Entertainment-Education Campaigns and COVID-19: How Three Global Organizations Adapted the Health Communication Strategy for Pandemic Response and Takeaways for the Future

"The future of EE will require planning, implementing, and evaluating the strategy from the long-running, narrative format to a more flexible format adaptable to rapidly changing times and media."

Entertainment-education (EE), sometimes termed "edutainment", is a theory- and evidence-based communication strategy that uses entertainment media for educational messaging. The arrival of the global COVID-19 pandemic required most EE campaigns to adapt to challenges such as lockdowns and social distancing. This paper: briefly reviews how EE campaigns pivoted in response to previous health emergencies; presents 3 case studies of EE responses to the COVID-19 pandemic by global organisations; and considers implications for theory and the future of EE as a health communication strategy.

The paper begins with a look at the evolution of theory in EE, briefly reviewing frameworks such as Bandura's social cognitive theory, Bentley's dramatic theory, Jung's archetypes, the Sabido Methodology, Slater and Rouner's extended-elaboration likelihood model, and Moyer-Gusé's entertainment overcoming resistance model. It also briefly describes key concepts in the EE approach, including transportation (Green & Brock, 2000), narrative engagement (Busselle & Bilandzic, 2009), identification (Cohen, 2001), and parasocial interaction (Horton & Wohl, 1956).

As outlined here, the 3 organisations whose work is at the centre of the case studies that follow - PCI Media, BBC Media Action, and Sesame Workshop - have past experience in adapting their EE work to health crises. For example:

• In 2014, PCI Media implemented the I Survived Ebola multimedia campaign, comprised of short video and audio narratives, a radio miniseries, songs, music videos, and social media, which reached 9.5 million people throughout Guinea, Liberia, and Sierra Leone. Grounded in a positive deviance approach, the campaign publicised the stories of people who had survived Ebola despite the odds. Importantly, information was tailored to the different countries.
• Also during the Ebola crisis, BBC Media Action adapted existing radio shows and launched new content, including a mini radio drama series, Mr. Plan-Plan and the Pepo-oh. The 12 six-minute episodes aired across 150 radio stations in Guinea, Liberia, and Sierra Leone and were shared via Facebook and WhatsApp. In this case, BBC Media Action adapted fundamental EE principles, namely the use of narrative and characters, to create a new format - "fast fiction" - that could be produced quickly, relying on an understanding of the community's existing knowledge and practices. By broadcasting stories in local languages, the drama reportedly built trust with the community.
• Sésamo (formerly Plaza Sésamo, the Latin American brand of Sesame Workshop) implemented a campaign in response to the 2015 Zika outbreak in Latin America. In partnership with the United Nations Children's Fund (UNICEF) and the Pan-American Health Organization (PAHO), Sésamo produced short videos in Spanish and Portuguese featuring well-known characters Elmo and Clara (Raya in other parts of the world) to disseminate information on Zika virus and mosquito avoidance. The videos were shared on Sesame's, PAHO's, and UNICEF's local distribution channels and on YouTube. The idea here is that "existing characters and storylines can be used to expediently create new content that is easily recognizable and impactful".

Highlights from case studies of these same 3 organisations, which were each in the process of planning, implementing, and/or evaluating EE campaigns at the time of COVID-19, include:

