hypothesis on gender based violence

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• Published: 08 March 2019

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

• Nancy Perrin 1 ,
• Mendy Marsh 2 ,
• Amber Clough 1 ,
• Amelie Desgroppes 3 ,
• Clement Yope Phanuel 4 ,
• Ali Abdi 3 ,
• Francesco Kaburu 3 ,
• Silje Heitmann 5 ,
• Masumi Yamashina 6 ,
• Brendan Ross 7 ,
• Sophie Read-Hamilton 8 ,
• Rachael Turner 1 ,
• Lori Heise 1 , 9 &
• Nancy Glass 1  

Conflict and Health volume  13 , Article number:  6 ( 2019 ) Cite this article

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Gender-based violence (GBV) primary prevention programs seek to facilitate change by addressing the underlying causes and drivers of violence against women and girls at a population level. Social norms are contextually and socially derived collective expectations of appropriate behaviors. Harmful social norms that sustain GBV include women’s sexual purity, protecting family honor over women’s safety, and men’s authority to discipline women and children. To evaluate the impact of GBV prevention programs, our team sought to develop 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 against women and girls in low resource and complex humanitarian settings.

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; and 2) testing phase using quantitative methods to conduct a psychometric evaluation of the new scale in targeted areas of Somalia and South Sudan.

The Social Norms and Beliefs about GBV Scale was administered to 602 randomly selected men ( N  = 301) and women (N = 301) community members age 15 years and older across Mogadishu, Somalia and Yei and Warrup, South Sudan. The psychometric properties of the 30-item scale are strong. Each of the three subscales, “Response to Sexual Violence,” “Protecting Family Honor,” and “Husband’s Right to Use Violence” within the two domains, personal beliefs and injunctive social norms, illustrate good factor structure, acceptable internal consistency, reliability, and are supported by the significance of the hypothesized group differences.

Conclusions

We encourage and recommend that researchers and practitioners apply the Social Norms and Beliefs about GBV Scale in different humanitarian and global LMIC settings and collect parallel data on a range of GBV outcomes. This will allow us to further validate the scale by triangulating its findings with GBV experiences and perpetration and assess its generalizability across diverse settings.

Introduction

Gender-based violence (GBV) remains one of the most prevalent and persistent issues facing women and girls globally [ 1 , 2 , 3 , 4 ]. Conflict and other humanitarian emergencies place women and girls at increased risk of many forms of GBV [ 5 , 6 , 7 ]. The Inter-Agency Standing Committee (IASC) 2015 Guidelines for Integrating GBV Interventions in Humanitarian Action defines GBV as any harmful act that is perpetrated against a person’s will and that is based on socially ascribed (i.e., gender) differences between females and males. It includes acts that inflict physical, sexual or mental harm or suffering, threats of such acts, coercion, and other deprivations of liberty. These harmful acts can occur in public and in private [ 8 ]. There continues to be limited global information on the burden of GBV in humanitarian emergencies. One systematic review found that approximately one in five refugees or displaced women in complex humanitarian settings experienced sexual violence, though this is likely an underestimation of the true prevalence given the many barriers to survivors’ disclosure of GBV [ 9 ]. A recent population-based survey on GBV across the three regions of Somalia examined typology and scope of GBV victimization with 2376 women (15 years and older). The study found that among women, 35.6% (95% CI 33.4 to 37.9) reported lifetime experiences of physical or sexual intimate partner violence (IPV) and 16.5% (95% CI 15.1 to 18.1) reported lifetime experience of physical or sexual non-partner violence (NPV) since the age of 15 years. Women at greatest risk of GBV (IPV and NPV) included membership in a minority clan, displacement from home because of conflict or natural disaster, husband/partner use of khat (e.g., leaves chewed or drunk as a stimulant), exposure to parental violence and violence during childhood. Women survivors of GBV consistently report negative impacts on physical, mental and reproductive health. Often negative health and social consequences are never addressed because women do not disclose GBV to providers or access health care or other services (e.g., protection, legal, traditional authorities) because of social norms that blame the woman for the assault (e.g., she was out alone after dark, she was not modestly dressed, she is working outside the home), norms that prioritize protecting family honor over safety of the survivor, and institutional acceptance of GBV as a normal and expected part of displacement and conflict [ 10 , 11 , 12 , 13 ].

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 , 19 , 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 , 29 , 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.

Results of phase 1: Formative phase

A total of 42 focus groups (22 in Somalia and 20 in South Sudan) with a total of 215 participants (111 in Somalia and 104 in South Sudan) were conducted. The composition of the focus groups varied by stakeholders (e.g., religious leaders, service providers, teachers, police, youth, elders), age (under 30, 31–45, and 46+), marital status, and sex. Themes identified for social norms that are protective against GBV included parents teaching/guiding children, marriage, and respect for female members of the family. Themes identified as harmful social norms included men’s responsibility/right to correct female behavior and the social expectation that a woman will obey her husband and fulfill her gender prescribed duties to his satisfaction, protecting the family’s dignity by not reporting violence/assault to avoid stigma associated with being a victim, husband’s right to force his wife to have sex, lack of status for women, and forced marriage. Mothers, fathers, parents, community and religious leaders, and male relatives were seen as people that influenced behavior and protected women and girls from GBV. Men and women’s behavior also emerged as subthemes associated with harmful social norms, such as indecent dressing, being out in public alone, and drug/alcohol use. Stigma associated with being a GBV victim, blaming women and girls for the violence/assault, and the importance of family honor and respect were identified as norms that prevent victims and families from reporting sexual violence and other forms of GBV to authorities. Items for the new scale were written for each of the themes and sub-themes relevant to harmful social norms and after elimination of redundant items, 30 items remained and were presented to the in-country teams. After discussion about the focus group themes and the items with the in-country teams, a total of 18 items remained. The team then collaborated to develop introductory statements and response scales for each of two domains of the scale, personal beliefs and injunctive social norms. The final scale to be tested in the evaluation phase had two sets of the 18 items, one for each domain.

Methods for phase 2: Psychometric testing

At each of the three sites in the two countries detailed above, trained local research assistants (RAs) recruited and consented 200 community members (15 years and older) to complete the Social Norms and Beliefs about Gender Based Violence Scale. The sampling frame was stratified by age group (15–18, 19–24, 25–45, 46+ years) and sex with a target of 25 people per age group/sex combination. As suggested by the in-country teams, male RAs recruited and interviewed male community members and female RAs recruited and interviewed female community members. Each RA recruited participants across age groups. The RA started from a central point determined by the research coordinator each morning. The RA would contact every 3rd house/dwelling counting on both sides of the street/pathway. If nobody was home, the person was not willing to participate, or the person did not match the sampling target for sex/age, the RA went to the next house/dwelling. Once a RA identified and consented an eligible participant in the household and completed the scale, the RA started the process to identify the next eligible participant by going to the next 3rd house/dwelling on the street/pathway. Only one eligible household member completed the scale.

Field procedures

RAs received detailed training on protocols for maintaining participant confidentiality and safety as well as protocols designed to ensure safety and security for the team members. In the field, when a RA identified an adult at a house/dwelling, he/she introduced the study. If that person met the eligibility criteria and agreed to participate, the RA worked with the participant to find a private and comfortable place to provide informed consent and administer the scale. If that person did not meet eligibility, he/she was asked if there was someone living in the household that did meet the eligibility. The RA provided each potential participant with informed consent information using the script provided on the study tablet and approved by the in-country team and the Johns Hopkins Medical Institution Institutional Review Board (IRB). If the eligible participant provided verbal consent the RA continued and administered the scale with brief demographic questions, including marital status, employment, and children in the household. The responses were entered by the RA directly on the tablet. Once finished, the RA thanked the participant for their time and answered any questions prior to moving on.

The 18 items generated from the formative phase were asked in two sets to capture the two domains, personal beliefs and injunctive norms. The injunctive social norms items started with “How many of the people whose opinion matters most to you….” with the response scale of: 1 – None of them, 2 – A few of them, 3 – About half of them, 4 – Most of them, and 5 – All of them. The personal beliefs items started with “We would like to know if you think any of the following statements are wrong and should be changed in your community. We also would like to understand how ready or willing you are to take action by speaking out on the issues you think are wrong” and used the response scale: 1 – Agree with this statement, 2 – I am not sure if I agree or disagree with this statement, 3 – I disagree with the statement but am not ready to tell others, and 4 – I disagree with the statement and I am telling others that this is wrong. The scale was translated into Somali and the translation was reviewed by the Somalia team and revised before it was programmed into the study tablet. In South Sudan, the scale was administered in the Kakwa language in Yei and Dinka language in Warrap. As these are not commonly written languages in South Sudan, the team preferred using the English version of the scale programmed on the tablet and translated into the local language at time of administration. The South Sudan team training included discussions and decisions on correct translation of items in the two languages and then the team practiced administering with volunteers not participating in the study to ensure consistency in real-time translation across RAs and sites.

Psychometric analyses

For each of the two domains of the scale, we examined construct validity with factor analysis using the common factor model with oblique rotation. Factor loadings of .40 or above were considered as loading on a given factor [ 31 ]. Items that did not load on any factor were considered for revision or elimination from the scale. Reliability was estimated with Cronbach’s alpha for each factor subscale. Known groups validity was examined by testing two a priori hypotheses: H 1 : The sites (Somalia, Yei, South Sudan, and Warrup, South Sudan) differ on social norms and personal beliefs due to differences in the extent of GBV programming within the districts of Mogadishu and regions of South Sudan; and H 2 : Men and women participants will differ on social norms and personal beliefs related to GBV. The first hypothesis was tested with analysis of variance and the second with t-tests.

Results of psychometric testing

The team administered the Social Norms and Beliefs about GBV Scale to 602 community members across Mogadishu, Somalia and Yei and Warrup, South Sudan. The sampling frame was successfully implemented by the research team with 50.0% of participants across the settings being female and 50.0% male with an equal distribution across age groups except in Yei, South Sudan. The team in Yei reported having difficulty finding community members in the region over 60 years of age. The lack of older community members could be related to deaths in the Second Civil War from 1983 to 2005. Over half (58.6%) of the participants were married and had children in the home (67.4%). One third (34%) reported working outside the home, 10.1% were looking for work, 21.4% were students, 29.4% were housewives, and 4.7% were too old to work. Table  1 summarizes the characteristics of the participants by country and site.

Factor analysis

The factor analysis for the items in the injunctive norms domain of the scale was based on responses from participants that completed all items ( N  = 587, 97.5%). There were 3 of the 18 items on the injunctive social norms scales that did not load on any factor and were thus removed from the scale. The first item “expect daughters to be married before 15 years of age” likely did not correlate with the other items on the scale because early marriage is seen as a different concept than sexual violence. The second item “think that if an unmarried woman/girl is raped by a man, she should marry him rather than not being married at all” captures two different concepts—marrying the man who raped her and that being better than not being married at all. This complexity likely made the question difficult to answer. The third item “expect a woman not to report her husband for forcing her to have sexual intercourse” did not reflect a consistent social norm. Discussions with the in-country teams revealed that there was considerable debate on this item even among people who agreed on other items. Based on the eigenvalues (first 5 eigenvalues were 4.27, 1.82, 1.23, 0.94, 0.81), the remaining 15 items formed three factors (Table  2 presents the factor loadings for each item on each of the three factors) with each item loading above 0.40 on only one factor. The following titles were given to represent the three factors, later describes as subscales: “Response to Sexual Violence” has 5 items, “Protecting Family Honor” has 6 items, and “Husband’s Right to Use Violence” has 4 items. The “Response to Sexual Violence” and “Husbands’ Right to Use Violence” subscales had the highest inter-factor correlation (0.46) followed by “Response to Sexual Violence” and “Protecting Family Honor” (0.34), then “Protecting Family Honor” and “Husbands’ Right to Use Violence” (0.30). Importantly, these 3 factors were consistent with and reflected the themes identified from the qualitative analyses of the focus groups in Phase 1. A very similar factor structure was found for the personal beliefs domain ( N  = 588, 97.7%). Eigenvalues (first 5 eigenvalues were 4.46, 1.76, 1.46, 0.90, 0.88) suggested 3 factors as illustrated in Table  3 . All items loaded at 0.45 or greater on only one of the three factors. One item, “a woman/girl would be stigmatized if she were to report rape” loaded on the “Response to Sexual Violence” in the personal beliefs domain whereas the corresponding item, “women/girls fear stigma if they were to report sexual violence”, loaded on the “Protecting Family Honor” subscale for the social norms domain. The inter-factor correlations on the personal beliefs domain were also very similar to the injunctive social norms domain scale: “Response to Sexual Violence” and “Husbands’ Right to Use Violence” had the highest correlation (0.43) followed by “Response to Sexual Violence” and “Protecting Family Honor” (0.32), then “Protecting Family Honor” and “Husbands’ Right to Use Violence” (0.26).

