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Gender norms are increasingly recognized as important modifiers of health. Despite growing awareness of how gender norms affect health behavior, current gender norms scales are often missing two important theoretical components: differentiating between descriptive and injunctive norms and adding a referent group. We used a mixed-methods approach to develop and validate a novel gender norms scale that includes both theoretical components. Based on qualitative data, the theory of normative social behavior, and the theory of gender and power, we generated a pool of 28 items. We included the items in a baseline questionnaire among 3,110 women in Odisha, India as part of a cluster randomized controlled trial. We then ran exploratory factor analysis which resulted in 18 items. Using a second wave of data with the same sample, we evaluated psychometric properties using confirmatory factor analysis and structural equation modeling. The analysis resulted in two subscales with nine items each, “descriptive gender norms” and “injunctive gender norms.” Both subscales represent high internal validity with Cronbach’s alpha values of 0.81 and 0.84 and the combined scale has an alpha of 0.87. The G-NORM, gender norms scale, improves on existing measures by providing distinct descriptive and injunctive norms subscales and moving beyond individual attitudes by assessing women’s perceptions of community-level gender norms.

Highlights • Iron folic acid consumption can reduce anemia, but compliance remains low. • Interventions can promote interpersonal communication for behavior change. • Topic-specific and general interpersonal communication modalities appear effective. • Interpersonal communication mediated the intervention effect on iron supplement use., Objective More than half of Indian women of reproductive age are anemic. Regular iron folic acid uptake can prevent and treat anemia. This study investigated the effect of interpersonal communication on improving IFA use among women of reproductive age. Methods The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized trial that collected longitudinal data from control (n = 1896) and intervention (n = 1898) communities in Odisha, India at Time 1 and six months later at Time 2. Structural equation models assessed the effect of the intervention on iron folic acid use via multiple interpersonal communication pathways. Results Compared to the control arm, iron folic acid use significantly increased in the intervention arm. Both, general health interpersonal communication and anemia-specific interpersonal communication were augmented in the intervention communities. The impact of the intervention on iron folic acid use was mediated through anemia-specific interpersonal communication. Conclusion The RANI Project increased interpersonal communication among participants, resulting in increased iron folic acid use for anemia reduction. Practice implications Strategic use of targeted interpersonal communication to promote behavior change appears to be a viable strategy to increase iron folic acid use to reduce anemia.

