to return than those of untrained nurses (84% vs. 44%; p.001). Moreover, of clients who chose to use the IUD at the 1st visit, 85% of those attended to by a trained nurse returned for follow up appointments compared to only 30% of those attended to by an untrained nurse (p.001). The corresponding percentages for those who chose an oral contraceptive were 91% and 70% p.001). The findings revealed that the training course did indeed improve the quality of family planning service delivery and client compliance. In fact, counseling training most likely provided even greater advantages than the study suggested since untrained nurses interacted with the trained nurses socially and on the job. Moreover they were also inquisitive about what methods their trained colleagues used.

Mass media family planning promotion in three Nigerian cities.

Television promotion of family planning and clinic sites in three cities of Nigeria--Ilorin, Ibadan, and Enugu--played a significant role in 1985-88 in increasing the number of new acceptors at family planning clinics in each city. Family planning skits, prepared with advice and support from the local service providers, were included in existing popular entertainment shows. Questions asked in a recall survey among the exposed population in Enugu and Ibadan revealed that about half of those surveyed in both cities had seen the television episodes. Of those who had watched, 79 and 99 percent, respectively, recalled the family planning messages, and 69 and 88 percent, respectively, recalled specific clinic sites mentioned. Following the media promotion, the number of new clinic clients per quarter in Ilorin increased almost fivefold (in the original clinics evaluated); in Enugu, the number of new clients per month more than doubled; and in Ibadan, the number of new clients increased threefold. Use of entertainment through this "enter-educate approach" is a promising technique that can be replicated in different settings to encourage new clients to seek family planning services.

New directions in family planning communication: 12 predictions for the 1990s.

PIP: Good communication about family planning is needed for many reasons: 1) what many people think they know about family planning is wrong, 2) about 25% of the Asian population (600 million people) are between the ages of 10 and 19 and they need to be informed, 3) individuals must want to use family planning so they will use it regularly and effectively, and 4) people hear competing messages from those opposed to family planning. The authors make the following predictions for the field of family planning IEC in the 1990s: 1) family planning communication will have many different audiences, so messages and media will have to be developed for very specific groups; 2) more time will be spent on research, learning about specific audiences, the media, and background before developing messages, and messages and products will be carefully tested before being widely distributed; 3) peer groups will be used more to reach peer groups; 4) entertainment will reach and teach wider audiences about family planning, AIDS, and sexual responsibility (promoting "enter-education," a combination of entertainment and education); 5) audiences will participate more actively in different kinds of family planning communication, including community mobilization and individual involvement; 6) family planning messages will be much more personal, using human interest stories to capture and persuade the audience; 7) multiple media will be used more and more to get the message across; 8) the best quality family planning entertainment materials will be able to compete with commercial products and produce revenue; 9) campaigns and other communications will be oriented towards large regional markets; 10) more creative and more sympathetic communication in clinics and by health care providers will increase acceptance and continuation rates for many methods; 11) communication among family planning professionals will increasingly depend on effective national population information centers that can use appropriate modern technology, and 12) more resources and creative effort will be put into evaluation of all forms of IEC and this evaluation will show that well-planned and well-implemented IEC programs can and do lead to behavioral change in family planning.^ieng

Population communication services: a global perspective.

PIP: Communication support for health and family planning programs is receiving renewed attention. The johns Hopkins University (JHU) Population Communication Services (PCS) project was established in 1982 to respond to the increasing need for communication expertise, to provide a responsive source for advice, and to develop implement the new directions that are necessary to make family planning communication programs more effective. The project extends a range of services to government programs, private family planning associations, and to media that want to improve the content or coverage of family planning communication, JHU/PCS emphasizes the close links between good communication and good management and the need for managers at all levels, from the Minister of Health to the supervisor of grass-roots field workers, to understand the components of a communication program for the 1980s. Principles underlying the project's work include: communication as process rather than product, the audience as participant, linking mass media and interpersonal communication, coordination with and among agencies, training that is specific and relevant, IEC as institution building, use of the private sector, an attempt to recover some of the costs of IEC work, and ongoing evaluation of program activities. IEC activities can be strengthened considerably b a knowledgeable commitment at the top of the decision-making process; constant feedback from intended audiences; and interactions among service delivery personnel, influential community members, and the media. In turn, strong IEC activities can substantially strengthen existing family planning programs.^ieng

Parental perception and self-concept of gifted and average underachievers.

Self-concept and parental evaluation of their child's self-concept were investigated in fifth to eighth grade gifted and average achievers and underachievers (n = 134). In the average sample achievers had higher self-concepts than underachievers. In the gifted sample, the reverse was true; underachievers had higher self-concepts than achievers. In general, the parental evaluations of their children were unaffected by the child's performance in school. In the average sample only the mothers evaluated their underachieving children lower, whereas in the gifted sample there was no significant difference between parents' evaluations. A tentative explanation is offered for the relationship among giftedness, achievement, and self-concept.