A proposed model to explain the drivers of behaviour change
In this section, we will introduce key aspects of the author’s research efforts (see note 1). The goal is to enrich the ongoing discourse in Sudan, providing new insights and strategies for understanding how individuals and communities change their behaviours. The objective is not only to expand the theoretical understanding of behaviour change but also to offer actionable, evidence-based strategies for organisations working in Sudan.
As campaigns against FGM/C evolve, it is essential to address the underlying social, cultural, and institutional factors that sustain the practice, while also recognising the complexities that drive its persistence. To address this gap, this study employs a novel approach by analysing the factors believed to influence the adoption of FGM/C abandonment, guided by four key questions. First, can the abandonment of FGM/C be sustained in communities where the practice is deeply embedded? Second, what are the most influential factors in prompting behavioural change? Third, which variables are most significant in accelerating the transformation towards abandonment? And finally, how can these insights inform more effective strategies for promoting the elimination of FGM/C? Through answering these questions, this chapter aims to provide valuable insights into the promotion of FGM/C abandonment. It moves beyond surface-level health messaging to delve into the underlying motivations and social pressures that drive communities to either continue or abandon the practice.
Models and theories related to behaviour change are grounded in extensive research, rigorously validated through scientific inquiry, and built upon established frameworks of epistemology, ontology, and methodology. These theoretical foundations have long served as tools to explain and predict how individuals alter their behaviours, particularly when it comes to deeply ingrained cultural practices. However, despite their proven utility, such models have been underutilised by those currently working to address the challenges of FGM/C in affected communities. The literature on this subject reveals a clear gap: these robust theoretical models have not been adequately applied in the practical efforts aimed at combating FGM/C. This oversight represents a missed opportunity to leverage established knowledge to guide more effective interventions and strategies for behavioural transformation.
The Decomposed Theory of Planned Behavior
This theory (DTPB for short) is an evolved version of Ajzen’s original Theory of Planned Behavior, as proposed by Taylor and Todd in 1995. While Ajzen’s theory (1991) provides a foundational framework for understanding the factors that shape our intentions to engage in specific behaviours, DTPB offers a more nuanced and comprehensive view. By disaggregating the primary influences into more detailed dimensions, DTPB enhances our understanding of how belief structures interact with behavioural intentions.
One of the key benefits of DTPB is its ability to clarify and deepen the relationships between the factors that influence intention. This refinement enables researchers and practitioners to pinpoint the specific beliefs that are most relevant to particular behaviours, making the model versatile and applicable across a wide range of contexts. Furthermore, the DTPB offers practical insights for designing and implementing strategies that promote the adoption and practice of desired behaviours (Taylor and Todd 1995).
Drawing from the model’s key principles, seven factors were identified that are particularly relevant to the abandonment of harmful practices like FGM/C. These are the facilitating conditions provided by intervention programmes that facilitate the adoption of a specific behaviour (Ajzen 1991); subjective norms within communities; perceived ease of adopting alternative behaviours; perceived usefulness of those behaviours; the influence of peers; the impact of superiors or authority figures; and the individual’s intention to change. Each of these factors plays a pivotal role in reshaping mindsets and fostering the abandonment of practices such as FGM/C. Through the lens of these elements, it becomes clear how social, environmental, and psychological forces converge to drive change within communities.
To test the relevance and validity of these factors in the Sudanese context, the DTPB model was applied to a sample of 600 cases from the Khartoum locality. Quantitative data for this study were obtained through a structured questionnaire featuring closed-ended questions, while qualitative data were gathered using semi-structured interviews. This mixed-methods approach facilitated the triangulation of findings, offering a more comprehensive and nuanced understanding of the complex social and cultural dynamics influencing the abandonment of FGM/C. The questionnaire was distributed to 600 participants, ensuring a diverse representation of individuals across different genders and age groups, ranging from twenty to eighty years. To ensure optimum representation, illiterate respondents received assistance from trained survey interviewers to help them complete the questionnaire. The interviewers took care to avoid influencing the respondents’ answers, ensuring that the collected data remained unbiased and genuine. Including illiterate individuals is particularly important, as they often represent key family members, such as grandfathers and grandmothers, who play a significant role in decision-making around practices like FGM/C. In Sudan, the perspectives of illiterate individuals, particularly within certain age groups, have considerable influence over family decisions, making their input crucial for gaining a comprehensive understanding of cultural practices. From the 600 distributed questionnaires, 517 were fully completed, yielding a notably high response rate of 86 per cent.
