Using structural equation modeling to explore the pathways between a social norms-shifting intervention and couple communication for family planning in Kinshasa, DRC

Abstract Background. Approaches to shifting social norms are an increasingly common component of interventions seeking to promote family planning (FP) use. Yet, gaps remain in our understanding of how these norms-shifting interventions (NSIs) work, including how pathways to behavior change that include norms and related mediating factors work. The Masculinité, Famille, et Foi (MFF) intervention in the Democratic Republic of the Congo was a multi-component NSI that included a variety of activities intended to generate synergistic effects and different pathways to achieve FP behavior change.Methods. We used structural equation modeling to assess the simultaneous relationships between: 1) the MFF intervention; 2) mediating variables, including descriptive and injunctive social norms, attitudes, and self-efficacy; and 3) couple communication for FP, which has been shown to facilitate voluntary, autonomous FP use. We assessed for aggregate, indirect, and direct effects among an endline sample of MFF participants who were newly married couples and first-time parents.Results. Our sample included n=435 women and n=356 men from 8 experimental and 9 control Protestant congregations in Kinshasa. Our models demonstrated strong goodness of fit, indicating support for the direction of effects. We found an overall aggregate effect of the intervention on couple communication among women (p=0.01). We did not find any statistically significant indirect effects in either model; however, we identified several significant direct effects between descriptive norms for FP, gender equity, and intimate partner violence and injunctive norms, attitudes, and self-efficacy for men and women. Conclusions. Our finding of aggregate intervention effects on couple communication for women confirms the need for multicomponent interventions that work simultaneously to shift norms and to modify attitudes and increase self-efficacy to achieve behavior change. A lack of comparable aggregate effects among men indicates that pathways to achieving improved couple communication may necessitate different messages or approaches for men than women. Findings also suggest that achieving shifts in descriptive norms may produce a ripple effect on other social and individual-level mediating factors. Additional intervention evaluations that account for the synergistic effects of intervention components and directed pathways to program outcomes are needed to inform the design of multicomponent NSIs.