Using social norms theory for health promotion in low-income countries.

Social norms can greatly influence people's health-related choices and behaviours. In the last few years, scholars and practitioners working in low- and mid-income countries (LMIC) have increasingly been trying to harness the influence of social norms to improve people's health globally. However, the literature informing social norm interventions in LMIC lacks a framework to understand how norms interact with other factors that sustain harmful practices and behaviours. This gap has led to short-sighted interventions that target social norms exclusively without a wider awareness of how other institutional, material, individual and social factors affect the harmful practice. Emphasizing norms to the exclusion of other factors might ultimately discredit norms-based strategies, not because they are flawed but because they alone are not sufficient to shift behaviour. In this paper, we share a framework (already adopted by some practitioners) that locates norm-based strategies within the wider array of factors that must be considered when designing prevention programmes in LMIC

Four avenues of normative influence: A research agenda for health promotion in low and mid-income countries.

Health promotion interventions in low and midincome countries (LMIC) are increasingly integrating strategies to change local social norms that sustain harmful practices. However, the literature on social norms and health in LMIC is still scarce. A well-known application of social norm theory in LMIC involves abandonment of female genital cutting (FGC) in West Africa. We argue that FGC is a special case because of its unique relationship between the norm and the practice; health promotion interventions would benefit from a wider understanding of how social norms can influence different types of health-related behaviors. We hypothesize that four factors shape the strength of a norm over a practice: (1) whether the practice is dependent or interdependent; (2) whether it is more or less detectable; (3) whether it is under the influence of distal or proximal norms; and (4) whether noncompliance is likely to result in sanctions. We look at each of these four factors in detail, and suggest that different relations between norms and a practice might require different programmatic solutions. Future findings that will confirm or contradict our hypothesis will be critical for effective health promotion interventions that aim to change harmful social norms in LMIC. (PsycINFO Database Recor

Self-rated health as a valid indicator for health-equity analyses: evidence from the Italian health interview survey.

BACKGROUND: Self-rated health is widely considered a good indicator of morbidity and mortality but its validity for health equity analysis and public health policies in Italy is often disregarded by policy-makers. This study had three objectives. O1: To explore response distribution across dimensions of age, chronic health conditions, functional limitations and SRH in Italy. O2: To explore associations between SRH and healthcare demand in Italy. O3: To explore the association between SRH and household income. METHODS: Cross-sectional data were obtained from the 2015 Health Interview Survey (HIS) conducted in Italy. Italian respondents (n = 20,814) were included in logistic regression analyses. O1: associations of chronic health conditions (CHC), functional limitations (FL), and age with self-rated health (SRH) were tested. O2: associations of CHC, FL, and SRH with hospitalisation (H), medical specialist consultations (MSC), and medicine use (MU) were tested. O3: associations of SRH and CHC with household income (PEI) were tested. RESULTS: O1: CHC, FL, and age had an independent summative effect on respondents' SRH. O2: SRH predicted H and MSC more than CHC; age and MU were more strongly correlated than SRH and MU. O3: SRH and PEI were significantly correlated, while we found no correlation between CHC and PEI. CONCLUSIONS: Drawing from our results and the relevant literature, we suggest that policy-makers in Italy could use SRH measures to: 1) predict healthcare demand for effective allocation of resources; 2) assess subjective effectiveness of treatments; and 3) understand geosocial pockets of health inequity that require special attention

Couples' Economic Equilibrium, Gender Norms and Intimate Partner Violence in Kirumba, Tanzania.

This study examines the link between the loss of men's status as breadwinners and their use of intimate partner violence (IPV) in Kirumba (Mwanza city, Tanzania), mediated by the entry of women into the cash work force. Using qualitative data from 20 in-depth interviews and eight focus groups with men (n = 58) and women (n = 58), this article explores how the existing gender-related social norm linked to male breadwinning was threatened when women were forced to enter into paid work (linked to the family's impoverishment), and how these changes eventually increased partner violence. The study draws implications for IPV reduction strategies in patriarchal contexts experiencing declining economic opportunities for men

Mapping the Social-Norms Literature: An Overview of Reviews.