To assess whether improvements in social norms related to iron and folic acid consumption are associated with increased iron and folic acid consumption.In a cluster randomized trial in Odisha, India, we implemented an intervention to improve descriptive norms (people's perceptions about how many other people take iron and folic acid), injunctive norms (social pressures people feel to take iron and folic acid) and collective norms (actual levels of iron and folic acid consumption). We assessed changes in these norms and self-reported iron and folic acid consumption in control and intervention arms after 6 months (September 2019-February 2020). We collected data from control (At follow-up, mean scores in self-reported iron and folic acid consumption in the control arm had decreased from 0.39 to 0.31 (21% decrease; not significant). In the intervention arm, mean scores increased from 0.39 to 1.62 (315% increase;Our results show that social norms can be improved and that these improvements are associated with positive behavioural changes. A social norms-based approach may help promote iron and folic acid consumption in India.Déterminer si l'évolution des normes sociales en matière de consommation de fer et d'acide folique a permis d'accroître cette consommation.Dans le cadre d'un essai randomisé en grappes dans l'Odisha, en Inde, nous avons mené une intervention visant à améliorer les normes descriptives (perception des gens vis-à-vis du nombre de personnes prenant du fer et de l'acide folique), injonctives (pression sociale ressentie par les gens, les incitant à prendre du fer et de l'acide folique) et collectives (niveaux de consommation réels pour le fer et l'acide folique). Nous avons évalué les changements affectant ces normes, ainsi que la consommation déclarée de fer et d'acide folique dans les groupes d'intervention et de contrôle après 6 mois (septembre 2019 – février 2020). Nous avons récolté des données dans les groupes de contrôle (Lors du suivi, les scores moyens en termes de consommation déclarée de fer et d'acide folique au sein du groupe de contrôle ont diminué de 0,39 à 0,31 (baisse de 21%; non significative). Au sein du groupe d'intervention, les scores moyens sont passés de 0,39 à 1,62 (hausse de 315%;Nos résultats montrent que les normes sociales peuvent évoluer, et qu'une telle évolution est liée à des modifications comportementales positives. L'adoption d'une approche fondée sur ces normes pourrait contribuer à promouvoir la consommation de fer et d'acide folique en Inde.Evaluar si las mejoras en las normas sociales relacionadas con el consumo de hierro y ácido fólico se asocian a un mayor consumo de hierro y ácido fólico.En un ensayo aleatorizado por grupos en Odisha, India, se implementó una intervención para mejorar las normas descriptivas (las percepciones de las personas sobre cuántas otras personas consumen hierro y ácido fólico), las normas por mandato (las presiones sociales que las personas sienten para que tomen hierro y ácido fólico) y las normas colectivas (los niveles reales de consumo de hierro y ácido fólico). Se evaluaron los cambios en estas normas y el consumo de hierro y ácido fólico informado por los participantes en los grupos de control y de intervención después de 6 meses (septiembre de 2019 a febrero de 2020). Se recopilaron datos de los grupos de control (En el seguimiento, las puntuaciones medias en el consumo de hierro y ácido fólico informado por los participantes en el grupo de control disminuyeron de 0,39 a 0,31 (disminución del 21 %; no significativa). En el grupo de intervención, las puntuaciones medias aumentaron de 0,39 a 1,62 (315 % de aumento;Los resultados de este ensayo demuestran que las normas sociales se pueden mejorar y que estas mejoras se asocian a cambios positivos del comportamiento. Un enfoque basado en las normas sociales puede ayudar a promover el consumo de hierro y de ácido fólico en la India.تقييم ما إذا كانت التحسينات في الثوابت الاجتماعية المتعلقة باستهلاك الحديد وحمض الفوليك مرتبطة بزيادة استهلاك الحديد وحمض الفوليك. اأثناء المتابعة، انخفض متوسط الدرجات في استهلاك الحديد وحمض الفوليك الذي أبلغ عنه الأشخاص ذاتيًا في ذراع التحكم من 0.39 إلى 0.31 (انخفاض بنسبة 21%؛ ليس ملموسًا). في ذراع التدخل، زاد متوسط الدرجات من 0.39 إلى 1.62 (زيادة بنسبة 315%؛ نسبة الاحتمال أقل من 0.001). كان الفرق بين الذراعين ذي دلالة إحصائية (نسبة الاحتمال أقل من 0.001). تحسن كل من الثوابت الثلاثة أيضًا بمعدلات أعلى بشكل ملموس في ذراع التدخل عنه في ذراع التحكم (نسبة الاحتمال أقل من 0.001 لكل من الثوابت). ارتبطت التغييرات في الثوابت الوصفية والجماعية (ولكن ليس الثوابت التحذيرية) بالتغيرات في استهلاك الحديد وحمض الفوليك الذي أبلغ عنه الأشخاص ذاتيًا (نسبة الاحتمال أقل من 0.001 لكلا الثابتين).تظهر نتائجنا أنه يمكن تحسين الثوابت الاجتماعية، وأن هذه التحسينات مرتبطة بالتغيرات السلوكية الإيجابية. قد يساعد الأسلوب القائم على الثوابت الاجتماعية في الارتقاء باستهلاك الحديد وحمض الفوليك في الهند.旨在评估与铁和叶酸消耗相关的社会规范的改善是否与铁和叶酸消耗量的增加有关。.在印度奥里萨邦的一项集群随机试验中，我们实施了一项干预措施以改善描述性规范（人们对有多少人服用铁和叶酸的看法）、指令性规范（人们对服用铁和叶酸感受到的社会压力）和群体性规范（铁和叶酸消耗的实际水平）。我们对这些规范的变化进行了评估，并对 6 个月后（2019 年 9 月至 2020 年 2 月）对照组和干预组中铁和叶酸的消耗量进行了自我报告。我们从对照组（n = 2048）和干预组（n = 2060）收集了基线数据和后续数据（分别为 n = 1966 和 n = 1987）。.在后续跟踪中，自我报告显示对照组中铁和叶酸消耗量的平均分值从 0.39 下降到 0.31（下降了 21%；不显著）。干预组中的平均分值从 0.39 增加到 1.63（增加了 315%；我们的结果表明社会规范可以得到改善，并且这些改善与积极的行为改变有关。基于社会规范采取的方法可能有助于促进印度地区铁和叶酸的消耗量。.Оценить, связаны ли улучшения социальных норм, относящихся к потреблению железа и фолиевой кислоты, с увеличением потребления железа и фолиевой кислоты.В кластерном рандомизированном исследовании, проводимом в штате Одиша, Индия, авторы осуществили мероприятие, направленное на улучшение дескриптивных норм (представления людей о том, какое количество человек принимают железо и фолиевую кислоту), предписательных норм (социальное давление, которое люди испытывают, чтобы принимать железо и фолиевую кислоту) и коллективных норм (фактические уровни потребления железа и фолиевой кислоты). Была проведена оценка изменения этих норм и самоотчетности о потреблении железа и фолиевой кислоты в группе контроля и экспериментальной группе после 6 месяцев (сентябрь 2019 г. — февраль 2020 г.). Авторы собрали данные группы контроля (В период последующего наблюдения средний балл по самоотчетности о потреблении железа и фолиевой кислоты в группе контроля снизился с 0,39 до 0,31 (снижение на 21%; несущественное). В экспериментальной группе средний балл увеличился с 0,39 до 1,62 (увеличение на 315%;Наши результаты показывают, что социальные нормы можно улучшить и что эти улучшения связаны с положительными изменениями поведения. Подход, основанный на социальных нормах, может способствовать увеличению потребления железа и фолиевой кислоты в Индии.