The questionnaire was carefully designed with eight sections to capture key variables for developing the FGM/C abandonment model, based on the DTPB framework. It addressed factors such as awareness campaigns, perceived ease and benefits of abandonment, subjective norms, peer and community influence, intentions, and actual behaviours related to FGM/C cessation. Responses were collected using a six-point Likert scale, enabling detailed analysis.
The findings from this study provide valuable insights into the psychological and social drivers that can foster meaningful change within communities. By understanding and addressing these drivers, we can better tailor our interventions to target the specific beliefs, social pressures, and perceived barriers that perpetuate the practice of FGM/C.
Figure 7.1 illustrates the variables hypothesised to predict the intention to adopt FGM/C abandonment. These variables – drawn from the DTPB – serve as the foundation for developing the structural equation model employed in this study. The specific components of the variables were carefully selected from the array of DTPB of Taylor and Todd (1995) to align with the case study presented here, ensuring that the model accurately reflects the unique cultural and social dynamics surrounding the issue under investigation.
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Figure 7.1. Measurement model: Hypothesised relationships influencing FGM/C abandonment. 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If other components are to use this menu script, we need to remove references to specific elements such as ʼ.stalker-menuʼ.*/ function hideAnchorMenus(menuElement) { if (menuElement != undefined) { menuElement.addClass(“not-visible”); menuElement.find(“.iosanchorcontrols-subviewopen”).removeClass(“iosanchorcontrols-subviewopen”); menuElement.removeClass(“iosanchorcontrols-subview”); menuElement.find(“.iosanchorcontrols-subview”).removeClass(“iosanchorcontrols-subview”); menuElement.find(“.childviewopen”).removeClass(“childviewopen”); $(“.stalker-menu”).offset( { left: -300 } ); } else { $(“.iosanchorcontrols-menu”).addClass(“not-visible”); $(“.iosanchorcontrols-subviewopen”).removeClass(“iosanchorcontrols-subviewopen”); $(“.iosanchorcontrols-subview”).removeClass(“iosanchorcontrols-subview”); $(“.childviewopen”).removeClass(“childviewopen”); $(“.stalker-menu”).offset( { left: -300 } ); } } $(document).ready(function() { // Handle when to close the anchor menu $(document).on(ʼclickʼ, function(event) { if ( $(event.target).is(“.trigger-close-iosanchorcontrols-menu”) ) { // Hide the menus and remove any temporary pins. hideAnchorMenus( $(event.target).parent(“.iosanchorcontrols-menu”) ); } }); // Handle opening a sub-menu of the anchor menu $(“.has-menu”).click(function(e) { e.preventDefault(); $(this).parents(“.iosanchorcontrols-menuitem.iosanchorcontrols-subviewopen”).removeClass(“iosanchorcontrols-subviewopen”); $(this).parents(“.iosanchorcontrols-menuitem.childviewopen”).removeClass(“childviewopen”); $(this).parent().addClass(“iosanchorcontrols-subviewopen”); $(this).parents(“.iosanchorcontrols-menuitem”).addClass(“childviewopen”); $(this).parents(“.iosanchorcontrols-menu”).addClass(“iosanchorcontrols-subview”); }); // Handle coming back out of a sub-menu of the anchor menu $(“.iosanchorcontrols-back .iosanchorcontrols-link”).click(function(e) { e.preventDefault(); $openView = $(this).closest(“.iosanchorcontrols-menuitem”); $openView.removeClass(“iosanchorcontrols-subviewopen”).removeClass(“childviewopen”); $newOpenView = $openView.closest(“.childviewopen”); if ( $newOpenView.length > 0 ) { $newOpenView.addClass(“iosanchorcontrols-subviewopen”); } else { $(“.iosanchorcontrols-menu”).removeClass(“iosanchorcontrols-subview”); } }); $(“.action-group”).click(function() { $(this).find(“.iosanchorcontrols-menu”).removeClass(“not-visible”); }); $(“.contains-anchorcontrols-menu”).click(function() { $(this).find(“.iosanchorcontrols-menu”).removeClass(“not-visible”); }); // close document.ready });.stalker-menu { display: block; position: absolute; min-width: 225px;/* uncomment for animated stalker menu -webkit-transition: all 0.5s ease 0s; transition: all 0.5s ease 0s;*/}.not-visible { opacity: 0; left: -2000px!important;/* uncomment for animated stalker menu -webkit-transition: all 0.5s ease 0s; transition: all 0.5s ease 0s;*/}.action-group .iosanchorcontrols-menu { position: absolute; left: -200px; top: 60px; text-align: left;}@media only screen and (max-width: 479px) { .stalker-menu, .action-group .iosanchorcontrols-menu { position: fixed; /* instead of this override - just turn off repositioning Menu in mobile */ top: auto!important; left: 0!important; } .stalker-menu.not-visible, .iosanchorcontrols-menu.not-visible { left: -500px!important; }}$(document).ready(function() {;(function ( window, document, undefined ) { var $OffcanvasContainers = $(“.overlay, .offcanvas”); $OffcanvasContainers.attr(“tabindex”, “-1”); $OffcanvasContainers.attr(“aria-hidden”, “true”); })( window, document );});div.ui-datepicker { z-index: 9999!important;}ul.ui-autocomplete { background-color: white; width: 200px; list-style-type: none; padding: 0px; margin: 0px; cursor: pointer; border-color: black; border-style: solid; border-width: 1px; font-family: arial; font-size: 11px; list-style-type:none; overflow: hidden; z-index: 999 !important;}ul.ui-autocomplete li { padding: 4px; z-index: 999;}ul.ui-autocomplete li a { text-decoration: none; color: black;}ul.ui-autocomplete li a:hover { text-decoration: underline; color: black;}.ui-helper-hidden-accessible { display: none;}body { padding-top: 0;} Login to Boydell & Brewer User name: Password: $(document).ready(function() {$(“input.ioslogin”).keydown(function(event) {if (event.keyCode == 13) {document.getElementById(ʼlibriosloginbuttonʼ).click();return false;}});}); Forgot password $(document).ready(function() { // hide any validation messages when clicking back in the form $(“.login-form”).click(function() { $(“.info”).hide(); }); $(“#libriosusername”).attr(“placeholder”, “Enter your username”); $(“#libriospassword”).attr(“placeholder”, “Enter your password”); }); .overlay-login { z-index: 9999; } .overlay-login span.iosusername, .overlay-login span.iospassword { font-size: 30px; /* constant */ line-height: 20px; /* constant */ margin: 0 -100px; padding: 0 0 0 100px; background-color: #FFFFFF; position: relative; } .overlay-login span.iosusername label, .overlay-login span.iospassword label { display: none; } .overlay-login span.iosusername:before, .overlay-login span.iospassword:before { position: absolute; top: 20px; left: 100px; color: #444444; } .overlay-login span.iosusername input, .overlay-login span.iospassword input { width: 110%; width: calc(100% + 100px); font-size: 1.5rem; border: none; border-top: 1px dashed #E3E3E3; color: #666666; 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};}$(document).ready(function(){// for browsers that dont support placeholder textif(!Modernizr.input.placeholder) { $(ʼ[placeholder]ʼ).focus(function() { var input = $(this); if (input.val() == input.attr(ʼplaceholderʼ)) { input.val(ʼʼ); input.removeClass(ʼplaceholderʼ); } }).blur(function() { var input = $(this); if (input.val() == ʼʼ || input.val() == input.attr(ʼplaceholderʼ)) { input.addClass(ʼplaceholderʼ);input.val(input.attr(ʼplaceholderʼ)); } }).blur(); $(ʼ[placeholder]ʼ).parents(ʼformʼ).submit(function() { $(this).find(ʼ[placeholder]ʼ).each(function() {var input = $(this);if (input.val() == input.attr(ʼplaceholderʼ)) { input.val(ʼʼ);} }) });}// for browsers that dont support the date input typeif (!Modernizr.inputtypes[ʼdateʼ]) { $(ʼinput[type=date]ʼ).datepicker({dateFormat:ʼyy-mm-ddʼ});} /*$(“.hasDatepicker”).each(function() { var $dateElementParent = $(this).parent(); if ( $dateElementParent.length > 0 ) { $dateElementParent.addClass(“date-picker”); }});*/});;(function ( window, document, undefined ) { if ( $(“.search-results”).length > 0 ) { var classList = document.getElementsByClassName(ʼsearch-resultsʼ)[0].className.split(/\s+/); 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}});});(function(){function x(b,a,c){if(b){if(a.element_.classList.contains(a.CssClasses_.LIB_JS_RIPPLE_EFFECT)){var d=document.createElement(“span”);d.classList.add(a.CssClasses_.LIB_RIPPLE_CONTAINER);d.classList.add(a.CssClasses_.LIB_JS_RIPPLE_EFFECT);var