Vol. 4 (2016) by Rajiv Rimal
Social norms, as a topic of inquiry, has garnered significant attention from a variety of perspec... more Social norms, as a topic of inquiry, has garnered significant attention from a variety of perspectives in recent years.
Because of the rapidly-growing interest in social norms from scholars in multiple disciplines, this area of scholarship
is often characterized by a lack of clarity on what constitutes social norms and how key concepts are operationalized.
The objectives of this article are to (a) provide a review of the fast-expanding literature on social norms, (b) delineate
similarities and differences in key operational definitions, (c) review theories that explicate how norms affect behaviors,
(d) propose a revised theoretical framework that helps organize our understanding of normative inf luence on
behavior, and (e) provide suggestions for future research in this area. This review highlights the need to consider
whether a behavior is enacted spontaneously or after deliberation. If the former, whichever attitude or norm is most
salient will likely have a direct effect on behavior. If the latter, we propose that behavioral, individual, and contextual
attributes will inf luence the extent to which norms shape behavioral intentions and subsequent behavior. Finally,
this review highlights the need for more studies designed to test the causal relationship between social norms
and behaviors, as well as those that study norms from a qualitative perspective.
Papers by Rajiv Rimal
Studies in Family Planning
Bulletin of the World Health Organization
Journal of Health Communication
We conducted a longitidinal assessment of 806 respondents in March, 2020 in the US to examine the... more 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.
Health Communication
How social norms are formed likely has a bearing on the mechanisms underlying their effects on be... more 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.
Current Developments in Nutrition
Objectives More than a third of women worldwide and more than half of women in India have iron de... more Objectives More than a third of women worldwide and more than half of women in India have iron deficiency anemia. In 2012, the World Health Assembly made a global target of a 50% reduction in anemia among all women of reproductive age by the year 2025. Based on formative research, the Reduction in Anemia through Normative Innovations (RANI) project designed a social norms-based intervention to increase iron folic acid supplement use among women of reproductive age in Odisha, India. The objective of this paper is to examine midline data to understand which intervention components had the most effect on taking iron supplements and to suggest intervention modifications accordingly. Methods We collected and analyzed longitudinal data at baseline from the control and treatment arms and again from the same two arms at midline, six months later (n = 1,966 and n = 1,987). For this analysis, our sample includes non-pregnant women of reproductive age (15 – 49 years old). Using nested models, ...
Current Developments in Nutrition
Objectives To investigate the effect of a social norms-based intervention on diet diversity among... more 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...
Current Developments in Nutrition
Objectives More than half of women of reproductive age in India are anemic, a condition treatable... more Objectives More than half of women of reproductive age in India are anemic, a condition treatable through regular iron folic acid uptake. Previous studies have shown the importance of participatory interactions and interpersonal communication in improving women's health. The Reduction in Anemia through Normative Innovations (RANI) study investigated the effect of general health and anemia- specific interpersonal communication on improving iron folic acid use among women of reproductive age. Methods The RANI Project is a cluster randomized trial that collected longitudinal data from control (N = 1896) and treatment (N = 1898) communities in Odisha, India at baseline and at midline, 6 months later. Structural equation models assessed the intervention effect on iron folic acid use through both, general health interpersonal communication focused on “the health of women in the community” and anemia-specific interpersonal communication. Results Compared to the control arm, iron folic ...
Gates Open Research
Background: Each year, 600,000 children under 5 years old die from vaccine-preventable diseases g... more Background: Each year, 600,000 children under 5 years old die from vaccine-preventable diseases globally. Immunization is an effective way to prevent many diseases, saving two to three million lives per year. The Nepal National Government recommends vaccinations for all children for 11 diseases by 15 months of age. However, only 78% of children between 1-2 years of age have received all recommended vaccines and only 43% receive them at the age-appropriate times for which they are scheduled. Objectives: This protocol describes the development of an intervention – called “Rejoice Architecture” – that is informed by three theoretical perspectives: choice architecture, the broken windows theory, and the theory of normative social behavior. We also describe a mixed-methods approach to develop the intervention, which will improve the physical and social environments of health facilities in Makwanpur, Nepal. We hypothesize this intervention will improve immunization behaviors and intention...
Current Developments in Nutrition
Objectives Over half of women of reproductive age in India are anemic so the World Health Organiz... more Objectives Over half of women of reproductive age in India are anemic so the World Health Organization recommends daily iron folic acid (IFA) for all women of reproductive age. The government has distributed free IFA for over four decades but initial uptake and adherence remain inadequate. Objectives 1) to understand the multilevel factors that hinder IFA use and adherence; and 2) to inform a behavioral intervention to increase IFA use to reduce anemia. Methods We conducted this study in four rural villages in the state of Odisha, India. We held 25 key informant interviews with front-line health workers, 16 focus groups with women of reproductive age, husbands, and mothers-in-law (n = 148) and 18 direct observations in health centers, pharmacies and women's groups. We purposively sampled key informants and randomly sampled focus group participants from an enumeration of all eligible residents of each village, and stratified them by sex, age and relation to a woman of reproductiv...
