Maternal and Newborn Health Promotion Theater in Timor-Leste: A Program Evaluation

The purpose of this project was to improve knowledge of maternal and newborn health practices in rural areas of Timor-Leste through live theater. Health Alliance International (HAI) and the Timorese drama group Bibi Bulak developed the health promotion-dramas over four months in 2005. The drama told the story of two pregnancies in two rural Timorese families, demonstrating relevant positive and negative health behaviors. It was was designed to increase knowledge of antenatal, delivery, postpartum and newborn care; pregnancy, newborn, and postpartum danger signs; and breastfeeding. It was initially performed and evaluated at four sites on four consecutive nights. A program evaluation assessed the drama's efficacy in improving health knowledge. An oral pretest-posttest survey (n=129) with posttest-only comparisons (n=30) was conducted at the four performances. The survey included demographic information and 16 questions (11 closed-ended, 2 multiple-choice and 3 qualitative). Pretest-posttest groups were surveyed immediately before and immediately after performances. Posttest-only groups were surveyed after performances. Pretest to posttest changes in score were analyzed for statistical significance at the group- and individual-levels, and results were shared with community partners. The four performances attracted 200-800 attendees each (total=1800). Evaluation results showed significant improvements in maternal and newborn health knowledge following performances compared to baseline. Significant increases were seen in 10 of the 12 questions testing specific health knowledge (p<0.05). Percentage of respondents providing new, correct responses ranged from 22% to 74% by question. The posttest-only comparison group results indicated minimal pretest-sensitization. Responses to the three qualitative questions indicated nearly universal approval of the drama. Evaluation results were used to improve future performances. This drama-project and its evaluation can be used as models for collaborative drama and theater projects elsewhere. Based on this successful collaboration, HAI has continued to work with Bibi Bulak to train local health activist groups in drama, and to help them develop maternal and newborn health street theater productions. Other organizations have provided Bibi Bulak with funding for repeat performances of this drama. The success of this project indicates that while international NGOs can effectively provide technical expertise and financial resources for health promotion projects such as this, local groups should maintain strong leadership roles.