Using Human-Centered Design to Create a Gender-Equitable Environment for Very Young Adolescents

As part of Breakthrough ACTION’s efforts to advance innovative social and behavior change approaches for youth, the project applied human-centered design to develop gender-equitable interventions with very young adolescents in three of the Global Early Adolescent Study multi-year cohort sites: Kinshasa in the Democratic Republic of the Congo and Denpasar and Semarang in Indonesia. Human-centered design was selected as a methodology for meaningful youth engagement in designing programs that shape their lives.

Design and Test Reports

Breakthrough ACTION produced several materials to document the design process, including three design and test reports that detail the HCD activities conducted in Indonesia and the Democratic Republic of the Congo.

Indonesia
Democratic Republic of the Congo

BAHASA INDONESIA

Pendekatan Human-Centered Design untuk Membangun Lingkungan yang Mendukung Kesetaraan Gender bagi Remaja Sangat Muda di Indonesia [PDF]

Penerapan pendekatan HCD untuk penguatan program kesetaraan gender remaja di Republik Demokratik Kongo dan Indonesia [PDF]

Mengatasi Ketidaksetaraan Gender di Masa Remaja Awal di Indonesia: Implikasi untuk Program dan Kebijakan dari Proses HCD [PDF]

Membangun Lingkungan yang mendukung Kesetaraan Gender bagi Remaja Sangat Muda: Pesan dan Bukti untuk Meyakinkan Pembuat Keputusan [PDF]

ENGLISH

Design & Test Report: Indonesia [PDF]

Human-centered design to promote a gender-equitable environment for very young adolescents in Indonesia [PDF]

Design & Test Report: DRC [PDF]

Leveraging Human-Centered Design to Improve Gender-Equitable Adolescent Programming in the DRC and Indonesia [PDF]

Engaging Parents in SRH: Programs for VYAs in the DRC [PDF]

Addressing Gender Inequity during Early Adolescence in Indonesia: Implications for Programs and Policies from an Human-Centered Design Process [PDF]

Creating a Gender-Equitable Environment for VYAs: Messages and Evidence to Persuade Decision Makers [PDF]

EN FRANÇAIS

Tirer parti de la conception centrée sur l’humain pour améliorer la programmation équitable sur le plan du genre pour les adolescents en RDC et en Indonésie [PDF]

Engagement des parents dans la SSR : Programmes pour les très jeunes adolescents en la RDC [PDF]

Pilot Package

Source: Johns Hopkins Center for Communication Programs

Date of Publication: July 30, 2026

Gender Equity Today for Youth (GET 4 Youth) Pilot Package

The Gender Equity Today for Youth (GET 4 Youth) Pilot Package aims to create a gender-equitable environment in which very young adolescents (VYAs) (10–14 years old) can grow and thrive. The five interventions that comprise this package are designed to complement each other and reach key audiences in the VYA environment. Users can adapt and apply these interventions to other settings and contexts.

Companion Materials

Process Brief: This brief documents process challenges and lessons learned from low- and medium-fidelity co-design, prototyping, and testing activities in Indonesia and the Democratic Republic of the Congo. [ Bahasa Indonesia | English | French ]

Advocacy Briefs: These briefs offer policy and program recommendations based on learnings from activities in Indonesia and the Democratic Republic of the Congo.

  • Addressing gender inequity during early adolescence in Indonesia: Implications for programs and policies from a human-centered design process [ Bahasa Indonesia | English ]
  • Engaging parents in sexual and reproductive health: Programs for very young adolescents in the Democratic Republic of the Congo [ English | French ]

Message Framework: This message framework can be used by advocates working to increase funding for and improve the implementation of programs that seek to create a gender-equitable environment for VYAs. [ Bahasa Indonesia | English ]

PILOT PACKAGE RESOURCES

EDITABLE FILES

Frequently Asked Questions

The pilot package is currently available in English; it will be available in Bahasa Indonesia in early 2024.

This package was developed using a human-centered design (HCD) approach, meaning it was created alongside the intended audiences across multiple rounds of testing. These intended audiences include key influencers across the very young adolescent (VYA) environment, as well as potential implementers and facilitators. One round of testing was conducted in the Democratic Republic of the Congo. Learnings were taken from that project and then applied to three additional rounds of designing and testing across two sites in Indonesia: Denpasar and Semarang.

The actual amount will vary depending on location, but the itemized resources required for piloting or implementing are available in the GET 4 Youth Pilot Package.

This largely depends on the resources available to the piloting organization, as well as the size of the location or jurisdiction of the pilot. While there is no set period, organizations should plan for at least six months, with evaluation occurring during and immediately after. Evaluating the pilot could take an additional three months, depending on the size of the population reached.