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

Scores for each of the factors (subscales) were computed by taking the average of the items within the subscales. The injunctive social norms domain subscales scores range from 1 to 5 with higher scores reflecting more negative responses to sexual violence and GBV, stronger support for social norms that prioritize protecting family honor by not reporting sexual violence or other forms of GBV, and stronger support for norms endorsing a husband’s right to use violence. Personal beliefs subscales can range from 1 to 4 with higher scores reflecting a more positive response to survivors of sexual violence, that protecting family honor and not reporting sexual violence is wrong, and that a husband should not have the right to use violence against his wife. The means, standard deviations, minimum, and maximum observed score for each of the subscales in each domain are presented in Table  4 . In general, the mean for the injunctive social norms subscales reflect participants’ views that “few to about half” of the people who are important/influential to them endorse harmful social norms about GBV with “Protecting Family Honor” being the strongest norm (means range from 2.00 to 2.77). The mean for the personal beliefs subscales reflects that participant beliefs range between “not being sure if they disagree” with the norms to “disagreeing but not being ready to speak out against them.” Specifically, participants’ beliefs ranged between not being sure if they disagree to disagreeing but not ready to speak out against protecting family honor (mean = 2.61) and husband’s right to use violence (mean = 2.90). Participants indicated that they were between disagreeing but not being ready to tell others to telling others that negative responses to sexual violence survivors are wrong (mean = 3.29). Cross domain correlations were − .318 (p < .001) for “Response to Sexual Violence”, −.512 (p < .001) for “Protecting Family Honor”, and − .427 (p < .001) for “Husband’s Right to Use Violence.”

Known groups validity

Analysis of variance with Bonferroni post-hoc tests revealed that the three sites differed significantly on all subscales for the injunctive social norms domain (i.e., “Response to Sexual Violence,” p < .001; “Protecting Family Honor,” p = .039; “Husband’s Right to Use Violence,” p < .001). Women and men participants in Yei, South Sudan, where there are few GBV programs and services, reported social norms that are significantly more accepting of sexual violence and other forms of GBV than Warrap, South Sudan and Mogadishu, Somalia. In terms of personal beliefs, women and men in Yei were also significantly less likely to speak out against harmful responses to sexual violence and other GBV (p < .001). In Mogadishu, Somalia, men and women were significantly less likely to speak out against “Protecting Family Honor” (p < .001) and “Husband’s Right to Use Violence” (p < .001) than the sites in South Sudan. Table  5 summarizes the t-test results examining differences in the subscales for both domains between men and women. Women participants had significantly higher scores on all of the subscales for the injunctive social norms, indicating women were more likely to endorse harmful norms related to “Response to Sexual Violence”, “Protecting Family Honor”, and “Husband’s Right to Use Violence” than men. Men and women did not differ on personal beliefs about “Response to Sexual Violence”, however, men reported that they are more ready to speak out against harmful social norms of “Protecting Family Honor” and “Husband’s Right to Use Violence” than women.

The psychometric properties of the Social Norms and Beliefs about GBV Scale (final scale is presented in Additional file  1 ) are strong. Each of the three subscales, “Response to Sexual Violence,” “Protecting Family Honor,” and “Husband’s Right to Use Violence” within the two domains of the scale illustrate good factor structure, acceptable internal consistency, reliability, and are supported by the significance of the hypothesized group differences. These three factors represent social norms that are known from previous research to maintain the high rates of GBV in many global settings [ 28 ]. The “Response to Sexual Violence” subscale captures the individual, family, and community response of blaming the victim for GBV. Most often a woman or girl is blamed for the sexual assault or other form of GBV and the family and larger community can respond with rejection and judgement of her behavior, which can result in the family not supporting or abandoning the victim. It reflects the acceptance of sexual violence and other forms of GBV as expected or even normal and that women and girls need to limit their movement and actions to prevent men from assaulting them, as men are not able to control their behavior if they are “tempted” by women. High scores on the injunctive norms domain of this subscale represent that the respondents believe that their influential others expect people to endorse victim blaming responses to sexual violence and other forms of GBV. The “Protecting Family Honor” subscale identifies the stigma associated with being a member of a family/clan where a women/girl experiences GBV and the importance placed on addressing the violence within the family/clan rather than reporting it to authorities. The priority is to protect the family and victim’s reputations rather than the safety and well-being of the woman or girl. High scores on the injunctive domain of this subscale represent that the respondent believes their influential other expects people to prioritize protecting family honor over safety and well-being of victims. The “Husband’s Right to Use Violence” subscale reflects social norms that support a husband’s use of violence to discipline his wife and to have sex with her even when she does not want to. It also reflects a norm that associates a man’s use of violence against his wife with illustrating his love for her. High scores on the injunctive norms domain for this subscale indicates that the respondents believe their influential others expect people to endorse a husband’s right to use violence against his wife. High scores on the personal beliefs domains for each of the subscales reflect a greater willingness to speak out against social norms that endorse GBV.

Validity of the injunctive norms subscales was supported by significant relationships with other variables (i.e., site and sex) as hypothesized during the development of the scale. The three sites were significantly different on the injunctive norms domain of the scale. Although all three sites experienced a high degree of conflict, the amount of humanitarian services to support GBV survivors and programming to raise awareness and change harmful social norms towards GBV varied. Mogadishu districts participating in the study had relatively active programming, with Warrap and Yei reporting few international and local NGOs with capacity to provide diverse GBV services and programs. Yei, South Sudan was found to have significantly stronger norms that endorse negative “Response to Sexual Violence” and other forms of GBV than other sites. The beliefs of participants from Yei also indicated less support for changing harmful social norms about GBV than other sites in the study. Participants in the four districts of Mogadishu scored the lowest on the personal beliefs subscales of “Husband’s Right to Use Violence” and “Protecting Family Honor.” This finding indicates that participants were less willing to speak out against social norms that support husbands’ rights to use violence against their wives or norms that support not reporting sexual violence to protect family honor than the South Sudan sites. Important to interpreting the findings are the differences in context, culture, and religion across the sites which inform social norms and personal beliefs.

Generalizability is one of the indicators of trustworthiness of the Social Norms and Beliefs about GBV scale  – the ability to interpret and apply the scale in a broader context to make it relevant and meaningful to GBV prevention programs being implemented and evaluated in diverse low-resource and humanitarian settings. Importantly, the 36-item two domain scaled applied with community members by local teams in diverse districts and regions within Somalia and South Sudan resulted in a valid and reliable 30-item scale to measure personal beliefs and injunctive social norms. The psychometric phase included randomly selected women and men across multiple age groups (15 years and older), living in both urban and rural communities, and included community members living in settlements and camps for displaced persons. Thus, the scale has the potential to be used in not only humanitarian settings, but also GBV prevention programs in other low-resource and fragile settings.

Although this psychometric evaluation has several strengths, including a mixed methods design to develop the scale and a large sample size to test the scale across diverse sites, it has limitations. The study does not include a separate validation sample to conduct a confirmatory factor analysis. Further, we did not test the relationship between the Social Norms and Beliefs about GBV Scale and community members’ reports on experience, perpetration, or witnessing of GBV in the participating communities. The research team decided in collaboration with local partners not to ask participants in the evaluation phase about personal experiences with GBV for either the scale development or testing. The local colleagues felt community members would be more comfortable and likely to participate in the scale development and testing if they were not asked about their own experiences and thus also increasing generalizability.

The study presents a mixed methods approach to developing a brief scale with strong psychometric properties to measure change in harmful social norms associated with GBV. The Social Norms and Beliefs About GBV Scale is a 30-item scale with three subscales, “Response to Sexual Violence,” “Protecting Family Honor,” and “Husband’s Right to Use Violence” in each of the two domains, personal beliefs and injunctive social norms. The scale to our knowledge is one of the first to demonstrate good factor structure, acceptable internal consistency, and reliability, and be supported by the significance of the hypothesized group differences by setting and sex. We encourage and recommend that researchers apply the Social Norms and Beliefs about GBV Scale in different humanitarian and global LMIC settings and collect parallel data on a range of GBV outcomes. This will allow us to further validate the scale by triangulating its findings with GBV experiences and perpetration and assess its generalizability across diverse settings.

Abbreviations

Demographic and Health Surveys

Democratic Republic of Congo

• Gender-based violence

Inter-Agency Standing Committee

Internally displaced persons

Intimate partner violence

Institutional Review Board

Low and middle-income countries

Non-partner violence

Research assistant

United Nations Children’s Fund

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Acknowledgements

We acknowledge our committed and talented implementing partners in South Sudan, two national NGOs, Voice for Change in Central Equatoria State and The Organization for Children Harmony in Warrup State. In Somalia, the Italian NGO, Comitato Internazionale per LoSviluppo dei Popoli (CISP) Mogadishu and other regions of the country.

United Nations Children’s Fund (UNICEF) provided the funding for the Communities Care program.

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The Communities Care program toolkit is available through United Nations Children’s Fund (UNICEF). Requests for research data and materials can be obtained by contacting UNICEF.

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NP, NG, MM, AC, SRH, SH, FK, AD, MY designed the study. MM, SRH, NP, RT, LH, NG and AC identified the theoretical framework for the formative and psychometric phases of the study. NG, NP, and LH conducted the psychometric analysis. MY, CYP, AA, AC, NP and NG implemented and interpretation the study findings in South Sudan and SH, BR, AD, AA, FK, AC, NG and NP implemented and interpretation of the study findings in Somalia. NP, NG, RT, AC and LH finalized the manuscript.

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Correspondence to Nancy Glass .

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The appropriate federal and state government ministry in each of Somalia and South Sudan and the Johns Hopkins Medical Institution Institutional Review Board (IRB) approved the study protocol and oral consent. The government ministry provided a letter of approval to Johns Hopkins and the local implementing partners to use as they reached out to authorities and key stakeholders to implement the research in each participating community.

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Social Norms and Beliefs about Gender Based Violence Scale. (DOCX 17 kb)

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Perrin, N., Marsh, M., Clough, A. et al. 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. Confl Health 13 , 6 (2019). https://doi.org/10.1186/s13031-019-0189-x

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Theoretical Perspectives on Understanding Gender-Based Violence

2021, International Journal of Political Activism and Engagement

This study focuses on the various theoretical perspectives that have been developed by various scholars to understand gender-based violence (GBV). These theories are very important as they influence on the interventions that can be taken to reduce GBV. The following nine theoretical perspectives will be discussed in this article: psychological, sociological, feminism, exchange, resources, stress, economic exclusion, intersectional, and ecological. This study will look at the strength and weaknesses of all the theoretical perspectives.

