Social Norms Learning Collaborative

Department of Sociology
Bayero University, Kano – Nigeria

Blending Social Norms into Undergraduate and Postgraduate Courses

SAMPLE OF COURSE MODULE

COUSRE TITLE/CODE: Medical Sociology SOC 4311

 TOPIC: Social Norms Theory and Practice in Health Interventions

OBJECTIVES: At the end of this course, students are expected to have an appreciable level
of understanding and the ability to:

1) Understand what social norms theories are and the ability to use them in practical
aspect
2) Comprehend the main sociological schools of thought on healthcare interventions
3) Show an understanding of how to use the theories in practical research
(Undergraduate projects)
4) Explain how our health care system works and how cultural values influence health
interventiona

The section would cover the following sub-topics;

a) Conceptual Review of Social Norms

b) Influence of Descriptive and Injunctive Norms
c) Theories of Normative Social Behaviour
d) Empirical Research of Social Norms in Health Interventions
e) Examples of Health interventions on Social Norms

Introduction:

All human beings comply with some social norms in their daily actions and interactions, to
the point that many of the choices that they make every day are conducted under the
influence of one or more of norms, albeit that often happens unwittingly.

Global health practitioners and scholars in the past have overestimated the role that new
knowledge alone can have in influencing people’s attitudes and practices. Despite a tendency
to focus on providing knowledge and material resources to change attitudes and practices, an
increasingly larger field of action and research has been advocating for a wider understanding
of how different institutional, material, individual and social factors intersect in influencing
people’s choices and actions. Among these several factors, social norms play an important—
and often underestimated—role.

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What are social norms?

Despite multiple, and sometimes contrasting, theories of what are social norms, several agree
that, at its simplest, a social norm is a (mostly unwritten) rule about what actions are
appropriate in a given group. Examples of such norms might include: shaking hands when
you meet someone or saying bless you when someone sneezes. Most global health
practitioners use the definition of social norms advanced by Cialdini and colleagues (1990)
which views social norms as one’s beliefs about: 1) What others in one’s group do
(descriptive norm), and 2) What others in one’s group approve/disapprove of (injunctive
norm).

The Influence of Descriptive and Injunctive Norms

Descriptive and injunctive norms can be powerful drivers of behaviour when they work both
independently and together. Experts in public advertisement have used for years the influence
of descriptive norms: when people believe that many others are doing something, they will be
more favourably oriented towards doing the same. Much empirical evidence on the influence
of descriptive norms comes from studies conducted in high-income countries, many of which
carried out by researchers interested in: 1) increasing pro-environmental behaviour (de Groot
& Schuitema, 2012; Griskevicius, Cialdini, & Goldstein, 2008; Hamann, Reese, Seewald, &
Loeschinger, 2015; Priolo et al., 2016); and 2) reducing consume of alcohol in university
campuses (Borsari & Carey, 2003; Dams-O'Connor, Martin, & Martens, 2007; H Wesley
Perkins, 2002; H. Wesley Perkins & Berkowitz, 1986; Prestwich et al., 2016; Reilly & Wood,
2008).

Injunctive norms have also been studied in isolation as powerful drivers. Injunctive norms are
also found in advertisements; very often injunctive advertisements are linked to gender roles
(see Figure 3). Injunctive messages tend to shape ideas of what it’s like to be an approved
person: using the right product will make you popular, likeable, or accepted. Studies that
looked exclusively at injunctive norms do exist (e.g. Prince & Carey, 2010; Taylor &
Sorenson, 2004), although researchers more commonly integrated in their empirical studies
analysis of both injunctive and descriptive norms. Most studies have looked at the combined
and relative effect of descriptive and injunctive norms. The evidence is mixed about which of
the two types of norms is stronger, suggesting that the difference in the strength of their
influence might be due to the behaviour being influenced, as well as the characteristics of the

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population influenced by the norm (age, gender, or economic status), the relation between the
influencers and the influenced (perceived social distance or proximity), or the characteristics
of the context in which the influenced live (urban or rural, familiar or unfamiliar, for
instance) (Bosson, Parrott, Swan, Kuchynka, & Schramm, 2015; Hamann et al., 2015; Smith
et al., 2012).

The Difference between a Norm and an Attitude

Norms and attitudes are different. One person can have an attitude towards something – say,
for instance, an adolescent who doesn’t like to smoke – and yet comply with the norm to
achieve a positive sanction – smoking with their classmates to be part of the group of the cool
guys. When attitudes and norms conflict, people might decide to do what the norm
commands, even when that includes a portion of self-harm. Anecdotal evidence during the
Ebola crisis in West Africa showed that people preferred to shake hands rather than come
across as impolite.

How are Norms relevant to Health?

There is a large body of evidence that social norms can have great influence on health-related
practices. Although most of the evidence comes from high-income countries, a substantial
amount does come from low and middle-income countries. These studies include research on
handwashing, sexual and reproductive health, child marriage, female genital cutting, open
defecation, and intimate partner violence, to cite a few examples.

The Role of Sanctions to Maintain Compliance

There is no widely shared agreement on why exactly people do comply with social norms,
although most likely the answer is not to be found in one reason or mechanism alone. There
are several mechanisms that increase norms compliance. The most frequently mentioned are
anticipation of rewards for complying with the norm and punishments for not complying.

The social norms literature often refers to these rewards and punishments as positive and
negative sanctions. Positive sanctions include: words of praise, a promotion, access to
resources etc. Negative sanctions include: gossiping, threats of violence, actual violence, etc.
It doesn’t matter

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whether sanctions would actually take place. What matters is that people believe that they
will take place. People might want to comply with a norm as they seek rewards and try to
avoid punishment.

