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      Youth Experiences with Social Norms Feedback: Qualitative Findings from The Drug Prevention Trial the GOOD Life

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          Abstract

          Background: Normative feedback is an intervention strategy commonly used in drug prevention programmes. This study collected process evaluation data about how programme recipients engage with social norms (SN) feedback in The GOOD Life intervention and how they experience it. Methods: Eight focus group interviews were conducted with a total of 44 adolescents (pupils aged 14–16 years) who have participated in the social-norms-based intervention The GOOD Life. The interviews focused on three topics: (1) interest in and impact of the intervention; (2) perception of the intervention elements; and (3) suggestions for improvement of The GOOD Life. They were transcribed and analysed with content analysis. Results: The analysis revealed that The GOOD Life motivated pupils to re-evaluate their own drug use behaviour and overall met their interest regarding receiving engaging and non-moral forms of drug prevention programmes. While pupils perceived the normative feedback session in the classroom and the posters with SN messages as positive, stimulating and surprising, the web-based application with SN feedback was rarely used and less positively evaluated. Anonymity and confidentiality were regarded as essential to provide honest answers in the poll. The pupils suggested even more variety in ways to engage them and to use more gaming elements. Conclusions: SN feedback was well perceived by adolescents. The intervention met their interest and needs and was able to achieve the intended impact of challenging norm perceptions. Anonymity and confidentiality are key in order to build trust and engage adolescents in the intervention.

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          Changing Norms to Change Behavior.

          Providing people with information about the behavior and attitudes of their peers is a strategy commonly employed by those seeking to reduce behavior deemed harmful either to individuals (e.g., high alcohol consumption) or the collective (e.g., high energy consumption). We review norm-based interventions, detailing the logic behind them and the various forms they can take. We give special attention to interventions designed to decrease college students' drinking and increase environment-friendly behaviors. We identify the conditions under which norm information has the highest likelihood of changing the targeted behavior and discuss why this is the case.
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            Effective ingredients of school-based drug prevention programs. A systematic review.

            Drug prevention in schools is a top priority in most Western countries and several well-designed studies have shown that prevention programs have the potential of reducing drug use in adolescents. However, most prevention programs are not effective and there are no general criteria available for deciding which program is effective and which is not. In this systematic review of the literature, the current scientific knowledge about which characteristics determine the effectiveness of drug prevention programs is examined. Three types of studies are reviewed: meta-analyses (3 studies were included), studies examining mediating variables of interventions (6 studies), and studies directly comparing prevention programs with or without specific characteristics (4 studies on boosters, 12 on peer-versus adult-led programs, and 5 on adding community interventions to school programs). Seven evidence-based quality criteria were formulated: the effects of a program should have been proven; interactive delivery methods are superior; the "social influence model" is the best we have; focus on norms, commitment not to use, and intentions not to use; adding community interventions increases effects; the use of peer leaders is better; and adding life skills to programs may strengthen effects.
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              A Critical Appraisal of the Social Norms Approach as an Interventional Strategy for Health-Related Behavior and Attitude Change

              The Social Norms Approach is a widely used intervention strategy for promoting positive health-related behaviors. The Approach operates on the premise that individuals misperceive their peers’ behaviors and attitudes, with evidence of under- and over-estimations of behaviors and peer approval for a range of positive and negative behaviors respectively. The greater these misperceptions, the more likely an individual is to engage in negative behaviors such as consuming heavier amounts of alcohol and other substances and reduce positive behaviors such as eating healthily and using sun protection. However, there are many complexities associated with the use of social norms feedback in interventions and empirical studies. Many social norms interventions do not attempt to change misperceptions of social norms or measure changes in normative perceptions pre- and post-intervention. This has led to a conflation of generic social norms interventions with those that are explicitly testing the Approach’s assumptions that it is misperceptions of peer norms which drive behavior. The aim of the present review was to provide a critical appraisal of the use of the Social Norms Approach as an intervention strategy for health-related behaviors, identify the current issues with its evidence base, highlight key opportunities and challenges facing the approach, and make recommendations for good practice when using the approach. There are three core challenges and areas for improved practice when using the Social Norms Approach. Firstly, improvements in the methodological rigor and clarity of reporting of ‘social norms’ research, ensuring that studies are testing the approach’s assumption of the role of misperceptions on behaviors are differentiated from studies investigating other forms of ‘social norms.’ Secondly, the need for a more explicit, unified and testable theoretical model outlining the development of normative misperceptions which can be translated into interventional studies. Finally, a need for a more robust evaluation of social norms interventions in addition to randomized controlled trials, such as the inclusion of process evaluations, qualitative studies of participant experiences of social norms feedback, and alternative study designs better suited for real-world public health settings. Such improvements are required to ensure that the Social Norms Approach is adequately tested and evaluated.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                04 May 2020
                May 2020
                : 17
                : 9
                : 3200
                Affiliations
                [1 ]Institute of Health and Nursing Science (IGPW), Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
                [2 ]Unit for Health Promotion Research, University of Southern Denmark, 6700 Esbjerg, Denmark; satakjaer@ 123456health.sdu.dk (S.L.K.); bmrasmussen@ 123456health.sdu.dk (B.M.R.)
                [3 ]Centre for Alcohol and Drug Research, Aarhus University, 8000 Aarhus, Denmark; lvh.crf@ 123456psy.au.dk
                Author notes
                Author information
                https://orcid.org/0000-0001-9379-3844
                https://orcid.org/0000-0001-5118-563X
                Article
                ijerph-17-03200
                10.3390/ijerph17093200
                7246615
                32375420
                d057cab6-3bd7-477c-a30c-a2e6061bd8ba
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 31 March 2020
                : 01 May 2020
                Categories
                Article

                Public health
                social norms,normative feedback,drug use,focus group,qualitative research,adolescents
                Public health
                social norms, normative feedback, drug use, focus group, qualitative research, adolescents

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