Globalization: Information and Communication Technology

In my previous blog, I discussed methodology to evaluate the efficacy of a community health radio program. I discussed the flawed nature of many of the ways that community health radio programs are evaluated. The use of surveys as a stand-alone indicator of a differential knowledge outcome is insufficient to evaluate the efficacy of a radio program. For instance, a program could have sparked a dialogue about HIV/AIDS in a family living, where the sensitive had not been broached before. This would be a success in and of itself; however, it would not be reflected in the results of a survey that evaluated a person’s understanding of how HIV/AIDS is transmitted. However, there are many different social change indicators that can be observed over time in order to ascertain whether a community radio has been successful. These social change indicators are discussed in the Department for International Development’s report on Radio Broadcasting for Health.
In this report, Dr. Andrew Skuse wrote that the example indicators relevant to health broadcasting include: expanded public and private dialogue and debate; increased accuracy of the information that people share in the dialogue and debate; the means available that enable people and communities to feed their voices into debate and dialogue; increased leadership and agenda setting role by disadvantaged people on issues of concern resonates with the major issues of interest to people’s everyday interests; linked people and groups with similar interests who might otherwise not be in contact. All of these indicators are based on dialogue that is stimulated by the health radio broadcasts. If health radio broadcasts successfully create dialogue, by continually reinforcing key points about critical health issues, there will be resulting action. An example of the type of action that could be taken as a result of listening to a radio health broadcast would be an increase in individuals engaging in healthy and health seeking behavior. An example of healthy seeking behavior would occur, if after listening to a series of broadcasts on the importance of HIV/AIDS testing, there was an increase in the number of people visiting a nearby HIV/AIDS testing site. An example of the positive influence of a public health radio station on a community was documented in the 1994 Save the Children United Kingdom study in Mali on HIV/AIDS, where they found that of the 2000 people surveyed 47% of the people had heard about AIDS through the radio.
Researchers should include an evaluation of the social change indicators when evaluating the efficacy of a community health radio intervention. A way to do this is through qualitative interviews and focus groups. Both of these methods of research can utilize protocols, which allow people to describe behavior change that occurred as a result of the introduction of health radio broadcasts. Unlike surveys, which are typically used to evaluate the efficacy of radio health broadcasts, interviews and focus groups go beyond an evaluation of a person’s knowledge about critical health issues.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

In a lecture given my Paul Wise at Stanford University, it was pointed out that in order for true and lasting change to occur in global public health, technical interventions had to be paired with social change. This is necessary in order to provide a social context for technical care that is accessible universally. It follows naturally, that the evaluation of any technical intervention is extremely important, if it is to be a successful counterpart to social change. In these difficult economic times, funds to support international health interventions are even more limited. It is important for potential interventions to be evidence-based. Research supporting the efficacy of said interventions is critical, if funding is to be directed towards international health interventions. The role of international aid specialists has widened, including not only the financing of international health interventions, but also the evaluation of the efficacy of their efficacy.

Dr. Wise explained that access to interventions was dependent on the efficacy of the intervention. If an intervention is highly effective, than people’s access to a health care provider or insurance will determine their access to the intervention. If the intervention is ineffective, than people’s disease burden will determine their access to the intervention. The most desirable situation would be the implementation of highly effective interventions within the context of a health system that is open to all people. In order to create a situation like this, researchers must evaluate the efficacy of interventions, so that they can be paired with social change (i.e. physicians/public health practitioner working with international policy makers/lawyers/politicians) to improve international health.

It follows, that there needs to be an evaluation of the efficacy of community health radio programs. If funding to support the development of future community health programs is to continue, there must be research that shows that the community of people listening to the community health radio program became more knowledgeable about critical health issues because of their exposure to health broadcasting. Researchers should employ a differential outcomes study, in order to ascertain the efficacy of a community health radio program. A differential outcomes study evaluates whether the intervention changed the behavior or knowledge of the audience. An example of a differential outcomes study for a community health radio program was done in Zambia in 1991 to evaluate the effectiveness of a radio drama program in improving a community’s understanding of HIV/AIDS. Researchers gave the audience a survey asking them general questions about the transmission, treatment, and prevention of HIV/AIDS before and after they introduced the radio drama. There was no difference in terms of the knowledge that the audience had about HIV/AIDS. But this does not show that the drama had no positive impact, but it does mean that the instrumentation used to measure the impact of the radio should be improved. Focus groups could be used to supplement these surveys. Focus groups are a much more organic research method, allowing people to build off of each other’s ideas and cumulatively produce an original idea that they would otherwise not have thought of in an individual survey. It is important to continue improving research methodology, so that community health radios can continue the important work of providing rural communities with critical health information.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