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The United Nations has identified gender-based violence against women as a global health and development issue, and a host of policies, public education, and action programs aimed at reducing gender-based violence have been undertaken around the world. This article highlights new conceptualizations, methodological issues, and selected research findings that can inform such activities. In addition to describing recent research findings that document relationships between gender, power, sexuality, and intimate violence cross-nationally, it identifies cultural factors, including linkages between sex and violence through media images that may increase women’s risk for violence, and profiles a host of negative physical, mental, and behavioral health outcomes associated with victimization including unwanted pregnancy and abortion. More research is needed to identify the causes, dynamics, and outcomes of gender-based violence, including media effects, and to articulate how different forms of such violence vary in outcomes depending on cultural context.

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Gender-based violence: concepts, methods, and findings

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The United Nations has identified gender-based violence against women as a global health and development issue, and a host of policies, public education, and action programs aimed at reducing gender-based violence have been undertaken around the world. This article highlights new conceptualizations, methodological issues, and selected research findings that can inform such activities. In addition to describing recent research findings that document relationships between gender, power, sexuality, and intimate violence cross-nationally, it identifies cultural factors, including linkages between sex and violence through media images that may increase women's risk for violence, and profiles a host of negative physical, mental, and behavioral health outcomes associated with victimization including unwanted pregnancy and abortion. More research is needed to identify the causes, dynamics, and outcomes of gender-based violence, including media effects, and to articulate how different forms of such violence vary in outcomes depending on cultural context.

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Theoretical Perspectives on Understanding Gender-Based Violence

Introduction.

Theories are important because they influence the actions chosen to address Gender Based Violence (GBV) and frame the general understanding of a social issue (Bowman, 2002; Jasinski, 2001). Understanding the causes of GBV is important for those who seek to prevent, predict, or intervene to avert the occurrence of violence within intimate relationships (Cunningham, 1998). GBV which is also termed Violence against Women (VAW) is a field where the link between theory and practice has been quite explicit (Holtzworth-Monroe & Saunders, 1996). Theory development has proceeded from a wide range of disciplines including criminology, law, psychiatry, psychology, public health, social work, sociology, and women’s studies (Jasinksi, 2001; O’Neil, 1998).

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A theory of change for community interventions to prevent domestic violence against women and girls in Mumbai, India

Nayreen daruwalla.

1 Program on Prevention of Violence Against Women and Children, SNEHA, Mumbai, Maharashtra, 400017, India

Surinder Jaswal

2 School of Research Methodology, Centre for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences, Mumbai, Maharashtra, 400088, India

Prakash Fernandes

3 Independent Researcher, Mumbai, Maharashtra, 400050, India

Preethi Pinto

Ketaki hate, gauri ambavkar, bhaskar kakad.

4 Institute for Global Health, University College London, London, WC1N IEH, UK

David Osrin

Associated data.

• Osrin D: Changing gender norms in the prevention of violence against women and girls in India . [Data Collection]. Colchester, Essex: UK Data Archive.2017. 10.5255/UKDA-SN-852735 [ CrossRef ]
• Osrin D: A Theory of Change for Community Interventions to Prevent Domestic Violence against Women and Girls in Mumbai, India. OSF. 2019. 10.17605/OSF.IO/47JMG [ CrossRef ]

Underlying data

UK Data Service: Changing gender norms in the prevention of violence against women and girls in India. https://doi.org/10.5255/UKDA-SN-852735 ( Osrin, 2017 ).

This project contains transcripts of focus group discussions and interviews, translated into English. The safeguarded data files are made available to users registered with the UK Data Service under UK Data Archive End User Licence conditions . The data files are not personal, but—given the subject matter of the interviews and focus groups—the data owner and research ethics committee consider there to be a limited residual risk of disclosure.

Extended data

Open Science Framework: A theory of change for community interventions to prevent domestic violence against women and girls in Mumbai, India. https://doi.org/10.17605/OSF.IO/47JMG ( Osrin, 2019 ).

This project contains the following extended data:

• Action_documentation_archive.xlsx
• Consultant_report_2016.docx (initial consultancy report)
• Reference_list.docx (reference list for development of theory of change)
• ToC_development_history.pdf (theory of change visual development history)
• ToC_meetings_summary.docx (theory of change meetings summary)

Extended data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Version Changes

Revised. amendments from version 1.

In response to the reviewers' comments, we have provided more information on the process of developing our program theory of change, the theoretical background to some of our idea, the process evaluation, and the processes in involved in field activities.

Peer Review Summary

Background: We describe the development of a theory of change for community mobilisation activities to prevent violence against women and girls. These activities are part of a broader program in urban India that works toward primary, secondary, and tertiary prevention of violence and includes crisis response and counselling and medical, police, and legal assistance.

Methods: The theory of change was developed in five phases, via expert workshops, use of primary data, recurrent team meetings, adjustment at further meetings and workshops, and a review of published theories.

Results: The theory summarises inputs for primary and secondary prevention, consequent changes (positive and negative), and outcomes. It is fully adapted to the program context, was designed through an extended consultative process, emphasises secondary prevention as a pathway to primary prevention, and integrates community activism with referral and counselling interventions.

Conclusions: The theory specifies testable causal pathways to impact and will be evaluated in a controlled trial.

Introduction

Although its pervasiveness and harms have long been addressed by the women’s movement, the importance of violence against women and girls as a public health priority has only been acknowledged relatively recently. The health effects are profound. Violence causes non-fatal or fatal injury: 21% of homicides in southeast Asia are committed by an intimate partner, constituting 60% of all female homicides (compared with 1% of male homicides) ( Stöckl et al. , 2013 ). Other harms include sexually transmitted infections, miscarriage, induced abortion, stillbirth, low birth weight, preterm delivery, harmful drug and alcohol use, anxiety and depression, self-harm, suicide, and trans-generational recapitulation of violence ( García-Moreno et al. , 2015b ; WHO and London School of Hygiene and Tropical Medicine, 2010 ; WHO, 2013 ). Physical and psychological trauma and fear also lead to mental health problems, limited sexual and reproductive control, somatoform conditions ( WHO, 2013 ), difficulties in seeking healthcare, and lost economic productivity ( Solotaroff & Pande, 2014 ).

Some 30% of women have experienced physical or sexual violence by an intimate partner or sexual violence by a non-partner ( WHO, 2013 ). A recent systematic review suggested that 22% of women in India had survived physical abuse in the past year, 22% had suffered psychological abuse, 7% sexual abuse, and 30% multiple forms of violence ( Kalokhe et al. , 2017 ). Non-partner sexual violence is reported regularly in the media ( Raj & McDougal, 2014 ), but culturally sanctioned household maltreatment ( Silverman et al. , 2016 ) in the form of emotional and economic domestic violence and abuses of power, control, and neglect have been reported as particularly common in India ( Kalokhe et al. , 2015 ).

India was one of 189 signatories to the 1980 Convention on the Elimination of All Forms of Discrimination Against Women ( United Nations, 1979 ). The United Nations declared a response imperative in 2006 ( United Nations, 2006 ), the World Health Organization (WHO) named it a health priority in 2013 ( García-Moreno et al. , 2015a ), and its elimination is a target of the fifth Sustainable Development Goal. The emphasis of the first wave of interventions—driven largely by feminist activism by the women’s movement from the 1960s—was support for survivors of violence, reduction in secondary perpetration, strengthening legal recourse, and advocacy ( Ellsberg et al. , 2014 ). This constitutional, rights-based approach led to the consolidation of services such as women’s shelters, counselling, legal advice, and, in India, laws such as the Protection of Women from Domestic Violence Act 2005. A second wave of interventions, again led by civil society organisations, emphasized primary prevention and community activism and took a public health position which emphasized population-based, interdisciplinary, and intersectoral interventions ( WHO and London School of Hygiene and Tropical Medicine, 2010 ).

The Society for Nutrition, Education and Health Action (SNEHA) is a non-government organisation addressing the health needs of women and children in the context of urban informal settlements in India. The program on prevention of violence against women and children follows a socio-ecologic model developed by Heise after the work of Bronfenbrenner ( Bronfenbrenner, 1979 ; Heise, 1998 ), with an understanding that determinants of violence need to be addressed at a range of levels, within families, communities, and societies. The program aims to develop strategies for primary prevention, ensure survivors’ access to protection and justice, empower women to claim their rights, mobilise communities around ‘zero tolerance’ for violence, and respond to the needs and rights of neglected groups.

The program delivers three sets of activities: community mobilisation, crisis counselling and extended response for survivors of violence, and work with police, medical and legal services. Community mobilisation includes group activities and individual voluntarism. Neighbourhood groups of women, men, and adolescents develop awareness, initiate campaigns and local action to support survivors, and build leadership. An emergent cadre of volunteers sanginis (female friends) identify and support survivors through crisis intervention and case management, linking them with counselling, police, and medical services. This encompasses both primary and secondary prevention. The program runs five community-based and four hospital-based counselling centres. Immediate and longer-term support for survivors of violence is provided by counsellors at each centre. Counsellors take a stepped-care approach to identification, intervention, and referral of survivors of violence with common and severe mental health disorders, including in-house psychologists when required. They also work with medical, legal, and police services, for whom collaborative training programs are regularly conducted. Counsellors collaborate with the police and District Legal Aid Services Authority to assist women in filing legal cases in response to domestic violence, sexual assault and rape, and other matters pertaining to civil and criminal acts.

Our program is comprehensive and aspires to ‘community building’. Its characteristics include horizontal complexity (across sectors), vertical complexity (across socio-ecologic levels), community building (participatory efforts to enhance the capacities of individuals and connections between them and outside resources), political, economic, and infrastructural contextual issues with little power to affect them, flexibility over time, and community saturation (clusters rather than individuals) ( Auspos & Kubisch, 2004 ).

After 15 years of cumulative program development, we wanted to understand how the components of the program fit together, think about the sequence of outcomes and indicators that we might measure, and evaluate effectiveness. We contemplated expansion and felt a need to crystallise the program for ourselves, for others, and for protocolised rollout. We felt that the service aspects of the program were intrinsic to a rights-based response in the spirit of the Istanbul Convention ( Council of Europe, 2011 ). Community mobilisation is less defined, despite its potential to prevent violence against women and girls ( Ellsberg et al. , 2014 ), and the theory of change focused on it for this reason. A theory of change is a hypothetical explanation of how and why an initiative works ( Weiss, 1995 ). It seeks to understand how program activities might lead to outcomes—desired or undesired—by articulating the connections between them ( Stein & Valters, 2012 ). Each program activity is linked with outcomes and each outcome is defined and assigned indicators ( Taplin et al. , 2013 ). Like a logic model, a theory of change is a kind of program theory ( Rogers et al. , 2000 ), or pragmatic framework ( De Silva et al. , 2014 ), in which concepts are linked with empirical findings in steps that are potentially examinable and falsifiable. Shaping evaluation around theories of change has been recommended for a variety of social programs ( Chen & Rossi, 1980 ; Chen, 1994 ). Evaluators in the field of health promotion were early adopters ( Birckmayer & Weiss, 2000 ), and there has been growing interest in evaluating complex public health interventions ( De Silva et al. , 2014 ). We were particularly interested in developing a theory of change for the prevention of violence against women that fit our specific context of work among informal settlements in urban India.

We developed a program theory of change informed by existing theories around social norms, networks, and behaviour change ( Davidoff et al. , 2015 ; Michie et al. , 2011 ), combined with tacit theory based on experience ( Birckmayer & Weiss, 2000 ; Chen & Rossi, 1980 ; Mason & Barnes, 2007 ; Weiss, 1997 ). Our focus was on two general types of behaviour: stimulation of pro-social action and bystander intervention, and identification, support, and secondary prevention for survivors of domestic violence. In this paper, we aim to describe our theory of change.

