Improving Bystander Self-efficacy to Prevent Violence Against Women Through Interpersonal Communication Using Mobile Phone Entertainment Education: Randomized Controlled Trial

"[O]bservational learning was likely one of the sources of efficacy enhancement: hearing about other women interfering to stop a violent act in progress could have communicated to...participants that they could do so, too."

Patriarchal social and gender norms suppress disclosure of violence experienced by women. When behaviours are both stigmatised and practiced extensively in society, as is the case with violence against women (VAW) in many parts of India, one has to be careful about running communication campaigns that have the potential of further driving the practice underground, as has been observed, for example, in interventions attempting to reduce female genital mutilation. Thus, this randomised controlled trial (RCT) was designed to address VAW as the distal goal by promoting bystander self-efficacy among participants in the treatment arm throughout the norms-based, 13-episode, audio-only entertainment-education (EE) programme, Rani Kuhe Kahani, delivered via phone calls in the Angul district of Odisha, India.

The mobile entertainment education intervention (mRANI) study used a 2-arm study design embedded within  the parent trial Reduction of Anemia through Normative Innovation (RANI), a cluster randomised study using social norms–based approaches to anaemia reduction (see Related Summaries, below). mRANI adopted a two-pronged strategy grounded in Carey's model of communication, approaching the issue in an incremental way. First, the researchers aimed to explore whether the Rani Kuhe Kahani intervention promoted interpersonal communication about violence against women as an initial step. Second, they examined whether the intervention improved women's self-efficacy to intervene when they witness violence in their community through interpersonal communication. The model is based on the social cognitive theory that posits that observational learning (i.e., hearing about other women interfering to stop violence) fosters self-efficacy, a proxy for behaviour change.

In total, 411 women of reproductive age were randomly assigned to the VAW intervention arm or a control arm if they were active mobile phone owners and assigned to the treatment arm (receiving social-norms intervention activities in addition to usual care) of the parent trial (RANI). Participants received 13 EE episodes (3-5 minutes each) daily as phone calls between December 2020 and January 2021. Built around a storyline of a family's journey during the COVID-19 pandemic, the plot of Rani Kuhe Kahani was developed to highlight the continuous rise of VAW in India and encourage listeners to intervene and prevent VAW within their sphere of influence using norm-based strategies. The programme set descriptive norms around VAW by depicting characters from all walks of life intervening VAW and incorporated injunctive norms by creating social expectations for the audience to act against VAW.

The programme included interactive components at 3 levels: programme-driven, audience-driven, and responsive interactions. Programme-driven strategies included jingles, episode teasers, and recaps. Audience-driven interactions were incorporated throughout the episodes using an interactive voice response (IVR) system, which allowed participants to like or replay individual episodes through voice-recognition or touch-tone keypad. The system also enabled responsive interactions that allowed listeners to take prerecorded quizzes and answer questions about character identification, engagement and satisfaction with the story, and agreement with plot themes.

The researchers further used the IVR system to collect data on process evaluation in real time. The primary endline analysis involved a structural equation model with interpersonal communication as a potential mediator on the pathway between intervention exposure and bystander self-efficacy to prevent violence against women. "Bystander self-efficacy to prevent VAW" was measured by asking participants the degree to which they agreed with the following 8 items: If I saw a woman in my community experiencing violence, I am confident I could manage the situation by banging pots and pans (i.e., distracting); by striking up a conversation to diffuse the situation (i.e., distracting); by checking in on the women after witnessing the violence (i.e., delaying); by offering her empathic and supportive words in private afterward (i.e., delaying); by recording what is happening on my phone or by taking a picture (i.e., documenting); by reporting the incident to local leaders, organisations, and authorities (i.e., documenting); by seeking help from self-help group members or influential community leaders (i.e., delegating); or by seeking help from respected elders in the family or the community (i.e., delegating). Responses were recorded on 5-point Likert scales, ranging from "strongly disagree" to "strongly agree" and averaged into an 8-item measure.

The findings from structural equation modeling demonstrated the significant mediating effect of interpersonal communication on the relationship between programme exposure and bystander self-efficacy. Exposure was positively related to interpersonal communication (β=.21, SE=.05; z=4.31; P<.001) and bystander self-efficacy (β=.19, SE=.05; z=3.82; P<.001). The partial mediation suggests that other factors were also at play in how the intervention affected self-efficacy, something beyond the scope of this study to pursue. For the researchers, these results mean:

• For potentially stigmatising (though prevalent) behaviours, it would appear to be better to adopt an incremental approach rather than a heavy-handed and intense one that can lead to counterproductive effects.
• Even though the ultimately desired outcome is to put the onus on the perpetrator not to engage in the violence, this intervention sought a different route: to change the environment where witnesses of violence deem it worthy of intervention and perceive higher efficacy to do so. Doing so, as the results seem to show, was a critical factor in changing social norms around VAW, to make violence both less prevalent (lower descriptive norms) and less acceptable (lower injunctive norms).
• The results seem to support the assumption that the efficacy to intervene could be affected by an intervention that promoted interpersonal communication about VAW to keep the issue salient in people’'s minds.

In conclusion, these "results demonstrate participant engagement in interpersonal communication following exposure to a 'light' entertainment education program with audio-only format via feature phones in rural settings can result in improved self-efficacy to prevent violence against women. This elevates the role of interpersonal communication as a mechanism of behavior change in mobile phone-based interventions, given that most entertainment education interventions tend to be mass media based...[F]indings also show the potential of changing the environment where witnesses of violence deem it worthy of intervention and perceive higher efficacy to stop violence in the community, rather than putting the onus on the perpetrator, to prevent any counterproductive effects."