Karamoja on the Move: Testing A Peer Learning & Community Theatre Model

Emorikinos Daadang Etogogongo Alatanakin Ngidwe (EDEAN) (Let's Come Together and Strengthen Child Spacing) is a community-based intervention in Uganda that is designed to test the hypothesis that increasing fertility awareness (FA) through community theatre can improve family planning (FP) use. (See Related Summaries, below). It forms part of the Fertility Awareness for Community Transformation (FACT) Project, a 5-year (2013 - 2018) research intervention and technical assistance project being implemented by the Institute for Reproductive Health, Georgetown University, and Save the Children, with funding by United States Agency for International Development (USAID).

As Esther Spindler explains in this presentation, 2011 data reveal that 7.4% of married women in Karamoja, a region in Uganda, use modern FP. Only 30% of women are counseled on FP methods, and less than 20% of postpartum mothers receive FP counseling. In this context, EDEAN began in April 2014 with a platform assessment, followed by formative research, development and pretesting of materials, district entry meetings, and selection of peer group members. Peer moderators and peer group members (18-25 yrs) attend meetings and rehearsals and then enact performances at 6 early childhood care and develoment (ECCD) centres on: couple communication, menstruation, fertility, and FP. The project was officially launched in June 2016 with community celebrations. EDEAN also created a digital story (see video, below).

The proof of concept evaluation involved a quasi-experimental study with mixed methods. Baseline data were collected in July 2016, with endline data collected in January 2017, at the end of the project. It involved: household surveys collected from 400 intervention and 200 control households at pre and post; focus group discussions with audience members and peers performing; key informant interviews with community leaders and health service providers; and monitoring and observations of EDEAN meetings, rehearsals, and performances.

Sample qualitative finding: "These performances are good because look at the way that woman was able to talk to a very difficult man, most of our men here in Karamoja are like him. I really like it when she eventually managed to talk to him." - Female audience member, 30 years old.

Adjusted logistic regression results for FA and FP outcomes, by post-performance non/viewers (n=600) found higher FA, higher intent to use modern FP, higher FP information seeking behaviour, and lower reported beliefs that FP methods cause side effects.

Lessons learned:

• A peer learning and community theatre social and behaviour change (SBC) intervention can generate higher demand for FA and FP information.
• When grounded in traditional storytelling practices, community theatre can be an effective communication vehicle to dispel myths about FP.
• FA and intent to use FP can be increased through a short, 6-month theatre SBC intervention.
• Demand generation activities such as community theatre need to be paired with strong service delivery platforms and linkages to shift behaviour from intent to use of FP.

Editor's note: The above is a summary of a presentation delivered by Esther Spindler at Shifting Norms, Changing Behaviour, Amplifying Voice: What Works? The 2018 International Social and Behavior Change Communication (SBCC) Summit featuring Entertainment Education, held April 16-20 2018 in Nusa Dua, Indonesia.

Click here for the 11-slide presentation in PDF format.