Encoded Exposure and Social Norms in Entertainment-Education

Study protocol for a randomized controlled trial of RealConsent2.0: a web-based intervention to promote prosocial alcohol-involved bystander behavior in young men

BACKGROUND

Sexual violence (SV) is a significant, global public health problem, particularly among young adults. Promising interventions exist, including prosocial bystander intervention programs that train bystanders to intervene in situations at-risk for SV. However, these programs suffer from critical weaknesses: (1) they do not address the proximal effect of alcohol use on bystander decision-making and (2) they rely on self-report measures to evaluate outcomes. To overcome these limitations, we integrate new content specific to alcohol use within the context of prosocial bystander intervention into an existing, evidence-based program, RealConsent1.0. The resulting program, RealConsent2.0, aims to facilitate bystander behavior among sober and intoxicated bystanders and uses a virtual reality (VR) environment to assess bystander behavior in the context of acute alcohol use.

METHODS

This protocol paper presents the design of a randomized controlled trial (RCT) in which we evaluate RealConsent2.0 for efficacy in increasing alcohol- and non-alcohol-involved bystander behavior compared to RealConsent1.0 or to an attention-control program ("Taking Charge"). The RCT is being implemented in Atlanta, GA, and Lincoln, NE. Participants will be 605, healthy men aged 21-25 years recruited through social media, community-based flyers, and university email lists. Eligible participants who provide informed consent and complete the baseline survey, which includes self-reported bystander behavior, are then randomized to one of six conditions: RealConsent2.0/alcohol, RealConsent2.0/placebo, RealConsent1.0/alcohol, RealConsent1.0/placebo, Taking Charge/alcohol, or Taking Charge/placebo. After completing their assigned program, participants complete a laboratory session in which they consume an alcohol (target BrAC: .08%) or placebo beverage and then engage in the Bystanders in Sexual Assault Virtual Environments (BSAVE), a virtual house party comprising situations in which participants have opportunities to intervene. Self-reported bystander behavior across alcohol and non-alcohol contexts is also assessed at 6- and 12-months post-intervention. Secondary outcomes include attitudes toward, outcome expectancies for, and self-efficacy for bystander behavior via self-report.

DISCUSSION

RealConsent2.0 is the first web-based intervention for young men that encourages and teaches skills to engage in prosocial bystander behavior to prevent SV while intoxicated. This is also the first study to assess the proximal effect of alcohol on bystander behavior via a VR environment.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04912492. Registered on 05 February 2021.

A Web-Based Sexual Violence, Alcohol Misuse, and Bystander Intervention Program for College Women (RealConsent): Randomized Controlled Trial

BACKGROUND

Sexual violence (SV) incidence among college women has been invariant for the past 20 years. Innovative prevention strategies that are low resource and technology driven but demonstrate efficacy are greatly needed.

OBJECTIVE

The aim of this study was to determine the efficacy of a novel theoretically driven internet-based intervention for first-year college students who identify as women (RealConsent) in reducing their risk of exposure to SV and alcohol misuse as well as increasing alcohol protective and bystander behaviors.

METHODS

This randomized controlled trial involved first-year college students who identified as women (n=881) attending 1 of 3 universities in the southeastern United States. Participants aged 18 to 20 years were randomized to RealConsent (444/881, 50.4%) or to an attention-matched placebo control (437/881, 49.6%). RealConsent is fully automated and consists of four 45-minute modules that incorporate entertainment-education media and proven behavior change techniques. The primary outcome was exposure to SV; the secondary outcomes were alcohol protective behaviors, dating risk behaviors, alcohol misuse, and bystander behavior. Study outcomes were assessed at baseline and 6-month follow-up.

RESULTS

Among participants with some exposure to SV, those in the RealConsent group experienced less exposure to SV than the placebo group (adjusted incidence rate ratio 0.48, 95% CI 0.33-0.69; P=.002). Furthermore, participants in the RealConsent group engaged in more alcohol protective behaviors (adjusted odds ratio 1.17, 95% CI 0.12-2.22; P=.03) and were less likely to binge drink (adjusted incidence rate ratio 0.81, 95% CI 0.67-0.97; P=.003). Finally, participants in the RealConsent group who had 100% dosage were more likely to engage in bystander behavior than those with <100% dosage plus placebo group (adjusted odds ratio 1.72, 95% CI 1.17-2.55; P=.006).

CONCLUSIONS

A comprehensive exposure to SV, alcohol use, and bystander educational program was successful in decreasing the occurrence of exposure to SV among those most at risk and in increasing alcohol protective behaviors. Because of its web-based and mobile technologies, RealConsent can be easily disseminated and holds potential for reducing campus SV.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03726437; https://clinicaltrials.gov/ct2/show/NCT03726437.

The Effects of the Type of Information Played in Environmentally Themed Short Videos on Social Media on People’s Willingness to Protect the Environment

This study used a 2 × 2 experimental design to explore the effects of message type (non-narrative vs. narrative information) and social media metrics (high vs. low numbers of plays) of low-carbon-themed social media short videos on people’s willingness to protect the environment. Subjects completed questionnaires after viewing short videos that contained different message types and social media metrics, and a final sample of 295 cases was included in the data analysis. The study found that, while the type of information (i.e., non-narrative or narrative) of the low-carbon-themed social media short videos had no direct effect on people’s willingness to protect the environment, its indirect effects were significant. These indirect effects were achieved through immersion experience and social influence. Subjects who watched narrative videos had a higher level of immersion experience, which in turn was significantly and positively correlated with environmental intention; meanwhile, those who watched non-narrative videos experienced a higher level of social influence, which in turn was significantly and positively correlated with environmental intention. In addition, subjects who viewed high-volume videos experienced a more positive effect on their willingness to protect the environment. This study explored how message design could promote subjects’ perceptions and positive attitudes towards environmental protection, with important managerial implications.

