Skip to main content
Top
Published in: Prevention Science 6/2019

Open Access 01-08-2019

Changing Social Norms: the Importance of “Organized Diffusion” for Scaling Up Community Health Promotion and Women Empowerment Interventions

Authors: Beniamino Cislaghi, Elaine K. Denny, Mady Cissé, Penda Gueye, Binita Shrestha, Prabin Nanicha Shrestha, Gemma Ferguson, Claire Hughes, Cari Jo Clark

Published in: Prevention Science | Issue 6/2019

Login to get access

Abstract

Some harmful practices are sustained by social norms—collective beliefs about what people expect from each other. Practitioners and researchers alike have been investigating the potential of social norms theory to inform the design of effective interventions addressing these practices in low- and middle-income countries. One approach commonly used to facilitate social norms change is community-based dialogs and trainings. This approach has often been criticized for not being cost-effective, as it usually includes a relatively small number of direct participants and does not allow for scaling-up strategies. In spite of some evidence (as for instance, the SASA! Program) that community dialogs can achieve social norms change, little exists in the literature about how exactly participants in community dialogs engage others in their networks to achieve change. In this paper, we look at the potential of “organized diffusion” as a cost-effective strategy to expand the positive effects of community-based interventions to participants’ networks, achieving sustainable normative shifts. We provide quantitative evidence from three case studies—Community Empowerment Program in Mali, Change Starts at Home in Nepal, and Voices for Change in Nigeria—showing that participants in community-based interventions can be effectively empowered to share their new knowledge and understandings systematically with others in their networks, eventually facilitating social norms change. Future community-based interventions intending to achieve social norms change would benefit from integrating ways to help participants engage others in their network in transformative conversations. Doing so has the potential to generate additional impact with little additional investment.
Literature
go back to reference Abramsky, T., Devries, K., Kiss, L., Nakuti, J., Kyegombe, N., Starmann, E., et al. (2014). Findings from the SASA! Study: A cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Medicine, 12(122), 1–17. Abramsky, T., Devries, K., Kiss, L., Nakuti, J., Kyegombe, N., Starmann, E., et al. (2014). Findings from the SASA! Study: A cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Medicine, 12(122), 1–17.
go back to reference Bajaj, M., Cislaghi, B., & Mackie, G. (2016). Advancing transformative human rights education. In G. Brown (Ed.), The universal declaration of human rights in the 21st century. Cambridge: OPB. Bajaj, M., Cislaghi, B., & Mackie, G. (2016). Advancing transformative human rights education. In G. Brown (Ed.), The universal declaration of human rights in the 21st century. Cambridge: OPB.
go back to reference Bell, D. C., & Cox, M. L. (2015). Social norms: Do we love norms too much? Journal of Family Theory & Review, 7(1), 28–46.CrossRef Bell, D. C., & Cox, M. L. (2015). Social norms: Do we love norms too much? Journal of Family Theory & Review, 7(1), 28–46.CrossRef
go back to reference Berkowitz, A. (2010). Fostering healthy norms to prevent violence and abuse: The social norms approach. In K. L. Kaufman (Ed.), The prevention of sexual violence: A practitioner’s sourcebook (pp. 147–172). Fitchburg, MA: NEARI Press. Berkowitz, A. (2010). Fostering healthy norms to prevent violence and abuse: The social norms approach. In K. L. Kaufman (Ed.), The prevention of sexual violence: A practitioner’s sourcebook (pp. 147–172). Fitchburg, MA: NEARI Press.
go back to reference Christiansen, J. (2009). Four stages of social movements. EBSCO Research Starters, 1248. Christiansen, J. (2009). Four stages of social movements. EBSCO Research Starters, 1248.
