Adapting the Social Norms Exploration Tool in the Democratic Republic of the Congo to Identify Social Norms for Behavior Change

"Project implementers or donors doing formative research on social norms can learn from the practical, on-the-ground experience of applying the SNET."

Social norms are unwritten rules of behaviour shared by members of a group or community. Research conducted both globally and in the Democratic Republic of the Congo (DRC) indicates limited spousal communication about health and pervasive norms that position men as decision-makers, inhibiting women's access to health services and discouraging adoption of family planning. This article discusses the adaptation of the Social Norms Exploration Tool (SNET), which identifies relevant social norms and community members upholding these norms, to inform the development of family planning interventions in the DRC.

Developed by the Institute for Reproductive Health at Georgetown University and available at Related Summaries, below, SNET is a rapid assessment tool to aid programme implementers in conducting qualitative, participatory activities to better understand the social norms that influence behaviour in a community. It includes 5 steps: (i) plan and prepare, (ii) identify reference groups, (iii) explore social norms, (iv) analyse results, and (v) apply findings. Tools and templates, which are intended to be modified, are provided for each step. The SNET was validated via pilot testing with 2 projects (Masculinité, Famille, et Foi and "Growing up GREAT!") in Kinshasa, DRC, from 2015 to 2019, before being tested in other countries

The United States Agency for International Development (USAID)-funded project Breakthrough ACTION DRC adapted the SNET for this qualitative research study. The study was implemented in 3 DRC provinces with low contraceptive prevalence representing varying regions, ethnic, and linguistic groups: Lualaba, Sankuru, and Kasaï Central. Applying the SNET in the DRC involved the selection and adaptation of data collection exercises presented in the SNET and the development of data collection instruments.

The paper describes how the Breakthrough ACTION DRC carried out the 5 SNET steps, one of which involved 144 participants taking part in 24  focus group discussions (FGDs) to understand how reference groups reinforce descriptive and injunctive norms around family planning. These FGDs revealed that gender norms invoking men as heads of household gave men authority over their wives and the final say in decisions about birth spacing and family planning method use. Injunctive norms stipulated that men who ceded decision-making power to their wives or whose wives used family planning were seen as weak or impotent.

Overall, the SNET approach resulted in helpful discussion of social norms, particularly around birth spacing and gender norms framing the man as the decision-maker. However, despite applying a methodology specifically designed to identify social norms, other factors limiting use of contraceptive methods were identified in the process, including lack of education, rumours, and misconceptions. Adaptations were needed to include the full range of reference groups due to narrow phrasing of primary questions, and some of the participatory methods were overly complicated. Feedback from experienced data collectors suggested that the social norms framework is not intuitive, is difficult to apply correctly, and may require that data collectors have a stronger foundation in the relevant concepts to produce valid and actionable results.

The experience in DRC offers insights and recommendations for future applications, including:
 

• The SNET "does not provide enough information or support for teams that may have less experience." Breakthrough ACTION DRC suggests "applying precise language to ask about differing roles played by reference groups rather than only identifying those to whom the respondent would talk about the behavior. For example, asking, 'With whom do you feel comfortable talking about family planning? If you were to use family planning with a partner, who would you tell? Who would approve? Who in your community do you think would disapprove?' Responses to these questions can be used to create different sets of reference groups based on whether they are perceived as 'enforcers' of sanctions against the behavior or 'supporters' of the behavior."
• The interviewer using the SNET could ask straightforward questions about what characters in the vignettes (step 3) would do next or who they would involve in their decision-making may provide more information than presenting the complete scenario and asking more complicated questions about motivations or community expectations.
• Breakthrough ACTION DRC advises integrating activities that increase knowledge of social norms for data collectors and workshop participants ahead of any data analysis workshop, as well as allowing enough time for the participatory analysis workshop such that participants are able to spend time with and discuss the data.

Based on this experience, Breakthrough ACTION DRC recommends the SNET as a framework to help projects develop research questions and instruments for exploring social norms, recognising that it is meant for programmatic purposes and requires modification and interpretation to serve as the basis for qualitative research. However, the SNET can be modified to render the findings more useful and more actionable, as well as to make the tool more straightforward to implement for future users. Breakthrough ACTION DRC hopes that this paper's in-depth analysis of their own experience adapting the SNET for research purposes will serve as a reference point for other researchers considering future social norms explorations.