Informal settlements (slums) are features of urbanization in India and have been described in two-thirds of cities and towns. The most recent estimate is that 41% of Mumbai’s households are in such settlements ( Chandramouli, 2011 ). The latest National Family Health Survey (NFHS-4) suggests that 21% of ever-married women in Maharashtra state, the location of our work, have experienced intimate partner violence in their lifetime ( IIPS, 2015 ). Risk factors for both physical and sexual violence include poverty, exposure to parental violence, childhood maltreatment, limited education, unemployment, young adulthood, mental disorder, substance use, individual acceptance of violence, weak community and legal sanctions, and gender and social norms supportive of violence ( WHO and London School of Hygiene and Tropical Medicine, 2010 ). These risk factors meet in Mumbai’s urban informal settlements, along with population density and stressful living conditions, and their toll in terms of violence is the reason for our activities. UN-HABITAT characterizes them in terms of overcrowding, insubstantial housing, insufficient water and sanitation, lack of tenure, and hazardous location ( Ministry of Housing and Urban Poverty Alleviation, 2010 ; United Nations Human Settlements Program (UN-Habitat), 2003 ). Women and girls in these communities lack both financial and social resources and an understanding of the possibility of relief from endemic violence.

We developed the theory of change in five overlapping phases. In the first phase (July 2015 to November 2016), an external consultant (Fernandes) met with our teams for counselling and community mobilisation, police and hospital liaison, two clinical psychologists, and a lawyer to understand their experiences, challenges, and perceptions of outcomes. He interviewed seven clients of our crisis and counselling services, six police officers, and five healthcare providers, and conducted focus group discussions with eight members of a community women’s group, 15 members of a men’s group, 17 members of a youth group, and nine adolescents involved in an education program (report available as extended data ( Osrin, 2019 )).

To begin the second phase, we convened a three-day research workshop (August 2015) with nine team members and four researchers in the field of violence against women and girls, anthropology, ethics, and public health. The discussions were primarily about outcomes: whether the impact towards which the theory of change would be directed was a reduction in violence against women and girls, gender-based violence, intimate partner violence, domestic violence, or violence perpetrated by others outside the home. The decision, supported by subsequent discussions, was to focus on domestic violence against women and girls.

The third phase, bracketed by workshops at the beginning and end involving members of the core team, data collectors, and SNEHA researchers, interrogated the first draft of the theory of change in terms of program experience and ethics. Participants discussed and refined potential outcomes, how they were related to preventing violence, and how they could be measured. This was accompanied by two activities: an action documentation exercise and a study on gender norms around domestic violence ( Daruwalla et al. , 2017 ). In order to understand what kinds of individual and collective action people might take, and therefore to align our expectations in the theory of change with potential reality, the action documentation exercise recorded community mobilisation team members’ experiences of the kinds of action that community members had undertaken in the past. It yielded 76 actions, documented as extended data ( Osrin, 2019 ). Adverse effects were also documented (although flare-ups in communities might actually suggest that the program was having an effect).

Table 1 provides examples of actions, categorising them as individual, collective, or individual followed by collective, whether an action was in the home or the neighbourhood, and the type of violence to which it was a response. The core team selected stories purposively to illustrate combinations of these categories. Individual action was often backed by the notional and practical security of being a member of a community group and having connections with a supportive organisation, using these connections as action escalated. Apart from help from our own organisation, and from periodic referral for skilled legal help and services for alcohol and drug dependency, the police force was a prominent institutional link. Although our commitment is to preventing domestic violence, both individual and collective actions often responded to incidents in the neighbourhood. Different kinds of violence – and particularly sexual violence in public spaces – coexist and response to each is both a source of confidence and a step toward a belief in collective efficacy. Likewise, groups often undertook collective action to improve their environment and we see this as contributing to a sense of collective efficacy and community building.

*Education, Persuasion, Enablement, Coercion, Incentivisation, Training, Modelling, Environmental restructuring, Restrictions ( Michie et al ., 2011 )

We also tried to classify behaviour change according to the Capability, Opportunity, and Motivation model (COM-B), a theoretical approach that we will use in subsequent process evaluation. Developed to inform public health programming, the COM-B model specifies nine functions by which an intervention might stimulate change: education, persuasion, incentivisation, coercion, training, restriction, environmental restructuring, modelling, and enablement. The examples in Table 1 point to education (awareness of the problem of violence and potential approaches to addressing it), persuasion (of either perpetrators or community bodies), coercion (primarily of perpetrators, and often through linkages with the police), and modelling (of exemplary successful actions by individuals and groups) as prominent functions.

The fourth phase involved collective adjustment of the theory of change. The program core team (six SNEHA program and research members and one UCL researcher) met 15 times to work on the theory, for 2-3 hours each time. During these meetings, we used ‘backward mapping’, in which we started with agreed outcomes and then stepped backwards sequentially to understand the necessary preconditions to meet them. This was accompanied by examination of assumptions and rationales, a strategic weighing of possible interventions, and the development of indicators with which to test the causal sequence ( Taplin & Clark, 2012 ). At the end of this phase, we presented, discussed, and adjusted the emerging theory in four workshops. We invited external activists, academics, and practitioners in Mumbai, our program base (April 2016), Delhi, where policy and advocacy expertise is concentrated (July 2016), and London, our collaborative academic base (July 2016). A summary of these meetings is available as extended data ( Osrin, 2019 ).

In order to make sure we had not missed anything, the fifth phase involved a more formal review of mechanisms in the literature (PROSPERO 2018 CRD42018093695 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018093695 ; a full review is forthcoming). We carried out a search for theories of change, logic models, or conceptual models of population-based interventions to prevent domestic violence. We included articles in English and excluded studies from high-income settings according to World Bank classifications . We limited the search to articles published between January 1960 and November 2018. We used Boolean combinations of the terms ("theory of change" OR "logic model" OR "conceptual model") AND ("intimate partner violence" OR "domestic violence" OR "violence against women" OR "sexual violence" OR "physical violence" OR "economic violence" OR "emotional violence" OR "gender-based violence") to search for articles on PubMed, Scopus, Web of Science, Google Scholar and Google sites. To limit the scope of the search, we inspected only the first 10 pages of Google Scholar and Google searches. We also read published impact evaluations listed in existing evidence reviews of interventions seeking to reduce domestic violence ( Bourey et al. , 2015 ; Ellsberg et al. , 2014 ; Gibbs et al. , 2017 ; Marshall et al. , 2018 ; Yount et al. , 2017 ).

Ethical approval

Approval for research associated with the development of the theory of change was given by the Ethicos Independent Ethics Committee (ref: 3 rd December 2015). Participants in interviews and focus groups provided written consent to use of anonymised information.

Primary and secondary intervention

Figure 1 summarises the emerging theory of change over a sequence of human resources or inputs, changes or outputs, and outcomes. The assumptions underlying the model are numbered and the activities of people involved are numbered and linked with a summary in Table 2 . Raw data from interviews and focus groups are available ( Osrin, 2017 ).

The theory of change narrative is that people involved in our intervention take action to help survivors of violence make informed choices, and to increase community awareness of violence against women and girls and the possibility of change. As a result of these activities, survivors and potential perpetrators understand the nature of violence. Survivors make decisions, potential perpetrators think again, and other people understand both the nature of violence and that action is possible. People stand up against violence against women and girls, individually and collectively, and community members think and act to help survivors. Families and communities stop accepting violence and strengthen community structures that support a conviction that it is intolerable. Institutional support from non-government organisations, the police, medical practitioners, and lawyers is accessible and functional and families and communities free themselves of violence against women and girls.

In this formulation, community mobilisation has two general aims: primary prevention through development of awareness of the importance and iniquity of violence against women, accompanied by knowledge of rights and law, and secondary prevention through increased identification of survivors and individual and collective action to support them. Prevention encompasses a range of interventions aiming to reduce risks or threats to health and wellbeing, grouped into three categories: primary, secondary, and tertiary. We believe that all three – particularly primary and secondary prevention - lead to reduction of violence at individual, relationship, and community levels. Primary prevention is exemplified by previous trials in which interventions have focused on increasing community awareness of violence against women, inequitable gender norms, and women’s rights. Primary prevention not only targets specific causes and risk factors for violence against women and girls, but also aims to promote healthy behaviours, increase knowledge of rights and entitlements, and improve women’s capacity to resist violence.

Secondary prevention usually describes interventions to support women survivors of violence in order to prevent it continuing or mitigate it. We see the enactment of these interventions as a means of both highlighting violence in the community and showing that redress and resolution are possible. In this sense, it speaks to the modelling function within the COM-B framework (a product of education, persuasion and coercion). Visible intervention to support survivors makes people aware of the problem and potential solutions. This helps to foster safe environments that reduce the risk of violence; for instance, through creating networks that offer support to women. Intervening in emergencies and demonstrating action builds trust and confidence, increases awareness and knowledge in communities, and reduces community members’ tolerance of violence. Tertiary intervention describes interventions to support women in dealing with the consequences of violence, particularly effects on their mental health. Again, the pathway of support, from community activist to counsellor to psychologist and psychiatrist, sends a message to other women in difficult circumstances.

Overall, the theory envisages counsellors, community mobilisers, community volunteers and groups of women, men, and youth working together to bring about individual and collective change with the ultimate aim of reducing domestic violence. The theory suggests that community mobilisation encourages transformation of participants and pro-social action prevents violence against women and girls, as well as bystander intervention, while local support and response, crisis counselling, medical, psychosocial, police and legal support contribute to the identification and support of survivors of violence. Visible instances of support and justice for survivors are thought to encourage greater community activism, thus completing a positive feedback loop between primary prevention (through community mobilisation) and secondary prevention (through institutional support for survivors). The detailed steps are described below.

Resources and interventions

First, the program inputs comprise salaried counsellors, community organisers, community officers, and coordinators, as well as voluntary human resources from women, men, and young people who join groups. Table 2 summarises expected roles for each type of individual, keyed numerically with Figure 1 in three categories. Mobilisation is primarily the remit of community organisers who identify potential group members, bring them together, and facilitate a sequence of modules and discussions. Group sessions aim to build a political agenda for change that privileges women’s interests and looks to transform gender and social power relations. Our group-work module follows a sequence over three years. The first year emphasises awareness of violence, gender norms, women’s rights and entitlements, and the importance and strength of women’s collectives in addressing violence against women and girls. The second year emphasises action, be it individual or collective. The third year emphasises leadership and group members are encouraged to take on prominent roles in the community. Generally, women who are proactive, articulate, have a social network in their neighbourhoods, and are willing to devote time to the issue are recommended as volunteer activists by groups and invited to become sanginis .

Along with group members, community organisers also identify survivors of violence and help group members to respond. Organisers are initiators and points of contact for involvement of counsellors and follow-up with survivors. They facilitate community events and campaigns and liaise with medical, police, and legal services. Counsellors are based close to communities and conduct crisis intervention, counselling, and home visits, as well as providing institutional support. Group members become involved in campaigns and identify and support survivors of violence. After about one year of group activity, sanginis emerge and are trained to identify and support survivors, as well as in communication and liaison with services. Community organisers work closely with sanginis whom they identify and mentor.

Second, the theory proposes three forms of local change: an increase in identification of and support for survivors of violence, changes in the beliefs and actions of group participants and volunteer sanginis , and broader changes in communities. Survivors are able to view their experience in a broader context, get help when they feel they need it, and take action to improve their situation. This visible secondary prevention leads to community awareness, increased identification and consultation, and a broad base of support. Participation in groups leads to changes in members and awareness of gender issues. This yields action in terms of individual and collective efficacy based on precedent, and visibility in the community for groups and individuals who take on leadership and volunteer roles.

Third, group and individual activities, linked with tangible service provision and successful interactions with counsellors, the police, and lawyers, lead to increased disclosure of violence. We believe that changes in attitudes are more likely to follow changes in behaviour than the other way around. Although there is a place for awareness and attitudinal change, our programmatic experience suggests that changes in social norms and attitudes can be accelerated by visible instances of successful response to the needs of survivors of violence. These responses themselves reduce the prevalence of domestic violence through secondary prevention, but the accompanying awareness and belief in rights and recourse is a form of primary prevention. Our main emphasis is on domestic violence, but it is conceivable that changes in community norms and bystander intervention will also reduce the likelihood of non-partner sexual violence outside the home.

