Scaling-up Normative Change Interventions for Adolescent and Youth Reproductive Health: An Examination of the Evidence

Abstract

Adolescent and youth reproductive health (AYRH) outcomes are influenced by factors beyond individual control. Increasingly, interventions are seeking to influence community-level normative change to support healthy AYRH behaviors. While evidence is growing of the effectiveness of AYRH interventions that include normative change components, understanding on how to achieve scale-up and wider impact of these programs remains limited. We analyzed peer-reviewed and gray literature from 2000 to 2017 describing 42 AYRH interventions with community-based normative change components that have scaled-up in low/middle-income countries. Only 13 of 42 interventions had significant scale-up documentation. We compared scale-up strategies, scale-up facilitators and barriers, and identified recommendations for future programs. All 13 interventions addressed individual, interpersonal, and community-level outcomes, such as community attitudes and behaviors related to AYRH. Scale-up strategies included expansion via new organizations, adapting original intervention designs, and institutionalization of activities into public-sector and/or nongovernmental organization structures. Four overarching factors facilitated or inhibited scale-up processes: availability of financial and human resources, transferability of intervention designs and materials, substantive community and government-sector partnerships, and monitoring capacity. Scaling-up multifaceted normative change interventions is possible but not well documented. The global AYRH community should prioritize documentation of scale-up processes and measurement to build evidence and inform future programming.

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

“…Notwithstanding contributing influencers and barriers to scaling up a tested intervention model, scaling-up efforts must always be accompanied with research documenting planning and implementation processes, health-related outcomes, and impact to communicate lessons learned and opportunities for strengthening scale-up. 32,34 Study findings are largely consistent with existing literature, [5][6][7][8][9][10][11][13][14][15] indicating that mobilizing financial resources and quality of care are of paramount importance for effective scale-up and sustainability of interventions that aim to improve RH outcomes among adolescents and youth nationally. In other words, support for adolescent and youth RH was on paper, but there was limited financial allocation.…”

“…national scale-up. [4][5][6][7][8][9][10][11][12][13][14][15] For example, in Ethiopia, Kyrgyzstan, and Bangladesh, strong political commitment aligned with good governance, coordinated donor support, and the ability to adapt to resource limitations and competing priorities within constrained and weak health systems have contributed to improving health outcomes. 6,12 In Nigeria, there was near nation-wide scale-up of a school-based comprehensive sexuality education program supported by strong political leadership, although lack of a predictable funding source and competing priorities for available human resources were recognized as major impediments for sustainability.…”

Getting to intent: Are social norms influencing intentions to use modern contraception in the DRC?

“…The social norm that a man should make decisions for his household and is justified to use physical force to enforce his decisions is one such example. Currently, there are a growing number of interventions designed to counter such social norms [14]. However, to date, the evidence base upon which these interventions are being designed and evaluated is small, resulting largely from the fact that the measurement of social norms has lagged behind [15, 16].…”

Social Norms Measurement: Catching up With Programs and Moving the Field Forward

“…To date, there are numerous normative change programs for AYSRH in the field and going to scale [1] . Many of these are doing so, however, with scant evidence of the desired normative change outcomes, resulting largely from the fact that social norms' measurement has lagged behind [2] , [3] .…”