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The impact of an entertainment education TV series, ‘C’est la vie!’ on Gender-based Violence and Sexual and Reproductive Health
Last registered on June 29, 2020

Pre-Trial

Trial Information
General Information
Title
The impact of an entertainment education TV series, ‘C’est la vie!’ on Gender-based Violence and Sexual and Reproductive Health
RCT ID
AEARCTR-0005134
Initial registration date
December 01, 2019
Last updated
June 29, 2020 1:05 PM EDT
Location(s)

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Primary Investigator
Affiliation
UNC
Other Primary Investigator(s)
PI Affiliation
University Cheikh Anta Diop
PI Affiliation
Independent
PI Affiliation
International Food Policy Research Institute (IFPRI) - Dakar
Additional Trial Information
Status
On going
Start date
2019-10-09
End date
2021-01-30
Secondary IDs
Abstract
Mass media campaigns can be an effective way of producing positive health-related behavior change across large populations Mass media campaigns allow for the integration of standardized repeated messages in an entertaining format, invoking cognitive or emotional responses. Educational mass-media to promote positive behavior change on radio, film, or television is also known as edutainment. Edutainment has been associated with improved knowledge, attitudes, and behaviors related to HIV/AIDS, fertility, and family planning in Mexico, South Africa, Tanzania, Brazil, Nigeria, and India. However, to date there have been few rigorous studies on the effectiveness of edutainment to improve women’s outcomes with respect to gender-based violence (GBV) or intimate partner violence (IPV).

This evaluation contributes to the sparse literature by evaluating the impact of a popular TV series in West Africa, C’est la vie!, on knowledge, attitudes and practices related to GBV, including IPV, and sexual and reproductive health. The study is conducted in rural Senegal, where populations have low exposure to the series and new dubbing into local languages provides a unique opportunity to experimentally test the effectiveness of C’est la vie!. The target group for the intervention are women aged 14 to 34 years old. The evaluation is a cluster-randomized controlled trial (cRCT) design by randomly assigning rural villages to three arms: 1) C’est la vie! screenings via film clubs, 2) same as arm 1 with the addition of post-discussion groups and interactive workshops reinforcing messages, and 3) a placebo film screened identically to arm 1 with no related themes to outcomes of the study. A cross cutting treatment will encourage the partners of target to attend the screenings in half of each study arm. In addition to the RCT, a process evaluation accompanies the evaluation to unpack impact pathways and explore participants experience with the film clubs. The original treatment screenings includes season 1 of C’est la vie!, or approximately 26 episodes, which screened in groups of three (1.5 hours total or 25 min each) on a bi-monthly basis. In March 2020, the intervention was interrupted due to the COVID-19 pandemic, due to presidential decree in Senegal to close public schools and prohibiting gatherings of more than 10 people. With approximately two-thirds of the intervention completed, the program will be converted to podcasts of 10-20 minutes via a free hotline in June 2020. The podcasts will comprise the final episodes of season 1, and season 2. An intermediate phone survey will be undertaken in June 2020 to capture the initial program impacts, and an in-person endline expected for November to December 2020 after the full intervention is implemented.
External Link(s)
Registration Citation
Citation
Peterman, Amber et al. 2020. "The impact of an entertainment education TV series, ‘C’est la vie!’ on Gender-based Violence and Sexual and Reproductive Health." AEA RCT Registry. June 29. https://doi.org/10.1257/rct.5134-2.0.
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Experimental Details
Interventions
Intervention(s)
The TV series C’est la vie! is now in it’s third season of production and is specifically designed to address issues related to adolescents’ and women’s rights. The plot revolves around everyday life in a maternal health clinic in Senegal and characters are based on extensive formative research. Themes presented in the series focus on GBV (IPV, forced and early marriage, sexual abuse, female genital mutilation and cutting (FGM/C), illegal abortion), on sexual and reproductive health (family planning, use of contraceptives, HIV and sexually transmitted infections), on maternal and child health (prenatal and postnatal care, quality of health care, traditional medicine), and more generally on gender equality, couple communication, and female autonomy. C’est la Vie! is developed and produced by the Réseau African pour l’Education à la Santé (RAES), a Senegalese non-governmental organization with support from UN partners.