Theory of Normative Social Behavior

the theory lays out the ways that behavior is influenced by both descriptive social norms
(perceptions about how other people behave) and by injunctive social norms (expectations
about how people should behave). Under this theory, descriptive norms hold a direct
influence over behavior, as people are more likely to engage in a behavior they perceived to
be common. The theory also holds that Injunctive norms like group identity, and the
perceived benefits or detriments of engaging in a behavior (also called rewards or sanctions)
moderate the influence of descriptive norms over behavior. Finally, agency, or people’s
perceived ability and resources to perform a behavior, plays a role in determining the uptake
and continuation of a behavior

Theory of Normative Social Behavior is supplemented by the Integrated Behavior Model,

which looks at intention to perform a behavior as deriving from multiple components. These
components of intention, including the intermediate outcomes of “improved attitudes around
FP/RH and gender,” “enhanced normative environment,” and “increased agency,” which in
turn predict behavior change. The Integrated Behavior Model also acknowledges the role of
resources as a constraint on behavior change. As an individual gains self-efficacy and a sense
of empowerment, they are more likely to be able to refuse to engage in undesirable group
behaviors.

The Theory of Normative Social Behavior and the Integrated Behavior Model both hold that
the broader socio-ecological environment is a key determinant of behavior. Roger’s
Diffusion of Innovations Model proposes the concept that interventions, including those
aimed at individual behavior, are communicated along various channels into this wider socio-
ecological environment, be it to members of a geographic, congregational, or other form of
community. Interventions, including those aimed at individual behavior, are communicated
along various channels into this wider socio-ecological environment, be it to members of a
geographic, congregational, or other form of community. In this model, diffusion is a type of
communication, encompassing many types of information exchange, by which messages
about new concepts are disseminated, as well as a type of social transformation.

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Rogers defines diffusion as comprising four key domains

• The innovation;
• The types of communication;
• The element of time, which encompasses the rate at which the innovation is adopted;
and
• The “social system” that forms the setting for diffusion.

For example, in an intervention on family planning, the innovation may be couples

communicating about seeking Family Planning, the type of communication may be sermons,
and the social system may be a congregation

TARGETS AND REFERENCE GROUPS

We mentioned that social norms are one’s beliefs about what others do and approve of. These
“others” are frequently referred to as members of one’s reference group.

Is the Reference group a specific group of people or just others?

Often (though not always), the feeling of being in the group is a strong pre-condition for
following a groups’ behaviour. In other words, the group is likely to exert a strong influence
on behaviour when the individual identifies with it (Terry, Hogg, & McKimmie, 2000; Terry,
Hogg, & White, 1999). For this reason, some theorists argue that social norms are always in
relation to a given reference group of people that matter to the individual conforming with the
behaviour under study (e.g. Bicchieri, 2006; Park & Smith, 2007). However, as Reid,
Cialdini, and Aiken (2010) observed, the behaviour of others can be normative even when the
group is not particularly meaningful, as, for instance, in the street, where we might align our
behaviour to what we believe is appropriate in front of complete strangers (Cialdini, Reno, &
Kallgren, 1990; Munger & Harris, 1989).

Reference groups, or those actors whose opinions on relevant behaviors matter to target
individuals, are placed around the primary target groups. They can circumscribe the
behaviors of young people through their normative influence. Reference groups often have
the power to enforce behavioral compliance with social norms by positively or negatively
sanctioning behavior. reference groups can be identified locally and include peers, faith and
community leaders, teachers, parents, and grandmothers.

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POSITIVE ROLE MODELS

Positive role models are individuals within a community selected for their demonstration of
attitudes and behaviors consistent with intervention goals, such as a husband supporting his
wife in her desire to use modern FP, or an adolescent who believes that men and women are
created equal. These individuals may be, opinion leaders, members of important reference
groups for a given behavior, and/or occupy key positions of social influence within
community social networks. Positive role models help to make healthy attitudes and
behaviors acceptable and visible for young people and communities

PEER SUPPORT

Peer support represents a strategy whereby young people provide a source of support (e.g.,
knowledge, experience, emotional, social, and/or practical assistance) for other young people
on an equal and reciprocal basis. Very often, peers are an important reference group for
young people’s attitudes and behaviors. Peer support activities can change perceptions of
social norms by bringing young people together to demonstrate and accept new, healthy
behaviors. It can also help to minimize barriers to behavior change and empower target
groups to adopt and maintain a new behavior by creating a system of emotional, social, and
practical support

Interpersonal Dialogue and Reflection

Interpersonal dialogue and reflection refer to a space for young people to critically reflect on
their own beliefs, values, and behaviors, particularly in relation to existing social norms
within their reference groups and communities. It is a space that facilitates deeper processing
of new information, allows for evaluation of what is desirable and possible, and where
participants can develop new understandings to inform future behavior. Critical reflection is
enhanced through dialogue with others facing similar experiences and challenges, and by
learning and reinforcing new, positive attitudes and behaviors.

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References

Prof. Kabir Bello, Social Norms Theory and its Relevance and Application to Social Norms
Practice. Paper presentatation 7 January 2023

Parsons, T. (1951). The social system. Glencoe: Free Press.

Parsons, T. (1951) cited in Segal, A. (1976) The Sick Role Concept: Understanding Illness

Behavior. Journal of Health and Social Behavior, 162-169.

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988) Social Learning Theory and the
Health Belief Model. Health Education & Behavior, 15(2), 175-183

Sheeram, P. Abraham, C. (1996) The Health Belief Model, in: Corner, M. Norman, P. (Eds),
Predicting Health Behaviours: Research and Practice with Social Cognition Models.
Open University Press, Buckingham, pp. 23-61

Sheeram, P. Abraham, C. (1996) The Health Belief Model. Predicting Health Behaviour 2,
29-80