Engaging Boys in Eradicating Gender-based Violence: A Pilot Study of a Promundo-adapted Program

The Brazil-based Promundo organization originated in 1997 and developed Program H to engage young men in the pursuit of gender equality. Research on Promundo and similar gender-transformative programs demonstrate that this type of intervention can significantly increase beliefs in gender equality and improve sexual health outcomes—pregnancy, safe sex practices, sexual and intimate partner violence, and STI and HIV transmission. Because Promundo has yet to be implemented in the United States, the authors worked alongside a victim service agency in the southeast United States--that has ties to Promundo--to adapt Program H for implementation with fourth grade boys. The program was piloted with a group of ten boys who attend a predominantly low-income and African-American public school. These boys were also a part of a statewide program to assist children at risk of academic failure due to poor test scores. This paper presents results of a pilot study which utilized a pre-posttest design. Assessment measures were adapted from program evaluations of Men Can Stop Rape’s Men of Strength (MOST) Clubs and include self-reported attitudes and beliefs about gender and masculinity, emotional expression and violence. Additionally, researchers conducted semi-structured qualitative interviews with program instructors. This paper concludes with a discussion of the implications of implementing such a program with this particular population. The paper also explains changes to the program that will take effect during the second program implementation in spring of 2015.

nternational public health organizations are increasingly aware of the tie between traditional gender norms and beliefs, violence, and sexual and reproductive health issues.According to a recent review of studies investigating these ties, stronger adherence to traditional conceptualizations of both masculinity and femininity influences health-related behaviors in gendered ways as well (National Council on Gender, 2012).For instance, men with more traditional attitudes are less likely to use condoms while women with more traditional attitudes are less likely to carry them or insist upon their usage.These men with traditional attitudes engage in sexual activity at earlier ages and with a higher number of partners, but are less likely to be tested for sexually transmitted infections and HIV.In addition, they are more likely to engage in forced or coerced sex and intimate partner abuse.Their female counterparts are less knowledgeable about sexual health and more likely to experience unplanned and teenage pregnancies, coercive sex, and intimate partner abuse (National Council on Gender, 2012).
Accordingly, many governmental organizations involved in preventing these health issues-especially HIV/AIDS-are increasingly requiring those they partner with and/or fund to target traditional gender beliefs in their programming.Research now suggests such programs do improve sexual health and also reduce outcomes related to sexual violence, including traditional gender attitudes (Boender, Santana, Santillán, Hardee, Greene, & Schuler, 2004;Population Reference Bureau, 2011;Ricardo, Eads, & Barker, 2011).
The World Health Organization, for instance, prefers "gender transformative" approaches (Gupta, Whelan, and Allendorf, 2002).These approaches "highlight, challenge, and ultimately change harmful gender norms and beliefs" (National Council on Gender, 2012, 2).The Interagency Gender Working Group (IGWG) of the United States Agency for International Development defines gender transformative programs as those which "actively strive to examine, question, and change rigid gender norms and imbalance of power… [as well as] encourage critical awareness among men and women of gender roles and norms" (Greene & Levack, 2010, 4).These programs have been found to be more effective on key outcomes of interest than programs that are not gender-transformative (Barker, Ricardo, & Nascimento, 2007).

