Social norms and beliefs about gender based violence scale: a measure for use with gender based violence prevention programs in low-resource and humanitarian settings

GBV primary prevention in humanitarian settings

GBV primary prevention programs seek to facilitate change by addressing the underlying causes and drivers of GBV at a population level. Such programs have traditionally included initiatives to economically empower girls and women, enhanced legal protections for GBV, enshrining women’s rights and gender equality within national legislation and policy, and other measures to promote gender equality. Increasingly, programs are also targeting transformation of social norms that justify and sustain acceptance of GBV. Social norms are contextually and socially derived collective expectations of appropriate behaviors [14]. Families and communities have shared beliefs and unspoken rules that both proscribe and prescribe behaviors that implicitly convey that GBV against women is acceptable, even normal [15, 16]. This includes social norms pertaining to sexual purity, family honor, and men’s authority over women and children in the family. Community leaders, institutions, and service providers, such as health care, education and law enforcement, can reinforce harmful social norms by, for example, blaming women and girls for the sexual assault they experience, or by justifying a husband’s use of physical violence as a means to discipline his wife. Both behaviors are viewed as essential to protect the family’s reputation in the larger community [16].

Diverse academic disciplines have developed different theories to explain the complexity of social norms and their influence on behavior. We use social norms theory as elaborated in social psychology [17]. This theory conceptualizes social norms as beliefs of two types: 1) an individual’s beliefs about what others typically do in a given situation (i.e., descriptive norm); and 2) their beliefs about what others expect them to do in a given situation (i.e., injunctive norm) [18–20]. For this study, we focus on developing a measure of injunctive norms—defined in this case as beliefs about what influential others (e.g., parents, siblings, peers, religious leaders, teachers) expect individuals to do in the case of GBV.

Even with the multiple challenges of humanitarian settings (e.g., separation of families, insecurity and limited resources), there is an opportunity to develop, implement, and evaluate innovations in GBV programming. In such settings, displacement and conflict have created situations where social rules about who can do what necessarily bend to accommodate new realities [16]. Women, for example, may be forced to assume new roles in the family and community, such as having decision-making power and control over household financial resources and assets and working outside the home to help support the family. These changing roles then lead to shifts in behavior and potentially power relations in the family and community that challenge traditional norms around male authority and women’s relegation to the domestic sphere. These circumstances can provide an opportunity to initiate GBV primary prevention efforts, such as those that engage community leaders and members in critical reflection on norms that legitimate gender inequality and what actions can be taken by the individual, family, and community to change norms that cause harm [15, 16]. Acknowledging the potential of the humanitarian setting as an opportunity for primary prevention programming and recognizing the need to strengthen GBV response systems, the United Nations Children’s Fund (UNICEF) built on their work to end female genital mutilation using social norms theory [19] to develop the Communities Care Program: Transforming Lives and Preventing Violence Program (Communities Care) [21]. The goal of Communities Care is to create safer communities for women and girls by challenging social norms that sustain GBV and catalyzing new norms that uphold women and girls’ equality, safety, and dignity [15, 21]. The description of the Communities Care program is published elsewhere [15, 16, 21].

However, a significant limitation for evaluating the effectiveness of GBV prevention programs such as Communities Care is the lack of validated instruments to measure change in norms supporting GBV. Therefore, our goal was to create a brief, valid, and reliable measure to examine change over time in harmful social norms and personal beliefs that maintain and tolerate sexual violence and other forms of GBV in low resource and complex humanitarian settings.

While validated instruments exist to measure attitudes towards gender roles and some types of GBV [22, 23], social norms are different from individual attitudes. For nearly two decades, the Demographic and Health Surveys (DHS), which are nationally representative surveys conducted in low and middle-income countries (LMIC), have provided information on attitudes about the acceptability of IPV or wife beating. Respondents are asked whether a man is justified in beating his wife in five different situations: a wife goes out without her husband’s permission; she neglects to keep the children well fed; she argues with her husband in public; she refuses to have sexual intercourse with her husband; and she does not prepare her husband’s meal on time. Response options for these questions are as follows: “agree,” “disagree,” “refuse to answer,” and “don’t know.” These questions are designed specifically to elicit personal beliefs (attitudes) about IPV; they have generally functioned well in that they capture various levels of endorsement of IPV both within and among settings, and respondents routinely vary their answers based on the transgression mentioned.

Investigators, however, have raised questions about whether the DHS questions reflect respondents’ own personal beliefs on the acceptability of beating or women’s perception of the social norm operative in their setting. Cognitive interviews with women in Bangladesh, for example, suggested that women’s interpretation of the attitude questions switched between personal and normative beliefs, although it is difficult to know whether this happens routinely in other settings, or whether it was a function of the especially low literacy and female mobility of rural Bangladesh [24, 25].

Scientists have also warned that changing key features of a scenario (e.g., setting, perpetrator, infraction committed, perceived intentionality) can influence measured attitudes and perceived norms on the acceptability of GBV. For example, in Uganda, researchers randomly assigned participants to answer attitude and norm questions on wife beating using three separate wordings [26]. The attitude questions compared the traditional wording of the DHS (whether a man is justified in beating his wife for 5 different infractions) to more contextualized scenarios that depicted the wife’s transgression as either willful or beyond her control. To elicit norms related to wife beating, participants were asked about the extent to which they thought other people in their village (reference group) would think the behavior described was justified. Response options for the five questions followed a four-point Likert-type scale: “all or almost all, for example, at least 90% of people in your village,” “more than half but fewer than 90% of people in your village,” “fewer than half but more than 10% of people in your village,” and “very few or none, for example, less than 10% of people in your village.”

