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Entertainment-Education for Better Health |
 
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| February 2008 Issue No. 17 |
The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org | |
How Can Entertainment-Education Influence Behavior?
Since the 1970s there have been several hundred major entertainment-education (E-E) projects to improve health. Most have been TV and radio dramas in developing countries (96). Among the earliest with a family planning theme were the TV serial drama Acompañame (Come Along With Me), broadcast in Mexico in 1977 and 1978, and the radio drama Grains of Sand in the Sea, which began in 1977 in Indonesia and continues today (5, 94, 96).
Entertainment-Education Engages Emotions
Entertainment-education engages the emotions as well as the intellect. This helps explain its power to change behavior. Entertainment is more than amusement. It can evoke a range of emotions. An emotional reaction often leads people to think about themselves and their own attitudes and behavior (75). At the same time, E-E presents role models who can show the audience how to adopt healthy behaviors.
Entertainment-education often uses story-telling. Story-telling may be the oldest form of education. It remains a powerful way to communicate knowledge and experience (29). Stories can transmit knowledge that would be difficult to translate into explicit statements. By portraying situations that audience members might experience, stories can show ways of handling the situations. Stories can suggest words and tone of voice, for example, for couples to talk about family planning, and for young people to refuse requests for sex (36, 41, 68).
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Audiences identify with characters and settings. Audiences respond emotionally to E-E that is realistic, culturally appropriate, and creatively produced. In a serial drama, for example, if the characters and settings are familiar to audiences, they can identify with the situations, conflicts, and feelings of the characters (70, 71, 100). When characters express their feelings, or when the story itself is dramatic, the audience responds emotionally. The audience feels a sense of empathy, and characters come to seem like friends (10, 70, 95, 100). When characters face a problem that evokes emotion, audience members who identify and empathize with them may be motivated to solve similar problems in their own lives in a similar way (50). Extensive research is necessary to help writers and artists accurately reflect the lives and culture of the audience.
The audience’s emotional responses depend on the different characters. Dramas typically include character types that are familiar in a particular society, for example, a couple struggling to take care of their children, or a truck driver with several sex partners (11, 109). Some dramas have attracted large audiences in several cultures because they present characters and themes that are universally recognizable (101, 111). For example, broadcasters in Australia, Belgium, Brazil, Saudi Arabia, and 24 other countries aired the Japanese serial drama, Oshin, which taught lessons of love, sacrifice, endurance, and forgiveness (111).
Many E-E dramas portray positive, negative, and transitional role models. This scheme developed from drama theory and from the work of Albert Bandura, the social psychologist who made major contributions to social learning theory, and Miguel Sabido, a Mexican television executive who pioneered E-E dramas (6, 77, 89). Largely positive characters model healthy values and behavior, and they are rewarded. Largely negative characters model unhealthy behavior and antisocial values, and they suffer as a result. Transitional characters, representing the audience, are uncertain at first about which behavior to adopt. Then, gradually, they become convinced. They begin to practice the healthy behavior, and they are rewarded (see also the case study on page 6 of the companion issue of Population Reports “Communication for Better Health”).
Minor characters, sometimes called satellite characters, also may go through a transition. The main characters talk to minor characters, who then change along with the main characters. Thus the audience watches several characters, rather than just one, making decisions that improve their lives (21).
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"The characters played in the show reflect the real life situation. I listened to a character that reveals harmful practices. Later, when I discussed some characters of the show with my friends, we got many useful things that can help us for our future life." A listener to Journey of Life, a radio drama in Ethiopia (43) |
Some dramas portray characters whose behavior is not predictably rewarded or punished. Sexto Sentido, the Nicaraguan TV drama series for young people produced by Puntos de Encuentro, deals with issues such as rape, domestic violence, homosexuality, and HIV infection. By portraying realistic characters with whom young people can identify, the series encourages young people to talk about these issues and reach a deeper understanding of society and the complex, uneven process of social change (54, 69).
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Theories Link Entertainment-Education and Motivation
Seeing how the characters in a drama solve problems can give audiences the sense that they, too, can control their lives and solve these problems. This sense of being in control and able to solve problems is called self-efficacy. Observing the success of others and trying new behavior and succeeding can lead to self-efficacy. Thus audiences come to believe in their own ability to change and to succeed like the characters in a story. People believe in their own individual ability to change, and the community as a whole can come to believe in its collective ability to change. Bandura’s social learning theory explains how, by observing others, people can learn, be motivated to change, and believe that they have the ability to change (6). For example, in Tanzania the radio drama Twende na Wakati created the sense among many listeners that they could control the size of their families (86). Married women who felt they had this control were more likely to use a family planning method than women who did not (11).
Other theories also help to explain the power of E-E. Social influence theory, also known as the theory of the two-step flow of communication, highlights the influence of interpersonal communication on behavior change (48, 56). Audience members may discuss an E-E drama with people who have not seen it—for example, close friends and family members. Such discussions can motivate these people to change behavior even if they have not seen the drama. In Nepal such indirect exposure to a radio serial drama influenced contraceptive use as strongly as directly listening to the drama (14).
The MARCH approach (Modeling and Reinforcement to Combat HIV), formulated by the U.S. Centers for Disease Control and Prevention, explicitly combines E-E with activities to stimulate interpersonal communication. For the E-E component, projects have used serial dramas. For interpersonal communication community members may distribute flyers to their neighbors. As they do, they discuss and repeat the messages in the drama (35). Also, in many countries formal listener groups have provided a forum for discussing the lessons in E-E broadcast in the mass media (104) (see An Approach to Managing Production).
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Watching how the characters in a drama solve problems can give audiences the sense that they, too, can control their lives and solve these problems. |
Social norms govern both group and individual behavior. Dialogue about the contents of E-E programming, especially in community groups, can make people reconsider social norms. This can generate collective self-efficacy and collective action to change traditional practices such as demand for dowry, child marriage, and tolerance of wife-beating (7, 70, 92, 94, 115). The ability of E-E to encourage community dialogue goes beyond conveying information and messages. It makes the audience participants in the development of their own communities and empowers them to start the process of social change (108, 113).
The theory of Diffusion of Innovation also addresses change in social norms. It focuses on how a critical mass of people must adopt a behavior for it to become the new social norm (85). E-E can help to achieve this critical mass when it reaches large audiences. Many audience members then discuss the programs and the recommended changes among themselves and with others. E-E also can depict the process of social change itself, presenting characters who are slow or quick to adopt a new behavior and characters in between, who are cautious and need convincing.
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