Evidence Synthesis Packet - Evidence Review Team 6: Science, Technology, and Innovation

"Implementers and policy-makers alike have recently explored the extent to which they can leverage science, technology, and innovation (STI) - with a focus on mHealth, health technologies, health literacy, and trans and social media - to improve behavior changes required for improved child survival outcomes. Increasing interest in the role of STI to improve child health is evidenced in the growing number of events, websites, and literature focused on this topic..."

In 2013, the United States Agency for International Development (USAID) convened a team of experts to conduct a systematic review of the evidence on a range of topics, including the role of STI on child survival. In conducting this review, evidence review team 6 (ERT6) was guided by the following question: What are the effective and sustainable interventions that utilise communication-based science and technology innovatively to promote and support behaviour and social changes that are needed to accelerate reductions in under-five mortality and optimise health and protective child development to age 5?

ERT 6 answered this focal question by dividing into 4 sub-groups and reviewing publications from 1990 to April 2013 (the time of the Evidence Summit) covering the main categories of STI interventions relevant to the child health field: (i) mHealth - defined as mobile technologies in health; (ii) health technologies - defined as diagnostic, therapeutic, and assistive medical devices seeking to prevent child mortality; (iii) health literacy - the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions; and (iv) trans and social media - defined as technology used to facilitate interactions and exchanges between individuals and virtual communities across different media forms and platforms in order to improve health. To gather relevant evidence, a systematic literature review was conducted in January 2013 by USAID. A Call for Evidence was also conducted, wherein ERTs were invited to submit peer-reviewed and grey literature that would to address the focal question.

An "evidence synthesis" for each of the 4 main categories is provided in the report. [Footnote numbers below have been removed by the editor but may be accessed in the full document, below.] For example, for the fourth category, the report notes that "[o]verall, evidence showcasing the direct influence of multi media platforms on child health is rare. While media has had an impact on changes in attitudes, awareness and knowledge, the influence of transmedia and social media on specific health outcomes has been more difficult to assess." Here is a summary of what has been found:

• Regarding transmedia and social media studies that met the review criteria, of the available research identified in the review, the most recent and comprehensive was a meta-analysis of the impact of localised Sesame Street education programming. This review, which included data from 24 studies, 15 countries, and over 10,000 children, examined, among a range of educational outcomes, impact on health attitudes and knowledge (including information on how disease is transmitted, basic hygiene practices, nutrition, and safety). The analysis found that the size of the Sesame Street intervention was comparable to that of other early childhood interventions, with one key difference: its media intervention reached more children than any other programme. "However, this evidence still only scratches the surface with respect to its potential for improving child health, given its lack of focus on assessing its direct impact on behavioral outcomes."
• The report notes that, putting methodological issues aside, "there is evidence to support the claim that media campaigns are an important complement to health education across a range of domains." For example, a study of community-based radio campaigns showed that individuals who heard pregnancy-related radio messages were twice as likely to report knowing danger signs associated with pregnancy within the first two years of the intervention, and three times as likely by the third year of the intervention. Another study found that a video documentary on the importance of catch-up tetanus vaccinations increased knowledge about the individual benefits of vaccinations as well as attendance at vaccination sessions. In a similar vein, an evaluation from the USAID-sponsored programme Health Communication for Child Survival (HEALTHCOM) described the impact of a mass media campaign in the Philippines on improving measles vaccination coverage over a 5-year period. The study found that overall vaccination levels increased and were sustained significantly following a mass media campaign utilising simple messaging about malaria through TV, radio, and print media channels. A study from Iran also found that a mass media campaign with targeted TV commercials yielded statistically significant increases in community awareness of measles vaccination campaigns, which helped to achieve target vaccination coverage rates for catchment areas. Although both of these studies show a linkage between mass media and vaccination related outcomes, neither included a discussion of study limitations, making it difficult to assess the full strength of the findings.
• The benefits of mass media on child health seems promising, yet often only result in a positive correlation or modest, causal impact. For example, one study found that a TV campaign that included radio, newspapers, and bus advertisements to support the use of zinc tablets as treatment for childhood diarrhoea lead to only modest improvements in caretaker awareness of zinc as a treatment option. Nearly two years after the media campaign, only 25% of urban non-slum, 20% of municipal and urban, and 10% of rural children under age 5 were actually receiving zinc as treatment for diarrhoea. The ERT note that this might be due to that fact that participants commonly gave zinc to their children for less than the recommended dosage (10 days), limiting the chances of the intervention to reach its maximum efficacy.
• The use of media to support HIV/AIDS education perhaps offers the richest data in favour of media interventions. For example, a study from South Africa examined HIV/AIDS communication programs and campaigns and found wide awareness of locally distributed multi-platform approaches (including Soul City, Soul Buddyz, loveLife, and Takalani Sesame) in this area. The value of such programmes in changing attitudes (e.g., de-stigmatising the face of the disease) has been highlighted in studies. "Interestingly, a central component of the Takalani Sesame intervention is a protagonist Muppet character, Kami, who, in being HIV positive, serves as a model for communicating age-appropriate messaging about the disease. The influence of such iconic characters and their linkage to promoting behavior change is hinted at in the literature, but an aspect whose power should be further and more systematically examined".
• The complexity of interpreting the range of findings from various media studies is, in large part, due to the challenges associated with designing and implementing this research in the first place. For example, a study from Bangladesh that incorporated the use of simple messaging around breastfeeding found no measurable impact of their communication strategy on child nutrition and health in the experimental area. The researchers reason that the lack of an effect may not be because the intervention was futile, but because the media campaign (especially radio spots) spilled over into the control area or because norms and messages in favour of breastfeeding were being broadcast nationally at the time of evaluation.
• "The challenges of studying social media's and transmedia's impact on health behaviors are extensive. Experimental trials, while necessary for isolating effects, can uncover only part of the story. To gain a full understanding of the capacity of social and transmedia to promote behavioral change, it is important to evaluate interventions as they are naturalistically encountered by end users. Such insight will only come from research designs that combine both experimental and quasi-experiment studies with qualitative methodologies that value systematic observation of access, exposure and use. While social media and transmedia are themselves only in nascent stages, so too are the tools for studying their effects."

In conclusion, it is noted that "[t]here have been hundreds of peer reviewed articles published that demonstrate the value of ethical, evidence, and science based interventions. Many of these have heralded work characterized by the value of what communication-based science and technology interventions in health can do....Nonetheless, despite the rich evidence, programs and academic inquiry advancing a field, our ERT had a challenge to sift through and present clear, peer-reviewed evidence that could help support future health strategies and program[s]....[I]t is incumbent upon the academic and development communities to advance the evidence base for STI interventions leading to sustained population behavior changes necessary for accelerated reductions of under-five child mortality. Social sciences need the full support of research institutions and must become an integral part of multisector development challenges such as child survival. Further, the social science community is encouraged to embrace scientific methods which enable assessment of causal attribution to both behavior and child survival outcomes."

Click here for the 51-page report in PDF format.