Evaluation of Changing the Scripts Intervention in Nigeria

Overview

The Center on Gender Equity and Health is evaluating a multimedia social and behavior change (SBC) intervention in Kano and Kaduna states in Nigeria to assess its impact, cost-efficiency and how it works. The intervention, led by BBC Media Action, uses radio, TV, other media, community outreach and SBC approaches to increase women's and couples' ability to make and act on reproductive and family planning decisions. Over a three-year period (2025- 2028), we will use a mixed-methods prospective longitudinal cohort study design to meet the research objectives. This includes estimating the impact of the intervention on use and intent to use modern contraception (alone, when combined with other family planning programs, and among non-users), exploring the pathways through which the intervention increases contraceptive use, estimating the cost-efficiency of the intervention and, evaluating the sustainability of the intervention. Data will be collected from three states - Kano and Kaduna (intervention states) and Nasarawa (comparison state). Through this evaluation, we aim to contribute to the family planning and mass media SBC fields by strengthening the evidence on the impact of a multimedia SBC intervention as well as the additional impact of combining the intervention with family planning service delivery interventions.

Detailed description

Background: Modern contraception use to space or limit births is an important aspect of reproductive health because it has the potential to improve maternal health and child outcomes, reduce poverty, and promote gender equality. Despite their benefits, modern contraceptive use remains low in many developing countries, including Nigeria. Nigeria has the largest population and one of the lowest modern contraceptive use rates in sub-Saharan Africa. The 2023-2024 Nigerian Demographic and Health Survey (NDHS) found that the prevalence of modern contraceptives among married women was 15.3%, a 3-percentage point increase from the 2018 NDHS. Rates in Kano and Kaduna continue to remain lower than the national average. In Kano, about 10.6% of married women were using a modern method, roughly double the level recorded in the 2018 NDHS, while in Kaduna, a slight decrease was observed (0.6%) over the years and by 2023-2024 survey about 13.1% were using a modern contraceptive method.

Mass media interventions have been used over the years to address low family planning uptake because they can simultaneously influence individuals, families, peer networks and communities. Evidence across these different ecological levels have found that mass media approaches can influence family planning behaviors, knowledge, perceptions, attitudes and expectations . However, despite the large body of evidence documenting the impact of mass media, there's a need for rigorous evaluations that measure multiple outcomes along the behavioral pathway as well as assessments that capture the cost implications.

Objective: The objective of this study is to evaluate a multimedia intervention to be implemented by BBC Media Action in Kano and Kaduna. This evaluation will estimate the intervention's impact on family planning/child spacing method use, examine behavioral mechanisms of change, estimate cost-efficiency, and generate insights into its sustainability.

Methodology: Using a quasi-experimental design, the evaluation will be conducted in Kano, Kaduna, and Nasarawa (comparison) States. It is a three-year (2026 - 2028), mixed-methods, longitudinal evaluation of the BBC Media Action multimedia SBC intervention. Data collected will include a longitudinal cohort survey with women of reproductive age who meet our inclusion criteria at baseline. The baseline survey will be collected before the intervention begins and a follow-up survey will be conducted two years after the start of intervention implementation. In addition, in-depth interviews will be conducted with a subset of the cohort women and their partners, and program monitoring interviews with intervention women, intervention men, and program implementers. Key informant interviews and an online survey will be conducted with key implementing partners to gather insights into sustainability. To inform the cost efficiency analysis, costs associated with implementation will be collected from the financial management systems of partners along with semi-structured interviews with partners.

Interventions

• Behavioral Multimedia (BBC MA) intervention: Changing the Script in Nigeria
  Led BBC Media Action (BBC MA) and implemented in collaboration with multiple partners, the intervention will create an integrated "story world" designed to shift knowledge, attitudes, and beliefs, spark conversations, and reshape social norms around family planning or child spacing. The aim is to empower women and couples to make and act on informed family planning/child spacing decisions, ultimately increasing uptake and continuation of contraception. This will be achieved through a range of mu
• Other Supply-side interventions (MSI)
  Family planning services in the public sector in Nigeria supported by supply-side interventions implemented by Marie Stopes International (MSI) Nigeria. Supply-side interventions include health provider training on family planning service provision, supporting family planning commodity supply, and monitoring family planning service quality.

Primary outcome measures

• Current family planning use [Time frame: Baseline and follow-up (2 years after implementation start)]
• Intent to use a family planning method [Time frame: Baseline and follow-up (2 years after implementation start)]
• Favorable attitude towards family planning [Time frame: Baseline and follow-up (2 years after implementation start)]

Secondary outcome measures (7)

• Confidence in ability to use family planning [Time frame: Baseline and follow-up (2 years after implementation start)]
• Self-efficacy to discuss family planning/child spacing with partner/husband [Time frame: Baseline and follow-up (2 years after implementation start)]
• Frequency of communication about family planning/child spacing with husband/partner [Time frame: Baseline and follow-up (2 years after implementation start)]
• Perceived prevalence of family planning use [Time frame: Baseline and follow-up (2 years after implementation start)]
• Concrete plan to use family planning [Time frame: Baseline and follow-up (2 years after implementation start)]
• Preference-aligned fertility management (PFM) [Time frame: Baseline and follow-up (2 years after implementation start)]
• Family planning intent actualized [Time frame: Follow-up (2 years after implementation start)]

Eligibility criteria

Inclusion criteria

All eligibility criteria based on self-report:

• Aged 15-44 years old at baseline
• Female
• Sexually active (based on self-report; i.e., in union)
• Able to provide informed consent
• Current residence in the selected intervention or comparison area

Exclusion criteria

• Are not considered sexually active (i.e. not in union)
• Are unable to provide consent
• Are younger than 15 years and older than 44 years at baseline

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

Nigeria · 3 centers

• Household survey — Kaduna
• Household survey — Kano
• Household survey — Nasarawa

Publications

• National Population Commission - NPC, & ICF. (2019). Nigeria Demographic and Health Survey 2018 - Final Report. http://dhsprogram.com/pubs/pdf/FR359/FR359.pdf
• High Impact Practices in Family Planning (HIPs). (2017). Mass Media: Reaching audiences far and wide with messages to support healthy reproductive behaviors. https://fphighimpactpractices.org/briefs/mass-media
• Federal Ministry of Health Social Welfare of Nigeria (FMoHSW), National Population Commission - NPC/Nigeria, & ICF. (2025). Nigeria Demographic and Health Survey 2024. https://www.dhsprogram.com/pubs/pdf/FR395/FR395.pdf
• Dasgupta, A., Kantorová, V., Ueffing, P., & Wheldon, M. (2022). Contraceptive use and fertility transitions: The distinctive experience of sub-Saharan Africa. Demographic Research, 46(4), 97-130. https://doi.org/10.4054/DemRes.2022.46.4

Identifiers

NCT: NCT07527364 · 813938

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