We mark World Malaria Day with a look at how our research team have adopted a new theory as part of the BBC World Service Trust’s work in Cambodia to combat the disease.

by Lizz Frost Yocum and Vipul Khosla

Marking World Malaria Day, we had the pleasure of presenting our Malaria Communications Model and welcoming Dr Kate Distin to talk with the BBC World Service Trust about cultural evolution theory. We drew heavily on this theory to help us better understand malaria in the lives of Cambodian audiences, and to bring this understanding to the making of the Trust’s malaria outputs.

Lizz gave us a background to malaria, and provided an epidemiological perspective on a disease we often have to look at in the abstract. We then talked about the detailed objectives of the Global Fund – who funded this project – which were heavy in public health-speak. The challenge for us was to unpack those objectives and turn them into engaging outputs. Moreover, we were tasked with delivering on these objectives with very few outputs: 1 short film, 4 radio spots and 4 TV spots over the two year period of the project. This meant that the media outputs needed to be very distinctive and their messages needed to be clear and focused, because there were so few opportunities to reach audiences with them.

Our first step was to map the objectives against the Trust’s 4 levels of engagement: system, organisation, practitioner and audience. We identified targets across key stages in the natural history of the illness: prevention, diagnosis, treatment and recovery, and for each we considered whether we wanted to change knowledge, attitudes or practices.
The Trust’s Research & Learning team in Cambodia used this framework to focus the formative research which would ground and guide the message brief at the heart of the project.

The formative research was conducted in 2 stages. First, interviewing organisations and practitioners, and second, conducting focus groups with audiences about malaria. The theoretical foundations for this were the Health Belief Model, and the MARCH approach. Using the findings from this research, we delivered key recommendations for the messaging priorities and target audiences. However, we still felt it was necessary to deepen the interpretation. We decided to conduct further analysis of the data to understand how it fit with Cambodian culture and its evolution.

Dr Distin, author of ‘The Selfish Meme’ spoke in detail about cultural evolution theory. An important point in this theory is that ideas are competing for attention, regardless of their truth. The theory draws on the 3 stages of evolution: ‘heredity’, ‘variation’ and ‘selection’.

Vipul reported how the research findings were mapped across these 3 stages. Formative research informed the ‘heredity’. Semiotic analysis of the drama treatment was used to deconstruct the messages and understand ‘variation’ in cultural evolution. Focus groups findings revealed the message ‘selection’ amongst the audience.

Analysis of the data using the memetic approach, helped us to gain a holistic perspective on the potential for the malaria intervention; it provided a common unit of analysis for knowledge, practices, beliefs and messages, and also highlighted their mutual dependence. Finally, it allowed us to prioritise and focus messages, while still accepting the complexity and contradictions around malaria, present among our Cambodian audiences.