The theoretical literature on social norms is multifaceted and at times contradictory. Looking at existing reviews, we aimed to offer a more complete understanding of its current status. By investigating the conceptual frameworks and organizing elements used to compare social-norms theories, we identified four theoretical spaces of inquiry that were common across the reviews: what social norms are, what relationship exists between social norms and behavior, how social norms evolve, and what categories of actors must be considered in the study of social norms. We highlight areas of consensus and debate in the reviews around these four themes and discuss points of agreement and disagreement that uncover trajectories for future empirical and theoretical investigation

Corporal punishment, discipline and social norms: A systematic review in low- and middle-income countries

There is increased recognition that incorporating a social norms approach provides insights for understanding corporal punishment and/or discipline (CPD). This review seeks to explore how the literature analyses social norms and CPD in low- and middle-income countries (LMICs). We searched eight electronic databases, Google Scholar, Google and institutional websites, including articles in LMICs which examined social norms and CPD perpetrated by family members or teachers. Data was extracted, assessed for quality and analyzed according to key themes. Of 21,708 articles from academic databases and 92 from other sources, 37 studies were included. We observed heterogeneity in study design, and in the definition and measurement of social norms. In the majority of studies, social norms supporting CPD were either harmful or, at times, protective. The review also finds that gender, age, power hierarchies and changes such as conflict, migration and modernization may influence norms on CPD. CPD interventions should be evaluated over longer periods and with consideration to the continuum of violence between homes and schools. Future research on CPD should (1) theorize and define social norms more clearly; (2) examine both harmful and protective norms linked to CPD; (3) explicitly examine perpetration of violence across the home-school continuum

The evolution of social norms interventions for health promotion: Distinguishing norms correction and norms transformation.

The evidence that social norms – informal rules of acceptable action within a given group – influence people’s health-related choices is abundant and cross-sectorial, ranging from health-related behaviours such use of contraception, handwashing, alcohol use and/or smoking, to social practices and behaviors such as corporal punishment, child marriage, sexual harassment and sexual assault. Following the large body of literature, especially coming in health promotion, underscoring the importance of addressing harm - ful social norms to improve people’s health, social norms theory has long been used to inform public health policy and practice. Even though several different theoretical perspectives exist on what social norms are and how they affect people’s practices, much contemporary research and practice in public and global health has adopted theory and terminology by Cialdini and colleagues, whose Focus Theory of Normative Conduct defined social norms as (1) one’s beliefs about what others in one’s group do (descriptive norms), and (2) the extent to which one believes others as approving or disapproving of something (injunctive norms)

A Call for Research: Adopting normative approaches to understanding violence against women and girls in public spaces

This guidance note is intended to support DFID advisors and programme managers with evidence, relevant examples and practical guidance on how to address harmful social norms in the context of programming to prevent VAWG.About the Violence against Women and Girls HelpdeskThe Violence against Women and Girls (VAWG) Helpdesk is a research and advice service for DFID (open across HMG) providing:Rapid Desk Research on all aspects of VAWG for advisers and programme managers across all sectors (requests for this service are called “queries”). This service is referred to as the “VAWG Query Service”

What influenced provision of non-communicable disease healthcare in the Syrian conflict, from policy to implementation? A qualitative study.

BACKGROUND: There has been increasing focus on tackling the growing burden of non-communicable diseases (NCD) in crisis settings. The complex and protracted crisis in Syria is unfolding against a background of increasing NCD burden. This study investigated factors influencing implementation of NCD healthcare in Syria. METHODS: This is a qualitative study, whereby semi-structured interviews were conducted with fourteen humanitarian health staff working on NCD healthcare in Syria. RESULTS: Challenges to NCD care implementation were reflected at several stages, from planning services through to healthcare delivery. There was a lack of information on unmet population need; little consensus among humanitarian actors regarding an appropriate health service package; and no clear approach for prioritising public health interventions. The main challenges to service delivery identified by participants were conflict-related insecurity and disruption to infrastructure, hampering continuity of chronic illness care. Collaboration was a key factor which influenced implementation at all stages. CONCLUSIONS: The historical context, the conflict situation, and the characteristics of health actors and their relationships, all impacted provision of NCD care. These factors influenced each other, so that the social views and values (of individuals and organisations), as well as politics and relationships, interacted with the physical environment and security situation. Infrastructure damage has implications for wider healthcare across Syria, and NCD care requires an innovative approach to improve continuity of care. There is a need for a transparent approach to resource allocation, which may be generalisable to the wider humanitarian health sector