go back to reference Cislaghi, B. (2017). Human rights and community-led development. Oxford: EUP. Cislaghi, B. (2017). Human rights and community-led development. Oxford: EUP.
go back to reference Cislaghi, B. (2018). The story of the ‘now-women’: Changing gender norms in rural West Africa. Development in Practice, 28(2), 257–268 d.CrossRef Cislaghi, B. (2018). The story of the ‘now-women’: Changing gender norms in rural West Africa. Development in Practice, 28(2), 257–268 d.CrossRef
go back to reference Cislaghi, B., & Heise, L. (2017). Measuring gender-related social norms: Report of a meeting, Baltimore Maryland, June 14–15, 2016. London: LSHTM. Cislaghi, B., & Heise, L. (2017). Measuring gender-related social norms: Report of a meeting, Baltimore Maryland, June 14–15, 2016. London: LSHTM.
go back to reference Cislaghi, B., Gillespie, D., & Mackie, G. (2015). Values deliberation and collective action in rural Senegal (UNICEF Ed.). New York City: UNICEF. Cislaghi, B., Gillespie, D., & Mackie, G. (2015). Values deliberation and collective action in rural Senegal (UNICEF Ed.). New York City: UNICEF.
go back to reference Cislaghi, B., Gillespie, D., & Mackie, G. (2016). Values deliberation and collective action: Community empowerment in rural Senegal. New York: Palgrave MacMillan.CrossRef Cislaghi, B., Gillespie, D., & Mackie, G. (2016). Values deliberation and collective action: Community empowerment in rural Senegal. New York: Palgrave MacMillan.CrossRef
go back to reference Cislaghi, B., Gillespie, D., & Mackie, G. (2017). Expanding the aspirational map. In M. Bajaj & N. Flowers (Eds.), Human rights education : Theory, research, praxis (pp. ix, 353 pages). Philadelphia: University of Pennsylvania Press. Cislaghi, B., Gillespie, D., & Mackie, G. (2017). Expanding the aspirational map. In M. Bajaj & N. Flowers (Eds.), Human rights education : Theory, research, praxis (pp. ix, 353 pages). Philadelphia: University of Pennsylvania Press.
go back to reference Cisse, M., Gueye, P., & Manel, V. (2018). A community-led approach to community empowerment in Mali, Mauritania, Guinea, and Guinea-Bissau. Endline evaluation brief. Dakar: Tostan. Cisse, M., Gueye, P., & Manel, V. (2018). A community-led approach to community empowerment in Mali, Mauritania, Guinea, and Guinea-Bissau. Endline evaluation brief. Dakar: Tostan.
go back to reference Clark, C., Spencer, R. A., Shrestha, B., Ferguson, G., Oakes, J. M., & Gupta, J. (2017). Evaluating a multicomponent social behaviour change communication strategy to reduce intimate partner violence among married couples: Study protocol for a cluster randomized trial in Nepal. BMC Public Health, 17(1), 75.CrossRef Clark, C., Spencer, R. A., Shrestha, B., Ferguson, G., Oakes, J. M., & Gupta, J. (2017). Evaluating a multicomponent social behaviour change communication strategy to reduce intimate partner violence among married couples: Study protocol for a cluster randomized trial in Nepal. BMC Public Health, 17(1), 75.CrossRef
go back to reference Costenbader, E., Lenzi, R., Hershow, R. B., Ashburn, K., & McCarraher, D. R. (2017). Measurement of social norms affecting modern contraceptive use: A literature review. Studies in Family Planning, 48(4), 377–389.CrossRef Costenbader, E., Lenzi, R., Hershow, R. B., Ashburn, K., & McCarraher, D. R. (2017). Measurement of social norms affecting modern contraceptive use: A literature review. Studies in Family Planning, 48(4), 377–389.CrossRef
go back to reference Gelfand, M. J., & Jackson, J. C. (2016). From one mind to many: The emerging science of cultural norms. Current Opinion in Psychology, 8, 175–181.CrossRef Gelfand, M. J., & Jackson, J. C. (2016). From one mind to many: The emerging science of cultural norms. Current Opinion in Psychology, 8, 175–181.CrossRef