Despite the importance of behaviours in promoting health and wellness, persuading people to adopt and sustain healthy behaviours remains a significant public health challenge. Considerable progress has been made in developing and testing theories about the personal, social, environmental and structural drivers of behaviours. However, theorizing about behaviours themselves has remained elusive, as evidenced by the absence of a widely accepted taxonomy of behaviours. By carefully examining the nature of behaviours, practitioners and researchers can identify the most effective ways to promote behavioural change. We propose attribute-centred theorizing as an approach for defining behaviours based on their relevant properties, which can then assist in developing a taxonomy of behaviours and theorizing about them. Behaviours differ because of their underlying properties; for example, some behaviours are addictive, others are publicly observable and others are expensive. Addictiveness, privacy and cost are therefore three (of the many) attributes relevant for theorizing about behaviours. We describe a framework for operationalizing attribute-centred theorizing, which includes generating behavioural attributes, verifying and testing those attributes, and constructing a behavioural matrix to inform campaigns or interventions. We illustrate this framework using the examples of Guinea-worm disease and cardiovascular diseases. The benefits of our approach include the ability to inform intervention development and the ability to generalize across different behaviours; however, more research on converting the behavioural matrix into actual policy is needed.Malgré l'importance des comportements dans la promotion de la santé et du bien-être, persuader les gens d'adopter et de conserver un mode de vie sain représente toujours un défi de santé publique non négligeable. Des progrès considérables ont été accomplis en ce qui concerne le développement et l'évaluation des théories sur les motivations personnelles, sociales, environnementales et structurelles exerçant une influence sur les comportements. Cependant, formuler des théories à ce propos demeure complexe, comme en atteste l'absence de taxinomie largement admise en la matière. En examinant attentivement la nature des comportements, les chercheurs et praticiens peuvent identifier les moyens les plus efficaces pour les faire évoluer. Nous proposons d'opter pour une théorisation axée sur les attributs afin de définir les comportements en fonction de leurs propriétés utiles, ce qui permettrait ensuite d'instaurer une taxinomie des comportements et d'énoncer les hypothèses qui en découlent. Les comportements varient en raison de leurs propriétés sous-jacentes; certains par exemple sont liés à une dépendance, d'autres sont clairement visibles et d'autres encore sont onéreux. La dépendance, l'intimité et le coût constituent donc trois (des nombreux) attributs utiles à l'élaboration d'hypothèses sur les comportements. Dans le présent document, nous traçons un cadre servant à concrétiser cette théorisation axée sur les attributs; il prévoit notamment de générer des attributs comportementaux, de vérifier et de tester ces attributs, et d'imaginer une matrice qui fournirait des orientations pour diverses campagnes ou interventions. Nous illustrons également ce cadre en prenant pour exemples la dracunculose et les maladies cardiovasculaires. Parmi les avantages de notre approche figurent la possibilité de guider le développement des interventions et celle d'intégrer différents comportements; néanmoins, une étude approfondie est nécessaire pour définir comment convertir la matrice comportementale en réelle politique.A pesar de la importancia de los comportamientos en la promoción de la salud y el bienestar, persuadir a las personas para que adopten y mantengan comportamientos saludables sigue siendo un importante reto para la salud pública. Se ha avanzado considerablemente en el desarrollo y la comprobación de teorías sobre los factores personales, sociales, ambientales y estructurales que impulsan los comportamientos. Sin embargo, teorizar sobre los comportamientos en sí sigue siendo difícil, como demuestra la ausencia de una taxonomía de comportamientos ampliamente aceptada. Al examinar cuidadosamente la naturaleza de los comportamientos, los profesionales e investigadores pueden identificar las formas más eficaces de promover el cambio de comportamiento. Proponemos una teoría centrada en los atributos como enfoque para definir los comportamientos en función de sus propiedades relevantes, lo que puede ayudar a desarrollar una taxonomía de