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One year of cross-promotion of TB information using traditional and new media to #EndTB and #BeatTB

One year of cross-promotion of TB information using traditional and new media to #EndTB and #BeatTB
Publication date: 
Apr 2019

Background 

Tuberculosis remains a significant public health concern in resource-poor communities in South Africa.  Communication has a critical role in supporting biomedical responses to the TB epidemic, especially considering assertions that ‘For perhaps the first time, the world is faced with a health threat against which the only effective barrier is not only medical, but also behavioural. 

Traditional media (radio, television and print), and new media platforms such as the social networking sites Facebook and Twitter are an important avenue used by the USAID Tuberculosis South Africa Project to reach large segments of the South African population with condensed and easy-to understand general and specific TB and related health information. Campaigns are implemented to: 

  • increase knowledge about TB
  • impact attitudes and practices
  • spark personal and community behaviour changes to prevent transmission of TB, promote health seeking behaviours, and encourage patients to adhere to treatment. 

The advocacy, communication and social mobilisation strategy that guides implementation of USAID TB South Africa Project emphasises integration of communication methods and cross-promotion of messages for maximum reach and impact, towards contributing to the country’s efforts to reach the 90-90-90-90 TB targets for TB. Further, by increasing knowledge levels about TB signs and symptoms, infection prevention, diagnosis and treatment, among patients and the public, the project aims to support efforts to plug holes in the TB Care Cascade. 

The broad approach

Cross promotion of health information is effective for reaching large numbers of people with information about TB. Repetition of messages across multiple platforms raises chances that messages will be seen/heard and internalised, and that audiences will take steps to change harmful behaviours conducive to the further transmission of TB infection. 

In this strategy, messages and information disseminated via one medium are linked to other – e.g. information published on the project’s website, www.tbsouthafrica.org.za is shared on the project’s We Beat TB South Africa Facebook page and then linked to the @WeBeatTB Twitter profile with the #BeatTB hashtag. Online platform details are added to all external communication such as presentations and education and communication (IEC materials) and mentioned at the end of radio interviews. Mass media campaigns are promoted on social media, and audiences are invited to share their feedback on the content of radio and television interviews on social media. Further, users of social media are kept abreast of discussions from community dialogues and social mobilization events, while community radio is used to direct residents to clinics nearest them to access TB and other health services following community mobilization and screening events.

This approach has the effect of increasing the number of times that a single person is exposed to our messages and growing the total number of people that are reached via the mix of traditional and new media forms utilized, materials, programs or messages, with notable results as discussed below.  

Intensified and targeted social media campaign around World TB Day 2017

The USAID TB South Africa Project approach to media engagement around World TB Day 2017 employed the cross-promotion of messages, information and materials, which involved sharing content via multiple media, including print, radio, social media, email and as interpersonal communication via community dialogues and social mobilization. 

Social media influencers: 
The project engaged ten social media influencers with a combined reach of 6.1 million followers on Twitter and Facebook to raise visibility of the disease during World TB Month (March) 2017. 

Social media influencer’s new and re-tweets about TB had the effect of encouraging users of social media to request specific information about TB infection prevention and treatment adherence. Audio-visual content was created by some social media influencers to further communicate TB information. 

Social media: 
Social media platforms were used to share information and gauge audiences’ reactions to messages on mass media, as measured by likes, retweets, shares or engagements, and to solicit insights into the effectiveness of parallel campaigns. Through the efforts of project staff, in January 2017 the project’s Facebook page reached 515 people and 44 engaged with content; these figures grew ten-fold in March when influencers were actively disseminating information. Facebook reached 5,207 people, with 818 engaging. The 10.6 million impressions achieved on Twitter in March 2017 when social media influencers were active are indicative of the utility of engaging with these stakeholders in increasing visibility of and communication around TB issues.

It is worth noting that on 20 March and again on 27 March 2017 #EndTB (hashtag created specifically to monitor the initiative) trended on Twitter. 

A shift in the quality of social media user’s engagements with content on the pages was observed, as followers were more likely to ask for information about where to access TB testing services, share experiences of dealing TB, or seek medical information about side effects of TB medications. Interestingly, while Twitter proved to be an effective medium to share information frequently, users were more likely to request information via the project’s Facebook Inbox. USAID TB South Africa Project clinical staff were on hand to respond to requests for information of a medical nature, although care was taken not to offer diagnoses, but to provide general and practical information and to refer clients to health facilities as necessary. 

Sixteen individuals regularly wrote to the project for TB treatment-related support and services information via Facebook inbox. Direct intervention was sometimes necessary, through project staff acting as health advocates in patient’s areas. 

Community radio station interviews:
Partnerships with community radio stations in high-burden TB areas were formed to provide further avenues to cascade information to encourage inhabitants of specific communities to access TB services. During this period, project staff and National TB Ambassadors participated in fourteen radio interviews on community, provincial and national stations to discuss various topic on TB, reaching more than 9 million people across the country. 

Radio stations used include Umhlobo Wenene FM, Motheo FM, Umgungundlovu FM, SABC Channel Africa and Lotus FM, among others.  Interviews on community radio were prioritized in Bloemfontein in Free State province where World TB Day was commemorated.

