Equal Access (EA)'s Change Starts at Home (Change) initiative uses a multi-component social behaviour change communication (SBCC) strategy involving a radio drama and community mobilisation to shift attitudes, norms, and behaviours that underpin intimate partner violence (IPV) perpetration in Nepal. It is being carried out in 3 districts - Nawalparasi, Chitwan, and Kapilvastu - as part of a randomised control trial (RCT) to examine potential pathways of change over the 3-year project period, designed to fill a gap: a perceived dearth of evidence on the effectiveness of primary violence prevention strategies. Whilst the project's main objective is to give married couples the knowledge, skills, and space to safely address power imbalances in their relationships, the impact is reinforced by activities that aim to bring couples and their family members and community leaders together in a movement to change social attitudes and practices towards girls and women in Nepal.
Recognising the social ecology of change, the Change intervention engages actors across multiple domains of influence, such as family members and community leaders, in addition to the primary intended audience of married reproductive age women and their husbands. As a SBCC strategy, the intervention approaches IPV prevention through 3 key approaches: advocacy, social mobilisation, and behaviour change communication. The latter component is a 9-month, weekly radio drama with listener engagement through interactive voice response (IVR) and short message service (SMS), to which both the intervention and control conditions are exposed. The intervention communities are further engaged in radio Listening and Discussion Groups (LDGs). These 72 LDGs are made up of a total of 360 married couples / 720 individuals, who meet on a weekly basis in gender segregated groups, but with combined sessions for couples to come together once a month. Each week, members are guided by a trained facilitator through a curriculum-based process of listening, discussion, activities, reflection and home-based tasks. LDGs serve as venues for life skills building and act as a platform through which community outreach activities are planned and executed, alongside local leaders who receive training and support to act as advocates in the community for more equitable social norms.
- Individuals in study communities (both intervention and control) are reached through radio programming that is entertaining and educational - a form of "edutainment" - that models non-violent behaviour and supports acquisition of life skills. The name of the radio programming broadcast during Change is called Samajhdari, which is Nepali for mutual understanding. The 30-minute drama is focused around a hotel along the East West Highway in Nepal that is run by a couple who, comparatively, have a positive and gender-equitable relationship. Their hotel is popular among travellers passing by, and the couple welcome different characters who meet to discuss and exchange stories about problems related to marriage, power, and gender identities. Local voices in the form of Vox Pops, interviews, and case studies are woven into the drama, which is followed by a summary segment that also showcases the IVR responses sent to the programme from listeners. Click here to listen to Samajhdari episodes.
- The project engages and mobilises community members within LDGs to promote discussion, reflection, and critical thinking around radio-broadcasted messages to facilitate behaviour change. EA trains facilitators that convene the discussion groups following a weekly curriculum that includes in-session activities and at-home tasks to be carried out with their spouse. This peer-to-peer group is meant to be a safe place to explore with greater depth some of the issues raised in the radio programme. Through tablet-based facilitator feedback forms and monitoring visits (captured through IVR forms), EA collects information and records listener reactions to the radio episodes, capturing perspectives on issues and feedback on which elements were of most interest to listeners, areas for improvement, questions, and requests for additional information. This feedback is then shared with EA's production team to guide the content of future episodes. LDGs also receive a tool kit to support community interactions, including a gender-focused film and for community screenings, a video recording of the gender-focused street theatre (below), audio from select radio sessions, and printed materials including a poster explaining the project. In addition to financial resources, this toolkit is meant to support the LDGs in holding awareness-raising events in their communities. Direct engagement of community leaders, family members, and friends of LDG members is expected to assist in facilitating the integration of the new social norms.
- The purpose of the street theatre is to allow large numbers of community members to be exposed to messaging that focuses on gender equity and to encourage them to interact with the issues through the drama. Throughout December 2016 and January 2017, Change and EA's partner Vijaya Development Resource Center (VDRC) organised 18 interactive street dramas across the 3 project districts. The dramas were performed by a local theatre group, Susheli Kala Samuha, and were watched by over 4,000 people in total. These were professionally recorded so that other communities without access to live performances can view the screenings; see the Change website. (The project also has a Twitter handle: @changestartsww and Change Facebook page.)
- Community leaders were trained in a 2-day workshop designed to: 1) introduce Change to key stakeholders who are knowledgeable and supportive of the project; 2) facilitate smooth implementation of project activities by getting community leader buy-in; 3) strengthen ties between EA/VDRC and the religious/community leaders to encourage better-coordinated responses to violence against women and girls (VAWG); and 4) provide a forum for the religious and community leaders to reflect on their own position and capacity to comprehend and respond to VAWG, especially IPV. To that end, in October 2016, Change organised a workshop with religious leaders, most of whom were leaders from Nepal's 3 major religions: Hinduism, Buddhism, and Christianity. Community leaders from other diverse background were also invited, including social workers, teachers, members of local co-operative institutions, and other community-based organisations. As part of this discussion on how religion and various cultural practices are perpetuating violence against women, EA facilitators kept the dialogue open by making it clear from the beginning that this would not be a training in the traditional sense, but more like a discussion forum. This meant that rather than the facilitator "teaching" the group, everyone was there to share their views openly and to listen to another person's perspective without any biases or judgment. According to EA, this approach helped participants to feel comfortable and willing to actively participate in a constructive discussion, rather than passively sitting through a training. By the end of 3 days, the group had managed to bring out various views and opinions on the current situation of women in the communities and what role religion and culture can play in women's equity and empowerment. There was reportedly a common agreement among the participants that religious teachings have been misinterpreted and that they should not be used to justify or ignore violence against women in their communities. Participants unanimously agreed that nothing can justify any form of violence against a human being and that religion can be a powerful tool to uphold this. There was a strong commitment from participating leaders to go back to their communities and organise various activities to raise awareness about VAWG and IPV. They even worked on their own action plans, including details on the type of activities they will conduct with a tentative timeline as part of their efforts to slowly change as an entire community until the social norms that accept, ignore, and even promote violence no longer exist. A follow-up session is planned for February 2017.
