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Evaluation of the “Break The Chain” Campaign

Evaluation of the “Break The Chain” Campaign. Mid-program Evaluation Conclusions August 2011. Unicef Namibia. Overview. The “Break the Chain” campaign to reduce multiple and concurrent partnerships (MCP) was implemented nation-wide, beginning in December 2009.

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Evaluation of the “Break The Chain” Campaign

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  1. Evaluation of the “Break The Chain” Campaign Mid-program Evaluation Conclusions August 2011 Unicef Namibia

  2. Overview • The “Break the Chain” campaign to reduce multiple and concurrent partnerships (MCP) was implemented nation-wide, beginning in December 2009. • From April-May 2011, a 1-year outcome evaluation was conducted.

  3. Campaign Overview • MCP is a key driver of the HIV epidemic • BTC Campaign behavioral objectives: • Increase awareness at population level of MCP and the associated risks [Focus of Phase 1 of campaign] • Reduce MCP among men and women 15-49 years of age • Increase consistent condom use among men and women 15-49 years of age • Campaign applied an holistic approach: mass-media, multi-media, & interpersonal channels

  4. Evaluation Objectives • Determine reach of campaign • Determine awareness of MCP and its risks • Determine whether MCP-related behaviors have decreased in association with the campaign

  5. Evaluation Design • Quantitative • Cross-sectional survey in 3 sites • Two-phase sampling: psu=household (systematically sampled); ssu= individual (SRS) • n=900 respondents aged 16-49 years • Comparisons made against baseline data in the 3 sites • Qualitative • 18 FGDs, age/sex stratified (SRS of persons exposed to campaign) • 3 FGDs with BTC program staff/volunteers • 14 Key-informant Interviews • Evaluation through triangulation of findings

  6. Evaluation Sites (quasi-rural) Oniipa Sites selected because useful baseline data were collected there by NawaLife in 2007-08. Oshikuku (quasi-rural) Rehoboth (urban)

  7. The Survey Sample N=900 Sex Relationship status Employment Age groups

  8. Campaign Reach • More than 20 different components transmitted via mix of mass (radio, TV, videos, billboards) and small media (posters, booklets, manuals, board games) and inter-personal communication (forums, small groups) • All transmitted at varying intervals, with varying intensities; some targeted at only specific age groups.

  9. Finding 1:Campaign Reach Overall finding: 100% of respondents received at least 1 component; 81% received 10 or more, 2009-2011.

  10. Finding 1:Campaign Reach Campaign component reach by evaluation site, 2009-2011

  11. Finding 2: Awareness of MCP HIV/AIDS-related topics about which participants (n=563) spoke to family and friends in past month, (unprompted responses) 2009-2011.

  12. Finding 2: Awareness of MCP Changes in (unprompted) awareness of HIV risk-reduction strategies, 2007/8 vs. 2011

  13. Awareness of MCP Risk 18 Focus Group interviews revealed understanding of MCP and its risks: • Respondents in discussion groups demonstrated clear understanding of the concept of sexual networks, and their possible connections to such networks • They reported a new awareness that HIV risk was not entirely due to their own behavior.

  14. Finding 2: Awareness of MCP Risk • So, I personally admired players….but [now] I know that they are putting themselves at risk, I personally don’t admire them, I pity them…if you are a player, you must also know that you are going to be infected soon. • Male, 16-19, Rehoboth

  15. Finding 2: Awareness of MCP Risk • Like when you are walking past the poster. Another person will point at you and the poster and advise you to break the chain…So people are publicly identifying other people who they think connect to the message of the poster and telling them to do what the poster is saying. • - Female, 16-19, Oniipa • When I see a lady walking by and see she’s good, that moment in my mind it is like break the chain. …That break the chain slogan it says more than the pictures. Even if you did not see the picture, you immediately know. • - Male, 20-30, Rehoboth

  16. Behavior change associated with Campaign • One in 5 (22%) randomly-sampled participants who reported a change in their sexual behavior in the past year (n=563/900) specifically reported having “broken the chain.” (unprompted responses) • This finding, triangulated with observed trends in reduction of MCP-related behavior from pre- to post-campaign periods, suggests an association between the campaign and behavior change.

  17. Finding 3: Behavior change associated with Campaign Reported behavioral changes by “dosage” of campaign components, 2009-2011.

  18. Finding 3: MCP behavior changes Comparison of multiple (2+) partnerships reported within the PAST MONTH, by region 2007/8 (Pre-BTC) vs. 2009-2011 (Post-BTC)

  19. Findings 3: MCP behavior change Comparison of multiple (2+) partnerships reported within the PAST MONTH, by marital status 2007/8 (Pre-BTC) vs. 2009-2011 (Post-BTC)

  20. Findings 3: MCP behavior change • We used to be reckless. We could drink and go somewhere and find beautiful girls and think it was fine. But after this campaign started, I decided to stop drinking and it changed my whole lifestyle and how I perceive things and do things now. It really made me realise the seriousness of a sexual network. Male, BTC implementer, Rehoboth • I have a boyfriend and each time want to cheat on him, I realise that this is a chain and it is a wrong thing to do and I won’t cheat anymore.” Female, 20-30, Rehoboth

  21. Triangulation Analysis

  22. Conclusion- Model 1: Delivery Impact

  23. Conclusion- Model 2: Message Impact CULTURAL SCRIPTS • Messages created a new sense of vulnerability • Messages were applicable to the individual’s real life situations • Messages reinforced persistent traditional norms on sexuality and social acceptability • _______________________ • Message recipients internalised concepts • Internalised meaning led quickly to actions to reduce risk, including building new social networks, and stopping MCP • Messages gave recipients a new vocabulary, “break the chain;” some recipients reproduced messages using their own organically-developed hand gesture (horizontal communication).

  24. Conclusion • The campaign has given a meaning to MCP with the target population. • This meaning contributes to some reported vulnerability reduction at the individual level, and contributes to reshaping peer norms through new ‘cultural script’ development. • There is triangulated evidenceof reduced MCP associated with the campaign.

  25. Thank You!

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