by Betsy Hinchey (Fall 2016) & Caitlin Gillespie (Spring 2015)
The normative/re-educative approach describes how individuals make decisions based on their culture and values, not rational reasoning. The theory suggests that people are motivated to conform to what they believe are societal standards or typical behaviors – “norms” – and therefore, their beliefs about societal norms influence their behavior. These “normative beliefs” consist of an individual’s expectation of whether or not people who are important to him will approve or disapprove of a particular behavior (1). A re-educative intervention would attempt to change behavior by changing an individual’s normative beliefs. For example, community health workers could attempt to change the beliefs of people in the community regarding health practices, such as when to seek care at a clinic, by expressing approval and slowly recruiting supporters until there are more people that approve of care-seeking behavior than disapprove. Once a person acquires knowledge of new norms (such as when to seek care at a clinic), then she is motivated to change her own actions in order to belong to her society (2).
Origins of the Theory:
Social psychology has explored social norms for over a century, beginning with LeBon’s “contagion effect”, which explains that people in a crowd are influenced by the behavior of others in that crowd (3). The idea of normative beliefs emerged in 1980 with Fishbein’s publication of “Theory of Reasoned Action”, which states that a person’s behavior is derived not just from his intentions but also the beliefs of the culture (3). Nicholas Hobbes, a prominent psychologist, added to this with his “Re-Education” program to help youth with behavioral disorders by emphasizing personal strengths as opposed to focusing on disease or weakness (3). Finally, Kenneth Benne and Robert Chin officially developed the “Normative Re-education Theory” in a series of papers on planned change in 1976 (4). Ever since, the theory has been a widely accepted management theory, along with three other prominent planned change theories – empirical/rational, power/coercive, and environmental/adaptive.
Application to Global Health:
Normative Re-education is most effective in producing behavior change when the behavior stems from emotional or value-based motivation, and community-level health workers or volunteers are often the most effective at leading the change, as discussed above. However, this approach can also be applied to produce behavior change among the community health workers themselves. For example, through a combination of formal interventions (such as supervision, trainings, and incentives) and informal interventions (such as mentoring, leadership, and community engagement), an organization could build motivation within community health volunteers to serve their community according to high quality standards. In Jordan, many community health volunteers (CHVs) are hesitant to provide care to Syrian refugees because their Jordanian community is not accepting of the refugees and does not believe that they deserve aid, and therefore, the CHVs are following community norms when they do not reach out to Syrian families. However, currently NGOs are leading re-education efforts of CHVs so as to reduce their stigma of Syrian refugees. The International Rescue Committee attempts to change this normative belief among its CHVs through regular trainings, the integration of Syrian refugees as CHVs, and creative team-building exercises (5). This re-education creates a new culture of acceptance and motivation that helps to improve CHV behavior towards new Syrian community members. Then, after the CHVs have changed their normative beliefs about how to treat Syrian refugees, they can be utilized to change the beliefs of Jordanian community members, again using the normative/re-educative approach, in order to change stigmatizing behavior. This process is depicted in Figure 1.
Figure 1. Cycle of change through the normative/re-educative approach among CHVs
The Normative/Re-educative Approach has five main limitations:
- This approach is best for long-term interventions because cultures (and subsequent normative beliefs) take a long time to change. Interventions therefore cannot expect behavior to change quickly.
- There are many people and organizations – both formal and informal – that influence normative beliefs, and thorough re-educative interventions would need to address all of these factors that influence culture. If the formal and informal organizations surrounding an individual are at odds with each other, then the a re-educative strategy will be very difficult (6).
- The approach’s ability to produce behavior change relies on the fact that the individual is empowered has the freedom to act according to his or her will. This approach therefore works best when barriers to healthy behavior are individual beliefs, not environmental constraints.
- The approach could be misused and could create stigma for people who do not follow the new norm. For example, re-educative programs that discourage drug use could make current users feel stigmatized and then hide their use, instead of seeking help.
(1) U.S. National Institutes of Health. DCCPS: Health Behavior Constructs: Theory, Measurement, and Research. Bethesda: National Cancer Institute; 2008. Available from: http://cancercontrol.cancer.gov/brp/research/constructs/normative_beliefs.html
(2) Southwest Educational Development Laboratory. Facilitative Leadership: The Imperative for Change. U.S. Department of Education; 1992. Available from: http://www.sedl.org/change/facilitate/approaches.html#early3
(3) Nicholas Hobbs and the Twelve principles of Re-Education. Reclaiming Children and Youth: 2002: 72-74. Available from: https://reclaimingjournal.com/sites/default/files/journal-article-pdfs/11_2_Hobbs.pdf
(4) Quinn R, Sonenshein S. Four General Strategies for Changing Human Systems. The Nature of Organization Development: 2007.
(5) International Rescue Committee. Interview. July 2016.
(6) Nickols, F. Four Change Management Strategies. Distance Consulting LLC: 2010. Available from: http://www.nickols.us/four_strategies.pdf
Bennis W, Benne K, Chin R. The Planning of Change. New York: Holt, Rinehart and Winston; 1969.
Glossary of Psychological Terms. American Psychological Association: 2015. Available from: http://www.apa.org/research/action/glossary.aspx?tab=14
Sociological Viewpoints: The Normative Perspective. Deviance.socprobs.net; 2015. Available from: http://deviance.socprobs.net/Unit_1/Page_2.htm
Miles M, Thangaraj A, Dawei W, Huiqin M. Classic Theories – Contemporary Applications: A comparative study of the implementation of innovation in Canadian and Chinese Public Sector environments. Beijing: Beijing Petroleum Managers Training Institute; 2015.