Publication Date
July 1, 2015

"We learned that helping adolescents manage key life transitions and encouraging discussion expectations of what it means to be a man or a woman makes a positive difference in their lives."

This brief highlights the results of an evaluation of the Gender Roles, Equality and Transformations (GREAT) project, a pilot project in Uganda which was designed to "shift social norms and attitudes to foster healthier, more equitable behaviors by correcting misinformation, encouraging critical reflection and dialogue, changing expectations for appropriate behavior and supporting groups to take action." Beginning in August 2012, the Institute for Reproductive Health at Georgetown University, Pathfinder International, and Save the Children pilot-tested GREAT for 22 months in two districts in Uganda in partnership with Concerned Parents Association and Straight Talk Foundation.

The brief explains how GREAT works and what makes it unique, and outlines the project's activities as follows: 1) Community Action Cycle: simple steps to bring communities together to take action to improve adolescent well-being; 2) Radio Drama: a serial drama with stories and songs about young people and their families living in Northern Uganda; 3) Village Health Team (VHT) Service Linkages: orientation to help VHTs offer adolescent-friendly services; and 4) Development and use of a Toolkit: engaging stories and lively activities and games.

Since the launch of the project, more than 260 community groups and school-based clubs used the GREAT toolkit, and activities reached over 100,000 people. (Click here for more information about the project or see Related Summaries below).

An evaluation was conducted in September and October 2014, which sought to answer the following questions:

  • Do adolescents exposed to GREAT have improved attitudes and behaviours related to: 1) Equality between men and women? 2) Couple relationships and family planning? 3) Gender-based violence (GBV)?
  • Do adults exposed to GREAT provide positive advice to adolescents about equality, couple relationships, family planning, and GBV?

The brief explains the methodology of the evaluation, which involved: 1) focus group discussions and in-depth interviews with 152 adolescents participating in GREAT; 2) four rounds of in-depth interviews with 30 males and 30 females in control and intervention areas over a two-year period; and 3) a survey of 4,500 adolescents and adults in Amuru and Lira districts before GREAT began and again after almost two years of implementation. Data were collected from communities where GREAT activities took place (intervention), as well as similar areas where no activities were planned (control).

Based on the research, the brief outlines the following results and lessons learned (explained in more detail in the brief):

  • GREAT led to significant improvements in attitudes and behaviours among exposed individuals, as compared to a matched control group created by propensity score analysis.
  • Participation of one group each of very young adolescents (VYAs), older adolescents, and newly married or parenting adolescents in each community was insufficient to spark community-wide change.
  • The serial radio drama was an effective strategy to reach community members who did not participate in small group activities.
  • Determining the effect of community mobilisation activities remains a challenge.
  • Although GREAT was successful in achieving individual change, expansion must focus on increasing depth and breadth of coverage to reach a "tipping point" of community change.

The brief goes on to outline the results as they relate to family planning attitude, communication, and use; gender equitable attitudes and behaviours; attitudes towards intimate partner violence, conflict management, and sexual harassment; and adult advice to adolescents on gender equality, SRH, and GBV. The following are a selection of the findings:

  • Older adolescents and newly married/parenting adolescents exposed to GREAT were more likely than those not exposed to: hold positive attitudes towards family planning use, talk to their partner about the timing of their next child, and discuss family planning use.
  • Newly married or parenting couples were also more likely to seek and use family planning.
  • A promising result of GREAT is that fewer newly married/parenting adolescents and older adolescents believe that it is more important for boys to be educated than girls.
  • There was a significant decrease in newly married/parenting women and men who report reacting violently to their partner when they are angry, and fewer older adolescents reported touching/being touched on the behind or breast without permission in the last three months.
  • Adults exposed to GREAT were significantly more likely to provide young people with positive advice on gender, couple relationships, avoiding pregnancy, and partner violence.

The brief explains that as an outcome of the project, "district officials and community organizations are now working to include GREAT in their budgets, work plans and monitoring activities in order to maintain the momentum. GREAT will act on pilot findings to scale up in a way that moves beyond individual to community-wide change, and contributes to broader learning."

It concludes with a short list of recommendations for community members and health providers, as well as for global technical experts, policymakers, and programme managers.

Click here to download the extended 12-page GREAT Project Endline Report, published in January 2016, in PDF format.


IRH website on July 25 2016.