TABLE 1.

Adaptation of the SNET Toolkit for Application in the Democratic Republic of the Congo

SNET Component	Process of Adaptation
Step 1: Planning and preparing	Two SNET activities were selected to determine root causes of low contraceptive prevalence: Problem tree analysis: Staff wrote a selected behavior of interest as the tree trunk and enumerated reasons why people did or did not perform the behavior as the roots and the consequences of performing or not performing the behavior as the branches. Five Whys activity: Team members paired up to pose a “why” question related to the behavior of interest. They asked each other “why” again for every answer for 5 iterations of “why.”
Data collection instrument for Phase 1: Identifying reference groups	SNET activity adapted: “My Social Networks” Central question: “When discussing family planning methods - whether it is questions about what they are, where to get them, how to use them, or whether you or your partner should use them - with whom do you feel comfortable discussing these topics?” The respondent was read a list of options to probe specific attributes of the person chosen. For example, if he said a family member, the questionnaire would skip to questions about how the person was related, if they were a spouse, whether they were older or younger than the participant, and on which side they were related (maternal or paternal). Adaptation: Unlike the example in the SNET, we asked only 1 question, and the participant was only able to share 1 influential person. Recruitment: systematic household sampling rather than convenience sampling. Implementation: A tablet-based digitized questionnaire to quickly analyze responses by site rather than the manual analysis template.
Data collection instruments for Phases 2 and 3: Exploring social norms	The decision of activities to include from the SNET for the qualitative data collection was informed by input from IRH staff. SNET activities selected: 5 Whys activity and vignettes. “Five Whys” activity: Questions were based on barriers identified through the problem tree analysis, and the activity was conducted in small groups with a facilitator rather than in pairs without a facilitator. Participants in focus groups were divided into subgroups and asked 2 initial questions. The second question that all focus group participants were asked was the same: “When a couple has decided to use family planning, some men do not allow their wife or partner to choose freely or independently which family planning method to adopt. Why is this?” Vignettes were developed and shared with the in-country team to be validated for cultural appropriateness and contextual accuracy. During the individual interviews, a vignette was read in full. It described a couple deciding whether to use a family planning method for birth spacing. A shortened version of the vignette was used with the focus groups.

SNET Component

Process of Adaptation

Step 1: Planning and preparing

Two SNET activities were selected to determine root causes of low contraceptive prevalence:

Problem tree analysis: Staff wrote a selected behavior of interest as the tree trunk and enumerated reasons why people did or did not perform the behavior as the roots and the consequences of performing or not performing the behavior as the branches.
Five Whys activity: Team members paired up to pose a “why” question related to the behavior of interest. They asked each other “why” again for every answer for 5 iterations of “why.”

Data collection instrument for Phase 1: Identifying reference groups

SNET activity adapted: “My Social Networks”
Central question: “When discussing family planning methods - whether it is questions about what they are, where to get them, how to use them, or whether you or your partner should use them - with whom do you feel comfortable discussing these topics?”
The respondent was read a list of options to probe specific attributes of the person chosen. For example, if he said a family member, the questionnaire would skip to questions about how the person was related, if they were a spouse, whether they were older or younger than the participant, and on which side they were related (maternal or paternal).
Adaptation: Unlike the example in the SNET, we asked only 1 question, and the participant was only able to share 1 influential person.
Recruitment: systematic household sampling rather than convenience sampling.
Implementation: A tablet-based digitized questionnaire to quickly analyze responses by site rather than the manual analysis template.

Data collection instruments for Phases 2 and 3: Exploring social norms

The decision of activities to include from the SNET for the qualitative data collection was informed by input from IRH staff.
SNET activities selected: 5 Whys activity and vignettes.
“Five Whys” activity: Questions were based on barriers identified through the problem tree analysis, and the activity was conducted in small groups with a facilitator rather than in pairs without a facilitator. Participants in focus groups were divided into subgroups and asked 2 initial questions. The second question that all focus group participants were asked was the same: “When a couple has decided to use family planning, some men do not allow their wife or partner to choose freely or independently which family planning method to adopt. Why is this?”
Vignettes were developed and shared with the in-country team to be validated for cultural appropriateness and contextual accuracy. During the individual interviews, a vignette was read in full. It described a couple deciding whether to use a family planning method for birth spacing. A shortened version of the vignette was used with the focus groups.

Abbreviations: IRH, Institute for Reproductive Health; SNET, Social Norms Exploration Tool.