go back to reference Gidycz, C. A., Orchowski, L. M., & Berkowitz, A. (2011). Preventing sexual aggression among college men: An evaluation of a social norms and bystander intervention program. Violence Against Women, 17(6), 720–742.CrossRef Gidycz, C. A., Orchowski, L. M., & Berkowitz, A. (2011). Preventing sexual aggression among college men: An evaluation of a social norms and bystander intervention program. Violence Against Women, 17(6), 720–742.CrossRef
go back to reference Gillespie, D., & Melching, M. (2010). The transformative power of democracy and human rights in nonformal education: The case of Tostan. Adult Education Quarterly, 60(5), 477–498.CrossRef Gillespie, D., & Melching, M. (2010). The transformative power of democracy and human rights in nonformal education: The case of Tostan. Adult Education Quarterly, 60(5), 477–498.CrossRef
go back to reference Goodrick, D. (2014). Comparative case studies, methodological briefs: Impact Evaluation 9. New York: UNICEF. Goodrick, D. (2014). Comparative case studies, methodological briefs: Impact Evaluation 9. New York: UNICEF.
go back to reference Greenhalgh, T., Robert, G., Bate, P., Macfarlane, F., & Kyriakidou, O. (2005). Diffusion of innovations in health service organisations - a systematic literature review. Oxford, UK: Blackwell.CrossRef Greenhalgh, T., Robert, G., Bate, P., Macfarlane, F., & Kyriakidou, O. (2005). Diffusion of innovations in health service organisations - a systematic literature review. Oxford, UK: Blackwell.CrossRef
go back to reference Heise, L. (2011). What works to prevent partner violence: An evidence overview. Heise, L. (2011). What works to prevent partner violence: An evidence overview.
go back to reference Jewkes, R., Flood, M., & Lang, J. (2015). From work with men and boys to changes of social norms and reduction of inequities in gender relations: A conceptual shift in prevention of violence against women and girls. The Lancet, 385(9977), 1580–1589.CrossRef Jewkes, R., Flood, M., & Lang, J. (2015). From work with men and boys to changes of social norms and reduction of inequities in gender relations: A conceptual shift in prevention of violence against women and girls. The Lancet, 385(9977), 1580–1589.CrossRef
go back to reference Kashima, Y. (2009). Culture comparison and culture priming: A critical analysis. In R. S. J. Wyer, C. y. Chiu, & Y.-y. Hong (Eds.), Understanding culture: Theory, research, and practice (pp. 53–77). New York, NY: Psychology Press. Kashima, Y. (2009). Culture comparison and culture priming: A critical analysis. In R. S. J. Wyer, C. y. Chiu, & Y.-y. Hong (Eds.), Understanding culture: Theory, research, and practice (pp. 53–77). New York, NY: Psychology Press.
go back to reference Kashima, Y. (2014). Meaning, grounding, and the construction of social reality. Asian Journal of Social Psychology, 17, 81–95.CrossRef Kashima, Y. (2014). Meaning, grounding, and the construction of social reality. Asian Journal of Social Psychology, 17, 81–95.CrossRef
go back to reference Katz, E., Levin, M. L., & Hamilton, H. (1963). Traditions of research on the diffusion of innovation. American Sociological Review, 28(2), 237–252.CrossRef Katz, E., Levin, M. L., & Hamilton, H. (1963). Traditions of research on the diffusion of innovation. American Sociological Review, 28(2), 237–252.CrossRef
go back to reference Kuenzi, M. (2005). The role of nonformal education in promoting democratic attitudes: Findings from Senegal. Democratization, 12(2), 223–243.CrossRef Kuenzi, M. (2005). The role of nonformal education in promoting democratic attitudes: Findings from Senegal. Democratization, 12(2), 223–243.CrossRef
go back to reference Kumar, V., Kumar, A., Ghosh, A. K., Samphel, R., Yadav, R., Yeung, D., & Darmstadt, G. L. (2015). Enculturating science: Community-centric design of behavior change interactions for accelerating health impact. Seminars in Perinatology, 39, 393–415.CrossRef Kumar, V., Kumar, A., Ghosh, A. K., Samphel, R., Yadav, R., Yeung, D., & Darmstadt, G. L. (2015). Enculturating science: Community-centric design of behavior change interactions for accelerating health impact. Seminars in Perinatology, 39, 393–415.CrossRef