comportamientos y a teorizar sobre ellos. Los comportamientos difieren por sus propiedades subyacentes; por ejemplo, algunos comportamientos son adictivos, otros son observables públicamente y otros son costosos. La adicción, la privacidad y el coste son, por tanto, tres (de los muchos) atributos relevantes para teorizar sobre los comportamientos. Describimos un marco para hacer operativa la teoría centrada en los atributos, que incluye la generación de atributos de comportamiento, la verificación y comprobación de dichos atributos y la construcción de una matriz de comportamiento para informar sobre campañas o intervenciones. Ilustramos este marco con los ejemplos de la enfermedad del gusano de Guinea y las enfermedades cardiovasculares. Las ventajas de nuestro enfoque son la capacidad de informar sobre el desarrollo de intervenciones y la capacidad de generalizar entre diferentes comportamientos; sin embargo, es necesario investigar más sobre la conversión de la matriz de comportamiento en una política real.على الرغم من أهمية السلوكيات في تعزيز الصحة والسلامة، فإن إقناع الناس بتبني السلوكيات الصحية والحفاظ عليها يظل من الصعوبات الكبيرة في مجال الصحة العامة. لقد تحقق تقدم كبير في وضع نظريات واختبارها بشأن الدوافع الشخصية والاجتماعية والبيئية والهيكلية للسلوكيات. إلا أن وضع النظريات التي تتناول السلوكيات نفسها ظل خادعًا كما يظهر في غياب تصنيف مقبول على نطاق واسع للسلوكيات. عند فحص طبيعة السلوكيات بعناية، يستطيع الممارسون والباحثون تحديد الطرق الأكثر فعالية لتعزيز التغير السلوكي. نطرح النظريات المرتكزة على السمات باعتبارها نهجًا لتعريف السلوكيات بناءً على خصائصها ذات الصلة، وهو الأمر الذي سيساعد بدوره على وضع تصنيف للسلوكيات والنظريات المتعلقة بها. تختلف السلوكيات بسبب خصائصها الكامنة، فبعض السلوكيات مثلاً إدمانية، وهناك سلوكيات أخرى ظاهرة علنًا وأخرى مكلفة. الإدمان والخصوصية والتكلفة إذن ثلاث من السمات (الكثيرة) ذات الصلة بوضع النظريات المتعلقة بالسلوكيات. نصف إطار عمل لتفعيل وضع النظريات المرتكزة على السمات، والذي يتضمن إنشاء سمات سلوكية، والتحقق من تلك السمات واختبارها، وإنشاء مصفوفة سلوكية لتوعية الحملات أو التدخلات. نوضح إطار العمل هذا باستخدام داء الدودة الغينية وأمراض القلب والأوعية الدموية كمثالين. تشمل الفوائد التي ينطوي عليها نهجنا القدرة على التوعية لوضع تدخل والقدرة على التعميم على السلوكيات المختلفة، إلا أن هناك حاجة لإجراء المزيد من الأبحاث على تحويل مصفوفة السلوكيات إلى سياسة فعلية.尽管行为对改善身心健康起到重要的作用，但说服人们采取和维持这些健康的行为仍然是一个巨大的公共卫生挑战。我们在开发和测试行为的个人、社会、环境和结构性驱动因素理论方面已经取得了重大进展。然而，仍然难以构建关于行为本身的理论，缺乏广泛接受的行为分类法就证明了这一点。通过细心研究行为的性质，从业者和研究者可以确认促进行为改变的最有效方法。我们提出以属性为中心构建理论，采取一种以行为的相关属性为基础的方法定义行为，它也有助于开发行为分类法并对其进行理论化。因为行为的潜在属性不同，行为也各不相同；例如，有些行为会让人上瘾，有些行为是可以公开观察到的，有些行为则是代价高昂的。因此，成瘾性、隐私和成本是与行为理论相关的（众多属性中的）三个属性。我们描述了一个可以实施的以属性为中心的理论框架，其中包括生成行为属性、验证和测试这些属性，以及构建行为矩阵来为活动或干预提供依据。我们通过麦地那龙线虫病和心血管疾病的例子来阐明这一框架。这些方法有利于为干预的开发提供依据和概括不同的行为；然而，我们仍需要更多的研究将行为矩阵转化为实际政策。.Несмотря на важность поведения в укреплении здоровья и хорошего самочувствия, убедить людей принять и поддерживать здоровый образ жизни остается серьезной проблемой для здоровья населения. Значительный прогресс был достигнут в разработке и проверке теорий о личностных, социальных, экологических и структурных факторах поведения. Однако теоретические представления о самом поведении остаются труднодостижимыми, о чем свидетельствует отсутствие общепринятой таксономии поведения. Тщательно изучив природу поведения, практикующие врачи и исследователи могут определить наиболее эффективные способы содействия изменению поведения. В качестве подхода к определению поведения на основе его релевантных свойств предлагается теоретизирование с акцентом на атрибутах, которое затем может помочь в разработке таксономии поведения и построении теорий о нем. Модели поведения различаются по своим базовым свойствам; например, некоторые модели поведения вызывают зависимость, другие соблюдаются на людях, третьи дороги в осуществлении. Таким образом, способность вызывать зависимость, конфиденциальность и стоимость являются тремя (из многих) атрибутами, имеющими значение для построения теорий в отношении поведения. В статье описана схема практического применения теоретизирования, ориентированного на атрибуты, которая включает создание поведенческих атрибутов, проверку и тестирование этих атрибутов, а также построение поведенческой матрицы для информирования кампаний или вмешательств. Эта схема проиллюстрирована на примере дракункулеза и сердечно-сосудистых заболеваний. Среди преимуществ предлагаемого подхода — возможность информационной поддержки при разработке мер вмешательства и способность обобщать различные модели поведения, однако необходимо провести дополнительные исследования по преобразованию поведенческой матрицы в фактическую политику.