The intervention being evaluated is Season 1 and 2 of the TV series C’est la vie!. Due to interruption of implementation by COVID-19, the intervention has two distinct implementation modalities. From December 2019 to March 2020, the intervention was screened through regular film clubs in each village. Season 1 of C’est la vie! is composed of 26 episodes (25 minutes for each episode). Each village screening showed three episodes in a row and took place every other week. Film versions of C’est la vie! season 1 are translated to Wolof and Pular, the dominate languages in study villages. In addition to the TV series, study arm 2 includes “Pedagogical kits,” which have been developed by the RAES social behavior change communication (SBCC) team, in collaboration with United Nations Agencies. The objective of the pedagogical kits is to strengthen the impacts of the TV series by stimulating personal reflections and collective debates. The kits are composed of post-projection discussion guides that accompany each episode and workshop guides that are composed of seven themes.

Implementation was carried out by MobiCiné, through mobile units that visited each village on a rotating basis. Mobile units are cars carrying projectors and screens. Each mobile unit staff includes a screening technician and a communication specialist for monitoring attendance and leading the SBCC component (Pedagogical kit including the post-screening discussions and workshops). Implementation of the film clubs was tested via a pilot study which was approved by the Senegalese ethics committee, Comité National d’Éthique pour la Recherche en Santé (CNERS), in March 2019, and carried out over a two week period in six villages over the month of April 2019. The pilot study was implemented with the objective of determining implementation feasibility, optimization and test intervention components prior to development of the present impact evaluation.

After the disruption of the intervention due to COVID-19, the implementation will take place remotely, via podcasts transmitted through 10-20 min segments (season 1 and 2 of C’est la vie!). These will be accessed via a free hotline by study women in both treatment arm 1 and 2, and run from June to September 2020. The intervention will continue to be overseen by MobiCiné, and post-discussion groups will be facilitated via one-to-one calls with communication specialists or in groups of up to 10 women via the call platform (treatment arm 2 only). C’est la vie! has already been converted to podcasts for radio dissemination in Wolof. A placebo podcast will also be administered on the control arm with content unrelated to the C’est la vie! themes. The podcast intervention will be rolled out in 60% of each treatment arm in order to disentangle impacts of the film clubs only versus film clubs plus additional podcast extended treatment. For the continued treatment groups, the intervention is expected to end with a last in-person ‘movie night’ in September or October 2020 to thank women for participation (pending the spread and containment of COVID-19). Similar to the original randomization, continued treatment villages will be selected randomly, stratified on region.
Intervention Start Date
2019-12-02
Intervention End Date
2020-10-30
Primary Outcomes
Primary Outcomes (end points)
Knowledge, attitudes and practices of C’est la Vie! themes, including GBV, sexual and reproductive health, and maternal and child health.
Primary Outcomes (explanation)
• Knowledge: Regarding GBV (including IPV, FGM/C and early marriage), sexual and reproductive health (including family planning and HIV/STIs), and maternal and child health;
• Attitudes and personal norms: Around GBV (including IPV, non-partner violence, FGM/C, and early marriage), sexual and reproductive health (including family planning), and gender equitable attitudes;
• Practices and behaviors: Regarding GBV (including IPV, non-partner violence, FGM/C of daughters and intentions, early marriage), sexual and reproductive health (including family planning utilization, HIV/STI testing and proxy indicators), and maternal and child health service utilization.
Secondary Outcomes
Secondary Outcomes (end points)
Moderators and facilitating factors, including intra-household decision-making power and self-efficacy, time allocation, communication, labor force participation, social cohesion/capital, emotional wellbeing, aspirations and community social norms.
Secondary Outcomes (explanation)
Outcomes expects to be affected by participation in the intervention, including benefits of gathering in groups and increased leisure time – but not key themes of C’est la Vie! – including time allocation, closer personal relationships with friends and family, social support and trust, emotional wellbeing, intra-household decision-making power and self-efficacy, and labor force participation.

Due to the large number of outcomes and indicators, for each theme, we will group outcomes into indices at the level of knowledge, attitudes and behavior. We will construct equally weighted averages of z-scores for index aggregation and also report outcomes for individual indicators. More details are given in our pre-analysis plan.