I
One of the leading experts on gender transformative programming worldwide is the Brazil-based Promundo organization, which originated in 1997 to study, implement programming, and achieve policy change in the areas of gender-based violence and sexual and reproductive health.In conjunction with partnering organizations, Promundo developed Program H to engage adolescent males in the fight for gender equality.Research reveals it significantly impacts gender-equitable beliefs and sexual health behaviors (Pulerwitz, Barker, & Segundo, 2004).After implementation and validation by the Brazilian, Mexican and Indian governments, this program was included in the 2005 UNFPA and 2007 UNICEF reports, suggesting it is effective in improving attitudes regarding gender equality.Program H was also awarded a 3 o Award for Best Practices by the Pan-American Health Organization and World Health Organization (Ricardo, Nascimento, Fonseca, & Segundo, 2010) and is recommended by the National Council on Gender in the United States (National Council on Gender, 2012).
The program has yet to be implemented in the United States, however, and programs such as Promundo are rarely implemented with elementary school children.In a review conducted in conjunction with Promundo, Ricardo, Eads, and Barker (2011) discovered 21 sexual violence prevention programs implemented throughout the world to "younger teens" aged 12 to 15.There are over twice as many programs which target "older teens" aged 15 to 19 years of age.Half of the programs for younger teens are implemented in the United States, but none reportedly include children younger than age eleven and all are actually designed for implementation to seventh graders, specifically, or middle school students more generally.
In addition, virtually none of the "younger teen" programs in the United States have been shown to improve attitudes about gender roles or attitudes about women.Few actually assess change on these outcomes, however, opting instead to assess change in sexual health and sexual violence more directly (Ricardo, Eads, & Barker, 2011).The exception to this-the Wise Guys program-is primarily a pregnancy prevention program for middle and high school aged boys (Gruchow & Brown, 2011).So while the key international organizations discussed above advocate that gender transformation ought to start at an early age, and while research highlights the salience of early childhood experiences in influencing adult male attitudes (Levtov, Barker, Contreras-Urbina, Heilman, & Verma, 2014), few programs do so.This is likely because topics related to sexual activity and sexuality are considered age-inappropriate for pre-adolescent, elementary school aged boys.Programming that seeks to challenge and transform gender socialization can, however, be designed without the inclusion of sexual content.
As such, the present study adapted Promundo's Program H to focus on gender socialization, gender beliefs, and emotional expression in order to implement the program with a younger age group.Gender transformative programming has traditionally been implemented in gender-specific groups, to the criticism of some (e.g.Fleming, Lee, & Dworkin, 2014).Many organizations now advocate for gender synchronicity-uniting males and females to act as allies in the pursuit of gender equity-in program implementation (Greene & Levack, 2010).Program H can be and has been implemented in both same-sex and mixed-sex groups.Because it was originally developed for implementation with males, and because boys were deemed as more in need of gender transformative programming by school officials in the present study's implementation site, we chose to implement our adapted version of Program H to boys only.

Methods
The adapted version of Program H was implemented in seven lessons by two teachers of elementary school aged boys during the last five weeks of the school year in 2014 at an urban school in the southeastern United States.The lessons included activities designed to increase awareness of gender inequities and to help them learn how to positively deal with negative emotions.The ultimate goal was to reduce attitudes conducive to genderbased violence.Because of scheduling complications, the curriculum was taught to a single class of ten boys (aged 10 and 11 years).All were African-American, which was to be expected given that the school is 96 percent African American.While specific socio-economic data was not collected from the boys or their parents, this school is located in an impoverished area and 100 percent of its students are eligible for free/reduced meals (Department of Student Services, 2014).
These boys were placed in a single class together because they were labeled as "intervention" students who are a part of the state and school district's "Early Intervention Program."This program "is designed to serve students who are at risk of not reaching or maintaining academic grade level performance.The purpose is to provide additional instructional resources to help students who are performing below grade level obtain the necessary academic skills to reach grade level performance in the shortest possible time" (Richmond County Board of Education, 2014).Students are primarily flagged for inclusion in this program due to low scores on placement and standardized exams, such as the state's Criterion-Referenced Competency Tests (CRCTs).The program teachers also reported, however, that these boys often have problematic home lives that place them at-risk in broader ways.Problems at home manifest themselves in multiple ways, including poor academic performance, disciplinary issues at school, and governmental contact with their families via social services or law enforcement.

