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A method for evaluating a mass education method – street drama – on knowledge about TB. |
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Setting
Nepal, South Asia (Indian subcontinent) |
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Issue
Community |
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Type
motivation or facilitation |
Accompanying Document
Report of Community Evaluation of TB knowledge (Nepal, 2003)(doc, 230.9KB)
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Where we were before this tool was used
Medecins du Monde (MDM) is a Secular French INGO which works in 4 districts in West Nepal for HIV / AIDS and TB prevention and control. We are funded by the European Union.
Over 18 months we established 11 community level drama teams, which we commissioned to perform plays about TB and HIV to raise awareness of these conditions in their localities.
We routinely evaluated these performances by questioning 3 members of the audience before and immediately after a show. On this basis, we demonstrated that drama improved people's knowledge. But was this knowledge retained?
In order to answer this question we conducted a before and after questionnaire evaluation over 12 weeks, in 3 rural communities where drama teams gave plays at the time of World TB Day in March 2003. |
Where the tool came from
We devised a questionnaire comprising 5 closed (multiple choice) question and one open question covering basic knowledge about Tuberculosis. We protested it on 10 people to clarify wording and revised accordingly. Questions were asked verbally by MDM staff who filled in the photocopied forms.
5 closed (multiple choice) questions - (marked out of 5)
* What kind of disease is TB? (A chest disease, not a chest disease, don't know, it is not a disease)
* What is the best way of diagnosing TB? (Blood test, x-ray, sputum test, don't know)
* For how many months must TB medicines be taken? (Free numerical answer, or don't know) (correct answer in Nepal context = 8)
* What is the main symptom of TB? (Fever, diarrhoea, more than 2 weeks of cough, don't know)
* How is TB medication obtained? (On cash payment, freely available, don't know, there is no treatment for TB)
1 open question (short answer) - (marked out of 2)
* What happens if you stop TB medication mid course? |
How the tool was implemented
Prospectively, and using a semi-random selection method, we recruited a cohort of 127 adults from 3 communities where we knew that a play would be performed. At the time of selection, we used the questionnaire to evaluate each respondent's knowledge of TB. Respondents were told that MDM planed to be involved in TB activities in the future, but they were not told to look out for a TB play.
2 to 3 weeks later, around the time of TB day, 6 local people, who had received an 8 day HIV / AIDS / TB and drama skills training from MDM performed 40 minute dramas which depicted men from two families - a wealthy business man and a poor farmer. Both men contracted a cough and were diagnosed as having TB. Half way through treatment the wealthy man decided that, since he now felt strong, he need not continue his medication. Some months later the poor man was fit and well, but the wealthy man was sick again. The story ended with the poor man encouraging his wealthy neighbour to return to the health post for re-treatment, because "DOTS cured me - it can cure you too". Approximately 100 people attended each community play. Drama team members and accompanying MDM staff did not know who had been recruited to the study cohort.
10 weeks later, the MDM staff who had undertaken the pre-test evaluation of TB knowledge returned to the 3 communities and met with respondents again. Each was asked if he / she had seen the TB play. If they had, they were asked to answer the same TB questionnaire again. If they had not, they were invited to learn about TB through reading a copy of a TB health education leaflet.
Data about respondents and their pre-test and post-test scores for TB knowledge were entered into Epi6 Info for analysis. Significance of key results was tested using a paired t-test.
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The outcome of using this tool
On 10 week follow up we met with 122 of the 127 people we had questioned before showing street dramas. 62 (62/122 = 51%) people reported having seen a street play. There were insignificant differences in attendance rates for the different communities and for different ages and sexes.
Pre-test knowledge of TB
Scores for closed questions (out of 5)
People who subsequently saw the play had the same pattern of pre-test score distribution as those who did not see the play, mean score: 2.
Scores for open question (out of 2)
More than half of respondents scored zero for this question at pre-test.
Post-test knowledge of TB 10 weeks after the shows
Scores for closed questions (out of 5)
Every respondent who had seen the play scored either 4 or 5 out of 5 at post-test. The median gain in score was 3. This was a highly significant gain in knowledge (t-test of significance).
Scores for open question (out of 2)
The majority of people who had seen a play scored 2 out of 2 at post-t |
What we learned
This study of 127 people was large enough to demonstrate very significant changes in basic knowledge about TB through a drama-based awareness raising event. This knowledge had been retained for 10 weeks by people who attended a street drama show.
Looking back, we realised that there were flaws in our method. Most importantly, we did not re-test the TB knowledge of people who reported that they had not seen a TB play. This would have enabled us to evaluate confounding factors such as the effect of TB-Day radio broadcasting on TB knowledge.
However, these results were encouraging and give support to our plans to increase the use of drama for awareness raising in our working area. Other organisations should consider drama as an effective means of mass awareness raising. |
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