CORE Group Global Health Practitioner Conference 2019

1. APPROACHING NORMS
THEORY AND ITS LINK TO
PRACTICE AS
A LEARNING
COLLABORATIVE:
The case of community-centered, norms-shifting
interventions for adolescent reproductive health
Susan Igras, MPH
Senior Technical Advisor, Institute for Reproductive Health, Georgetown University

2. • The LC and what is it aiming to accomplish
• Informing the LC’s work on theory - Social Norm & Behavior Change and
Communication & Behavior Change Theories and Systems/Complexity
Theory
• The role of ‘bottom-up’ theory – Program change theory in advancing
better Norms-Shifting Intervention practice
• Reflections on moving forward theory and practice of Norms-Shifting
Interventions and Programs
MAIN
POINTS

3. LEARNING
COLLABORA
TIVE Many new initiatives on adolescents and social norms
 Fragmented field, creating duplicative efforts and
communication and co-ordination gaps
 Poor theoretical understanding of normative change
mechanisms to support adolescent SRH
 Lack of a documented (and disseminated) evidence-base
shifting social norms: what works, why, and costs
 Few promising/best practices
 Limited understanding of scale-up and sustainability of
normative change initiatives

4. Advancing Research & Practice on Normative Change for
Adolescent Sexual & Reproductive Health and Well-being
2-Year Initiative Funded By Bill & Melinda Gates Foundation (2016-2019)
OUR MISSION
To facilitate collaboration between organizations working on adolescent sexual and
reproductive health norm change initiatives, enhancing collective efforts, building knowledge,
and developing shared tools to promote and guide effective social norm theory, measurement
and practice at scale.
LEARNING
COLLABORA
TIVE

5. SteeringCommittee
SUPPORT: IRH/Secretariat, FHI360
SCALE-UP &
COSTING
Learning
Community
(IRH & FHI360)
75 members
THEORY
Learning
Community
(IRH, LSHTM, CARE)
70 members
MEASUREMENT
Learning
Community
(IRH & FHI360)
92 members
294 members from 108 organizations
(Not all members are part of a learning community)

6.  System complexity and normative influence
 Social norm and behavior change theory
 Communication and behavior change theory
INFORMING THE
LC’s WORK ON
THEORY

7. The Flower for Sustained Health: An integrated socio-ecological framework for normative influence
and change. Version A. Adapted from Cislaghi and Heise by the Learning Collaborative. London,
2017

8. Theory of
Normative Social
Behavior
Integrated
Behavior
Model (Theory
of planned
behavior)
Ideational Model
Of Communication
Diffusion of
Innovation
Theory
Norms
Shifting
Intervention
designs
Many
others
Community Psychology
Norms are a social phenomenon
consisting of informal
understandings that govern
the behavior of members of a
society. As norms change so can
behavior
Communication
Norms are a social
phenomenon transmitted
within a social system
through communication.
Communication can shape
perception and influence
behavior
Systems & Complexity
The interconnectedness of social
systems expresses synergy or
newly-emerging behavior.
Changing one part usually
affects other parts and the

9. Many theories
Many disciplines
Psychology and behavior
• Fishbein & Ajzen. 2012
Communication theory and health promotion
• Rimal, Lapinski, Cook, and Real. 2005
• Kincaid, Figueroa, Storey, Underwood. 2006
• Kincaid, 2004
Diffusion of innovation
• Rogers & Kincaid 1981
Systems theory and health promotion
• Naaldenberg et al 2016
The LC is not promoting any
one theory; all speak to the
work.

10. • Multiple norms influence a specific behavior
• Key norm types: Descriptive and Injunctive
• Role of meta-norms?
• Group identity: Importance of reference groups and social
networks in influencing individuals to adopt new behaviors,
attitudes, beliefs
• Diffusion of ideas/ideation: Social networks; norm change tipping
points
• Intentions: Predict behaviors
From various theory, though, there is some consensus on what is practically
important for community-focused NSI seeking to create enabling
normative environments for peoples’ health and well-being.

11. IMPLICATIONS FOR SBC PROJECTS
EXPLICITLY WORKING IN THE
NORMATIVE SPACE• Being relational in your approach
• Assess the number and types of norms influencing a specific behavior
• Assess the extent that norms are driving a behavior versus other factors
• Intervention focus
• Individuals, but also influential reference groups (are these secondary
audiences?)
• Not just knowledge, attitudes, behaviors, but also Perceptions
• Systems approach
• Monitoring emerging change, unexpected change, expecting and mitigating
pushback

12. PROGRAM CHANGE
THEORY
 The role of ‘bottom-up’ theory derived from implementation experience and
other evidence
 Its relation to norms and behavior change theories
"In theory there is no difference between theory and
practice. In practice, there is." -Yogi Berra

13. 13
PARTICIPATORY
DEVELOPMENT
OF PROGRAM
THEORY AND
CHANGE
PATHWAYS
CHANGE
MECHANISMS
Expected
Outcomes
?
?
?
Intervention
implementation
?

14. HUSBA
NDS’
SCHOO
LS
CHANGE PATHWAYS
DEVELOPED AND ANALYZED
BY STAKEHOLDERS, 2016
Increased use of RH services by women
SRH

15. 15
UNFPA Niger’s Husbands’ Schools
Husbands’
Schools
Sensitization, &
Leadership Sessions
for Model
Husbands
Outreach to other
husbands about RH
Outreach reserved/
opposed husbands
Public service
facilities &
community
Mediating/Enabling Effects
Community trust
& confidence in
Model Husbands
Public/private
discussion
about RH
between men
RH knowledge
for men
Shifting men’s
attitudes about
RH for women Individual
More RH-supportive attitudes
& behaviors of men and women
Changed attitudes and
behaviors of men and women
about their roles/
communication in improved RH
Environment
Greater collaboration/ trust
between men and RH services
Changed gender role
expectations by women and
men for RH and services use by
men and women
Increase in RH
services use by
women
Behavioral &
Normative Shifts
Diffusion
to community
-New ideas
-Expectations
-Model behaviors
of men and
women vis-à-vis
RH and gender
roles
Men’s approval
of RH services
Improving
men’s linkage
to SRH services
Shifting men’s
relationships
with wives and
RH needs
THEORY OF
CHANGE

16. VALUE OF WORKING
COLLABORATIVELY
Being theory-aware but
also agnostic allows for
more experimentation in a
nascent field
Defining some parameters
based on theory allows
community to move
forward and compare
theory, practice, and
results
Better understanding
 What part of theory is
not operationalize-
 What is measurable
what is not
A ‘WHAT NEXT’ QUESTION
LC focus is limited to
community and incremental-
change NSI.
 LC thinking does not
necessarily apply to all NSI,
e.g., behavioral economics,
mass media, norms-
disruptive or activist
approaches