Recent research calls for the sexual and reproductive rights field to prioritize changing gender norms to ensure that women can act on their reproductive rights. However, despite this professed commitment to global gender equality, there still remains a notable gap in accepted methodologies for measurement and data. We sought to resolve this issue by addressing important missing theoretical components of gender norms measures, including differentiating between descriptive and injunctive norms and adding a referent group. Our team originally developed and validated The Gender Norms (G-NORM) scale in India. In this paper, we describe how we subsequently adapted and validated it in Nepal. After analyzing qualitative data, we administered all items to women of reproductive age. We conducted psychometric testing including exploratory factor analysis, confirmatory factor analysis, and construct validity- associations with theoretically relevant scales. Like the original G-NORM, exploratory factor analysis showed a two-factor structure, descriptive norms and injunctive norms, with high alphas for both subscales (0.92, 0.89). Fit statistics showed that our model fit the data well and as hypothesized, more equitable gender norms were associated with having higher scores on the decision-making scale, increased odds of intending to use family planning, and older ideal age at marriage. These findings can contribute to greater theoretical consistency in the social norms literature, provide an improved measure of gender norms in Nepal, and add to the body of evidence that gender norms are critical to consider for both agency and reproductive health outcomes.

Health care providers are critical to quality service delivery. In addition to delivering SBC interventions, they are increasingly targeted by interventions to support compliance with good practice. However, SBC remains under-explored as an approach to improve providers' experience in service delivery and respond to their priorities, which can have direct and indirect effects on quality of care. Innovative behavioral solutions require nuanced understanding of the provider's experience, including the psychological and contextual drivers shaping their choices and the influence of time and resource constraints on factors such as perceived agency, motivation, and task prioritization. We have applied the behavioral design approach to health provider behavior across a variety of contexts, developing tailored solutions through collaborative and iterative design and testing processes with providers and other stakeholders. This presentation will include examples related to malaria diagnosis and treatment, prevention and management of postpartum hemorrhage, provision of respectful maternity care, and care for childhood illnesses. Several cross-cutting behavioral insights have emerged from our work which directly informed the design of innovative and context-specific solutions. These tested solutions aim to make it easier for providers to comply with clinical protocol, minimize the perceived trade-offs of adherence, provide alternatives to further their goals, and to build empathy and alleviate pressures. Behavioral solutions have the potential to not only improve quality of care, but also to address elements of the provider experience that can contribute to burnout and low motivation, thereby strengthening the capacity and resilience of the health workforce.

Village workers, such as nutritionist-dietitians and health volunteers, are a pillar of the country's zero-hunger initiatives. However, while their roles and responsibilities are well considered in research, programming, and policymaking, their emotional and psychological wellbeing are less understood. In 2021, WFP Philippines evaluated these determinants as part of a broader program in social and behavior change communication. The SBCC project targeted nine groups, including key stakeholders, such as village workers. These workers are the focus of this abstract. From four municipalities with known chronic malnutrition, 15 workers were purposively invited for in-depth interviews, in-person or over the phone. To explore if and how their thoughts and feelings about public service might be linked to how they experience their work in the field, thematic analysis examined relationships among possible themes and clusters of possible meanings. Two themes emerged. For one, village workers described persistent emotional and psychological exhaustion as well as feelings of neglect or being left behind. For another, this burnout appeared linked to their negative views of behavior change among the families they helped. Village workers are especially essential. However, despite evidence that emotional and psychological wellbeing indeed have sizable impact on job performance and job satisfaction, there remains an overemphasis on developing skills in how to do job and less on how workers experience that job. Emotions and empathy have a role in programming and policymaking but, as evidenced by these interviews, are neglected. 

Provider attitudes limiting family planning (FP) provision to certain groups, such as unmarried or nulliparous women have been found in a variety of settings, inhibiting informed choice and contraceptive access when acted upon. Factors such as providers' personal values, cultural norms, empathy for clients, and perceptions of their role as providers can shape provider attitudes toward clients or services. This study sought to understand whether healthcare provider attitudes across three domains: 1) perceptions of their roles as providers, 2) perceptions of their clients, and 3) gender norms are related to beliefs about FP provision. A cross-sectional survey was conducted with 52 family planning providers sampled from urban health facilities in Togo. Provider attitudes, based on three subscales developed under the Breakthrough RESEARCH project, were assessed. Beliefs regarding obligations of FP service provision were also assessed based on agreement with statements such as, "I should NOT have to provide family planning service to unmarried women and girls." Univariable and multivariable linear regressions of FP attitudes on each provider attitude subscale, adjusting for provider gender, years of experience as a provider and at the facility, training, and managerial status, were conducted. Favorable/equitable provider attitudes related to perceptions of their professional roles, their clients, and gender norms, were significantly associated with more equitable FP service provision beliefs. Provider behavior change programming should seek to address other influences on providers, such as gender norms, attitudes about clients, and explore norms in provider training and management.