1. PCI Media - One project adapted to address COVID-19 is Ouro Negro (Black Gold), a multimedia campaign in Mozambique. The campaign includes 2 EE radio dramas: the original (on air since 2015 and airing weekly on 115 stations) and a spinoff for adolescents. It also includes live radio call-in shows in 20 local languages, community theatre, and social media. For COVID-19, PCI Media first developed a new Ouro Negro mini-series, using characters from the original radio drama. The miniseries was produced with health content from the World Health Organization (WHO) and included information on social distancing, prevention, quarantine, and hygiene and is featured on the Mozambique Ministry of Health (MoH)'s website. In addition, live call-in shows featured local health personnel who answered listeners' questions and concerns on the air; to date, call-in shows have generated over 500 unique COVID-19 questions. Furthermore, planned community theatre performances were recorded and broadcast on the radio. Social media efforts included MoH-approved Facebook posts and an interactive chatbot with the character Lura. Decisions regarding redesign of programme components were made in collaboration with UNICEF and the MoH, and these long-standing partnerships in Mozambique are, as detailed here, one of the reasons the adaptations could occur quickly and smoothly. In addition, it helped that the call-in show infrastructure was already in place, allowing an avenue for a dialogue with what is described here as a trusted and well-known programme. One challenge was producing the radio mini-series while respecting the health and safety of the writers, producers, and actors.
2. BBC Media Action - examples:
   • In Somalia and Myanmar, existing radio programmes Making Waves and the Tea Cup Diaries have been shifted to include storylines and discussions around COVID-19.
   • In Indonesia, a series of 10 fast fiction audio dramas focused on social distancing is engaging communities on COVID-19 misinformation and the need to limit exposure during Ramadhan.
   • In Afghanistan, a series of 40 fast fiction episodes on radio and interactive voice response (IVR) is designed to reach the country's nearly 2 million nomads with COVID-19 messaging.
   • In Somalia, the focus of radio and IVR programming around COVID-19 is on addressing hygiene norms that directly affect internally displaced persons (IDPs), many of whom live in camps or in close quarters with poor access to sanitation facilities.
   • BBC Media Action India, supported by the H2H Network, created a series of 2-minute radio interstitials for rural and peri-urban audiences featuring Paheli Pehelwan (The Riddleman), who presents riddles to explain hand and respiratory hygiene, physical distancing, COVID-19 symptoms, and treatment-seeking behaviour. The interstitials, which are also available online, were broadcast 5 or 6 times daily on 30 community radio stations for 3 months, reaching 6 million people. They were converted to simple audiovisuals; 16 community radio stations disseminated them on their social media pages, and a few published related content including videos with feedback from listeners. Testimonials indicate that audiences remembered the interstitials and appreciated the simple storytelling format. In addition, BBC Media Action's old EE content is being rebroadcast, which revived interest in them, especially when the country was in lockdown in March 2020.
3. Sésamo - Part of Sesame's global Caring for Each Other initiative, Sésamo's Cuidándonos Unos a Otros was designed to reach both children and their primary caregivers with educational TV content on physical health, socioemotional health, and learning at home. New content included a web series featuring Comegalletas (Cookie Monster), an ageless character who could appeal and talk to adults and children alike. Due to sanitary restrictions, the series was written and produced in less than a week with a 3-person crew in Mexico City, Mexico. These 12 short videos, which have reached over 140,000 people on YouTube, feature Comegalletas performing preventive behaviours from his own funny point of view. Similar short videos on how to have fun at home and stay connected with friends were written and produced in Brazil and dubbed into Spanish for regional distribution. Additional EE formats included comics, infographics, and social media posts, as well as WhatsApp automated chatbots. Another approach to COVID-19 included redistributing previously developed content through partnerships with television networks and federal and state governments. Finally, Sésamo adapted its direct engagement by transitioning from in-person interventions to engaging with teachers and caregivers via WhatsApp. One challenge Sésamo faced was delivering content through a mix of low and high technology to bridge the digital divide.

As noted here, an overall challenge with evaluating COVID-19 EE programmes has been the lack of lead time in planning strong evaluations and restrictions; there is a lot of "fast feedback" that can help organisers understand which misconceptions need addressing (e.g., people thinking COVID is no longer a problem) and thus guide iterative changes in content so that programming responds to realities on the ground.

In short, these cases demonstrate that EE initiatives responding to future pandemics may be well served by: starting with existing infrastructure to quickly build capacity, support, and trust; working with partners to tailor programmes to the local context; and continuing to focus on good storytelling while simultaneously considering evolving media formats and theory. (As an example of the latter: If EE moves in the direction of shorter, web-based video content, it will be necessary to further explain how individuals are experiencing these new messages and relevant theoretical implications.)

In conclusion: "By utilizing existing infrastructure, tailoring programs, and focusing on storytelling and connections to theory, EE can continue to be an efficient communication solution, among a suite of global health communication approaches, to rapidly and effectively change hearts and minds for public health."