This document summarizes the development and validation of social norms scales on reproductive empowerment in sub-Saharan Africa. It describes developing conceptual frameworks and conducting focus groups to create scales measuring reproductive decision-making, partner communication, social support, and social norms. Cognitive interviews were conducted in Kenya to understand participants' interpretation of questions and ability to respond. Lessons learned include ensuring interviewers are well-trained in cognitive interviewing and pretesting questions. The step-by-step validation process has helped ground measures in theory and reality.

1. Development and Validity of
Social Norms Scale on
Reproductive Empowerment:
Lessons from sub-Saharan
Africa
Carolina Mejia, PhD, MPH
MEASURE Evaluation
University of North Carolina
November 9, 2017
AEA Conference, Washington D.C.

2. Overall Goal
Develop culturally-specific
measures grounded on a new
conceptual model of
reproductive empowerment
(RE) for rigorous evaluations
and program planning

3. Development and Validation
The Process
Content validity:
Expert
consultation
(online)
May 2017
Face-
validity:
Cognitive
interviews
November
2017
Criterion
validity:
Population-
based survey
TBD 2018Expert
consultation
framework (in-
person)
November 2016
Development of
conceptual
framework and
literature review
August 2016
Development of draft
measures/ focus
groups
January 2017

4. Focus Groups
• Conducted 10 focus groups (FGs)
with women and 4 with men in
urban and rural areas
• Used vignettes to explore domains
of RE
• Findings led to the development of
scales on:
• Reproductive decision- making
• Partner communication
• Social support
• Social norms
Zambia
Report is available at
measureevaluation.org

5. Social Norms
Categories of Measures
What the
respondent
does
What the
respondent
believes she
should do
What the
respondent
believes
others do
What the
respondent
believes others
think she should
do
believes
Behavior Attitude
Empirical
expectation
Normative
expectation
Source: Gerry Mackie, University of California at San Diego

6. Social Norms Questions:
Subdomain Corresponding Survey Items
(Response options: “agree,” “strongly agree,”
“disagree,” or “strongly disagree”)
• Individual behavior/self-
efficacy
You can use contraception, even if
your partner doesn’t want you to.
• Personal attitude You think you should be able to
use contraception, even if your
partner doesn’t want you to.
• Empirical expectations Other women you know use
contraception, even when their
partners don’t want them to.
• Normative expectations Other people think you should be
able to use contraception, even
when your partner doesn’t want
you to.

7. Relevant Social Network
• People who matter in an individual’s choices
(parents, in-laws, “Nkwose,” friends, religious
leaders)
• What she/he expects them to do matters: it
influences her/his reproductive choice
• What she/he believes they think she/he ought
to do matters: it influences her/his reproductive
choice
Reference Group

8. Cognitive Interviews (CIs)
• Stratified purposive sampling; 96
interviews with men and women
from Nairobi (urban) and Machakos
(rural) in Kenya
• CIs are being conducted by local
interviewers who are fluent in English
and Swahili
• Participants are asked to “think
aloud” as when responding to
questions
Kenya

9. Challenges
• Getting participants to capture the
“think aloud” process of cognitive
interviewing
• Changing back and forth during
interview between English and
Swahili
• Length of interview (1.5 hours or
longer)
• Questions on social norms seem
repetitive to participants

10. Lessons Learned
• Ensure that interviewers are well-trained in
cognitive interviewing approaches.
• Pretest questions with interviewers before
pretesting with participants.
• The cognitive interview process is providing
insights into the participants' understanding of,
ability to answer, and willingness to answer
questions.
So Far

11. Conclusion
A step-by-step process of developing and validating
measures of RE in Zambia and Kenya has been vital in
ensuring that measures are grounded in theory and in
“reality.”

12. Acknowledgments
• Mary Paul, research assistant at MEASURE Evaluation
• Jacinta Nzinga (local consultant in Kenya)
• Data collection team:
• Celestine Adipo
• Peterson Kraithe
• Joan Nzinga

13. This presentation was produced with the support of the United States Agency for
International Development (USAID) under the terms of MEASURE Evaluation
cooperative agreement AID-OAA-L-14-00004. MEASURE Evaluation is
implemented by the Carolina Population Center, University of North Carolina at
Chapel Hill in partnership with ICF International; John Snow, Inc.; Management
Sciences for Health; Palladium; and Tulane University. Views expressed are not
necessarily those of USAID or the United States government.
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