Measuring the effectiveness of communication programming on menstrual health and hygiene management (MHM) social norms among adolescent girls in India

This manuscript has two objectives: (1) operationalise and measure the fit of two theory-based measures of social norms and (2) examine the relationship between a social and behaviour change communication (SBCC) initiative, social norms, and menstrual health and hygiene management (MHM) among rural adolescent girls in Uttar Pradesh, India. A population-based, case-comparison design was utilised. Interviews were conducted (n = 2212) using quantitative questionnaires. Social norms were operationalised in two ways: (1) a composite additive measure of self-approval, perception of other girls’ approval and perception of other girls’ practice of the desired MHM behaviour; (2) based on social restrictions. The composite measure had a better model fit, suggesting that social norms should be examined as a multi-dimensional construct with a two-way relationship between personal beliefs and injunctive and descriptive norms. Bivariate and multivariate analysis assessed the relationship between the SBCC intervention, social norms, and adequate MHM. Adolescent girls in the intervention group had more positive social norms (43.99% versus 21.11%) and those reporting positive social norms had 1.66 (95% CI: 1.33–2.09) times greater odds of being in the ‘high’ MHM practice group, indicating that SBCC interventions promoting positive social norms can impact practice of MHM.