While the package provides detailed adaptation guidance for each intervention, the best place to start is the Theory of Change (see pages 6–7 of the GET 4 Youth Package). The Theory of Change is rooted in the need to address gender norms. For example, if suicide and teen pregnancy are identified as the most salient issues related to VYA health and well-being in your community, your first task in adapting this package would be to link these topics and their corresponding outcomes to gender norms—what, if any, are the gender norms that are influencing these outcomes of interest?

This is such an important question and a critical reason why harmful gender norms are often not addressed. We learned through the design and test process that a critical first step is to level-set with people about what we mean when we say gender and gender norms; for this package, we simply are referring to the social expectations for boys and girls.

To that end, we created a customizable Overview Presentation within the Multi-Stakeholder Forum intervention that is designed to help level-set with audiences, specifically with public officials or government representatives who may be limited in what they can address.

It is important to note this package was designed with and for heterosexual, cisgender people due to the predominance of this relationship type and the legal and political context in Indonesia. Breakthrough ACTION recognizes this as an inherent limitation and encourages those who may adapt these materials for use in other contexts to include sexual and gender minorities in all aspects of the adaptation, implementation, and evaluation to ensure this package meets the needs of as many people as possible.

This is an important point, and particularly salient to one of the intended audiences for this project: low-income urban families. We recognize that in these settings, families often have competing priorities, especially if they have other children and the parents or caregivers work or take care of older relatives. This is why we made sure the family space includes whole families; though the material is largely intended for caregivers, all children in the family are welcome to participate. Additionally, building buy-in and support from community leaders through the Multi-Stakeholder Forum is intended to create an environment in which families receive positive reinforcement and resources to participate in the interventions.

Since facilitation is a very important component, detailed guidance and resources for facilitators are included in the GET 4 Youth Pilot Package. Please see the Facilitator Guide for detailed information, as well as the intervention-specific guidance within the package.

This is a pilot package that has not yet been piloted and, therefore, has not been evaluated. However, the process undertaken to develop this package incorporated the best practices of HCD and social and behavior change (SBC) to create a program with the greatest chance for success. The HCD process enabled us to refine and test prototypes across three rounds of testing, where we tested for desirability, feasibility, and the potential for scalability. See the graphic below for details about what was tested in each round. For more information about the design and test process and results, please see the Design & Test Reports.

Additionally, we infused known SBC mechanisms into the interventions themselves. These are listed in the Theory of Change on page 6 of the intervention package.

We started knowing we needed a multi-level approach that addressed key influencers and systems in the VYA environment, based on evidence and lessons learned from the literature, Global Early Adolescent Study research, and previous programming for VYAs. With this in mind, we developed a series of “design challenges” for the low-fidelity co-design workshop that would lead to a package of interventions operating at multiple levels of the Socio-Ecological Model (see page 13 in the Design & Test Report: Low- and Medium-Fidelity Prototyping for the list of design challenges). We also worked with our intended audiences to understand which gender norms are most applicable to this population and issue (mental health and bullying). This was done by starting with the gender norms developed through formative research with 15 countries worldwide and identified as particularly salient to young adolescents. We then used co-design to identify which specific norms we should be targeting to shift to achieve our intended outcomes.
After the co-design workshop, our team developed these concepts into low-fidelity prototypes for testing. During this stage, the Core Design Team*—with expertise in gender, VYAs, and SBC—used what we know from theory, evidence, and past programming to inform prototype development. For example, the interactive video was designed to prompt collective reflection and discussion on gender norms, diffuse positive social norms, and create opportunities for observed social normative decision-making, while the family space fosters empathy building between caregivers and VYAs and employs role modeling to strengthen caregivers’ listening and communication skills.
These “change mechanisms” are a mix of evidence-informed strategies and best practices. You can find the full list of change mechanisms and our Theory of Change in the GET 4 Youth Pilot Package. You can find more information about the design process in our Design & Test Reports.
*The approach to ensuring human-centered co-design in this activity draws inspiration from the Four Voices of Design Model© created by ThinkPlace, the HCD lead for Breakthrough ACTION. The intention of leveraging this model is to suspend the power that comes from rank and ensure that all participants have equal power and the opportunity to contribute. Therefore, one of the first steps was to establish a Core Design Team: a multi-disciplinary group that coalesces the four voices of design—intent, design, experience, and expertise—and the necessary diversity of skills and experience to drive the design process. More information about the Core Design Team can be found on page 7 of the Design & Test Report: Low- and Medium-Fidelity Prototyping.