Undesirable changes

Finally, the intervention might lead to a number of changes for the worse in homes and communities ( Chen & Rossi, 1980 ). These are based on program experience and have been called ‘dark logic’ in the context of program theory ( Bonell et al. , 2015 ). Community interventions might lead to an increase in violence against women and girls as gender norms are transgressed and people push back against existing controls on women’s behaviour. This could be a short-term negative effect. Conversely, growing opposition to violence might lead to vigilantism and precipitate action and punishment meted out to either survivors or people who were not perpetrators. For example, after a group session on ration rights, a men’s group member called for a violent protest. Awareness of the problem of non-partner sexual violence might lead families to set limits to women’s mobility, and awareness of community and legal sanctions might lead perpetrators to modify the kind of violence they use. As concerns surface, it is conceivable that group members, volunteer sanginis , community organisers, counsellors, or the families of survivors of violence might face threats or exclusion. At one point, ration shopkeepers threatened a sit-in outside our organisation’s office because of our help with complaints. The unexpectedly positive effect of this negative response was that more people volunteered to join the organisation. Finally, the program’s focus on personal development and leadership might support people with personal agendas not entirely aligned with its aims, or might lead to favouritism. An example is a case in which a women’s group member stood out as a leader. She started her own group, which undertook several successful actions, but took community action on herself and would not allow others to lead. Eventually, community members would not participate in an electricity campaign and when she moved out of the area nobody took her work forward.

General theory

Three areas of disciplinary theory meet in the ideas that underlie our program theory: social norms theory (already prominent in prevention of violence against women), network theory (prominent in political science, economics, and latterly in public health), and behaviour change theory (prominent in behavioural psychology and public health).

Our ideas about norms are informed by integrated theory with a feminist perspective ( Heise, 1998 ), which also underlies our organizational approach to working with survivors of violence. Beyond the need to work with families, we aim to ensure that no further harm is done to women, who remain the focus and whose views and making of meaning are prioritized. We believe that violence against women deserves attention as a gendered phenomenon beyond family violence ( Lawson, 2012 ), and that gender needs to be in the foreground ( Dobash & Dobash, 1979 ; Gelles, 1985 ). Our attempts to achieve gender transformative change are particularly indebted to theory around asymmetric distribution of power between genders ( Rodrígues-Menés & Safranoff, 2012 ), and hegemonic patriarchy ( Connell, 1987 ; Connell, 1995 ).

Our thinking on potential mechanisms has been influenced by social norms theory, and particularly by discussions of the need to transform gender norms as a route to addressing violence against women ( Alexander-Scott et al ., 2016 ). This is particularly relevant because we are concerned about the forms of violence that constitute gender-based household maltreatment: emotional and economic violence, control and neglect. Our previous work suggested that we might focus on three ideas about norm change ( Daruwalla et al ., 2017 ). The first is to make use of the mismatch between descriptive and injunctive norms. A descriptive norm describes beliefs about what other people do ( Bicchieri, 2006 ; Cialdini et al ., 1991 ; Muldoon et al ., 2014 ), while an injunctive norm describes beliefs about what other people think one ought to do ( Bicchieri, 2006 ; Cialdini et al ., 1991 ). Descriptive norms intolerant of violence are likely to be magnets for behaviour and if we are able to show examples of non-violent interaction we might be able to influence people’s perception of what is actually prevalent in the community. This is helped by our second idea, which is that injunctive norms disapprove (at least in principle) of violence. How to spread awareness of this turns on the reference group - the people surrounding an individual from whom she takes her cue ( Levy Paluck et al ., 2010 ) - and our third idea is to expand the currently limited reference groups around individuals so that they can process a larger pool of opinion on norms intolerant of violence.

When we ‘expand a reference group’, we are basically saying that individuals meet and engage with more people, and this evokes ideas from network or social capital theory ( Putnam, 1995 ). Another way of seeing the new connections between people that develop in community groups is as weak ties or bridging social capital, in contradistinction to the (hierarchical) strong ties or bonding social capital that the family circle typifies ( Granovetter, 2005 ; Patulny & Svendsen, 2007 ). Added to this is the idea of linking social capital between, for example, community members and institutions that might help them to address violence against women ( Szreter & Woolcock, 2004 ), a process explicit in our theory of change. So, although community mobilisation is a way to address violence against women, it can be seen equally as a community building or social capital endeavour (see ( Szreter & Woolcock, 2004 ) for an anatomisation of the debates around social capital and public health).

We use the Capability, Opportunity, and Motivation model (COM-B) to think about individual behaviour change, particularly in terms of the functions of interventions that it summarises ( Michie et al ., 2011 ). The program aims to increase the capability of participants to understand violence against women, identify survivors, and take supportive action, with knowledge of law and rights, decision-making and negotiation skills, self-efficacy, and collective efficacy. This it does predominantly through education, training, enablement, and modelling (first by program staff and then by community members). It presents opportunities to engage with others, learn, develop confidence and leadership, and connect with supportive non-government and government organisations; again predominantly through education, training, enablement, and modelling. Motivation comes from the development of belief in preventing violence against women and children, increased by education, persuasion, enablement, training, and modelling. From the point of view of potential perpetrators of violence, the primary functions are persuasion, coercion, and education, accompanied (we hope) by awareness and change in attitude brought about by education and modelling and reduced opportunity for violent behaviour.

Our theory of change differs from existing theories of change in a number of ways: it is adapted for the program’s context; it was designed through an extended consultative process from 2015 to 2017; it places major emphasis on secondary prevention as a pathway to primary prevention; it integrates community activism with referral and counselling interventions; and it makes explicit specific testable causal pathways to impact, which will be evaluated within the context of an on-going cluster-randomised controlled trial. While some previous theories of change share some of these characteristics, to our knowledge, no previous theory has had them all.

This article describes the theory of change behind a comprehensive community-based intervention to prevent violence against women through primary and secondary prevention. It took 22 months to develop the theory and involved primary data collection with multiple stakeholders, multiple workshops with critical commentators, and many team meetings. This long and careful process of theory building has resulted in a theory that improves on existing theories of change for the prevention of violence against women in a few ways.

First, the theory highlights the interconnectedness of primary and secondary prevention through a positive feedback loop. Community members become capable and motivated to identify and refer survivors to crisis counselling and institutions; in turn, successful resolution of cases of violence with institutional actors - non-government organisations, the police, medical practitioners, and lawyers - raise awareness and strengthen community members’ confidence in their own activism. Community activism still takes place through individual outreach, group discussion and reflection, or community-wide campaigns, but it is closely linked to support from local counselling and legal aid centres. This model contrasts with previous theories of change, which have tended to place their main emphasis on primary prevention through community activism and capacity building to develop awareness of burden, rights, law, and recourse ( Abramsky et al. , 2016 ; Falb et al. , 2016 ; Pettifor et al. , 2015 ; Wagman et al. , 2015 ).

Second, the theory was fully adapted to the local context of urban informal settlements in India, while previous theories of change have predominantly been developed for a Sub-Saharan African context ( Abramsky et al. , 2016 ; Falb et al. , 2016 ; Pettifor et al. , 2015 ; Wagman et al. , 2015 ) with the notable exception of a single study in Nepal ( Clark et al. , 2017 ). Many elements of the current theory of change reflect previous experience over the past 15 years of program activity.

Third, the theory provides greater specificity than previous theories. These can broadly be categorised into three types: quasi-linear logic models ( Clark et al. , 2017 ; Wagman et al. , 2015 ), stages of change models ( Abramsky et al. , 2014 ; Falb et al. , 2014 ; Michau, 2007 ), and ecological models ( Abramsky et al. , 2016 ; Michau et al. , 2015 ). Ecological models tend to see violence reduction as arising from the simultaneous operation of a large number of activities and processes at individual, household, and community levels which interact in unspecified ways. Stages of change models view violence prevention activities as progressing in stages from community entry to awareness-raising to behaviour change, but do not always specify why or how communities progress from one stage to the next. Quasi-linear logic models present intervention processes as a block of activities leading via a block arrow to another block of changes and outputs. Such models often lack clarity on the exact ‘context-mechanism-outcome configurations’ ( Pawson & Tilley, 1997 ) that are expected to occur. The current theory of change lists the pre-conditions that need to be fulfilled for each component of the theory to ‘work’, the causal connections between each component, as well as any adverse effects that may arise. A similar approach has been taken in the development of Sonke CHANGE, a cluster randomised controlled trial in periurban Johannesburg, South Africa. The Sonke Gender Justice intervention involves workshops and community action teams working predominantly with men with an emphasis on changing harmful gender norms and prevailing hegemonic masculinity. The program theory of change proposes that community action and advocacy to promote equitable gender norms and non-violent masculine attitudes and practices will lead to enhanced critical consciousness, collective efficacy and action, and better social cohesion and trust. These will lead in turn to self-efficacy to take action, reduced influence of harmful gender norms, and an enabling environment for policy implementation ( Christofides et al ., 2018 ).

Theories of change are necessarily provisional, and may not be right, but they still serve useful functions as guides to evaluation ( Birckmayer & Weiss, 2000 ). By providing a theoretical framework for collecting and analysing data, they can help overcome problems intrinsic to “omnibus data” ( Auspos & Kubisch, 2004 ) that are insufficiently directional to test theory ( Weiss, 1997 ). The current theory of change has allowed us to understand our program, consider the necessity of specific components, and be specific about intermediary changes ( Birckmayer & Weiss, 2000 ). It also helped to clearly articulate program objectives across a range of team members—community organisers, qualitative and quantitative evaluators, anthropologists, economists, medical practitioners, psychologists, and legal advisors—with stakes in the program ( Mason & Barnes, 2007 ). In turn, this has helped to draw lessons from experience, conduct strategic planning, communicate the working of SNEHA’s program to other people, and select outcomes and indicators for monitoring and evaluation.

We are currently doing a cluster randomised controlled trial of a scalable set of interventions, specifying components and evaluating effectiveness in direct response to the theory of change. Previous evaluations have presented program theories which were subsequently only partially used for evaluation purposes. For example, many individual proposed mediators of intervention effect remain untested. Changes in policymakers, community leaders, and professionals’ attitudes, knowledge and beliefs about violence against women and girls are often hypothesised as mediators of intervention effect, but they have rarely been measured or reported ( Abramsky et al. , 2016 ; Wagman et al. , 2015 ). Similarly, policy change at national or sub-national levels is often included in the theory of change, but excluded in the intervention impact evaluation ( Abramsky et al. , 2016 ; Clark et al. , 2017 ; Wagman et al. , 2015 ). For example, Falb et al. (2016) hypothesised that their intervention would increase the human, social, physical, and financial assets of girls, but focused on human and social assets in their outcome evaluation. A recent review of 62 studies of theory-informed evaluation in public health noted that integration of theory into randomised controlled trials was often limited ( Breuer et al. , 2016 ). We intend to measure and evaluate all aspects of our theory of change in our cluster randomised controlled trial.

A potential criticism of a theory of change is that the connections between specific activities and outcomes are often insufficiently understood, a challenge that we call the block and arrow problem. Given our theory’s provisional nature, we hope to open up the blocks to understand the ways in which their components ‘work’. This is clearly difficult in a complex system with multiple inputs and emergent phenomena, but can be divided into three projects. The first project involves the stuff of process evaluation: to understand what was delivered, how well, what was received, and by whom. An evaluation framework is in place to address these questions both qualitatively and quantitatively in terms of reach, efficacy, adoption, implementation, and maintenance (the RE-AIM framework ( Glasgow et al ., 1999 ), which we have used before ( Shah More et al ., 2013 )). The second project is to understand whether each of the components of the three boxes describing change happens. We hope to evaluate this quantitatively through an electronic intervention monitoring system and simultaneous qualitative observation and interview: each of the changes listed in the boxes has been taken as an indicator. For example, we will track bystander intervention quantitatively and through case studies. We will enumerate identification of survivors and their subsequent communication with medical, police, and legal services. We will conduct qualitative and quantitative assessments of people’s understanding of violence and the degree to which it ceases to be thought of as a private family matter. We will follow group membership, actions taken by members, and the development of leadership. And we will document community enquiries and referrals as a result of violence against women.