I introduced the topic of using the radio to train community health workers in an earlier blog that was focused on how health broadcasting could support HIV/AIDS prevention. This topic was extremely interesting, so I have decided to explore the themes surrounding radio communication intervention that supports health workers, in more detail, focusing specifically on SMS texting as the new radio. In much of the developing world, physicians are scarce. The “brain drain” phenomenon describes the recurring removal of physicians from resource poor locations to resource rich locations. In many developing nations there is training for Doctors, however, once a Doctor has been trained there is a very low likelihood that they will continue to live in the resource poor location. For this reason, many health organizations, such as Partners in Health, have touted community health workers as the future for health in developing nations. However, although community health workers do provide a very compelling solution to the brain drain problem, they are still challenged to work at low-wages, without centralized support systems, and within scattered communities. Health communication technology must be paired with community health workers in order to improve their efficiency, support, and retention rates.

A good example of a health communication technological device that can support a health worker (other than the radio) is the cell phone. In sub-Saharan Africa, studies have shown that the rates of cell phone use have gone up by 60% for the last 5 years. Cell phones have pre-existing infrastructure (unlike the internet), are low cost, and have many benefits that can be used to support health workers. SMS texting has been called the new radio, because it can be used to transmit health information to many people. Text-for-Change is an example of radio as SMS. Text-for-change allows community health workers to send out mass texts informing people about things like HIV/AIDS testing sites and follow-up drug care. Radio as SMS has allowed health workers to improve drug adherence, communication with patients, and communication with other health workers. Like the radio, SMS allows the transmission of information to a recipient who would otherwise be unable to access health services and information. Unlike the radio, SMS texting allows the listener/audience to transmit information back. Unlike SMS texting, radio can send more extensive and detailed information to a wider audience, reaching hundreds of thousands of listeners. Radio and SMS texting can be paired together, to help maximize the efficiency of community health workers who are working in resource poor countries with scattered communities. This summer, I will be working with FACE AIDS to create a community health radio program and text-for-change hotline in Rwanda. The natural pairing of these two global health communication technologies, will hopefully, improve many rural Rwandan’s understanding of HIV/AIDS. I will be evaluating the efficacy of each of these health communication technologies independent of each other, and also together, to determine the best way to maximize the positive results of SMS texting and community health radio programs.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

Community health radio programs provide a unique way to introduce an audience to information about how to avoid getting infected by HIV/AIDS. A community health radio program can bring information about how to prevent HIV/AIDS infections, which would otherwise be inaccessible, especially in rural areas of developing nations, where communities are scattered and resources are limited. In Zambia, 16% of the population is infected with HIV/AIDS and 50% of the population is not within normal walking distance of a community clinic or hospital. This makes it impossible to do diagnostics at the point of care, increasing the already important role preventative treatment plays in combating HIV/AIDS. In Zambia, John’s Hopkins University helped to develop and implement a 26-week, 30 min session radio distance-learning program to train health workers to address HIV/AIDS in their communities. The researchers went to the various scattered communities in Zambia and organized Neighborhood Health Committees (NHC). These NHCs were responsible to listen to the radio distance learning scripts, in order to be equipped to address HIV/AIDS in their communities. The program was extremely successful; it supported community mobilization and helped provide scattered communities with access to preventive HIV/AIDS treatment. The results of this effort could have been improved if the NHCs were connected to centralized clinics and hospitals for support and advice.