go back to reference Lau, I. Y.-M., Chiu, C.-y., & Hong, Y.-y. (2001). I know what you know: Assumptions about others’ knowledge and their effects on message construction. Social Cognition, 19(6), 587–600.CrossRef Lau, I. Y.-M., Chiu, C.-y., & Hong, Y.-y. (2001). I know what you know: Assumptions about others’ knowledge and their effects on message construction. Social Cognition, 19(6), 587–600.CrossRef
go back to reference Lee-Rife, S., Malhotra, A., Warner, A., & McGonagle Glinski, A. (2012). What works to prevent child marriage: A review of the evidence. Studies in Family Planning, 43(4), 287.CrossRef Lee-Rife, S., Malhotra, A., Warner, A., & McGonagle Glinski, A. (2012). What works to prevent child marriage: A review of the evidence. Studies in Family Planning, 43(4), 287.CrossRef
go back to reference Linos, N., Slopen, N., Subramanian, S. V., Berkman, L., & Kawachi, I. (2013). Influence of community social norms on spousal violence: A population-based multilevel study of Nigerian women. American Journal of Public Health, 103(1), 148–155. Linos, N., Slopen, N., Subramanian, S. V., Berkman, L., & Kawachi, I. (2013). Influence of community social norms on spousal violence: A population-based multilevel study of Nigerian women. American Journal of Public Health, 103(1), 148–155.
go back to reference Mackie, G., & LeJeune, J. (2009). Social dynamics of abandonment of harmful practices: A new look at the theory. Florence: UNICEF. Mackie, G., & LeJeune, J. (2009). Social dynamics of abandonment of harmful practices: A new look at the theory. Florence: UNICEF.
go back to reference Mackie, G., Moneti, F., Shakya, H., & Denny, E. (2015). What are social norms? How are they measured? New York: UNICEF and UCSD. Mackie, G., Moneti, F., Shakya, H., & Denny, E. (2015). What are social norms? How are they measured? New York: UNICEF and UCSD.
go back to reference Michau, L., Horn, J., Bank, A, Dutt, M., & Zimmerman, C. (2015). Prevention of violence against women and girls: Lessons from practice. The Lancet, 385, 1672–1684.CrossRef Michau, L., Horn, J., Bank, A, Dutt, M., & Zimmerman, C. (2015). Prevention of violence against women and girls: Lessons from practice. The Lancet, 385, 1672–1684.CrossRef
go back to reference Miller, D. T., & Prentice, D. A. (2016). Changing norms to change behavior. Annual Review of Psychology, 67, 339–361.CrossRef Miller, D. T., & Prentice, D. A. (2016). Changing norms to change behavior. Annual Review of Psychology, 67, 339–361.CrossRef
go back to reference Mintrom, M. (1997). Policy entrepreneurs and the diffusion of innovation. American Journal of Political Science, 41(3), 738–770.CrossRef Mintrom, M. (1997). Policy entrepreneurs and the diffusion of innovation. American Journal of Political Science, 41(3), 738–770.CrossRef
go back to reference Nonaka, I., & Takeuchi, H. (1995). The knowledge creation company: How Japanese companies create the dynamics of innovation. New York, NY: Oxford University Press. Nonaka, I., & Takeuchi, H. (1995). The knowledge creation company: How Japanese companies create the dynamics of innovation. New York, NY: Oxford University Press.
go back to reference Robertson, T. S. (1967). The process of innovation and the diffusion of innovation. Journal of Marketing, 13(1), 14–19.CrossRef Robertson, T. S. (1967). The process of innovation and the diffusion of innovation. Journal of Marketing, 13(1), 14–19.CrossRef
go back to reference Rogers, E. M. (1962). Diffusion of innovation. London: The Free Press. Rogers, E. M. (1962). Diffusion of innovation. London: The Free Press.
go back to reference Saxena, D. P. (1971). The “reference group” concept. Social Science, 46(3), 155–164. Saxena, D. P. (1971). The “reference group” concept. Social Science, 46(3), 155–164.