l=document.createElement(“span”);l.classList.add(a.CssClasses_.LIB_RIPPLE);d.appendChild(l);b.appendChild(d)}b.setAttribute(“href”,”#LibPanel_”+a.instanceRef_+”_”+c.toString());0==c&&b.classList.add(a.CssClasses_.ACTIVE_CLASS);b.addEventListener(“click”,function(d){”#”===b.getAttribute(“href”).charAt(0)&&(d.preventDefault(),d=b.href.split(“#”)[1],d=a.element_.querySelector(“#”+d),a.resetTabState_(),a.resetPanelState_(),b.classList.add(a.CssClasses_.ACTIVE_CLASS),d.classList.add(a.CssClasses_.ACTIVE_CLASS))})}}var e={upgradeDom:function(b,a){},upgradeElement:function(b,a){},upgradeElements:function(b){},upgradeAllRegistered:function(){},registerUpgradedCallback:function(b,a){},register:function(b){},downgradeElements:function(b){}},e=function(){function b(b,a){for(var d=0;d<k.length;d++)if(k[d].className===b)return”undefined”!==typeof a&&(k[d]=a),k[d];return!1}function a(b){b=b.getAttribute(“data-upgraded”);return null===b?[””]:b.split(“,”)}funct”/> Note: H1 through to H11 represent the hypotheses proposed by the researcher, which are detailed in the following sections. The numbers of each table or figure reflect the chapter number (7) followed by the sequential number of the figure in the chapter (e.g. 1).
From the array of factors of the DTPB figure, seven key constructs were selected based on their assumed influence on the adoption of the new behaviour of abandoning FGM/C. These factors were facilitating conditions, subjective norms, perceived ease of use, perceived usefulness, peer influence, superior influence, and behavioural intention to abandon FGM/C. Each of these variables was integrated into the development of a structural equation model designed to assess the relative influence of each variable on the actual behaviour of abandoning FGM/C. The developed model allows for a comprehensive analysis of how these elements interact to shape the decision-making process within affected communities, providing valuable insights into the drivers of behaviour change. The ultimate goal of this model is to determine the magnitude of each factor’s impact on the adoption of FGM/C abandonment. By doing so, it will offer a clear roadmap for practitioners, policy makers, and organisations working towards FGM/C eradication.
The key focus is on the role of facilitating conditions – resources within awareness programmes that educate communities about the health risks of FGM/C. This includes factors such as the programme’s accessibility, clarity, comprehensibility, and the effectiveness of the messages conveyed. These programmes are considered ‘cognitive instrumental influencers’, helping individuals comprehend the importance of abandoning FGM/C.
The study hypothesises that facilitating conditions influence subjective norms, perceived ease of use, and perceived usefulness, which in turn affect the intention to abandon FGM/C. Key hypotheses include:
Facilitating conditions positively impact subjective norms (H1).
These conditions influence the perceived usefulness (H2) and ease of use (H3) of abandoning FGM/C. Perceived ease of use positively affects the perceived usefulness (H6).
Perceived usefulness influences the intention to abandon FGM/C (H7).
Facilitating conditions also directly affect perceived usefulness and ease of use (H4, H5).
The study also investigates peers’ influence (H9) and superiors’ influence (H8) on behavioural intention to abandon FGM/C. It posits that peers’ socialisation and authoritative figures (e.g. community leaders) play a critical role in shaping individuals’ decisions, either reinforcing or challenging FGM/C practices.
Additionally, subjective norms – societal expectations – are highlighted as major factors influencing behaviour (H2), particularly in culturally sensitive areas like FGM/C. The research suggests that interventions targeting these social pressures can be effective in promoting behavioural change.
Finally, the study explores the relationship between behavioural intention and actual behaviour (H11), hypothesising that strong behavioural intentions lead to actual abandonment of FGM/C. Overall, the research aims to provide a comprehensive framework for understanding and influencing the complex behaviours surrounding FGM/C, with a focus on integrating social influence and perceived benefits into intervention strategies.