The Change intervention relies on a number of theoretical models, including: the Socio-Ecological Model (to conceptualise the multiple contexts and factors that influence behaviour change), the Steps to Behaviour Change Framework and the Integrative Model of Behaviour Prediction (to anchor project activities and curriculum to particular stages and entry points toward behaviour change), and the Diffusion of Innovations theory (to guide efforts to extend the impact of the intervention beyond those most directly exposed). Collectively, the theoretical underpinning of the project recognises that change is a process, although not necessarily linear, that occurs within embedded contexts of interpersonal, social, and political contexts. This process involves:
- Phase 1: knowledge and approval - Current behavioural, normative, and control beliefs related to gender norms and VAWG are identified and questioned through a mix of information, role modelling, and discussions that highlight the diversity within "normative" behaviour. During this phase, couples (both as listeners to the radio programme and participants in the LDG sessions) are asked to not only acknowledge the existence of a range of behavioural, normative, and control beliefs, but to also approve of and internalise those alternatives for themselves. By asking people to accept (and consider applying) new norms and roles, phase 1 begins to shift negative attitudes related to acceptability of VAWG towards positive attitudes of acceptability of non-violence.
- Phase 2: intention - The focus on life skills-based information and education (through both the radio programme and LDG curriculum) in this phase enables couples to not only accept that alternative norms and roles exist, but to develop beliefs and skills (example: good communication, empathy, critical thinking, self-awareness) necessary to begin achieving more equitable power in their own relationships. By this phase, those couples who are part of the LDGs should also begin to experience the positive benefits of having a new reference group / positive social identity supporting them to make good decisions as individuals and as a couple.
- Phase 3: practice and advocacy - As per the integrative model, alongside intention and skills, behaviour change is most likely to occur if people have the necessary environment required to support the change. Therefore, whilst the primary beneficiaries of Change are couples, family and community members are also reached (through community activities faciliated through the training sessions described above and the radio programme) to ensure they provide an enabling environment and serve as catalysts for change. For instance, family members of LDG participants will be invited to special family-oriented LDG sessions alongside community-based events, such as community theatre, town hall meetings, etc. Together, these activities at the various levels of society are hypothesised to affect beliefs, behaviours, and perceptions of social norms to reduce IPV.
Violence against Women
As of this writing, an RCT is being conducted - click here for details on the study protocol - that seeks to: a) assess whether the multicomponent Change programme (i.e., media + community engagement strategy) yields a greater reduction in cluster-level IPV rates compared to the Change radio programme alone; b) determine whether any potential reductions in cluster-level IPV rates are sustained 6 months after cessation of intervention activities; c) explore what mechanisms and factors may explain any differences that may or may not be detected; and d) identify potential socio-demographic or contextual factors that may moderate the impact of the Change programme. Secondarily, the trial expects to observe improved conflict resolution techniques, couple communication, attitudes toward gender equity and acceptability of IPV, and perceptions of community acceptance of IPV among Change intervention communities versus communities receiving the Change radio programming alone. As the target of the intervention is social norms underpinning individual behaviour, a cluster design is utilised. The quantitative aspect of the evaluation is a pair-matched, repeated cross-sectional 2-armed, single-blinded trial (RCT: N = 36 clusters [Village Development Committees (VDCs)], 1,440 individuals), comparing the SBCC strategy to radio programming alone for its impact on physical and / or sexual IPV at the end of programming (12 months post-baseline; February-March 2017) and 6-months post the cessation of project activities (18-months post baseline; September-October 2017). The qualitative aspects of the design include several longitudinal approaches to understand the impact of the intervention and examine mechanisms of change, including in-depth interviews with participants (N = 18 couples), and focus group discussions with community leaders (N = 3) and family members of participants (N = 12).
EA, with local implementing partner VDRC. Funding by the United Kingdom (UK) Department for International Development (DfID) through the What Works to Prevent Violence Against Women Innovation Fund.
"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", by Cari Jo Clark, Rachael A. Spencer, Binita Shrestha, Gemma Ferguson, J. Michael Oakes, and Jhumka Gupta. BMC Public Health 2017, 17:75. DOI: 10.1186/s12889-016-3909-9; Change website and Change Facebook page - both accessed on January 25 2017; and email from Gemma Ferguson to The Communication Initiative on January 26 2017.