Dietary Behaviors, Physical Activity, and Reported Role Models Among Emerging and Young Adults With Overweight and Obesity

This article characterizes role models identified by emerging/young adults for healthy eating and physical activity (PA), explores variations in reported role models by age, sex and race/ethnicity, and examines dietary/physical activity behaviors in relation to role models. Emerging/young adults (n=397) enrolled in a randomized controlled weight management trial completed assessments at baseline: self-reported role models for healthy eating and PA, Healthy Eating Index, device-measured PA, and demographics. Participants were 78% female, 50% non-White, with mean age 23.3 years, mean BMI 31.1 kg/m². For both healthy eating and PA, the most frequently reported role model was friend (diet: 35%; PA: 39%). Parent was reported second most frequently for healthy eating (21%) and third most frequently for PA (11%). Role models for healthy eating, but not PA, differed by race/ethnicity. Role models did not differ by age or sex. Results may inform future interventions to promote healthy behaviors in emerging adults.

"On the Wings of Wishes" (Icchedana), Adolescent Girls in Bangladesh Taking Flight Using A Social Behavioral Change Communication Program to Address Child Marriage Related Social Norms: A Longitudinal Panel Study

This paper examines the relationship between exposure to a transmedia entertainment-education (EE) social and behavior change communication (SBCC) initiative with shifting child marriage-related social norms. Districts were selected purposively, whereas households were selected randomly. A total of 1102 households (n = 3905) with fathers, mothers, adolescent boys, and girls completed the baseline and endline survey. Logistic regression using panel data was conducted. There was a decline in the perceived prevalence of child marriage and dowry exchange within respondents' communities at endline. For injunctive norms, fathers reported significantly higher levels of disapproval for child marriage at endline. However, the reverse was true for mothers and adolescent girls. Almost all respondents had a significantly lower odds of identifying rewards/benefits and punishments/consequences associated with rejecting child marriage at endline. Most respondents with exposure to Icchedana were more likely to report the importance of injunctive norms or expectations of others on their behaviors, than those who were not exposed. Exposure to EE contributes to improved articulation of and shifts in social norms and engenders normative changes at the population level.

mHealth for Anemia Reduction: Protocol for an Entertainment Education-Based Dual Intervention

Background

More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India’s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages.

Objective

This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India.

Methods

Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education–based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women–related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement.

Results

Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study’s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021.

Conclusions

This study will provide evidence on whether a mobile health norms–based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women–related bystander intervention.

International Registered Report Identifier (IRRID)

PRR1-10.2196/26252

Narrative Persuasion and Social Norms in Entertainment-Education: Results from a Radio Drama in Mozambique

Narrative persuasion and social norms are part of the most recent theorizing behind the health communication strategy known as entertainment-education. There is little research, however, that compares these theoretical constructs from Mozambique, a setting that has not been researched to the same extent as other EE practice locations. This study uses mixed methods data from the midline evaluation of Ouro Negro (English translation: Black Gold), an EE radio program for individual health and social change in Mozambique to answer two research questions: what is the relationship between exposure to Ouro Negro and narrative persuasion?, and what is the relationship between narrative persuasion with Ouro Negro and social norms? Quantitative results related to the first question indicated that exposure significantly predicted three narrative persuasion constructs in multivariate regression models, results confirmed by a storytelling activity in focus groups. Quantitative results for the second question, which utilized propensity score matching, were not significant, and findings from a qualitative 2 × 2 table activity confirmed that behaviors were not normative in the directions promoted by the radio drama. Implications and recommendations for future entertainment-education research are discussed.

How does a Social and Behavioral Change Communication Intervention Predict Menstrual Health and Hygiene Management: A Cross-Sectional Study

Background

Interventions in India to improve menstrual health and hygiene management (MHHM) have been implemented at the national, state, district and school level. However, evaluations of these interventions have been scarce. The objective of the study was to determine if a social and behavioral change communication (SBCC) intervention (GARIMA) had a relationship with knowledge, attitudes, interpersonal communication, restrictions and MHHM using a comparison group post-test only design among 2206 adolescent girls.

Methods

Intervention villages and adolescent girls were selected through stratified random sampling based on where GARIMA was implemented. Villages and adolescent girls in comparison villages were matched socio-demographically to intervention villages and adolescent girls. Multi-level logistic regressions assessed the relationship between the encoded exposure, mediators and MHHM.

Results

The results showed that the encoded exposure predicted all behaviors corresponding to MHHM. Additionally, adolescent girls in the high encoded exposure group had significantly higher knowledge about puberty and reproductive parts (AOR: 2.03 (95% CI: 1.31 – 3.15)), positive attitudes towards gender (AOR: 1.48 (95% CI: 1.02 – 2.16)) and higher levels of some discussion and dialogue (AOR: 1.41 (95% CI: 1.04 – 1.92)).

Conclusions

Future programs should use SBCC to improve MHHM behavior but involve families, peers and community members to a greater extent in order to improve attitudes towards menstruation, attitudes towards restrictions, attitudes towards absorbent use and reduce restrictions within the community.