Current Developments in Nutrition
Objectives Half of women of reproductive age in India have iron deficiency anemia compared to onl... more Objectives Half of women of reproductive age in India have iron deficiency anemia compared to only 23% of men. Most research focuses on biological reasons for this discrepancy and access to iron-folic acid and iron-rich foods. However, recent research in India shows that inequitable gender norms may affect a woman's ability or desire to take iron supplements and to eat iron-rich food. The objective of this study is to examine how and why gender norms may be affecting high and persistent rates of anemia in India. Methods We conducted 25 key informant interviews and 16 focus group discussions with women of reproductive age, adolescents, husbands and mothers-in-law (n = 148) in Odisha, India. We purposively sampled key informants and randomly sampled focus group participants. We analyzed the data using applied thematic analysis in Nvivo software. Results Our data shows that unequal gender norms impact behaviors that are directly related to high rates of anemia. Women are often serv...
Climatic Change
We used qualitative in-depth interviews to evaluate the effects of a mass media climate change pr... more 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.
Journal of Global Health Reports
Background Over the last decade, Ethiopia has substantially increased uptake of modern contracept... more Background Over the last decade, Ethiopia has substantially increased uptake of modern contraception and experienced a decline in total fertility, coinciding with implementation of the national Health Extension Programme (HEP), involving an extensive deployment of health extension workers (HEWs), and a health development army (HDA) of volunteer families. The dynamics of such change are important. This multi-method qualitative study was conducted in a rural community in Oromia, Ethiopia, as part of a larger effort to understand the influence of social networks on modern contraceptive use. Methods Data were collected in five focus groups and twelve individual interviews (n=59) with men, women, adolescents and key informants in a rural area in Oromia, Ethiopia, together with participant observation. Analysis was conducted using NVivo qualitative research software. Results We found two types of decision-making social networks for family planning: (i) one pertaining to basic decisions about having children per se, which remains the prerogative of traditional, patriarchal social structures; and (ii) a second network, which included HEWs, that applies after initial childbirth, concerning family size and spacing decisions for additional children. Conclusions While this study supports other research on the effectiveness of the HEP, the study also identified limitations, and raised questions about the replicability of the Ethiopian model for reducing fertility. The level of government commitment and resources required for the HEP are linked to Ethiopia's key position among recipients of development assistance, likely connected to its history and geopolitical role. These circumstances may not be widely applicable. Declining fertility has long been regarded as a key to economic growth in developing countries. Fertility decline is associated with a broader social transformation that has led to reductions in preventable maternal mortality (1, 2), and a range of positive outcomes at the individual, family, and population levels, including increased economic growth, reduced poverty, higher levels of www.joghr.org •
Journal of health communication, 2017
Individuals' behaviors are influenced by those of others in their social environment (i.e., d... more Individuals' behaviors are influenced by those of others in their social environment (i.e., descriptive norms), as well as by how individuals perceive they should behave in that environment (e.g., injunctive norms). Although social norms are thought to play an important role in hepatitis B virus (HBV) screening, limited theoretical or empirical guidance exists on how the underlying process works. In addition, norms are social phenomena that are spread through family discussion about the importance of getting HBV screening. Using the theory of normative social behavior (TNSB), this study examined the roles of injunctive norms (IN), descriptive norms (DN), and family discussion in HBV screening behavior among Asian Americans. Data from a survey of Asian Americans in the Baltimore Washington metropolitan area (N = 877) were used to test underlying theoretical propositions. DN and family discussion emerged as key factors in HBV screening behavior among all Asian Americans. IN were a...
Cancer Epidemiology Biomarkers & Prevention
Journal of health communication, 2017
Traffic road accidents are one of the leading causes of mortality in Nepal and around the world. ... more Traffic road accidents are one of the leading causes of mortality in Nepal and around the world. Drivers in Nepal are not adequately educated about road safety rules. Road conditions are chaotic as traffic regulations are also not strictly enforced. Public safety campaigns may be able to alter drivers' attitudes and behaviors; however, little is known about which persuasive strategies may be most effective. Drawing on self-determination theory and the Health Belief Model, the current study used a post-only experimental design to test the impact of a short video message. The video included collective vs. individual appeals, and messages emphasizing one's ability to make the right choice (autonomy support) vs. directive language. Participants were Nepali college students (mean age 20, N = 199). Using structural equation modeling, the study found that directive messages rather than autonomy support influenced an individual seeing value in the recommended behavior (identified re...
