Radio Role Models for the Prevention of Mother-to-Child Transmission of HIV and HIV Testing Among Pregnant Women in Botswana: Documenting Change

This study, published in the journal Health Promotion International, presents an evaluation of the serial radio drama Makgabaneng (Rocky Road) in Botswana, which is designed to encourage use of prevention of mother-to-child transmission (PMTCT) programmes and promote HIV testing during pregnancy, among other objectives. The evaluation was undertaken to establish whether women identified with the PMTCT role models in the drama, and if this led to increased uptake of PMTCT and HIV testing. The study argues that, coupled with other supporting elements, serial dramas could contribute to HIV prevention, treatment, and care initiatives.

The Makgabaneng radio drama was developed and implemented by the Government of Botswana in collaboration with the United States Centers for Disease Control and Prevention (CDC). The drama is designed to encourage safe behaviours and promote the use of PMTCT services and works in conjunction with activities designed to reinforce these behaviour changes in the population. The drama is based on the Modeling and Reinforcement to Combat HIV/AIDS (MARCH) strategy, which is grounded in social cognitive theory and focuses on both showing people how to change and supporting their efforts to maintain healthy behaviours. The drama includes good and bad characters, as well as transitional characters who are designed to be like the audience - struggling and changing over time and eventually achieving specific behaviour goals. Approximately 250 episodes of the 15-minute serial had been broadcast prior to the study.

The survey was conducted among just over 500 pregnant and postpartum women in 10 antenatal clinics. The study found that approximately four out of five women (79%) reported ever listening to the drama, and just over half (53%) reported listening at least once a week. Data suggested that women did pay attention to the PMTCT storylines. In responses to unprompted questions, findings showed that over 51% of women recalled one or more characters and 20% named one of the PMTCT characters as their favourite.

According to the article, simply listening to the programme was not associated with HIV testing during pregnancy. However, women who named a PMTCT favourite character were significantly more likely to have tested for HIV during pregnancy than those who did not. This relationship remained even after controlling for variables such as pregnancy characteristics, exposure to other PMTCT information, knowing a pregnant woman taking azidothymidine (AZT), partner testing, and demographic variables, although the study did show that many of these variables are also significantly associated with HIV testing during pregnancy.

The research also found that 69% of women tested for HIV during pregnancy, a substantial improvement in the uptake of PMTCT services from 2002, when only 49% of women attending antenatal clinics were tested. Analyses suggest that a number of factors may have contributed to this increase, including paying attention to PMTCT role models in the Makgabaneng drama.

The report states that naming a character from the drama as a favourite may indicate a degree of identification with that character that goes beyond simply frequent listening or recall. Women who identify with a particular character may see that character as a role model for how to behave during pregnancy. Real-life models, such as knowing pregnant women taking AZT, are also associated with HIV testing. According to the document, the results of the study illustrate the potential effects of both fictional and real-life role models and support the utilisation of role models in HIV/AIDS-related behaviour change interventions. Furthermore, additional efforts to bring women living with HIV together in safe settings may allow them to serve as real-life role models for one another and facilitate the development of supportive social norms.

The research concluded that programmes such as Makgabaneng have the potential to reach large audiences and provide a significant vehicle for HIV preventive interventions, and that attention to the identification with specific characters in a radio serial may prompt behaviour change. As stated in the report, with the increasing availability of HIV testing, treatment, and care in African countries, interventions that encourage and support the utilisation of services, as well as the initiation and maintenance of related prevention and care behaviours, are greatly needed. Makgabaneng is one example of such an intervention. The programme is designed to motivate listeners to change their behaviour through entertaining storylines that depict characters making decisions and behavioural choices, experiencing positive and negative consequences, and modeling new ways of thinking and behaving.