Soap operas are another method of introducing information about HIV/AIDS prevention through the community health radio. In Rwanda, “Uranana,” which means “hand in hand” is a popular radio soap opera that addresses women’s health issues and HIV/AIDS. HIV/AIDS prevention information pertaining to abstinence, being faithful, and condomising, is introduced in conjunction with dramatic plots and thrilling cliff -hangers. The content of these dramatic productions is often audience-led. The themes used in Uranana were developed after researchers asked about the critical health issues that locals were interested in learning about. HIV/AIDS was consistently listed as a concern. In Rwanda, for every one television, there are 101 radios. The dominance of radio, as the primary mode of communication, allows soap operas to have a wide reaching affect, informing many people about how to avoid contracting HIV/AIDS. These soap operas overcome problems of illiteracy. In Rwanda, a 1996 study by the government showed that there was an illiteracy rate of 48.3%. This is a gendered issue, because of that 48.3%, 68% are women. Soap operas that address women’s health issues and HIV/AIDS are especially powerful, because they incorporate women into a dialogue about HIV/AIDS. Women, who would not otherwise be able to get information about HIV/AIDS from a book, can now gain access to information about preventative treatment.

Another way community health radio disseminates information about HIV/AIDS prevention is through public service health campaigns. Simple catchy phrases like “take the test, take control,” have been used to remind young people to inform themselves about HIV/AIDS. These public health campaigns push the use of protection, using background sounds such as a baby crying, to illustrate the consequences of having unprotected sex. These public health campaigns have encouraged HIV/AIDS testing, wearing a condom, and being faithful. They’re not only used in developing nations, they’re also used on MTV and BET, two channels that attract a wide teen and young adult audience in the United States.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

Community health radio allows an audience to have the unique opportunity of listening to the stories and experiences of fellow community members who are infected with HIV/AIDS. A very important component of community health radio is it’s ability to engage in meaningful dialogue with community members, by giving them a space to share their own experiences with personal health and the healthcare system with the people living around them. These personal stories bring make each community radio program uniquely tailored to reflect the shared experiences of a group of people. The community health radio is a unique social space, where people who are infected with HIV/AIDS have the opportunity to influence the de-stigmatization of hundreds or thousands of people. By sharing their personal experiences, they are providing a powerful example of a person who is living with, not dying of HIV/AIDS.

All too often, HIV/AIDS is view as a disease that leads to death, isolation, and shame. When community members who are infected with HIV/AIDS, courageously share their experiences own exeeriences, they are breaking downthis stigma by providing audience members with a very real and compelling example of a human being who is finsding ways to live with HIV/AIDS. However small the detail, from sharing how they began taking antiretroviral drugs, to the larger experience of getting tested for HIV/AIDS, the simple act of sharing how to live, cope, and even thrive with HIV/AIDS brings back a sense of “humanity” to those who are infected with the disease. In many places around the world, especially in developing nations where women have limited social, political, and ecoomic rights, community health radio provides people infected HIV/AIDS with the opportunity to “deconstruct” the de-humanizing identity that has been placed, on people, especially women, who are infected with HIV/AIDS. Instead of being viewed as the “other,” a living dead who exsist in isolation and shame, community health radios, allow those infected with HIV/AIDS to share their very real, and very human experiences. Ultimately, by sharing these experiences they reduce the social distance between themselves and their community members, introducing a dialogue about how to support and empathize with those with HIV/AIDS .

In many developing nations in sub-Saharan Africa, such as Rwanda, there is little to no dialogue about HIV/AIDS, because of it’s connection to one’s sexuality. Community health radio provides a way to introduce into the home, conversation about HIV/AIDS, which might not otherwise have been had. Hopefully, these conversations will have a transformative power of removing the shame associated with HIV/AIDS. Hopefully, community health radio programs will help people understand the difficulties faced by those infected with HIV/AIDS, encouraging empathy, rather than disdain. Another important element created by increasing conversation about HIV/AIDS in the home, is to create a sense of solidarity among those infected with HIV/AIDS. Hearing someone else talk about an experience that you are going through, helps one to understand that they are not alone. Community health radios can help create a powerful support system for people infected with HIV/AIDS, by bringing those who are and are not infected with HIV/AIDS, into a more empathetic, collaborative, and supportive role.