Intervention
The authors reviewed Promundo's Program H along with the local program partners: the school principal, the two teachers who implement the lessons, and the local rape crisis director.Seven lessons were chosen and adapted for the youth.The seven lessons included interactive activities about the violence the boys experienced in their lives; gender behaviors and expectations; the association of male "honor" and violence; being in touch with and expressing emotions; understanding and expressing anger in nondestructive ways; and conflict resolution.
The first lesson is a violence clothesline in which the young men are asked to reveal the violence they practice and the violence practiced against them.This lesson is meant to help participants think about the acts of violence they perpetrate, to take ownership for this violence, and to think about the pain that violence causes.Promundo literature makes the case that thinking about the pain caused by past acts of violence is a potential way of interrupting the victim-to-aggressor cycle of violence.The second session intends to help the boys recognize the challenges men and women face in fulfilling societal gender expectations and to understand these are not innate characteristics; rather, they vary across individuals and even change over the course of a person's life.Much of this lesson focuses on what it means to "Act like a man" and "Not act like a girl" and seeks to illustrate how ideas such as these are limiting.The importance of men and women being able to express their selves in a variety of ways is emphasized.The third lesson focuses on male honor and has the boys develop skits in which a young man's honor is called into question.Discussion centers on how to reduce tension in such situations and how real men can walk away from a fight.The fourth and fifth lessons focus on emotions.The fourth lesson focuses on identifying anger and expressing it in non-destructive, positive ways.In the lesson, teachers work with the boys on ways of expressing their anger through spoken words that share how they feel rather than by yelling or becoming aggressive and acting out in violence.Then, the fifth lesson emphasizes that emotions are normal and not bad or good but a part of being human.The point is that although it can be difficult to express certain emotion, it can be a problem to either suppress or exaggerate emotions; rather, there are positive and healthy ways to express the incredibly diverse array of emotions that humans experience.The final lesson is a fairly standard lesson on creative resolution of conflict in which role playing is used to help the boys find non-violent and culturallyappropriate ways to solve conflicts.With one exception, each of the lessons were adapted almost verbatim from two sections of Promundo's Program H: "From Violence to Coexistence" and "Reasons and Emotions" (available via Promundo's website, www.promundo.org.br).The second lesson regarding gender roles and expectations was adapted from the "Act like a man; Act like a woman" lesson available through the Interagency Gender Working Group website as well as activity seven in Promundo's Program M for women and girls.
The program began with two days of pretests and introductions.Each of the boys who had parental consent to be in the study were excused from class for approximately 20 minutes in pairs or groups of three to learn about the program and the current study, and to complete a pretest survey.The current authors (all white college professors, one male and two female) jointly sat with the boys and explained that their teacher and the Physical Education coach at the school were going to be teaching some special lessons about emotions and how girls and boys are treated.The boys were instructed that the survey asks questions that have no right or wrong answers, and that their answers would be used to understand what they learned from the program.To avoid any issues with literacy or reading comprehension, all questions were read aloud by the researchers (or, if requested, the boy himself).After all lessons were completed, the three authors returned to the school to implement posttest surveys using the same method as the pretests.
The male researcher then completed interviews with the program teachers.The interview was conducted with both teachers simultaneously and was semi-structured, consisting primarily of open-ended questions related to the teachers' perceptions of the curriculum, the success of the lessons, and the overall experience of the students.Further questions were geared towards uncovering what the teachers identify as some of the more severe challenges facing this specific group of young men and their classmates at the school.

Measures
Promundo's Gender Equity Men Scale is typically used in its program evaluations (Pulerwitz & Barker, 2008).Because of the program's focus on sexual health and sexual violence, however, most of the scale items reference sexual or dating activity.Because of a concern that such content would not resonate with the younger population of ten-year-old boys-and the added difficulty in achieving Board of Education approval to incorporate sexual content into the classroom for this age group-the GEM Scale was not utilized.Survey measures were instead adapted from those utilized by Men Can Stop Rape in evaluations of their Men of Strength clubs.These clubs are implemented with young men in junior high and high school.Program evaluation measures assess attitudes and beliefs regarding masculinity, gender norms and social responsibility, as well as intended responses to witnessing mistreatment (Anderson, 2011).Several measures are also related to beliefs in rape myths and thus have a sexual connotation and were omitted.Attitudes towards emotional expression were assessed by constructing additional items, both closed and open-ended.