Health Communication, 2016
Underage drinking is a serious public health problem in the United States, and youth exposure to ... more Underage drinking is a serious public health problem in the United States, and youth exposure to alcohol advertising has been indicated as a possible contributing factor. Although a number of studies have identified advertising content features that youth find appealing, a key limitation of this research is the absence of a broader tool to examine those features, especially those used by alcohol brands that are popular with underage drinkers. We created an index of content elements found in the research literature to be appealing to youth, and then used this index in a content analysis to identify the degree to which youth-appealing content appeared in a sample of alcohol ads that aired on television shows popular among youth. Finally, using bivariate analysis, we tested the relationship between alcohol brands' use of this content and the popularity of those brands among youth. We found that many of the ads featured youth-appealing content, and that the ads for the alcohol brands most popular among youth had more youth-appealing content than the less popular brands.
Prevention Science, 2016
Individual factors associated with HIV testing have been studied across multiple populations; how... more Individual factors associated with HIV testing have been studied across multiple populations; however, testing is not just an individual-level phenomenon. This secondary analysis of 2005 and 2011 Ethiopia Demographic and Health Survey data was conducted to determine the extent to which the 2007 institution of an opt-out policy of HIV testing during antenatal care increased testing among women, and whether effects differed by women's stigmatizing beliefs about HIV. A logit model with interaction between pre-/post-policy year and policy exposure (birth in the past year) was used to estimate the increased probability of past-year testing, which may be attributable to the policy. Results suggested the policy contributed to a nine-point increase in the probability of testing (95% CI 0.06-0.13, p < 0.0001). A three-way interaction was used to compare the effects of exposure to the policy among women holding higher and lower HIV stigmatizing beliefs. The increase in the probability of past-year testing was 16 percentage points greater among women with lower stigmatizing beliefs (95% CI 0.06-0.27, p = 0.002). Women with higher stigmatizing beliefs were less likely to report attending antenatal care (ANC), testing at their last ANC visit, or being offered a test at their last ANC visit. We encourage researchers and practitioners to explore interventions that operate at multiple levels of socio-ecological spheres of influence, addressing both stigma and structural barriers to testing, in order to achieve the greatest results in preventing HIV.
Journal of health communication, 2016
Social norms affect human behavior, and underage drinking is no exception. Using the theory of no... more Social norms affect human behavior, and underage drinking is no exception. Using the theory of normative social behavior, this study tested the proposition that the association between perceptions about the prevalence of drinking (descriptive norms) and underage drinking is strengthened when perceived pressures to conform (injunctive norms) and beliefs about the benefits of drinking (outcome expectations) are high. This proposition was tested on a nationally representative sample of underage drinkers ages 13-20 (N = 1,031) in relation to their alcohol consumption, expanding on research with college-age youth. On average, males and females reported drinking 23 and 18 drinks per month, respectively. The main effect of descriptive norms (β = .10, p < .01) on alcohol consumption was modified by interactions with injunctive norms (β = .11, p < .01), benefit to self (β = .12, p < .001), and benefit to others (β = .10, p < .01). Underage drinkers are most vulnerable to excessiv...
Uploads
Vol. 4 (2016) by Rajiv Rimal
Because of the rapidly-growing interest in social norms from scholars in multiple disciplines, this area of scholarship
is often characterized by a lack of clarity on what constitutes social norms and how key concepts are operationalized.
The objectives of this article are to (a) provide a review of the fast-expanding literature on social norms, (b) delineate
similarities and differences in key operational definitions, (c) review theories that explicate how norms affect behaviors,
(d) propose a revised theoretical framework that helps organize our understanding of normative inf luence on
behavior, and (e) provide suggestions for future research in this area. This review highlights the need to consider
whether a behavior is enacted spontaneously or after deliberation. If the former, whichever attitude or norm is most
salient will likely have a direct effect on behavior. If the latter, we propose that behavioral, individual, and contextual
attributes will inf luence the extent to which norms shape behavioral intentions and subsequent behavior. Finally,
this review highlights the need for more studies designed to test the causal relationship between social norms
and behaviors, as well as those that study norms from a qualitative perspective.
Papers by Rajiv Rimal
Because of the rapidly-growing interest in social norms from scholars in multiple disciplines, this area of scholarship
is often characterized by a lack of clarity on what constitutes social norms and how key concepts are operationalized.
The objectives of this article are to (a) provide a review of the fast-expanding literature on social norms, (b) delineate
similarities and differences in key operational definitions, (c) review theories that explicate how norms affect behaviors,
(d) propose a revised theoretical framework that helps organize our understanding of normative inf luence on
behavior, and (e) provide suggestions for future research in this area. This review highlights the need to consider
whether a behavior is enacted spontaneously or after deliberation. If the former, whichever attitude or norm is most
salient will likely have a direct effect on behavior. If the latter, we propose that behavioral, individual, and contextual
attributes will inf luence the extent to which norms shape behavioral intentions and subsequent behavior. Finally,
this review highlights the need for more studies designed to test the causal relationship between social norms
and behaviors, as well as those that study norms from a qualitative perspective.