Department of Social and Behavioral Sciences, Institute for Health and Aging, University of California San Francisco, San Francisco, CA, United States of America.
Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
PLoS One. 2024 Nov 4;19(11):e0308249. doi: 10.1371/journal.pone.0308249. eCollection 2024.
Restrictive gender norms exacerbate health inequalities all over the world. More specifically, they prevent women from seeking preventive health services, constrain women's economic empowerment, and are associated with reproductive health decision making. Gender norms, a subset of social norms, are dynamic and change over time. However, we lack data on how they are changing and how these changes affect health outcomes because current measures do not adequately capture the complex concept of gender norms.
We originally developed and validated a gender norms scale, the G-NORM, in India. In this study, using cross-sectional data, we adapted the G-NORM from Southeast Asia (India and Nepal) to sub-Saharan Africa (Uganda) in four steps: 1. Formulation of new scale items (via qualitative analysis) 2. Cognitive Interviewing 3. Questionnaire Administration (n = 2422 women of reproductive age) and 4. Psychometric analysis (Confirmatory Factor Analysis).
Like the original scale, descriptive norms and injunctive norms comprised two unique sub scales with high Cronbach's alphas (.80 & .92). Average scores differed depending on the type of norm suggesting that some gender norms are changing faster than others. Specifically, more equitable injunctive norms were associated with lower odds of partner-dominated contraceptive decision making but descriptive norms were not.
Gender norms serve as a multi-faceted determinant of health and wellbeing and require measurement tools which account for their conceptual complexity. Validating the G-NORM in Uganda expands measurement options for researchers in the sub-Saharan African region working to change norms to reduce health inequalities or to understand the gender normative context before beginning a study.
限制性别规范在全球范围内加剧了健康不平等。具体来说，它们阻止妇女寻求预防保健服务，限制妇女的经济赋权，并与生殖健康决策有关。性别规范是社会规范的一个子集，是动态的，随时间而变化。然而，我们缺乏关于它们如何变化以及这些变化如何影响健康结果的数据，因为当前的衡量标准不能充分捕捉性别规范这一复杂概念。
我们最初在印度开发并验证了性别规范量表 G-NORM。在这项研究中，我们使用横断面数据，通过四个步骤将 G-NORM 从东南亚（印度和尼泊尔）改编到撒哈拉以南非洲（乌干达）：1. 制定新的量表项目（通过定性分析）；2. 认知访谈；3. 问卷调查（n = 2422 名育龄妇女）；4. 心理测量分析（验证性因素分析）。
与原始量表一样，描述性规范和指令性规范由两个具有高克朗巴赫α系数（分别为.80 和.92）的独特子量表组成。平均得分因规范类型而异，这表明一些性别规范变化得比其他规范更快。具体来说，更公平的指令性规范与伴侣主导的避孕决策的较低可能性相关，但描述性规范则不然。
性别规范是健康和幸福的一个多方面决定因素，需要衡量工具来解释其概念的复杂性。在乌干达验证 G-NORM 扩大了撒哈拉以南非洲地区研究人员的测量选择，这些研究人员致力于改变规范以减少健康不平等，或在开始研究之前了解性别规范的背景。