The findings demonstrated that when measuring both attitudes and social norms, adding contextual details about the intentionality of a wife’s transgression changed participants’ perception of the acceptability of IPV. In the vignettes, wives who intentionally violated norms about acceptable wifely behavior had a “large” effect [27] on increasing the number of items for which wife beating was viewed as acceptable. In contrast, the vignette that depicted the wife as unintentionally violating norms of behavior had a “small” effect in decreasing the number of items where IPV was considered acceptable. The study authors interpreted this difference as measurement error, arguing that question wordings without context may mis-represent attitudes and norms on violence. While context does matter, the specific details added in this study were likely critical to its findings. Qualitative studies have repeatedly shown that wife beating in LMIC is understood as “discipline” and its acceptability varies depending on the nature of the transgression (whether it is perceived as for “just cause”), who is doing the “correction,” and whether the beating stays within acceptable bounds of severity [24, 25, 28–30].

In this paper, we describe the formative research and psychometric testing of the Social Norms and Beliefs about Gender Based Violence (GBV) Scale. The Scale is designed to measure change over time in harmful social norms and personal beliefs associated with violence against women and girls among men and women community members in low resource and complex humanitarian settings. The development and validation of the scale was essential for use in measuring change in harmful social norms and beliefs among community members in districts and regions implementing the Communities Care program in two countries with ongoing humanitarian crises, Somalia and South Sudan. The development and testing of the scale was conducted in two phases: 1) formative phase of qualitative inquiry to identify social norms and personal beliefs that sustain and justify GBV perpetration against women and girls across the lifespan in low-resource and humanitarian contexts; and 2) testing phase using quantitative methods to conduct a psychometric evaluation of the new scale in targeted areas of Somalia and South Sudan.

Study settings

The formative and testing phases of the psychometric evaluation was conducted in two countries, Somalia and South Sudan. In Southern Central Somalia, we worked in four districts (Bondhere, Karaan, Wadajir, Yaqshid) in Mogadishu and in South Sudan, we worked in two regions (Yei and Warrap). Somalia has experienced more than two decades of conflict as well as ongoing emergencies including drought, famine, and a large number of internally displaced people (IDPs). Yei is located in southwestern South Sudan and was the re-entry point for South Sudanese who fled to the Democratic Republic of Congo (DRC) and Uganda during the Second Sudanese Civil War. Since many people stayed in Yei upon returning, there is conflict between those native to Yei and IDPs from other regions of South Sudan. Warrap is in the northern region of South Sudan and is a gateway between South Sudan and Sudan. Militia activity, cattle-raiding, and conflict over oil, along with the influx of people returning to South Sudan, has caused significant challenges for access to and use of limited resources. The districts and regions in each country were selected based on multiple factors. We focused efforts on districts and regions where GBV reporting systems existed and could be accessed to generate data on case reports and referrals. When engaging GBV survivors and other community members in research on sensitive issues it is essential to have partnerships with diverse service sectors (e.g., health, protection, legal, advocacy) for participants that disclose GBV and request referrals. The evaluation also required safe access to the sites and security while doing the study for both participants and local researchers, therefore this required establishing relationships and obtaining permission from national, regional, and district governmental authorities and ministries as well as traditional leaders in the communities.

Phase 1: Formative phase methods

For the formative phase, we worked with local partners to identify male and female key stakeholders (e.g., religious leaders, youth and women’s group leaders, advocates for GBV survivors, health providers, child protection staff, police officers, traditional leaders, elders, and teachers) to advance our understanding of and identify harmful and protective social norms associated with GBV within and across settings. The focus group guide was developed and translated to the local language in partnership with team members in each setting. Johns Hopkins provided in-depth training to local staff on facilitating focus groups, data collection, human subjects’ protections, working with distressed participants, and providing referrals to services as appropriate. The focus group guide focused on identification of social norms that protect women and girls from sexual violence and other forms of GBV, norms that are harmful (e.g., hide, sustain, or encourage), norms about disclosing and reporting sexual violence and other forms of GBV to authorities, and who are the people in the family or larger community that are influential in maintaining and changing social norms. For example, the team used scenarios created from aggregating GBV experiences in each setting to explore social norms about the situations and the survivor-perpetrator relationship. We varied the perpetrator and circumstances in each scenario from the perpetrator being a family member, a known person to the family but not part of the family, and an unknown person. For each scenario, focus group participants were asked about their beliefs and norms about how the family and community would respond to victims of the sexual assault or other forms of GBV, if the assault would be reported to authorities, and reasons for reporting or not reporting the assault.

Qualitative analysis

A qualitative descriptive approach was used to identify themes related to harmful and protective social norms within and across settings. The transcripts were read by three research team members to identify thematic codes. Themes with sub-themes were identified and defined by exemplars or quotes from the transcripts. The three researchers independently assigned codes and discrepancies in coding were discussed in weekly meetings. The codes and corresponding quotes were used to write items for the scale representing each of the identified themes. The themes, sub-themes, and items were then shared with the in-country teams in a joint Somalia/South Sudan meeting. The relevance of the themes and their interpretation for each context was discussed leading to a refinement of the items. Meeting participants from each country rated the importance of each item and offered suggestions on wording of the items to ensure they were capturing the relevant aspects of the different contexts and cultures.

Factor analysis

Reliability

Cronbach alpha reliabilities, a measure of internal consistency of the scale, were in an acceptable range for all factors/subscales within each domain. Cronbach alphas ranged from 0.69 to 0.75 for the injunctive norms domain and 0.71 to 0.77 for the personal beliefs domain (the last row of Tables 2 and 3 present the Cronbach alphas for each scale).

Descriptive statistics

Known groups validity