A total of 216,000 listeners in Bloemfontein were targeted with information via community radio. The campaign is credited as having contributed to 13,243 more people being screened for TB in public healthcare facilities in Bloemfontein in March 2017 (112,936) than in February (99,693). Post-campaign, in April this figure dropped to 89,681 people screened. 

Print media: 
Four article were accepted for publishing in print media (newspapers and magazines) covering TB management-related work being done by the project in South Africa.

National and community mass media campaign

From November 2017 to January 2018, the project implemented a national mass media campaign to saturate the South Africa media space with key messages about TB to enhance general knowledge and awareness. The campaign employed multiple platforms on national television stations SABC 1, SABC 2 and eTV as well as five African-language radio stations: Lesedi FM, Motsweding FM, Thobela FM, Ukhozi FM and Umhlobo Wenene FM. Further, billboards and rank, massive and transit TV were also used to disseminate content, to enhance awareness of TB prevention, diagnostics and treatment services among the people reached via these mediums. 

For the transport sector-focused communication implemented in the sites indicated in Figure 2, billboards in and around 15 stations, and Beat TB public service broadcast on: 

  • 135 taxis (on transit TV) (reaching estimated 5 million captive audiences as they commuted per month) 
  • 15 taxi ranks (rank TV)
  • 14 taxi, bus and train stations (massive TV) 

The campaign was timed to coincide with commemorations of World Diabetes Day (November 24th) and World TB Day (December 1st) 2017 respectively, and to reach commuters/travellers during the festive season. 

An estimated 20 million people were reached nationally, with a projected ten million commuters alone reached via transit TV as they travelled on public transport. 

Broadcasting audio-visual content on the Mindset Network (January to April 2018)

To keep up the momentum of communication around TB built in the previous year, From January to April 2018, the USAID TB South Africa Project broadcast five short documentary films it developed based on the stories of actual TB patients receiving care from funded sub-grantees working at community level in Eastern Cape Province on the Mindset Network. The Network broadcasts directly into the waiting areas of 993 public health facilities in South Africa and on the DSTV platform, reaching approximately 3.5 million homes. 
Each of the five videos, on the topics of: TB prevention, TB in children, contact management, stigma reduction and MDR-TB and treatment adherence, was broadcast twice a day (at 9am and noon) and was shown 70 times during the four months. The Mindset Network was chosen for its ability to strategically increase visibility of TB and of the USAID Tuberculosis South Africa Project before and during World TB Month 2018, bringing the mass and social media intervention full circle.

Partnerships with community radio stations to increase public awareness of TB (2017 to 2019)

The project leverages on partnerships with community radio stations to raise public awareness and educate communities about TB in supported districts and nationally. Partnerships have been established with 20 radio stations in 14 districts. Partnerships were formed with 24 community radio stations in 20 districts in nine provinces of South Africa. From 2017 to 2019, project staff participated in115 unpaid community radio interviews, many of which included call-in sections for audiences to interact with interviewees. In 2016/17, approximately 17 million people were reached in nine provinces through 20 interviews. In 2017/18, an estimated 2 million people were reached through 76 interviews covering six provinces. In quarter 1 2019, through 17 radio interviews in four provinces, approximately 3.9 million listeners were reached. 

Interviews were cross-promoted on social media. Call-in interviews and social media were used to gauge audiences’ reactions to content shared. Quantity and quality of social media engagement increased, with followers requesting information and sharing personal experiences of living with TB. In two and a half years 817,854 people were reached via Facebook and Twitter and 7,984 engaged with posts. 

The project leverages on partnerships with community radio stations to raise public awareness and educate communities about TB in supported districts and nationally. Partnerships have been established with 20 radio stations in 14 districts. Partnerships were formed with 24 community radio stations in 20 districts in nine provinces of South Africa. From 2017 to 2019, project staff participated in115 unpaid community radio interviews, many of which included call-in sections for audiences to interact with interviewees. In 2016/17, approximately 17 million people were reached in nine provinces through 20 interviews. In 2017/18, an estimated 2 million people were reached through 76 interviews covering six provinces. In quarter 1 2019, through 17 radio interviews in four provinces, approximately 3.9 million listeners were reached. 

Interviews were cross-promoted on social media. Call-in interviews and social media were used to gauge audiences’ reactions to content shared. Quantity and quality of social media engagement increased, with followers requesting information and sharing personal experiences of living with TB. In two and a half years 817,854 people were reached via Facebook and Twitter and 7,984 engaged with posts. 
A project website developed from scratch and launched in November 2018 is another medium used to share TB communication. 

Information shared on the website not only provides insight into the project’s initiatives but also TB journeys of patients, national and international TB news and answers to frequently asked questions about the disease. 

The site, which records increasing numbers of users each month, can be visited at www.tbsouthafrica.org.za. 

Conclusion

Through implementation of an advocacy, communication and social mobilisation strategy, the USAID TB South Africa Project works to strengthen TB patient and health provider-centered communication using innovative and integrated dissemination methods. Implementation of the strategy aims to enhance external communication, maximize the visibility of the project’s interventions, demonstrate its vision, show evidence of impact and highlight USAID’s contributions to the control and prevention of TB in South Africa.