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Alternatives to RCTs: Evaluation of A&T’s national mass media campaign, lessons from Viet Nam

Alternatives to RCTs: Evaluation of A&T’s national mass media campaign, lessons from Viet Nam. Silvia Alayón 20 th International Congress on Nutrition Granada, Spain September 18, 2013. Presentation Summary. Viet Nam context Mass media campaign Evaluation challenges

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Alternatives to RCTs: Evaluation of A&T’s national mass media campaign, lessons from Viet Nam

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  1. Alternatives to RCTs: Evaluation of A&T’s national mass media campaign, lessons from Viet Nam Silvia Alayón 20th International Congress on Nutrition Granada, Spain September 18, 2013

  2. Presentation Summary • Viet Nam context • Mass media campaign • Evaluation challenges • Evaluation approaches • Preliminary results • Lessons learned

  3. Viet Nam Background • Total Population (2011): 88 million in 63 provinces • 31% Urban (2011) • Literacy rate: 93% (2011) • Total Fertility Rate (2011): 2 children/woman • Infant mortality rate (2011): 17/1,000 live births • Life expectancy (2011): 75 years • Television ownership (2005): 85% • Weekly television viewership (2011): 92% • Stunting (2010): 29% • Exclusive Breastfeeding (2010): 20%

  4. Alive & Thrive Model Evaluation of Mass Media

  5. A&T’s behavior change model

  6. Elements of the mass media campaign

  7. Evaluation challenges • Inability to randomize, universal coverage of national TV • Many interventions occurring concurrently—policy changes*, national program, etc. *Poster on Building political commitment for longer ML and marketing of BMS 5-6pm, Wednesday, Screen 6.

  8. Four Evaluation Approaches • Analysis of national EBF trend • Constructed cohort design • Geographic cohort design • Trends & associations along the causal pathway: exposure to the campaign, behavioral determinants and EBF

  9. Data Sources Mass media Campaign1 Interim 3 4 provinces Interim 2 4 provinces Interim 1 4 provinces

  10. Approach #1: Analysis of National Trend (%EBF)

  11. Approach #2: Constructed cohort design • Using post-campaign data (e.g. TV viewership habits, etc.) to predict the likelihood of exposure among pre-campaign respondents • Based on prediction, create two cohorts from the baseline data: likely exposed and likely unexposed • Disaggregate baseline data by these two groups to simulate comparable groups from the baseline data

  12. Approach #3: Geographic cohort design • Use natural variability in exposure among geographic areas to create areas of “high” and “low” exposure • Compare trends between the “high” and “low” exposure geographic areas

  13. And now for the exciting results. . .

  14. Approach #3: Geographic cohort designExposure to EBF campaign by district (2012) n=2,065

  15. Approach #3: Geographic cohort designEBF by levels of exposure (without IPC) (2012) n(2011)=2,344; n(2012)=2,065

  16. Approach #4: Exploring the causal pathway • Measure the level of exposure to the campaign and recall • Measure behavioral determinants • Measure EBF • Determine associations among these

  17. Exposure: A&T campaign and infant formula ads n=2,305 (Aug 11) n=2,065 (Oct 12) n=2,321 (May 13)

  18. Mothers’ recall the media messages n=2,065 (Oct 12) n=2,321 (May 13)

  19. Knowledge and beliefs have improved n=2,305 (Aug 11) n=2,065 (Oct 12) n=2,321 (May 13)

  20. Mothers’ beliefs about water are changing n=2,305 (Aug 11) n=2,065 (Oct 12) n=2,321 (May 13)

  21. Differences exist in determinants between exposed and unexposed women (May 2013) n=2,321; ***p<.001

  22. EBF and No water % Exclusive BF % No water n=2,305 (Aug 11) n=2,065 (Oct 12) n=2,321 (May 13)

  23. Summary of Findings • In the four evaluation provinces: • 85% of mothers have been exposed to the campaign • Only about 1 in 3 women now believe a breastfed infant needs water • EBF has increased by 20 percentage points • More rigorous analysis to: • control for possible confounders and covariates • mediating effects of behavioral determinants

  24. Lessons Learned: Evaluation • Building the theoretical model and documenting the approaches before collecting data ensured that we had the right data to evaluate the campaign. • Analyzing the relationships between determinants and behaviors using baseline data helped us prioritize which ones to continue measuring. • Planning multiple approaches guarded against unexpected data limitations (e.g. our inability to predict media exposure).

  25. Acknowledgements • The Bill and Melinda Gates Foundation • A&T Vietnam Team • National Institute of nutrition • Ministry of Health • ISMS • Media partners - TKL, OMD and Maxus • Ogilvy Vietnam • UNICEF and WHO in Vietnam

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