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Evidence for Gender as a Gateway Factor to other Behaviors – Ethiopia

Evidence for Gender as a Gateway Factor to other Behaviors – Ethiopia. Team Members. Team Members. Susan E. Middlestadt, Indiana University Julie Pulerwitz, Horizons/PATH Karabi Acharya, AED Geeta Nanda, AED Bridget Lombardo, AED We’d also like to acknowledge:

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Evidence for Gender as a Gateway Factor to other Behaviors – Ethiopia

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  1. Evidence for Gender as a Gateway Factor to other Behaviors – Ethiopia

  2. Team Members Team Members • Susan E. Middlestadt, Indiana University • Julie Pulerwitz, Horizons/PATH • Karabi Acharya, AED • Geeta Nanda, AED • Bridget Lombardo, AED • We’d also like to acknowledge: Gloria Coe, Douglas Storey, Margaret Greene, Martin Fishbein, Peter Gottert, Kokeb Kassa, Efua Orleans-Lindsay, Miz Hasab Research.

  3. Challenges to Behavior Change Communication How to: • Boost public health impact • Increase scale • Go beyond individual to social change • Become more efficient • Address multiple behaviors

  4. What is a gateway factor? • A variable that potentially influences many health behaviors and outcomes • An “upstream” causal factor • Theoretically, an intervention that influences a gateway factor • will improve many behaviors and outcomes • will be a more efficient approach to Behavior Change

  5. Potential Gateway Factor: Gender Norms Definition: social expectations about how men and women should behave due to the fact they are men and women Since these expectations influence many behaviors, gender norms might operate as a gateway factor.

  6. Model Structural Factors Specific Norms & Other Determinants Outcomes Gateway Factor Health Behaviors Attitude toward condom use Self-efficacy Reduced HIV Condom Use Degree of Gender Inequity Gender Norms Attitude toward contraception Self-efficacy Increased Spacing Use Modern Method

  7. Research Question • Do gender norms – measured by GEM Scale - function as a gateway factor and show a relationship to many behaviors – measured by Intimate Partner Behaviors Index?

  8. Model Attitude toward condom use Self-efficacy Reduced HIV Condom Use Degree of Gender Inequity Gender Norms Attitude toward contraception Self-efficacy Increased Spacing Use Modern Method GEM Scale Intimate Partner Behavior Index

  9. GEM Scale Measure support for (in)equitable gender norms addressing: violence, sexuality, reproductive health & domestic life. Intimate Partner Behavior Index • A composite measure that captures the performance of a number of behaviors

  10. Initial Phases of Ethiopia StudySeptember 2006 – July 2007 1. Open-ended questionsasked of work group members to elicit behaviors for indices 2. Qualitative researchwith Ethiopian men living in DC to get input on GEM scale and indices 3. Development professionalsrated behaviors to select 40 behaviors for indices 4. Group interviewdiscussions in Ethiopia to pre-test and modify instrument

  11. Phase 5 • Face-to-face • interviews with • 522 married men • Purposive sampling • frame • Instrument includes - GEM Scale • - Behavioral index • - Religiosity Index • - Demographics and • sexual behaviors

  12. Key Results

  13. Ethiopian Adaptation of GEM Scale • Original GEM Scale plus additional locally relevant items administered in Phase 5. • Frequency, reliability, and factor analyses to finalize scale • Items with low variance (<10%), and negative or low factor loadings removed • Most original and some new items remain (24 items; alpha=.88) • Examples of items: • A woman should tolerate violence to keep her family together. • A man should have the final word about decisions in his home. • A woman who has sex before she marries does not deserve respect (new question).

  14. Developing Intimate Partner Behavior Index • List of 82 behaviors developed by working group, tested for wording with Ethiopian men in US. • Close-ended rating of behaviors by 30 development experts via web-based survey. • What will happen if the men in a society shift from traditional to more equitable gender norms……..will behavior increase, decrease, or stay the same? • Examples of final 34 intimate partner behaviors: • Have sex without a condom. • Ask wife her opinion. • Walk away instead of hitting your partner when angry. • Help your wife when she is sick or busy.

  15. GEM Scale is related to Index of Intimate Partner Behaviors ** p<.0000, n=522, numbers are Pearson correlation coefficients.

  16. GEM Scale is also related to 10 individual intimate partner behaviors. **** p<.0000, *** p<.001, ** p < .01, * p<.05, n=522, Spearman correlation coefficients.

  17. Preliminary Conclusions Demonstrated reliability of two tools • GEM Scale adapted to married Ethiopian men • Intimate Partner Behavior Index (IPBI) Showed relationship between GEM Scale and multiple behaviors • Related to Intimate Partner Behavior Index • Related to several individual behaviors • NOT related to index of religious behaviors

  18. Implications For programs • Include explicit discussion of gender norms in Behavior Change Communication • Invest more resources in interventions to address gender norms For research • Can use these two tools in research and evaluation • Can use behavior index as an outcome indicator • Look for other types of gateway factors

  19. Thank You

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