The belief that contraceptive use causes infertility has been documented across sub‐Saharan Africa, but its quantitative association with actual contraceptive use has not been examined. We collected and analyzed sociocentric network data covering 74 percent of the population in two villages in rural Kenya. We asked respondents to nominate people from their village (their network), and then we matched their network (alters) to the individual participant (ego) to understand how their beliefs and behaviors differ. We asked about contraceptive use and level of agreement with a statement about contraceptive use causing infertility. We calculated the average nominated network contraceptive use score and the average nominated network belief score. Holding the individual belief that contraceptive use causes infertility was associated with lower odds of using contraceptive (AOR = 0.82, p = < 0.01); however, when one's own nominated network connections held this belief, the odds of using contraceptive were even lower (AOR = 0.75, p

INTRODUCTION: Safe and effective vaccines against Coronavirus Disease 2019 (COVID-19) provide the best opportunity to control the pandemic. Having safe and efficacious vaccines available is only half the equation; people must also take them. We describe a study to identify COVID-19 vaccine attitudes, values and intentions immediately preceding authorization of COVID-19 vaccines in the US. METHODS: A national panel survey was conducted to measure intent to receive COVID-19 vaccines as well as disease and vaccine attitudes, values and trust in local, state and federal public health authorities. RESULTS: Greater than 80% of respondents reported confidence they could adhere to COVID recommendations such as mask wearing, social distancing and hand washing. The majority of respondents (70%) reported believing that current drugs were somewhat or very good at treating COVID-19 infection. Vaccine intent fell into three groups: Intenders (50%), Wait and Learn (40%), and Unlikelys (10%). Intent to get vaccinated was substantially lower among African American (32%), and higher among men (56%), those over 60 years of age (61%), those with a Bachelor's degree or higher (63%), and Democrats (63%). The Wait and Learn group, compared to the Intenders, were less likely to report being diagnosed with a high risk condition for COVID-19, receiving an influenza vaccine in the past 12 months, discussing COVID-19 vaccine with their healthcare provider, perceiving COVID-19 as severe, considering a COVID-19 vaccine important to stop the spread of infection, and wering a mask usually or almost always. CONCLUSION: Only half of US adults intend to accept COVID-19 vaccines; most others (40%) are uncertain. Levels of immunity associated with community protection will not be achieved without reaching those who are currently uncertain. Characterizing COVID-19 vaccine attitudes and intentions and ascertaining values and trust in local, state, and federal public health authorities that impact vaccine decision-making are essential.

Infectious disease outbreaks highlight the importance of trust in public health authorities to avoid fear and improve adherence to recommendations. There is currently no established and validated measure for trust in public health authorities. We aimed to develop and validate an instrument that measures trust in public health authorities and to assess the association between trust in public health authorities and vaccine attitudes. We developed 20 items to measure trust in public health authorities. After implementing a survey in January 2020, we investigated relationships between the items, reduced the number of items, and identified latent constructs of the scale. We assessed variability in trust and how trust was associated with vaccine attitudes, beliefs, and self-reported vaccine acceptance. The pool was reduced to a 14-item trust in public health authorities scale and we found that this trust model was strongly associated with acceptance of vaccines. Our scale can be used to examine the relationship between trust in public health authorities and adherence to public health recommendations. The measure needs to be validated in other settings to determine whether they are associated with other areas where the public question public health authority recommendations.

BackgroundThe negative impact of anemia on work capacity has been studied extensively in male and female workers; however, the simultaneous contributions of confounding variables such as physical activity, as well as other behavioral and sociodemographic characteristics have not been considered. The purpose of this study was to examine cross-sectionally the multivariable correlates of work capacity in non-pregnant women (n = 330) living in rural India.MethodsThe Reduction in Anemia through Normative Innovations (RANI) Project is a norms-based, clustered randomized controlled trial to reduce anemia among women (15–49 years) living in Odisha, India between 2018 and 2021. For the larger trial, 89 clusters of villages were randomized into treatment and control groups on a 1:1 basis. Women (2055/group) living in 15 selected clusters (40–41 villages) were then randomly selected for data collection. The sampling design also randomly-generated a subset (n = 375) of non-pregnant participants who performed a modified Queen’s College Step Test (QCST) and who wore an activity monitor for 3 days. Predicted work capacity (VO2max) was determined using the QCST. Levels (h/day) of daily reclining, sitting, standing, walking (steps/day), and energy expenditure (MET∙h/day) were determined using an ActivPAL accelerometer. Hemoglobin concentrations (g/dL) were determined using a HemoCue photometer. Predetermined hierarchical (non-multilevel) regression models tested the independent associations between the primary study variables of interest (physical activity, hemoglobin concentrations) and predicted VO2max, while adjusting for age, body mass index (BMI: kg/m2), education, parity, and dietary diversity score.ResultsApproximately 61% of the participants had anemia (Hb 2(β = − 0.01; 95% CI: − 0.01, 0.00), BMI (β = − 0.19; 95% CI:-0.28, − 0.09), educational attainment (β = − 1.35; 95% CI: − 2.34, − 0.36), and MET∙h/day (β = 0.19; 95% CI: 0.00, 0.38) were significant and independent determinants of work capacity. Hemoglobin concentration was marginally associated with work capacity in the presence of the other covariables (β = 0.22; 95% CI:-0.02, 0.47).ConclusionsOur data indicate that factors other than anemia are important correlates of work capacity and should be considered when promoting the health and economic capacity of rural Indian women.Trial registrationClinical Trial Registry- India (CTRI)http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26285&EncHid=&userName=CTRI/2018/10/016186on 29 October 2018.