The third project is to understand the mechanisms through which program effects are achieved. Like many public health implementors, we have a strong interest in realist evaluation ( Pawson & Tilley, 1997 ). Within an intervention with many moving parts, which activities work well, for whom, and in which contexts? Our aim is to generate candidate context-mechanism-outcome configurations that we can propose as hypotheses, and to test them. The context of program sites will be described after a combination of ethnographic work, participatory learning and action activities, and quantitative data collection on demography, sociocultural indices, and experience of and response to violence against women. We take a method-neutral approach, combining ethnographic interviews and observation, targeted qualitative interviews with staff, group members, and volunteers, and case studies of how the intervention unfolds in selected localities; these augmented with data from our intervention monitoring system that can be used to answer specific questions. Central issues for consideration include the contribution of secondary prevention to primary prevention, the role of collective action ( Gram et al ., 2019 ), the role of expanded reference groups in norm change, and the role of men in program effectiveness ( Chakraborty et al ., 2018 ).

An interesting challenge to the development and use of our theory of change has been understanding how to frame work that has traditionally taken a feminist social position within the developing public health paradigm for complex interventions. Sociologists have proposed that randomised controlled trials could be used hypothetico-deductively to test and refine theories of change for complex public health interventions ( Bonell et al. , 2018 ). Coryn and colleagues have proposed five principles for theory-driven evaluation. It should (1) formulate a plausible program theory, (2) formulate and prioritise evaluation questions around the theory, (3), be used to guide planning, design, and execution of the evaluation, (4) measure constructs postulated in the theory, and (5) identify breakdowns and side-effects, determine program effectiveness or efficacy, and explain cause and effect associations between theoretical constructs ( Coryn et al. , 2011 ). These principles sometimes fit awkwardly with feminist concerns with building an activist social movement rather than a managerial, professional organisation. We are trying to do both.

20 years ago, Weiss said that, “If theory is taken to mean a set of highly general, logically interrelated propositions that claim to explain the phenomena of interest, theory-based evaluation is presumptuous in its appropriation of the word. The theory involved is much less abstract and more specific, more selective, and directed at only that part of the causal chain of explanation that the program being evaluated is attempting to alter” ( Weiss, 1997 ). This certainly applies to several existing theories for prevention of violence, which include macro concerns such as national development, sectoral issues, organisational aims, or program aims ( James, 2011 ), and whose lack of specificity has made it hard to apply them to the current theory of change.

We are particularly struck by the rapidity with which draft theories are often developed. The field tends to quite quickly adopt new approaches and there is a danger that, if theory of change is seen as something that can be produced after two or three variably attended workshops ( Gooding et al. , 2018 ), its undoubted benefits will be seen as a fad. Again, the assumption is that theory will be revisited and amended ( Mason & Barnes, 2007 ), but program realities—and perhaps a lack of time and space to interrogate assumptions ( Archibald et al. , 2016 )—conspire to make this uncommon.

We hope that our theory of change is plausible, feasible, and testable ( Kubisch, 1997 ). In developing it, we had four advantages: sufficient time, 15 years of program activities to examine, evaluators as core team members, and stakeholder involvement ( Auspos & Kubisch, 2004 ). This meant that we were able to ensure that the theory fitted the context and the opinions of diverse contributors ( Moore & Evans, 2017 ). We hope that our theory will become a useful tool for researchers, practitioners and policy-makers working in similar contexts to think through the pathways through which they hope to achieve impact on violence against women.

Data availability

Acknowledgments.

We thank Salla Sariola and Audrey Prost for their formative contributions to development of the theory of change. We thank Vanessa D’Souza, Shanti Pantvaidya, and Archana Bagra for organisational management, and the clients, community volunteers, police, and clinicians who contributed through interviews.

[version 2; peer review: 2 approved]

Funding Statement

The work that informed this paper was supported by the United Kingdom Medical Research Council and Newton Fund (MC-PC-14097), and by the Wellcome Trust (091561 and 206417).

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Reviewer response for version 2

Abigail m. hatcher.

1 Department of Medicine,  University of California, San Francisco (UCSF), San Francisco, CA, USA

2 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

I have no additional comments and felt the authors responded fully to the first review.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Angela Taft

1 Judith Lumley Centre, La Trobe University, Bundoora, Australia

While I might quibble with the positioning of the description of range of general theories after the outline of the methods used in this theory development, I am comfortable that this paper deserves to be indexed and I look forward to reading the trial outcomes.

I think the argument about the need for evidence informing prevention theory on VAW that takes into account the interdependence of actions at community level that are secondary responses but that may have preventive consequences or cause harm is valid and important.

An important study in a small field in LMI countries.

Reviewer response for version 1

This theory development and the impressive amount of empirical work preceding has the potential to make a substantial contribution to a very limited literature of prevention interventions, as it aims to develop and test a theoretical model of feedback between primary and secondary prevention in a low-income and patriarchal society. It is well written and structured. It is part of an ambitious and impressive set of studies over many years by the team at SNEHA.

I have articulated below where I think your outline could be clarified for improved understanding by readers. My comments echo those of Abigail Hatcher in suggesting that more clarity is needed about the mechanisms of action between all three phases of the model.

Excellent and clear rationale for the study and the need for theory in a very challenging environment for an IPV prevention program.

I urge you to define how you understand primary and secondary prevention and apply it to your work, especially to clarify your intentions in the penultimate paragraph prior to the Methods section. For example, you mention both in the second paragraph of page 3, but it is not clear to which category the activities you describe belongs.

• P.3 Second column, second paragraph. You talk about your cadre of volunteers who take on special responsibilities. I suggest you name them as ' sanginis ', as I remained puzzled as to what their responsibilities and roles were until you defined them only in the top paragraph on page 9, which is too late.

You mostly clearly present the set of strategies used to develop your emerging theory of change.

• p.4  - 21% of ever-married women have experienced IPV – ‘ever’ or in previous twelve months?
• It would be helpful to describe what characterised the actions at each ecological level you describe, and I agree with the first reviewer about the need to understand how these were selected for Table 1.
• In Table 1, why were your actions not included under these category levels which would have been more useful than below types of violence, given your decision to focus on domestic violence against women and girls? Why is non intimate partner violence and child abuse included in this table if it is part of your theory building exercise?

Ethical approval – can you please provide more information about Ethicos, given that searches for them do not reveal much about their scope and practice.

How was the literature review incorporated with your previous work and who had access to its findings. How did it contribute to your findings, given it was your last undertaking?

• Primary and secondary intervention are now defined for the first time. Again, if you have decided on domestic violence against women and girls only, why is non-partner sexual violence (very important but different) prevalence included in Figure 1 - Theory of change?

It is not clear to me how institutions such as the health care system are involved or mobilised, although their crisis responses are critical to the responses. How are they theorised into this model? It is only mentioned in passing on page 9 at the end of the paragraph on outcomes.

• Please clarify what ‘institutional support’ means in the first paragraph on Page 9.
• I also congratulate the investigators for their attention to ‘dark logic’ - potential adverse effects, but I would like more discussion about how they were predicted and managed, as there are considerable and real dangers to your workers illustrated in Table 1. You address a description of what you found or could anticipate in ‘Undesirable changes' on page 9 – but you do not theorise how you might address it in your prevention theory.

You argue that the theory has a strong empirical basis in their previous programs of work, is adapted to the South Asian (Indian) context rather than Africa and posits a feedback loop between secondary and primary prevention. This is admirable and indeed innovative and it will be interesting to read the outcomes of the randomised trial that is proposed to ‘measure and evaluate all aspects of our theory of change’.

However, you also argue that your current theory ‘lists pre-conditions that need to be fulfilled for each component to work’. Without comprehensive process evaluation for the interim stages between the resources – changes – outcomes sections of the theory (for example above of effective training programs or organisational links), the proposition that these demonstrate causal pathways appears very speculative.

Indeed your interim stages of training and building strong and essential individual, team and organisational capacity and these process outcomes or levels of quality are missing stages in the theory development and really need to be better addressed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

University College London, UK

Thanks to both reviewers for their enthusiasm for the paper and very helpful suggestions.

My comments echo those of Abigail Hatcher in suggesting that more clarity is needed about the mechanisms of action between all three phases of the model.

We hope that the additions presented in response to Abigail Hatcher go some way toward clarity.

We have added to the text in the Results.

“In this formulation, community mobilisation has two general aims: primary prevention through development of awareness of the importance and iniquity of violence against women, accompanied by knowledge of rights and law, and secondary prevention through increased identification of survivors and individual and collective action to support them. Prevention encompasses a range of interventions aiming to reduce risks or threats to health and wellbeing, grouped into three categories: primary, secondary, and tertiary. We believe that all three – particularly primary and secondary prevention - lead to reduction of violence at individual, relationship, and community levels. Primary prevention is exemplified by previous trials in which interventions have focused on increasing community awareness of violence against women, inequitable gender norms, and women’s rights. Primary prevention not only targets specific causes and risk factors for violence against women and girls, but also aims to promote healthy behaviours, increase knowledge of rights and entitlements, and improve women’s capacity to resist violence.”

“Secondary prevention usually describes interventions to support women survivors of violence in order to prevent it continuing or mitigate it. We see the enactment of these interventions as a means of both highlighting violence in the community and showing that redress and resolution are possible. In this sense, it speaks to the modelling function within the COM-B framework (a product of education, persuasion and coercion). Visible intervention to support survivors makes people aware of the problem and potential solutions. This helps to foster safe environments that reduce the risk of violence; for instance, through creating networks that offer support to women. Intervening in emergencies and demonstrating action builds trust and confidence, increases awareness and knowledge in communities, and reduces community members’ tolerance of violence. Tertiary intervention describes interventions to support women in dealing with the consequences of violence, particularly effects on their mental health. Again, the pathway of support, from community activist to counsellor to psychologist and psychiatrist, sends a message to other women in difficult circumstances.”

P.3 Second column, second paragraph. You talk about your cadre of volunteers who take on special responsibilities. I suggest you name them as 'sanginis', as I remained puzzled as to what their responsibilities and roles were until you defined them only in the top paragraph on page 9, which is too late.

Thanks. We’ve done this.

Methods. You mostly clearly present the set of strategies used to develop your emerging theory of change. p.4  - 21% of ever-married women have experienced IPV – ‘ever’ or in previous twelve months?

It is ‘ever’ and we have clarified this in the text.

It would be helpful to describe what characterised the actions at each ecological level you describe, and I agree with the first reviewer about the need to understand how these were selected for Table 1. In Table 1, why were your actions not included under these category levels which would have been more useful than below types of violence, given your decision to focus on domestic violence against women and girls? Why is non intimate partner violence and child abuse included in this table if it is part of your theory building exercise?

We have redrafted Table 1, added columns, and added text to the Methods. Please see our response to Abigail Hatcher, and we have added the following to the Methods:

“Although our commitment is to preventing domestic violence, both individual and collective actions often responded to incidents in the neighbourhood. Different kinds of violence – and particularly sexual violence in public spaces – coexist and response to each is both a source of confidence and a step toward a belief in collective efficacy. Likewise, groups often undertook collective action to improve their environment and we see this as contributing to a sense of collective efficacy and community building.”

The Ethicos Independent Ethics Committee is registered with the Central Drugs Standard Control Organization, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India. It includes physicians, psychologists, and other healthcare professionals. The ethics committee is organised and operates according to the requirements of the Indian Council of Medical Research, Good Clinical Practice, local law, and regulatory requirements.

