Behavior change using social norms: Does the popular opinion leader intervention work in LMICs?

The popular opinion leader (POL) intervention aims to increase safe sex norms among a target population. It is based on the diffusion of innovation theory, which predicts that an idea can spread through a population or social system and be adopted by the social system. This idea then becomes a social norm, which in turn may influence behaviors. The POL intervention can be tailored to specific groups, which allows the challenges for the group to be addressed directly. This intervention has been implemented in populations such as male sex workers, migrant MSM (men who have sex with men), and women. The POL intervention was originally designed for MSM and tested in the United States among white men. The positive results in the United States have led some to try the intervention in other countries.

Among the included studies in our ongoing rapid systematic review of social norms-based interventions, we found two studies that evaluate POL interventions implemented in low- and middle-income countries (LMICs). Caceres et al. (2010) report the results of a multi-country evaluation (China, India, Peru, Russia and Zimbabwe), while Duan et al. (2013) evaluate a different POL implementation in China. The interventions utilize POLs in similar ways, so we review them together in this post.