We conducted a longitidinal assessment of 806 respondents in March, 2020 in the US to examine the trustworthiness of sources of information about COVID-19. Respondents were recontacted after four months. Information sources included mainstream media, state health departments, the CDC, the White House, and a well-known university. We also examined how demographics, political partisanship, and skepticism about COVID-19 were associated with the perceived trustworthiness of information sources and decreased trustworthiness over time. At baseline, the majority of respondants reported high trust in COVID-19 information from state health departments (75.6%), the CDC (80.9%), and a university (Johns Hopkins, 81.1%). Mainstream media was trusted by less than half the respondents (41.2%), and the White House was the least trusted source (30.9%). At the 4-month follow-up, a significant decrease in trustworthiness in all five sources of COVID-19 information was observed. The most pronounced reductions were from the CDC and the White House. In multivariate analyses, factors associated with rating the CDC, state health department, and a university as trustworthy sources of COVID-19 information were political party affiliation, level of education, and skepticism about COVID-19. The most consistent predictor of decreased trust was political party affiliation, with Democrats as compared to Republicans less likely to report decreased trust across all sources.

We evaluated the short-term effects of transportation on efficacy beliefs and risk perceptions after exposure to a climate change documentary. Data were collected in randomized laboratory ( N = 624) and online ( N = 1,391) experiments. Participants watched one episode of Years of Living Dangerously or a control video. Regression analyses assessed whether narrative transportation and/or political affiliation were predictive of outcomes. Transportation and political affiliation were significantly associated with efficacy beliefs and risk perceptions ( p < .001). A significant transportation by political party interaction for efficacy beliefs ( p < .01) and risk perceptions (p < .01) indicated that cross-party differences could be mitigated by higher levels of transportation.

The aim of this study is to examine diet diversity, predictors associated with it, and its associations with anemia among non-pregnant women of reproductive age in rural India. Baseline data from the Reductions in Anemia through Normative Innovations (RANI) project were used and included 980 non-pregnant women aged 15-49 years from Odisha, India. The Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W) was used to assess diet diversity. Anemia was determined by hemoglobin level and categorized as normal (hemoglobin ≥ 12 g/dL), mild (11 ≤ hemoglobin

Background and purpose Asian-Americans suffer from significant liver cancer disparity caused by chronic hepatitis B virus (HBV) infection. Understanding psychosocial predictors of HBV screening is critical to designing effective interventions. Methods Chinese-, Korean-, and Vietnamese-Americans in the Baltimore-Washington metropolitan region (N=877) were recruited from community-based organizations. Applying the Social Cognitive Theory (SCT), three main theoretical constructs (knowledge, outcome expectancy, and self-efficacy) were tested. Descriptive analyses using Chi-square and ANOVA and multivariate logistic regression models were conducted. Results About 47% of participants reported ever having screening for HBV. Vietnamese-Americans had the lowest HBV screening rate (39%), followed by Korean-Americans (46%) and Chinese-Americans (55%). Multiple logistic regression analyses showed significant effects of HBV-related knowledge on screening in all three groups, whereas self-efficacy had significant effects in the Chinese and Korean subgroups, but not Vietnamese. HBV outcome expectancy had no effect on the screening outcome in any of the groups. Additionally, consistent in all three groups, those who had lived in the United States longer were less likely to have screening. Conclusion HBV screening rates in Asian Americans remain low; targeted interventions need to consider the differences across ethnic subgroups and address the psychosocial risk factors.

Diet diversity has an important role in the prevention and treatment of anemia. Based on formative research in the community and the theory of normative social behavior, we designed an intervention to improve diet diversity among women of reproductive age. Our study, the Reduction in Anemia through Normative Innovations (RANI) Project, investigated the effect of a social norms-based intervention on diet diversity among women of reproductive age. We randomized villages in Odisha, India, into treatment or control arms, with a minimum of one village buffer between them. We assessed exposure to the intervention by frequency of self-reported images seen from the participatory learning modules, videos watched, and number of hemoglobin tests administered. We assessed diet diversity with the Food and Agriculture Organization’s Minimum Dietary Diversity for Women (MDD-W) questionnaire. We used multiple logistic regression to examine the associations between intervention and diet diversity, adjusting for covariates. Compared with baseline, diet diversity score increased in both treatment and control groups. The odds of having a diverse diet was 47% higher in the treatment group. Higher level of exposure to the RANI intervention was associated with a better diet diversity score, indicating that the intervention was effective in improving diet quality.

Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despit...

We used qualitative in-depth interviews to evaluate the effects of a mass media climate change program on audiences’ efficacy beliefs, outcome expectations, emotional responses, and motivations and intentions to address climate change. We conducted in-depth interviews with 73 participants from five US cities and three political parties who had watched episodes of the documentary television series, Season Two of Years of Living Dangerously. Eligible participants completed an in-depth interview within 24 h of viewing a select episode. Data were transcribed and then coded and analyzed using QSR NVivo 10. Weak efficacy beliefs limited intentions to enact concrete behavioral change. Outcome expectations, national-level actions, imagery, and emotional responses to stories played an important role in these processes. Explicit information about expected outcomes of various actions, and specifically successes, should be provided in order to boost efficacy and incentivize behavior.

