Table 5

Logic model for the factors influencing implementation and effect of the intervention

The IHC podcast interventionEffect modifiersIntermediate effectsDesirable effects
Facilitators
Factors that facilitated implementation and potential desirable effects
Value of the podcast
  • All those interviewed found the IHC podcast to be valuable. They felt that it provided relevant information and new knowledge and skills for assessing health information.


Quality of the podcast
  • The podcast was clear and understandable to people in the target audience for which it was prepared.

  • Listeners felt that the explanations that the IHC podcast provided were clear and sufficient and that any questions they had were answered by the end of each episode.

  • For the most part, participants felt that the length of the podcast episodes and the number of episodes was appropriate.

  • Participants felt that the podcast was well organised, although the reasons that they gave for this varied.


Delivery of the podcast
  • A podcast delivered by research assistants facilitated listening to the entire podcast and reflecting on it by making it convenient to listen and providing personal support. It also made it possible for others (family and neighbours) to listen to the podcast together with the participants.

  • The majority of participants found it suitable to listen to two episodes per week for about 7 weeks when visited by the research assistants, and to be able to listen to the podcast at their convenience after that.

Child’s school environment
  • Some parents, whose children were in intervention schools, were motivated to participate by their children and wanting to learn what their children were learning.

  • Parents also were motivated to participate by headteachers and teachers, whom they trusted.


Education of the target audience
  • Participants’ level of formal education did not appear to influence how they listened to the podcast or their overall understanding of the podcast but may have affected the extent to which they retained what they learnt.


Participants’ attitudes
  • Participants had positive attitudes towards learning new information, science and critical thinking.


Listening environment and technology
  • Most participants did not have a problem listening to the podcast. A quiet listening environment and making sure that the batteries in the portable media player are charged could help prevent interruptions and facilitate listening.

Appropriateness of the podcast
  • Participants found the podcast to be relevant and engaging.


Credibility of the podcast
  • Participants found the podcast to be credible.


Effort
  • It required very little effort to listen to the podcast.


Entertainment
  • All those interviewed found the IHC podcast and song to be entertaining and engaging. The skits made the explanations non-threatening, facilitated understanding and made the messages memorable.


Motivation to listen and learn
  • Key factors that motivated participants to listen to the podcast included the perceived value of what they were learning, its practical application to daily life, and that the podcast was entertaining and enjoyable.


Competing messages
  • Listening to the IHC podcast led some participants to be more critical and aware of health advice that was given in other messages without providing a basis for the advice.

Observed effects
  • Parents who listened to the IHC podcast in the trial were better able to assess the trustworthiness of treatment claims, compared with parents in the control group.

  • After 1 year, there was a large relative reduction in the ability of participants to assess the trustworthiness of treatment claims among participants who listened to the IHC podcast compared to those who did not.


Potential effects
  • Listening to the IHC podcast led some participants to be more critical and aware of health advice that was given in other messages without providing a basis for the advice.

  • Listening to the IHC podcast led some participants to become more thoughtful about claims not related to health.

Factors that could facilitate scaling up
  • A well-designed podcast may appeal to many people in the target audience and be convenient.

Factors that could facilitate scaling up
  • Introducing the IHC podcast through primary schools that are using the IHC primary school resources may be an effective strategy for disseminating the podcast to many parents and others in the community.

Barriers
Factors that impeded implementation and potential desirable effects
Length of the episodes
  • Some episodes were reportedly long, which makes them confusing.

Child’s school environment
  • Few or no parents attended meetings or were recruited to participate at some schools. The reasons for this are uncertain.

Observed effects
  • No adverse effects were reported by participants or observers in the trial.

Participants’ expectations
  • Some participants expected to hear messages about how to manage common health conditions rather than messages about how to assess the trustworthiness of treatment claims. Nonetheless, most participants understood the purpose of the podcast after listening to it and most listened to the entire podcast.


Participants’ beliefs
  • Many participants had prior beliefs about treatments that were in conflict with messages in the IHC podcast. This did not appear to interfere with their listening to the podcast but might have affected their understanding of the podcast.


Listening environment and technology
  • Participants who were in a busy and noisy place found difficulties listening, which might have affected how they listened and understood the content of the podcast.

Potential effects
  • Some participants mentioned that there might be a potential for scientific information to conflict with traditional and religious beliefs. However, we did not observe any conflicts, and no participant reported having experienced these as a result of listening to the IHC podcast.

Factors that could impede scaling up
  • Delivery of the podcast by research assistants is not feasible on a large scale.

Factors that could impede scaling up
  • The ability to reach parents through schools may depend on how much interest and enthusiasm is shown by head teachers and teachers. This, in turn, may depend on effective outreach to introduce the IHC podcast together with the IHC primary school resources into schools.

  • Many people in the target audience (parents of primary school children) may not initially be interested in learning new information, science and critical thinking.

  • Availability of portable listening devices may limit dissemination of the podcast.

  • IHC, informed health choices.