Apologies for the lack of clarity. We were reviewing literature throughout the theory building process but did not conduct a formal systematic review until the end. The purpose of the review was in part to uncover theoretical gaps we had not considered in our framework, but we did not find any major gaps.

Results. Primary and secondary intervention are now defined for the first time. Again, if you have decided on domestic violence against women and girls only, why is non-partner sexual violence (very important but different) prevalence included in Figure 1 - Theory of change?

We have added information about our inclusion of non-domestic violence to the Methods (response to Comment 5). Managing community expectations is critical for programs to prevent violence against women. One of the principles of community organisation and mobilisation is to work on issues that community members prioritise. Consciousness raising is an important strategy in our prevention work. Violence against women and girls is pervasive, ubiquitous, and multiform and our program seeks to build a holistic understanding. Although domestic and intimate partner violence are the commonest reasons for consultation at our counselling centres (and are our priority), women face other forms of violence in their communities. For example, during the microplanning process, women consistently report non-partner sexual violence in their families and outside their homes. It is difficult to segregate interventions on different forms of violence when we expect communities to take over and build strategies to prevent it. Moreover, community members are more interested in intervening in non-partner sexual violence as this is not considered to be a private matter and everyone has a stake in it.

We hope that the revised version makes this clear. Health system responsiveness can be seen on a continuum of prevention and response in in addressing violence, including recognition and voicing of the issue, identification of vulnerabilities, facilitating referrals and institutional linkages, and creating an enabling environment. The tertiary initiatives entail counselling and legal service, advocacy for burn survivors and sensitization of staff, referrals, counselling and legal services, and ensuring deputation for training and provision of space. Tertiary prevention can be enhanced if linkages are built between the health care system and community members to monitor cases of violence, ensure long-term medical treatment in cases of mental ill health and extend support by the community as and when required.

I also congratulate the investigators for their attention to ‘dark logic’ - potential adverse effects, but I would like more discussion about how they were predicted and managed, as there are considerable and real dangers to your workers illustrated in Table 1. You address a description of what you found or could anticipate in ‘Undesirable changes' on page 9 – but you do not theorise how you might address it in your prevention theory.

In restructuring Table 1, we have removed the information on adverse events and placed it in the Results under undesirable changes . These were based largely on experience over the years. Although response to each eventuality will differ and it may, as the examples included in the section now show, have an unpredicted positive outcome, it is always based on three principles: the safety of both survivors of violence and team members, organisational support, and adherence to protocols. A range of protocols are in place for response to threat and crisis, and field team members are mandated to call for support from experienced managers in any eventuality. A recent example is an incident in which local individual men became aware that women were discussing violence with our team and immediately called for suspension of activities. Senior managers met with the individuals involved, local women, and the sitting political representative - with support from the police – and the situation was clarified and resolved to the satisfaction of all parties. A second example from some years ago involved our activities being opposed by local community members after assistance for a survivor of child sexual abuse. This was resolved after community discussions with senior managers and program activities have continued in the area to date.

Discussion. You argue that the theory has a strong empirical basis in their previous programs of work, is adapted to the South Asian (Indian) context rather than Africa and posits a feedback loop between secondary and primary prevention. This is admirable and indeed innovative and it will be interesting to read the outcomes of the randomised trial that is proposed to ‘measure and evaluate all aspects of our theory of change’.

Response : These comments are well taken and we have added material to Results and Discussion sections. Please see our response to Abigail Hatcher.

This manuscript was a joy to read and addresses an issue sorely under-explored in the violence prevention literature: how to design programs so that the underlying theory is testable. To be fair, the prevention of intimate partner violence is also lacking efficacious interventions (with or without theoretical underpinnings). Yet, if new projects can be developed with strong theories of change articulated alongside them, it is feasible for outcomes to be achieved alongside a consistent advance of the theory. This is laudable and I am grateful for the hard work the authors have led towards this goal.

I have a few comments that may inform future efforts for this team and for others aiming to prevent intimate partner violence.

• How were the actions detailed in Table 1 chosen from among the 76 total actions documented by the community mobilization team? Were these coded thematically, and was that coding undertaken by a single researcher or multiple team members? How was consensus reached and discrepancies resolved? The “Action type” and “Intervention function” are interesting but these do not map onto the theory of change, as far as I can tell. A better description of these categories and what they mean would be valuable.

The theory of change itself in Figure 1 adds considerably to the literature. I am particularly impressed by the assumptions that are articulated. However, I’m concerned that the arrows leading from “Resources” to “Changes” seem to be, in and of themselves, something of a black box. I would like to know (and the IPV field is search for answers to the question of) how community volunteers and groups of women and men work together to change participants? Indeed, how do these volunteers and community members take up their work in such a way that communities change overall? Is it through solidarity and group mutual support? Or is it through personal change that leads to an overall community-level benefit (i.e. the whole is greater than the sum of its parts)? The mechanism of action is not identified, which makes it very challenging to test the underlying assumptions of the theory. One suggestion would be to highlight important Theory (as in, sociological or behavioral theory) either within the figure or the accompanying text.

The notion of a “ceiling of accountability” is interesting, and I wonder if the authors can discuss how many IPV prevention programs position themselves along these lines. While many programs cite their stated aim is to reduce domestic violence, few projects globally have ever proven that they are able to do this.

It would be nice to hear a bit more about how sanginis “emerge” (or are chosen by the program to take up this role).

• The section on “Undesirable changes” is excellent and crucial for the field, though this is the first time I have seen these concerns articulated so thoughtfully.

As above, the discussion statement around “makes explicit specific testable causal pathways to impact” is not entirely right, since the pathways themselves are poorly fleshed out. While the ‘context’ and ‘outcome’ configurations are indeed mapped out, I believe the ‘mechanism’ linking the two requires additional thinking.

• I agree with the authors position that this is among the first projects to meaningfully combine primary and secondary prevention, and this is also crucial for the field.
• The protocol by Christofides et al (2016) 1  would be important to include in the discussion, given its emphasis on a theory of change for primary prevention of IPV in a similar peri-urban setting. This would be particularly valuable in the sections on the three types of theory and the section about how policy change is incorporated into a theory of change and the concomitant impact evaluation.

What methods beyond running a trial are the authors engaged with presently? For example, will they harness path analysis to unpack the mechanisms underlying intervention success? Will they conduct a qualitative process evaluation alongside the trial?

While the contradictions between feminist framing and the needs of trials/projects to be managerial in nature is important, I wonder if it could use additional thinking. In particular, this is an area where Theory (capital T) could be brought forward more intentionally, since the authors are clearly drawing from multiple approaches and epistemologies.

How were the actions detailed in Table 1 chosen from among the 76 total actions documented by the community mobilization team? Were these coded thematically, and was that coding undertaken by a single researcher or multiple team members? How was consensus reached and discrepancies resolved?

The “Action type” and “Intervention function” are interesting but these do not map onto the theory of change, as far as I can tell. A better description of these categories and what they mean would be valuable.

Both reviewers commented on Table 1, which means that it was not clear enough. In order to understand what kinds of individual and collective action people might take, and therefore to align our expectations in the theory of change with potential reality, we documented previous actions. Table 1 was included simply to give some illustrations through which readers could imagine the situation. We have redrafted it substantially, including columns categorising actions as individual, collective, or individual followed by collective, whether an action was in the home or the neighbourhood, and the type of violence to which it was a response. The core team (Daruwalla, Gram, Osrin) have selected stories purposively to illustrate combinations of these categories: again, to give readers a flavour of the kinds of things that were done. We have retained the column categorising intervention functions in the COM-B model because we think it is educative. We have included more background on all of this in the Methods:

“In order to understand what kinds of individual and collective action people might take, and therefore to align our expectations in the theory of change with potential reality, the action documentation exercise recorded community mobilisation team members’ experiences of the kinds of action that community members had undertaken in the past. It yielded 76 actions, documented as extended data (Osrin, 2019). Adverse effects were also documented (although flare-ups in communities might actually suggest that the program was having an effect).”

“Table 1 provides examples of actions, categorising them as individual, collective, or individual followed by collective, whether an action was in the home or the neighbourhood, and the type of violence to which it was a response. The core team selected stories purposively to illustrate combinations of these categories. Individual action was often backed by the notional and practical security of being a member of a community group and having connections with a supportive organisation, using these connections as action escalated. Apart from help from our own organisation, and from periodic referral for skilled legal help and services for alcohol and drug dependency, the police force was a prominent institutional link. Although our commitment is to preventing domestic violence, both individual and collective actions often responded to incidents in the neighbourhood. Different kinds of violence – and particularly sexual violence in public spaces – coexist and response to each is both a source of confidence and a step toward a belief in collective efficacy. Likewise, groups often undertook collective action to improve their environment and we see this as contributing to a sense of collective efficacy and community building.”

“We also tried to classify behaviour change according to the Capability, Opportunity, and Motivation model (COM-B), a theoretical approach that we will use in subsequent process evaluation. Developed to inform public health programming, the COM-B model specifies nine functions by which an intervention might stimulate change: education, persuasion, incentivisation, coercion, training, restriction, environmental restructuring, modelling, and enablement. The examples in Table 1 point to education (awareness of the problem of violence and potential approaches to addressing it), persuasion (of either perpetrators or community bodies), coercion (primarily of perpetrators, and often through linkages with the police), and modelling (of exemplary successful actions by individuals and groups) as prominent functions.”

These comments are well taken and we have added material to the Results and Discussion sections. We think that the reviewer’s suggestions are both correct: the intervention develops solidarity and group support, along with collective efficacy and action, and also personal change in terms of capability, opportunity, and motivation to take action.

In Results: “The theory of change narrative is that people involved in our intervention take action to help survivors of violence make informed choices, and to increase community awareness of violence against women and girls and the possibility of change. As a result of these activities, survivors and potential perpetrators understand the nature of violence. Survivors make decisions, potential perpetrators think again, and other people understand both the nature of violence and that action is possible. People stand up against violence against women and girls, individually and collectively, and community members think and act to help survivors. Families and communities stop accepting violence and strengthen community structures that support a conviction that it is intolerable. Institutional support from non-government organisations, the police, medical practitioners, and lawyers is accessible and functional and families and communities free themselves of violence against women and girls.”

In Discussion: “A potential criticism of a theory of change is that the connections between specific activities and outcomes are often insufficiently understood, a challenge that we call the block and arrow problem. Given our theory’s provisional nature, we hope to open up the blocks to understand the ways in which their components ‘work’. This is clearly difficult in a complex system with multiple inputs and emergent phenomena, but can be divided into three projects. The first project involves the stuff of process evaluation: to understand what was delivered, how well, what was received, and by whom. An evaluation framework is in place to address these questions both qualitatively and quantitatively in terms of reach, efficacy, adoption, implementation, and maintenance (the RE-AIM framework (Glasgow, Vogt, & Boles, 1999), which we have used before (Shah More et al., 2013)). The second project is to understand whether each of the components of the three boxes describing change happens. We hope to evaluate this quantitatively through an electronic intervention monitoring system and simultaneous qualitative observation and interview: each of the changes listed in the boxes has been taken as an indicator. For example, we will track bystander intervention quantitatively and through case studies. We will enumerate identification of survivors and their subsequent communication with medical, police, and legal services. We will conduct qualitative and quantitative assessments of people’s understanding of violence and the degree to which it ceases to be thought of as a private family matter. We will follow group membership, actions taken by members, and the development of leadership. And we will document community enquiries and referrals as a result of violence against women.”

