Shifting social norms to prevent age-disparate transactional sex in Tanzania: what we can learn from intervention development research

Lottie Howard-Merrill; Cathy Zimmerman; Revocatus Sono; John Riber; Joyce Wamoyi; Piotr Pawlak; Lori Rolleri Insignares; Robyn Yaker; Ana Maria Buller

doi:10.3389/fpsyg.2023.926531

Shifting social norms to prevent age-disparate transactional sex in Tanzania: what we can learn from intervention development research

Front Psychol. 2023 May 2:14:926531. doi: 10.3389/fpsyg.2023.926531. eCollection 2023.

Authors

Lottie Howard-Merrill^{1

2}, Cathy Zimmerman¹, Revocatus Sono³, John Riber⁴, Joyce Wamoyi⁵, Piotr Pawlak⁶, Lori Rolleri Insignares⁷, Robyn Yaker⁸, Ana Maria Buller¹

Affiliations

¹ Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
² Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom.
³ Amani Girls Home, Mwanza, Tanzania.
⁴ Media for Development International, Arusha, Tanzania.
⁵ Department for Sexual and Reproductive Health, National Institute of Medical Research, Dar es Salaam, Tanzania.
⁶ Independent Consultant, Washington, DC, United States.
⁷ Lori Rolleri Consulting Inc., New York City, GA, United States.
⁸ HIAS, New York, NY, United States.

Abstract

This paper reflects on the development process (2015-2020) of the Learning Initiative for Norms, Exploitation, and Abuse (LINEA) Intervention. The LINEA Intervention is a multi-component social norms intervention to prevent age-disparate transactional sex in Tanzania. This paper aims to: (1) critically reflect on the LINEA Intervention development process by retrospectively comparing it with a pragmatic, phased framework for intervention development in public health, the Six Essential Steps for Quality Intervention Development (6SQuID); and (2) discuss the usefulness and applicability of this framework to guide intervention development for gender-based violence prevention. This paper contributes to a growing field of intervention development research to improve the designs of interventions to prevent gender-based violence. Findings showed that the LINEA Intervention development approach mostly aligned with the steps in 6SQuID framework. However, the LINEA Intervention development process placed particular emphasis on two phases of the 6SQuID framework. First, the LINEA Intervention development process included significant investment in formative research, feasibility testing, and refinement; and second, the LINEA Intervention was informed by a clearly articulated behavior change theory-social norms theory. Beyond the 6SQuID framework the LINEA Intervention development process: (i) followed a non-linear, iterative process; (ii) applied ongoing feasibility testing to refine the intervention, and (iii) relied on co-development with local implementers and participants. This paper suggests future components for a robust intervention development process, highlighting beneficial additions to the 6SQuID approach, a well-recognized intervention development sequence. Particularly useful additions include incorporating sufficient time, flexibility, and resources to foster meaningful collaborations and iteration on the intervention design.

Keywords: adolescence; age-disparate transactional sex; curriculum-based intervention; intervention development; mass media interventions; reproductive and sexual health; sexual exploitation; social norms.