Quantitative Outcomes: Self-Reported Attitudes and Beliefs
While all boys in the class were subject to the lessons, we present data on just seven boys (70 percent of program participants).Parental consent was not obtained for two of the boys and one boy was absent for the posttest.As previously mentioned, each boy was African-American in a single class of ten boys in an impoverished inner-city school in the southeastern United States.As indicated in Table 1, many of the boys gave pretest answers that fit the goal of this program.For instance, all of the boys thought girls and boys should be treated the same; over half agreed it was okay for young men to feel afraid, affectionate, sad and happy and that showing emotions is okay.However, on other questions, more than half indicated that young men should be brave, they should not back down from a fight, and that men are born to be tough and in control.More than half also indicated that their friends would think less of them if they walked away from a fight.Only 42.9 percent felt it was okay for boys to feel angry.
We performed comparison of means tests to determine whether there was a significant difference in answers to the survey questions before and after the completion of the Promundo-adapted curriculum.As Table 1 indicates, there was only one significant change over time.While less than half of the boys (42.9 percent) agreed that it was okay for boys to feel angry before the implementation of the curriculum, a full 100 percent agreed that it was okay for boys to feel angry after the curriculum.
It is important to note that the comparison of means found no other significant differences between pre-and post-test.However, some nonsignificant changes that are consistent with program goals are worth noting.On items related to general emotional expression, two more boys agreed that men should not have problems expressing their emotions and one additional boy felt it was okay for men to show their true emotions.On items more specific to particular emotions, results were less clear.One fewer boy agreed that men should not cry; one additional boy believed it was okay for boys to feel affectionate.Two additional boys felt it was not okay for boys to feel afraid and one fewer boy felt it was okay for boys to feel sad.On items related to fighting and violence, results were also mixed; one fewer boy agreed that men should not back down from a fight and one additional boy agreed that men should never hit women or girls.Only three of the seven boys agreed that young men should never hit another young man, which did not change over time.Additionally, the boys were in greater agreement that it is important for them to be ready to fight when challenged and that sometimes violence is the only way to express their feelings.Effects were also mixed for the two items regarding beliefs in gender equality (whether men and women/boys and girls should be treated the same) and for questions regarding men's dominance (being in control).While there was no change over time on whether "men are born to be tough and in control," two additional boys agreed that young men should be the ones in control; however, this could mean in control of a situation or relationship, or in control of their emotions.The latter possibility is interesting, given that the program teachers reported in their post-program interview that they spent a lot of time trying to help the boys feel it was okay for them to be honest about their feelings and emotions.(SA = Strongly Agree, A= Agree, N= Neutral, D= Disagree, SD = Strongly Disagree.)NA = Standard error of the difference is 0 so the correlation and T cannot be computed.

Qualitative Outcomes: Post-program Interviews with Program Teachers
In spite of the limited nature of this pilot research, the interview conducted with the program instructors provides some useful insights into the challenges, realities and sociological nuance involved in the larger movement to incorporate gender-transformative approaches into antiviolence programming.
The Promundo-adapted program teachers reported that lessons "went well," were "all very necessary," and were good for the boys because "lots of our kids are super-aggressive, super-competitive… [and] punch walls and shove each other a lot, in anger."The physical education teacher who was implementing the Promundo-adapted program stated: "In [physical education] class, the boys will really want to fight over a "bad" call in a game.What they really need to learn is how to react positively when in conflict, or when challenged, disrespected." In terms of the specific content of the curriculum, four lessons seem to be most potentially useful in this specific research context.These are, firstly, the third lesson which discusses walking away from a fight when honor is challenged and the related topics of pride, sport, and competition.Lessons 4, 5 and 6, which deal with positive, adaptive expression and resolution of emotions, were also especially useful.
The teachers reported that most of the participating boys felt special because of the small scale of the program implementation, but were also concerned that "until you break that wall [down], they gonna say what they think you want to hear."A desire to please or say the right thing may have been exacerbated by their status as Early Intervention Program students, since they had some history of disciplinary issues.Some may even have viewed the program as additional intervention or even somewhat of a punishment.The program teachers both spoke to this issue at different points during their post-program interviews.For instance: I sense a little bit of that [influence of the stigma of the Early Intervention Program] all the time.I do hear some of them saying "we're in a special ed class" from time to time.They do tend to sense that something is up when they are together in settings that are different than what they're used to.That can make them uncomfortable, shut them down.
The other teacher followed up on this comment by stating, "They do sense something is up when they're all together, singled out from the other students and all."He also emphasized the "need to come up with ways to make them feel safe to talk about emotions and personal issues."Teachers also reportedly felt the program and the Early Intervention Program students would benefit by including non-EIP students and students from other grade levels.Teachers also felt the program length should be extended.
Finally, the teachers made statements that suggest a broader need for anti-violence programming within the school.When asked about the scale of interpersonal violence at the school, "Coach", a veteran of the school, relayed that the most extreme scene he could recall played out just last year and broke out in the midst of a charity fundraiser.He reported that two female students started fighting and soon other boys and girls "swarmed", taking the opportunity to engage in violence as well.