go back to reference Shakya, H., Fleming, P., Saggurti, N., Donta, B., Silverman, J., & Raj, A. (2017). Longitudinal associations of intimate partner violence attitudes and perpetration: Dyadic couples data from a randomized controlled trial in rural India. Social Science & Medicine, 179, 97–105.CrossRef Shakya, H., Fleming, P., Saggurti, N., Donta, B., Silverman, J., & Raj, A. (2017). Longitudinal associations of intimate partner violence attitudes and perpetration: Dyadic couples data from a randomized controlled trial in rural India. Social Science & Medicine, 179, 97–105.CrossRef
go back to reference Starmann, E., Heise, L., Kyegombe, N., Devries, K., Abramsky, T., Michau, L., et al. (2018). Examining diffusion to understand the how of SASA!, a violence against women and HIV prevention intervention in Uganda. BMC Public Health, 18(1), 616.CrossRef Starmann, E., Heise, L., Kyegombe, N., Devries, K., Abramsky, T., Michau, L., et al. (2018). Examining diffusion to understand the how of SASA!, a violence against women and HIV prevention intervention in Uganda. BMC Public Health, 18(1), 616.CrossRef
go back to reference Stern, E., Heise, L., & McLean, L. (2017). The doing and undoing of male household decision-making and economic authority in Rwanda and its implications for gender transformative programming. Culture, Health & Sexuality, 20(9), 1–16. Stern, E., Heise, L., & McLean, L. (2017). The doing and undoing of male household decision-making and economic authority in Rwanda and its implications for gender transformative programming. Culture, Health & Sexuality, 20(9), 1–16.
go back to reference Stock, C., Mcalaney, J., Pischke, C., Vriesacker, B., Van Hal, G., Akvardar, Y., et al. (2014). Student estimations of peer alcohol consumption: Links between the Social Norms Approach and the Health Promoting University concept. Scandinavian Journal of Public Health, 42(15), 52–59. Stock, C., Mcalaney, J., Pischke, C., Vriesacker, B., Van Hal, G., Akvardar, Y., et al. (2014). Student estimations of peer alcohol consumption: Links between the Social Norms Approach and the Health Promoting University concept. Scandinavian Journal of Public Health, 42(15), 52–59.
go back to reference Tankard, M. E., & Paluck, E. L. (2016). Norm perception as vehicle for social change. Social Issues and Policy Review, 10(1), 181–211.CrossRef Tankard, M. E., & Paluck, E. L. (2016). Norm perception as vehicle for social change. Social Issues and Policy Review, 10(1), 181–211.CrossRef
go back to reference UNICEF. (2008). Long-term evaluation of the Tostan Programme in Senegal: Kolda, Thiès and Fatick regions. New York: UNICEF. UNICEF. (2008). Long-term evaluation of the Tostan Programme in Senegal: Kolda, Thiès and Fatick regions. New York: UNICEF.
go back to reference Vaitla, B., Taylor, A., Horn, J. V., & Cislaghi, B. (2017). Social norms and girls’ well-being. New York: United Nations Foundation. Vaitla, B., Taylor, A., Horn, J. V., & Cislaghi, B. (2017). Social norms and girls’ well-being. New York: United Nations Foundation.
go back to reference Weber, A., Fernald, A., & Diop, Y. (2017). When cultural norms discourage talking to babies: Effectiveness of a parenting program in rural Senegal. Child Development, 88(5), 1513–1526.CrossRef Weber, A., Fernald, A., & Diop, Y. (2017). When cultural norms discourage talking to babies: Effectiveness of a parenting program in rural Senegal. Child Development, 88(5), 1513–1526.CrossRef
Metadata
Title
Changing Social Norms: the Importance of “Organized Diffusion” for Scaling Up Community Health Promotion and Women Empowerment Interventions
Authors
Beniamino Cislaghi
Elaine K. Denny
Mady Cissé
Penda Gueye
Binita Shrestha
Prabin Nanicha Shrestha
Gemma Ferguson
Claire Hughes
Cari Jo Clark
Publication date
01-08-2019
Publisher
Springer US
Published in
Prevention Science / Issue 6/2019
Print ISSN: 1389-4986
Electronic ISSN: 1573-6695
DOI
https://doi.org/10.1007/s11121-019-00998-3

Other articles of this Issue 6/2019

Prevention Science 6/2019 Go to the issue