“The third project is to understand the mechanisms through which program effects are achieved. Like many public health implementors, we have a strong interest in realist evaluation (Pawson & Tilley, 1997). Within an intervention with many moving parts, which activities work well, for whom, and in which contexts? Our aim is to generate candidate context-mechanism-outcome configurations that we can propose as hypotheses, and to test them. The context of program sites will be described after a combination of ethnographic work, participatory learning and action activities, and quantitative data collection on demography, sociocultural indices, and experience of and response to violence against women. We take a method-neutral approach, combining ethnographic interviews and observation, targeted qualitative interviews with staff, group members, and volunteers, and case studies of how the intervention unfolds in selected localities; these augmented with data from our intervention monitoring system that can be used to answer specific questions. Central issues for consideration include the contribution of secondary prevention to primary prevention, the role of collective action (Gram, Daruwalla, & Osrin, 2019), the role of expanded reference groups in norm change, and the role of men in program effectiveness (Chakraborty, Osrin, & Daruwalla, 2018).”

A ceiling of accountability is recommended by experts in theory of change. We are not aware of other theories from violence prevention programs having used it. It is particularly relevant because of the need to be realistic about what a program could achieve. We do aim to reduce domestic violence, but wider effects are unlikely in the short term.

We have added to the Results section:

“Group sessions aim to build a political agenda for change that privileges women’s interests and looks to transform gender and social power relations. Our group-work module follows a sequence over three years. The first year emphasises awareness of violence, gender norms, women’s rights and entitlements, and the importance and strength of women’s collectives in addressing violence against women and girls. The second year emphasises action, be it individual or collective. The third year emphasises leadership and group members are encouraged to take on prominent roles in the community. Generally, women who are proactive, articulate, have a social network in their neighbourhoods, and are willing to devote time to the issue are recommended as volunteer activists by groups and invited to become sanginis .”

This challenge has been articulated by both reviewers. We have added information about our evaluative plans to the Discussion section.

“A potential criticism of a theory of change is that the connections between specific activities and outcomes are often insufficiently understood, a challenge that we call the block and arrow problem. Given our theory’s provisional nature, we hope to open up the blocks to understand the ways in which their components ‘work’. This is clearly difficult in a complex system with multiple inputs and emergent phenomena, but can be divided into three projects. The first project involves the stuff of process evaluation: to understand what was delivered, how well, what was received, and by whom. An evaluation framework is in place to address these questions both qualitatively and quantitatively in terms of reach, efficacy, adoption, implementation, and maintenance (the RE-AIM framework (Glasgow et al., 1999), which we have used before The second project is to understand whether each of the components of the three boxes describing change happens. We hope to evaluate this quantitatively through an electronic intervention monitoring system and simultaneous qualitative observation and interview: each of the changes listed in the boxes has been taken as an indicator. For example, we will track bystander intervention quantitatively and through case studies. We will enumerate identification of survivors and their subsequent communication with medical, police, and legal services. We will conduct qualitative and quantitative assessments of people’s understanding of violence and the degree to which it ceases to be thought of as a private family matter. We will follow group membership, actions taken by members, and the development of leadership. And we will document community enquiries and referrals as a result of violence against women.”

“The third project is to understand the mechanisms through which program effects are achieved. Like many public health implementors, we have a strong interest in realist evaluation (Pawson & Tilley, 1997). Within an intervention with many moving parts, which activities work well, for whom, and in which contexts? Our aim is to generate candidate context-mechanism-outcome configurations that we can propose as hypotheses, and to test them. The context of program sites will be described after a combination of ethnographic work, participatory learning and action activities, and quantitative data collection on demography, sociocultural indices, and experience of and response to violence against women. We take a method-neutral approach, combining ethnographic interviews and observation, targeted qualitative interviews with staff, group members, and volunteers, and case studies of how the intervention unfolds in selected localities; these augmented with data from our intervention monitoring system that can be used to answer specific questions. Central issues for consideration include the contribution of secondary prevention to primary prevention, the role of collective efficacy (Gram et al., 2019), the role of expanded reference groups in norm change, and the role of men in program effectiveness (Chakraborty et al., 2018).”

The protocol by Christofides et al (2016) would be important to include in the discussion, given its emphasis on a theory of change for primary prevention of IPV in a similar peri-urban setting. This would be particularly valuable in the sections on the three types of theory and the section about how policy change is incorporated into a theory of change and the concomitant impact evaluation.

We actually discussed this protocol in a recent team seminar, but had not included protocols in our paper. We have added text in the relevant section.

“A similar approach has been taken in the development of Sonke CHANGE, a cluster randomised controlled trial in periurban Johannesburg, South Africa. The Sonke Gender Justice intervention involves workshops and community action teams working predominantly with men with an emphasis on changing harmful gender norms and prevailing hegemonic masculinity. The program theory of change proposes that community action and advocacy to promote equitable gender norms and non-violent masculine attitudes and practices will lead to enhanced critical consciousness, collective efficacy and action, and better social cohesion and trust. These will lead in turn to self-efficacy to take action, reduced influence of harmful gender norms, and an enabling environment for policy implementation (Christofides et al., 2018).”

Unfortunately, we are still waiting for the trial protocol to be published. It contains a fairly comprehensive discussion of what we intend to do. We are doing a qualitative and quantitative process evaluation as part of the trial, along with the development and testing of context-mechanism-outcome configurations. We have added information on to the Discussion section and it is included in the response to Comment 5.

In light of this and other comments, we have added a discussion of theory to the Results.

“Three areas of disciplinary theory meet in the ideas that underlie our program theory: social norms theory (already prominent in prevention of violence against women), network theory (prominent in political science, economics, and latterly in public health), and behaviour change theory (prominent in behavioural psychology and public health).”

“Our ideas about norms are informed by feminist theory (Heise, 1998), which also underlies our organizational approach to working with survivors of violence. Beyond the need to work with families, we aim to ensure that no further harm is done to women, who remain the focus and whose views and making of meaning are prioritized. We believe that violence against women deserves attention as a gendered phenomenon beyond family violence (Lawson, 2012), and that gender needs to be in the foreground (Dobash & Dobash, 1979; Gelles, 1985). Our attempts to achieve gender transformative change are particularly indebted to theory around asymmetric distribution of power between genders (Rodrígues-Menés & Safranoff, 2012), and hegemonic patriarchy (R. Connell, 1987; R. W. Connell, 1995).”

“Our thinking on potential mechanisms has been influenced by social norms theory, and particularly by discussions of the need to transform gender norms as a route to addressing violence against women (Alexander-Scott, Bell, & Holden, 2016). This is particularly relevant because we are concerned about the forms of violence that constitute gender-based household maltreatment: emotional and economic violence, control and neglect. Our previous work suggested that we might focus on three ideas about norm change (Daruwalla et al., 2017). The first is to make use of the mismatch between descriptive and injunctive norms. A descriptive norm describes beliefs about what other people do (Bicchieri, 2006; Cialdini, Kallgren, & Reno, 1991; Muldoon, Lisciandra, Bicchieri, Hartmann, & Sprenger, 2014), while an injunctive norm describes beliefs about what other people think one ought to do (Bicchieri, 2006; Cialdini et al., 1991). Descriptive norms intolerant of violence are likely to be magnets for behaviour and if we are able to show examples of non-violent interaction we might be able to influence people’s perception of what is actually prevalent in the community. This is helped by our second idea, which is that injunctive norms disapprove (at least in principle) of violence. How to spread awareness of this turns on the reference group - the people surrounding an individual from whom she takes her cue (Levy Paluck, Ball, Poynton, & Sieloff, 2010) - and our third idea is to expand the currently limited reference groups around individuals so that they can process a larger pool of opinion on norms intolerant of violence.”

“When we ‘expand a reference group’, we are basically saying that individuals meet and engage with more people, and this evokes ideas from network or social capital theory (Putnam, 1995). Another way of seeing the new connections between people that develop in community groups is as weak ties or bridging social capital, in contradistinction to the (hierarchical) strong ties or bonding social capital that the family circle typifies (Granovetter, 2005; Patulny & Svendsen, 2007). Added to this is the idea of linking social capital between, for example, community members and institutions that might help them to address violence against women (Szreter & Woolcock, 2004), a process explicit in our theory of change. So, although community mobilisation is a way to address violence against women, it can be seen equally as a community building or social capital endeavour (see (Szreter & Woolcock, 2004) for an anatomisation of the debates around social capital and public health).”

“We use the Capability, Opportunity, and Motivation model (COM-B) to think about individual behaviour change, particularly in terms of the functions of interventions that it summarises (Michie, van Stralen, & West, 2011). The program aims to increase the capability of participants to understand violence against women, identify survivors, and take supportive action, with knowledge of law and rights, decision-making and negotiation skills, self-efficacy, and collective efficacy. This it does predominantly through education, training, enablement, and modelling (first by program staff and then by community members). It presents opportunities to engage with others, learn, develop confidence and leadership, and connect with supportive non-government and government organisations; again predominantly through education, training, enablement, and modelling. Motivation comes from the development of belief in preventing violence against women and children, increased by education, persuasion, enablement, training, and modelling. From the point of view of potential perpetrators of violence, the primary functions are persuasion, coercion, and education, accompanied (we hope) by awareness and change in attitude brought about by education and modelling and reduced opportunity for violent behaviour.”

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Handbook of Interpersonal Violence and Abuse Across the Lifespan pp 2539–2552 Cite as

Inclusion and Exclusion: Intersectionality and Gender-Based Violence

• Sujata Warrier 7  
• Reference work entry
• First Online: 13 October 2021

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The ideas embedded within the concept of intersectionality have been around before they were coined by Kimberle Crenshaw in 1989. Intersectionality is a practical concept that assists in understanding how survivors of gender-based violence experience violence from multiple sources. It takes into account how a particular survivor’s overlapping identities (such as gender, race, sexual orientation, or class) expose them to differing levels of discrimination, oppression, and violence. Intersectionality is not only a theoretical tool but is necessary for advocacy, interventions, and policy development. It enables us to move away from single axis and binary thinking that have long hampered the movement to end gender-based violence as well as engage in individual work with survivors. Intersectionality provides the necessary grounding that enables all intervenors to acknowledge the multiple identities and institutional structures that disempower women historically and currently in marginalized communities.

Within the context of gender-based violence, it is important to go beyond a simple analysis that focuses primarily on gender as the explanatory factor to exploring the multiple types of discrimination endured by survivors from the margins. Exposing the convergence of different types of discrimination is necessary for work with survivors as well as in research and public policy.

This chapter was initially published with an incorrect copyright holder name. It has been corrected to © Springer Nature Switzerland AG.

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Battered Women’s Justice Project, Minneapolis, MN, USA

Sujata Warrier

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Institute on Violence, Abuse, and Trauma, San Diego, CA, USA

Robert Geffner

Department of Psychology College of Arts and Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA

Jacquelyn W. White

Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

L. Kevin Hamberger

Department of Psychology, Northern Illinois University, DeKalb, IL, USA

Alan Rosenbaum

Ethelyn R. Strong School of Social Work, Norfolk State University, Norfolk, VA, USA

Viola Vaughan-Eden

Education and Research, Zero Abuse Project, St. Paul, MN, USA

Victor I. Vieth

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University of North Carolina- Charlotte, Charlotte, NC, USA

Jennifer Langhinrichsen-Rohling

Consultant, Alexandria, VA, USA

Glenna Tinney

College of Arts and Sciences - Society, Culture, and Language, University of South Florida - St. Petersburg, St. Petersburg, Florida, USA

Shelly M. Wagers

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Warrier, S. (2022). Inclusion and Exclusion: Intersectionality and Gender-Based Violence. In: Geffner, R., White, J.W., Hamberger, L.K., Rosenbaum, A., Vaughan-Eden, V., Vieth, V.I. (eds) Handbook of Interpersonal Violence and Abuse Across the Lifespan. Springer, Cham. https://doi.org/10.1007/978-3-319-89999-2_49

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DOI : https://doi.org/10.1007/978-3-319-89999-2_49

Published : 13 October 2021

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Online ISBN : 978-3-319-89999-2

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