Published 2019. This article is a U.S. Government work and is in the public domain in the USA. This study explored patients' experiences and perceptions of living with thalassemia (an inherited hematologic disorder), perceptions of social stigma, and impact on disclosure decision-making. Semistructured, in-person interviews were conducted in Singapore with 30 individuals: 16 thalassemia major patients and 14 parents of children with thalassemia. Findings were indicative of felt or enacted stigma that may have influenced disclosure decisions. Although affected individuals commonly disclosed their thalassemia diagnosis to family members, they either downplayed the condition with or avoided disclosure to unrelated individuals. Disclosure outside the family occurred only in response to triggers, such as questions about absences due to medical care. Health professionals should provide anticipatory guidance about disclosure strategies when managing individuals with thalassemia.

Research testing the risk perception attitudes (RPA) framework has demonstrated that efficacy can moderate the effect of risk perceptions on behavior. This effect of efficacy has also been seen at the social-level through tests of the theory of normative social behavior (TNSB). We tested if efficacy could bridge normative factors at a social-level and risk perception at an individual-level. Data for this study come from the Reduction in Anemia through Normative Innovations (RANI) project’s baseline survey in Odisha, India. We used hierarchical regressions to analyze interactions between predictors at various levels and efficacy to predict behavioral intention. Efficacy beliefs moderated the effect of injunctive norms (β = 0.07, p < 0.01), collective norms (β = 0.06, p < 0.01), and risk perception (β = 0.04, p < 0.01) on intentions. This study provides preliminary evidence for a multilevel theoretical framework.

OBJECTIVES: To investigate the effect of a social norms-based intervention on diet diversity among women of reproductive age. METHODS: Data from the Reduction in Anemia through Normative Innovations (RANI) Project were used. Up to three contiguous villages in Odisha, India were assigned to clusters, which were then randomized into treatment or control arm. Within each cluster, homes were randomly chosen in proportion to cluster size and one woman of reproductive age was randomly chosen from each selected home (N = 3797). The RANI intervention is based on the theory of normative social behavior and includes: participatory learning modules coupled with games; short videos shown to participating women and their families; and monthly hemoglobin testing followed by community discussion. Exposure to the intervention was assessed by the frequency of viewing images from the participatory learning modules, number of videos seen, and number of hemoglobin tests taken. Diet diversity was assessed by the Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W, score ranging 0–10 with MDD-W score ≥ 5 considered to represent a diverse diet). Multiple logistic regression examined the effect of exposure to the intervention on diet diversity. RESULTS: Compared to baseline, diet diversity score increased in both treatment and control groups by 13% and 8%, respectively. The odds of having a diet diversity score ≥ 5 was 47% higher in treatment group than the control group (P

Background: With the proliferation of the digital age, Information and Communication Technologies paired with feedback loops have the potential to facilitate process evaluations which include continuous iteration and innovation of intervention delivery. Objective: To describe how a multilevel social norms field trial is using feedback loops to innovate and enhance intervention delivery.Methods: We use a mixed-methods process evaluation design. Surveys and structured observation monitor fidelity to implementation and receptivity to implementation activities among study participants. Quantitative data evaluates implementation dose, coverage, exposure, and reach of intervention activities, and qualitative data will delve more deeply into reasons for high or low functioning. Iron folic acid supplement supply and demand are also monitored for stock-outs. Data collected from 130 intervention villages is processed, visualized, and triangulated in near to real-time via Real-time Monitoring for Knowledge Generation (RPM4K), a locally developed software application. Data visualization products facilitate the examination of monitoring data to mitigate bottlenecks and identify and implement tweaks to the RANI Project’s intervention delivery strategy on an ongoing basis. Discussion: Feedback loops assist with decision-making to facilitate timely course corrections. Feedback loops can also engender a shared understanding of ground realities for a geographically dispersed and culturally diverse team. Leveraging feedback loops, we identify opportunities to provide on-going supportive supervision for our community facilitators promoting joint problem-solving, and communication. Monthly media and hemoglobin level demonstration strategies are informed by participant engagement and receptivity. Stock-outs of iron folic acid tablets activate contingency plans to mobilize local stakeholders and advocate for timely resolutions. Unintended effects are monitored based on ongoing feedback from community facilitators.Conclusions: Documenting our processes can inform the future implementation or scale up of similar projects embracing feedback loops to iterate and innovate their intervention delivery. Trial Registration: The parent trial (RANI) was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.