Discussion
Overall, self-reported data from surveys reveal only one significant change over time: boys were more likely to agree it was okay to feel angry.There were a number of mixed effects regarding emotional expression, gender equality, and fighting and violence, though all were statistically insignificant.Many of these insignificant effects were, however, in a positive direction in line with program goals.
Results from interviews with the program teachers suggest they feel the program has value because the lessons are appropriate for the needs of students at the school.Teachers also discussed the possibility that some of the participants may have felt a need to, as their teacher explained, "say what they think you want to hear."This may have been a particular issue at pretest when the program was unfamiliar, which could be a reason for the mixed and insignificant outcomes.However, it should be noted that the sample size for this pilot study is extremely small and thus significant differences are difficult to detect in the first place.
Teachers also hinted at girls' enactment of violence, though.If the ultimate goal is indeed the construction, implementation, and fluid evaluation of a program that actually gives children the tools they need to live lives of peace and gender equality, by reducing attitudes which perpetuate the cycle of violence, then these data suggest the critics (Fleming, Lee, & Dworkin, 2014) have a point.Broader efforts should include girls as well.Moreover, because the current data also suggest diversity within program participants would be of value, gendertransformative programs should promote inclusivity in many ways, to be inclusive of children with myriad identity factors---gender identity, religion, socioeconomic status, sexual orientation, and ethnicity among them.

Future Directions
In line with the results of this pilot study, the research team and local rape crisis director (who is consulting and funding the program) made several modifications in advance of the spring 2015 implementation.Firstly, the program will be implemented with a larger and more varied group of fourteen boys.Half will be in fourth grade and half in fifth grade.These boys will be from different classes throughout the school and are not all involved in the Early Intervention Program.The students were selected after program teachers solicited recommendations from administrators and additional fourth and fifth grade teachers.Two of the fourth graders and two of the fifth graders were rated by teachers to have high disciplinary problems; similarly two fourth and two fifth grade students were rated as having very little to no disciplinary issues.The others were rated as moderate.The majority of the fifth grade boys selected for the second implementation were a part of the pilot study, by design, as teachers and the rape crisis director wished to incorporate peer mentoring.
Secondly, and related to the mentoring aspect, teachers suggested the program provide more time for all involved to interact in a noninstructional setting or context.This is expected to facilitate mentoring and relationship-building between students and teachers, as well as increase student buy-in and engagement.As such, a kickoff pizza party and activity hour was hosted for incoming program participants in December 2014.A second activity hour in early January 2015 allowed the students to personalize and decorate the supplies and storage containers they will be using during the program.An off-campus field trip to the local university will take place midway through the program and program completion will be celebrated with a graduation ceremony that will follow the program's final curricular element--a drama performance.
Thirdly, modifications were made to the curriculum itself.The primary change involves the interactive components of the program.While the Program H curriculum currently involves a number of interactive elements-brainstorming exercises, group assignments, role playing, writing and performing skits-the lessons most appropriate for our younger population involve short-term interactive elements.They do not formally ask or require students to revisit tasks completed in previous lessons and explicitly utilize that knowledge later on in the program.For the second program implementation, the curriculum will involve a long term interactive project where students will keep and store products of early lessons and revisit them in the creation of a play or series of skits that they 41 Foley et al.-Engaging Boys in Eradicating Gender-based Violence will perform upon program completion.This will allow certain lessons to be reiterated over time, culminating in a performance wherein the boys model positive conflict resolution and emotion management skills in situations where one may be tempted to use violence and/or wherein one's masculinity is threatened or challenged.
Lastly, program teachers will provide feedback more regularly and in a manner that will provide additional qualitative, process evaluation data.The two program teachers will complete brief additional surveys with both closed and open ended questions after each lesson.This will include notes on discussions and general student learning that took place in that day's session.In total, there will be at least fifteen sessions, inclusive of all of the activities and events described above.The implementation schedule is flexible to allow for one lesson to be delivered in more than one class session if needed.
Overall, the implementation of these changes should enhance student exposure to gender-transformative lessons, increase student engagement, and facilitate peer and teacher mentoring.It is our hope that these changes will translate to improved program effects that may lead to broader social change.Those of us studied in the area of social change, of course, recognize that structural or institutional social change is easier said than done, and requires untold amounts of exertion on the part of agents and participants of that change.Through these changes, and by implementing the program with a somewhat more diverse group of boys (who are not all a part of the Early Intervention Program), we can better understand if this particular adaptation of the internationally recognized Promundo program can indeed transform gender beliefs in such a youthful, American population.

Table 1
Comparison of Means Tests (n=7)