Due to concerns around ethics of asking sensitive behaviors remotely, the intermediate phone survey will assess only primary outcomes of knowledge and attitudes, alongside select secondary outcomes. The full set of behavioral outcomes will be assessed at endline when in-person surveys are possible. See pre-analysis plan for further details.
Experimental Design
Experimental Design
In total, 120 rural villages across two regions of Senegal – Kaolack and Kolda – are randomly assigned to one of three arms:

• Arm 1: C'est la vie! season 1 and 2 transmitted through film clubs and podcasts
• Arm 2: Same as Arm 1 plus “pedagogical kits”;
• Arm 3: a TV series "placebo" (on a subject not related to GBV or gender issues) screened through film clubs and podcasts (control group).

Randomization is stratified on region, and at the village level as opposed to the household level because it is likely that individuals will discuss the TV series C’est la vie! with other community members; thus, even individuals who are not directly invited to the film clubs may be exposed to the messages, and they cannot be considered ‘untreated’. In each intervention arm, 34 young adult women aged 14-34 per village, living up to 2 km radius to the film club location (village primary school) were invited to attend the sessions. Each woman was allowed to bring one guest. The second stage of randomization assigns women to use their guest pass on either: 1) their husband, partner, boyfriend/male peer, or brother or 2) a female friend, sister or neighbor. The second stage randomization is at the individual level across all three treatment arms and takes the form of a soft nudge (suggestion) at the time of invite, as there is no strict monitoring or consequence if the women does not bring the type of person suggested.

Prior to the first screening and baseline survey, a census was conducted in 160 villages to identify 34 eligible women to participate in the study. Of the villages with at least 34 eligible females, 120 were randomly selected to participate in the study and randomized into one of the three treatment arms. Women are eligible if they 1) meet the age criteria, 2) speak and understand wolof or pular, 3) live within a 2km radius of a primary school.
Experimental Design Details
Not available
Randomization Method
In office, by a computer.
Randomization Unit
First level (treatment arm): Villages
Second level (sex of second invitee): Individual
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
120 villages
Sample size: planned number of observations
4,080 women (1,360 per study arm)
Sample size (or number of clusters) by treatment arms
Equal numbers of clusters (40) per treatment arm, stratified on region (20 per region per arm).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Power calculations for this study drew on data from the 2017 Senegalese Demographic and Health Survey (DHS). We conducted power calculations on three primary outcomes related to behaviors and attitudes of IPV and sexual and reproductive health among women – modern contraceptive use, attitudes justifying IPV and 12-month experience of IPV. Desired statistical power was set to 80 percent, and desired significance level was set to 0.05. Means and intra-cluster correlations were estimated from the 2017 DHS, using the rural population and accounting for survey weights. We allow for 0.10 correlation with baseline characteristics. The desired minimum detectable impacts were set to 6 percentage points for contraceptive use and IPV, and 10 percentage points for attitudes. Given the low prevalence of IPV in the last 12 months and modern contraceptive use, 6 percentage points are large effect sizes, however, these are in the range found by studies examining impacts of social behavior change communication and mass media on both outcomes. For contraceptive use and attitudes towards IPV we need a minimum of 28 women per village by endline. For IPV, we are not powered to detect impacts across each intervention arm, but we are powered to detect impacts if we combine intervention arm 1 and arm 2. The needed sample for IPV when arm 1 and arm 2 are combined is 23 married (partnered) women per village at endline. Assuming 5 percent attrition by endline, this means a sample of 24 married (partnered) women per village at baseline. If we assume approximately 70 percent of women 14-34 years are partnered, then this would mean we need a sample of approximately 34 women per village at baseline – 24 of which will likely be partnered and 10 without a partner. The total sample of women is thus 4,080 across the 120 villages. We note that due to geographical variation and differences in recall periods, among others, power calculations are not able to provide exact predictions of statistical power. However, given a sample design, they can provide useful guidance in designing the sample.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
International Food Policy Research Institute IRB
IRB Approval Date
2020-05-11
IRB Approval Number
PHND-19-0739M
IRB Name
Comite National d’Ethique pour la Recherche en Sante (Sengalese national ethics committee on health research)
IRB Approval Date
2020-06-03
IRB Approval Number
SEN 19/39 No 000102/MSAS/DPRS/CNERS
IRB Name
Comite National d’Ethique pour la Recherche en Sante (Sengalese national ethics committee on health research)
IRB Approval Date
2019-08-16
IRB Approval Number
No 000132/MSAS/DPRS/CNERS
IRB Name
International Food Policy Research Institute IRB
IRB Approval Date
2019-08-05
IRB Approval Number
PHND-19-0739 (IRB #00007490)
Analysis Plan

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