The Passages Project is a USAID-funded seven-year implementation research project that aims to address a broad range of social norms, at scale, to achieve sustained improvements in family planning (FP), reproductive health (RH), and gender-based violence. Passages seeks to build an evidence base and contribute to the capacity of the global community to strengthen normative environments that support RH and well-being, especially among young people at key life stages transition points, including young adolescents, newly married couples, and first-time parents. As part of this effort, the Passages Project conducted a scoping review of evidence related to social norms affecting adolescents and young adults in low- and middle-income countries.
To conduct the scoping review, Passages Project consortium members first developed consensus around a list of priority behaviors for each of three age groupings: very young adolescents (VYA; 10-14 years); older adolescents (OA; 15-18 years); and young adults (19-25 years). For each of these groups, consortium members outlined behaviors from three broad thematic areas: 1) RH and FP, focusing on puberty for VYA and voluntary use of contraception for OA and young adults; 2) primary and secondary education for VYA and OA; and 3) family violence, focusing on child marriage for VYA and OA, and intimate partner violence for OA and young adults. Experts on adolescent social and behavior change (SBC) were engaged to rank priority behaviors based on criteria including current evidence gaps, their importance to thematic area outcomes, and promise for norms-shifting approaches.
This process resulted in seven priority behavior-age group combinations that were subsequently re-organized in five behavior studies, with some age groupings combined due to lack of specific evidence or lack of disaggregation compatible with Passages’ original groupings. These five behavior studies are:
- Adolescent education: Ages 10-25; includes very young adolescents, older adolescents and young adults; a majority of the available evidence focused on adolescent girls and young women.
- Puberty among very young adolescents: Ages 10-14.
- Voluntary use of contraception among older adolescents and young adults: Ages 15-25; includes groups of young adults such as first-time parents and newly married couples.
- Intimate partner violence among older adolescents and young adults: Ages 15-25; includes groups of young adults such as first-time parents and newly married couples.
- Child marriage among very young adolescents and older adolescents: Ages 10-18; includes very young adolescents and older adolescents; a majority of the available evidence focused on very young adolescent girls.
Scoping reviews were conducted for each priority behavior/age grouping combination. This phase reviewed four databases (PubMed, Embase, CINAHL, and PsycINFO) of peer-reviewed literature focusing on literature from 2010 – 2021. Over 5,000 studies were screened, of which 521 met the inclusion criteria in at least one priority behavior/age grouping. After further evaluating each study that met the initial inclusion criteria, Passages selected studies that:
- Investigated the influence of specific social norms on the priority behavior and age groupings, and/or how these norms are held in place; and/or
- Described or evaluated promising approaches to address or shift these social norms for a given behavior and age grouping.
The resulting literature base for each behavior study was analyzed by Passages project staff and volunteers with expertise in SBC programming for adolescents and young people. Each behavior studies include information on:
- Social norms relevant to the behavior that emerged from across the literature for the age grouping. These are ‘tagged’ by the identified underlying meta-norms they reflect, using terminology from the Learning Collaborative’s Social Norms Atlas and Passages’ Social Norms Lexicon.
- Other, non-normative variances that affect the behavior or practice within the age grouping.
- Influential reference groups. In reporting findings, there are differences in the specificity of naming these influential groups (i.e., religious leaders versus communities at large) that directly reflect the literature.
- Two selected relevant interventions that described addressing norms related to the priority behavior for the age grouping, or contained a norms-shifting component, regardless of rigorous measurement of this norms-shifting component. Each selected intervention is ‘tagged’ with the identified norms-shifting approaches in their programming, using terminology from the Passages Theory of Change).
Literature Gaps
The majority of published literature focuses on investigating the influence of social norms on target behaviors, often finding a strong influence of gender and other social norms on target behaviors. However, many of these studies did not disaggregate or analyze data by age or gender.
It is therefore challenging to understand either the influence of norms on the behaviors and practices of and for young people or how these norms may be shifted– and especially for different and distinct stages of youth. Adolescence, marriage, and first pregnancy are key transitional phases in the life course in which norms are likely different; it is thus vital to disaggregate findings by age or life stage and gender. Few of the studies measured norms rigorously, and many used attitudes as a proxy for norms. For example, many studies used the Gender-Equitable Men (GEM) scale to measure norms, although the scale measures individual attitudes rather than social expectations.
Only a few of the studies reviewed included a definition of social or gender norms, discussed formative work to identify existing norms, or outlined a named framework or their program theory of change. Social norms were conceived in various manners and according to various disciplines, and were not always consistent with the Passages Project’s definition of social norms as “what I think people do and what I think people should or should not do in my community.” It was not common for studies to report the boundaries of the communities (for example, ‘parents of very young adolescents within X region,’ rather than just ‘parents’) within which norms, or proxies, where measured. Nor was it common for studies to explicitly identify reference groups (see the Passages Social Norms Lexicon for full definitions).
Most of the interventions included in the review were multi-component interventions, of which norms-shifting activities were often only a small component of the overall activities. Very few studies evaluated the effect of norms-shifting interventions on target behaviors, and fewer still measured norms or norm changes over time. Asa a result, it is challenging to attribute behavioral changes to norms-shifting activities. More work is needed to evaluate norms-shifting interventions using valid and reliable social norms measures, measuring norm shifting against a comparison group to better understand the added effect of norms-shifting activities on norms and behaviors.
All said, the review affirmed that promising practices to address youth behavior across these three domains exist. We believe that it is possible, feasible, and important to design and evaluate norms-shifting interventions for adolescent and youth sexual and reproductive health behaviors based on understood and accepted definitions, strong formative work to identify norms and meta-norms, and outlining the communities, influencers, and pathways through which norms impact behaviors.