We propose and test several hypotheses derived from the expanded theory of normative social behavior (TNSB) that also includes collective norms (with descriptive and injunctive norms). Data come from a quasi-experiment intervention to promote safer driving among adolescents in Serbia. The intervention was administered among high school students, most of whom were on the verge of receiving their driver's licenses. Longitudinal data were collected from treatment and control schools at baseline (

Background More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India’s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education–based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women–related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study’s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions This study will provide evidence on whether a mobile health norms–based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women–related bystander intervention. International Registered Report Identifier (IRRID) PRR1-10.2196/26252

Contains fulltext : 219521.pdf (Publisher’s version ) (Closed access) We investigated the influence of framed norm messages about food consumption on motivation to consume, and actual consumption of, healthy and unhealthy foods. We proposed that the effects of positive and negative message frames would vary by the type of underlying norms (i.e., injunctive, descriptive). More specifically, based on information processing theories, it was expected that injunctive norms would be more effective when framed negatively compared with positively, while the opposite was expected for descriptive norms. In both experiments, participants were randomly assigned to one of four framed social norm conditions or a no-norm control condition. In Experiment 1, motivation to consume healthy and unhealthy foods was assessed by means of both indirect and self-report measures. In Experiment 2, actual food consumption was assessed. In both experiments, the predicted interaction was found. Results show that injunctive norms benefit from a negative (vs. positive) frame, while preliminary evidence suggests the opposite for descriptive norms. 33 p.

Background: The Delta COVID-19 variant caused a resurgence in cases and deaths during the summer of 2021, particularly among the unvaccinated, highlighting the need to increase vaccine coverage. We describe a survey conducted in September 2021, in the midst of the Delta variant surge, after the FDA fully approved Pfizer-BioNTech’s vaccine for ages 16+ and issued an emergency use authorization for ages 12–15. Methods and Findings: US adults were surveyed to measure COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities. More than three-quarters (77%) reported receiving at least one dose of COVID-19 vaccination. Of the unvaccinated, 6% intended to vaccinate, 40% were unlikely to ever vaccinate, and 55% remained uncertain. Most of the unvaccinated were

Background: Nepal has a maternal mortality ratio of 186 per 100,000 live births, the second highest in South Asia. Institutional delivery, or giving birth in a medical facility with a skilled birth attendant, can prevent up to 16-33% of maternal deaths. Despite recent progress, Nepal’s institutional delivery rate is only 54%. As maternal mortality remains high and institutional delivery low, a transition from a biomedical to a psychosocial approach is needed, through which normative beliefs may be an entry point. The purpose of this study is to examine the relationship between descriptive norms and institutional delivery among mothers in Makwanpur, Nepal. Methods: This study uses baseline data from the Rejoice Architecture Project, a quasi-experimental study conducted in the Makwanpur District in Nepal in 2020. Female Community Health Volunteers (FCHVs) recruited 356 women from catchment areas of six health facilities across three Palikas (equivalent to municipalities) and administered oral surveys. Participants were eligible if they were 18 years or older, had a child younger than 2 years, and lived within the catchment area of a study site. Logistic regression was used to determine associations between descriptive norms and institutional delivery, controlling for antenatal care (ANC) visits, demographics, and interpersonal communication (IPC) with husband.Results: Approximately 30% of participants perceived most women in their community gave birth at home compared to medical institutions and nearly 65% gave birth in an institution during their last delivery. Logistic regressions showed an association between descriptive norms and institutional delivery after controlling for external factors such that on average, women who perceived institutional delivery to be most common had 3.18 greater odds of giving birth in an institution. Conclusions: Findings from this study support the notion that social norms relate to actual birthing behavior, specifically in the context of institutional delivery. These findings contribute to the growing body of literature relating to institutional delivery and offer insights for a potential norms-based approach for increasing rates of institutional delivery and reducing maternal mortality in developing countries.

The role of mass media during a public health crisis is an ineluctable part of providing the public with critical information rapidly, particularly messages about self- and response efficacy. However, little is known about the role local news media play in disseminating efficacy information during infectious disease outbreaks. Here, we use the 2014 Ebola outbreak in Liberia as a case to explore this question. We content analyzed newspaper and radio messages disseminated between March 2014 and March 2015, during the midst of the outbreak. Results show that both radio programs and newspaper articles mentioned over 21 prevention steps at some point, with noticeable differences within which disease prevention messages were communicated most frequently to the public. At least 1 mention of self-efficacy was identified in 31.5% of radio content (n = 127), 23.6% of radio programming (n = 55), and 10.6% of newspaper content (n = 745). Response efficacy, signifying effectiveness of preventive methods, was detected in 25.2% of radio (n = 127), 16.4% of radio programming (n = 55), and 15% of newspaper content (n = 745). This is important as efficacy reporting can impact public readiness to adopt preventative measures and affect beliefs about self- and response efficacy, ultimately decreasing chances of spreading the infection and poorer health outcomes.

How social norms are formed likely has a bearing on the mechanisms underlying their effects on behavioral outcomes. We propose three mechanisms of norms formation - through direct experience, symbolically through media, or imaginatively - and introduce ideas about normative durability, normative subscription, normative volume, personal agency, and polarization of norms - that likely have a bearing on how norms affect behaviors. The COVID-19 pandemic has important implications for how norms are formed, which in turn invoke different underlying mechanisms in the relationship between social norms and behaviors. We propose a number of hypotheses for future studies to test.