Public Engagement in Malawi through a Health-talk Radio Programme 'Umoyo Nkukambirana': A Mixed-methods Evaluation

"...radio provides an effective means of public engagement in resource-poor settings..."

Public and community engagement have been increasingly recognised as a critical component of international medical research. Relative to population, Malawi produces high numbers of research outputs through both local and international institutions, but there remain common misconceptions about health research among Malawians. In this resource-poor country, where radio has the potential to reach wide audiences, including less literate populations, the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW) introduced an interactive health-talk radio programme to improve engagement between researchers and clinicians with the media and general public. This article discuss a mixed-methods evaluation of Umoyo Nkukambirana (literally translated as "let's talk about health"), focusing on national responses, as well as impact on knowledge and reported treatment-seeking behaviour.

Umoyo Nkukambirana was produced in collaboration with the Development Broadcasting Unit (DBU) of Malawi Broadcasting Corporation (MBC), whose main role is to use participatory communication approaches to promote national dialogue around development and health issues. DBU works with rural communities by organising radio listening clubs (RLCs) that meet regularly to listen to recorded programmes for feedback. In addition, RLCs identify problems in their community and discuss them with relevant service providers to develop a locally relevant action plan. During the establishment of the radio programme, MLW's science communication department worked with six preexisting RLCs from six districts. A participatory radio broadcasting approach was adopted to ensure relevance and ownership by involving the RLCs in generating content for the programme through local case studies, poetry, songs, questions, and drama. Medical researchers presented health topics (e.g., research and blood, diabetes, tuberculosis (TB), drugs and vaccines, cancer, malaria, meningitis, and DNA) in the local language, Chichewa, and responded to questions asked by listeners through SMS (text messaging) and via RLCs. Every week, 5 listeners who responded correctly to a question related to the weekly topic won t-shirts. The pilot programme, which was advertised widely through the radio, newspaper, and posters, as well as at community launch events, aired every Sunday from 5:00 p.m. to 5:30 p.m. on MBC Radio 1 from August 2012 to April 2013.

For the study, focus group discussions (FGDs) were conducted with RLCs, and the national response was monitored quantitatively through FrontlineSMS. Select findings:

• Reach and engagement: Most participants felt that the duration of the programme (30 minutes) was very short and insufficient to develop themes adequately. A total of 277-695 SMS (median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%).
• Knowledge: FGDs with RLCs demonstrated improved understanding of medical research and its role when introducing new drugs and interventions. Listeners and FGD members stated that the radio programme increased their understanding of symptoms, causes, and prevention of a range of diseases. The radio programme was perceived to clear up misconceptions about malaria, meningitis, DNA, diabetes, and cancer. Some FGD participants stated they had not understood why blood is drawn for donation or laboratory tests, associating this with blood stealing and Satanism; these beliefs were addressed. However, people expressed difficulties with understanding the topic of DNA due to challenges in translating scientific terms into a locally appropriate language.
• Action: Participants from some RLCs stated that knowledge acquired through the radio programme empowered them to improve their own responses to illness experienced within the household. Several examples are provided. Claims that response to illness was improved focused particularly on meningitis programmes that included case studies, which "suggests the need to develop programmes that focus on increasing knowledge through personal examples since these are likely to sustain the empathetic interest of listeners." Knowledge gained through listening to the radio programme was also felt to empower some individuals to counsel and encourage others to seek medical treatment on time, spreading messages within communities beyond those who listened to the programme.

In reflecting on the findings, the researchers point out, for example, that radio may be an effective means of exposing men to health information in resource-poor settings due to their increased access to radio. (Low participation of men in health interventions or research has been widely reported.) In settings where men are often household decision-makers, their understanding of research and health is likely to affect household decisions to seek biomedical treatment or to enrol or withdraw from research studies.

That said, Umoyo Nkukambirana was developed to increase awareness among both men and women. In this case, the lower response rate from women is likely to have been a reflection of lower phone access, ownership, and literacy, as well as limited time to listen and respond to the programme, particularly for rural women engaged in domestic chores. Women also stated they failed to engage because they felt they lacked knowledge to respond to the weekly questions through SMS. "Careful consideration of the respective needs of men and women should, therefore, be included in the design of programme content and process to improve knowledge of health issues."

In conclusion: "Findings from this study demonstrate how the radio can be used as a tool to increase public understanding, demystify research and clear up misconceptions. The radio programme generated interest throughout Malawi, facilitating access to health information among people from all districts and answered to the high demand for interactive programmes about health, with regular requests for increased transmission times and rebroadcasts."