Source: Johns Hopkins Center for Communication Programs

Date of Publication: July 30, 2026

Very Young Adolescent Gender Equity: Messages and Evidence to Persuade Decision Makers

In 2022, Breakthrough ACTION conducted informal interviews with gender, sexual and reproductive health (SRH), and youth programming subject matter experts and with youth-led and youth-serving organizations seeking to improve gender equality for very young adolescents (VYAs). The purpose of these interviews was to understand the facilitators and barriers that influence the extent to which stakeholders support and prioritize gender-related policies and programs for VYAs.

The project also conducted a narrative review of publicly available information on gender norms and gender transformative interventions for VYAs, focusing on reports and results from the Global Early Adolescent Study, a multi-country longitudinal study exploring gender socialization and its implications for adolescent health and wellbeing. All of this information was synthesized and transferred into an operational message framework and validated with experts in SRH, gender, and youth.

About the Message Framework

The Creating a Gender-Equitable Environment for Very Young Adolescents: Messages and Evidence to Persuade Decision Makers [ Bahasa Indonesia | English ] is designed for advocates working to increase funding for—and improve the implementation of—programs that seek to create a gender-equitable environment for VYAs (aged 10–14). While gender equality among VYAs is a critical outcome on its own, it is also an important social determinant of health that can support improvements in a broad array of health outcomes, including SRH, violence prevention, mental health, and more.

The document provides a core set of key messages and recommendations that can and should be tailored to specific contexts and stakeholders. It is designed to be used as part of a strategic advocacy process, such as SMART Advocacy, particularly during the process of developing key “asks” and compiling supporting evidence. Users can adapt the messages provided to create advocacy materials, events, and campaigns supporting VYA gender equity.

VYA Pilot Package

Source: Johns Hopkins Center for Communication Programs

Date of Publication: July 30, 2026

Addressing Gender Inequity during Early Adolescence in Indonesia

Focusing on formative developmental windows, this technical brief outlines programmatic and policy implications for addressing gender inequity among very young adolescents ages 10 to 14 in Indonesia. The resource synthesizes evidence from a human-centered design process, illustrating how restrictive gender expectations take root during early puberty and impact mental health, education, and social development. It offers actionable recommendations for engaging families, addressing the intersection of gender and violence, and building cross-sectoral partnerships across education, health, and social services. Program managers, policy makers, and youth advocates can leverage these insights to design gender-transformative interventions tailored to young adolescents and their surrounding support networks.

Addressing Gender Inequity during Early Adolescence in Indonesia – Bahasa [PDF]

VYA Pilot Package

Source: Johns Hopkins Center for Communication Programs

Date of Publication: July 29, 2026

Addressing Barriers to Family Planning for Postpartum Women Experiencing Depression and Anxiety

Examining the intersection of perinatal mental health and reproductive autonomy, this technical resource highlights specialized approaches to address family planning barriers among postpartum women experiencing depression and anxiety. The document identifies how psychological distress impacts self-efficacy, health-seeking behaviors, and decision-making regarding voluntary contraception. It offers actionable strategies for health providers and program managers to integrate empathetic mental health screening and counseling into routine postpartum care settings. SBC practitioners, clinical leaders, and maternal health advocates can leverage these insights to design holistic care models that support both mental well-being and reproductive health outcomes.

Source: Johns Hopkins Center for Communication Programs

Date of Publication: July 27, 2026

Reproductive Health Innovation Exchange

The Reproductive Health Innovation Exchange highlighted 16 interactive solutions that use social and behavior change to improve reproductive health service delivery.

The Exchange provided opportunities to discover innovations, coordinate with partners, spark creativity, and discuss practical applications and adaptations of impactful social and behavior change approaches for family planning and reproductive health service delivery.

Behavioral and Digital Tools to Prevent Teenage Pregnancy 
[factsheet (English | French) | video]

Behavioral Tools for Providers to Promote Birth Spacing
[factsheet (English | French) | video]

Club Courage for Midwives: Building Resiliency through Peer Support
[factsheet (English | French) | video]

Empathways: Building Empathy into Youth Family Planning Services
[factsheet (English | French)| video]

Gamified Family Planning Counseling Tools to Promote Meaningful Choice
[factsheet (English | French) | video]

Growing Up: Film-Based Interactive Learning
[factsheet (English | French) | video (English | French)]

Integrating Family Planning and Immunization Services
[factsheet (English | French) | video (English | French)]

La Chance: Interactive Game for Girls to Take Control of Their Reproductive Futures
[factsheet (English | French) | video (English | French)]

Ma’ana Fe Al-Dawar: Community Plays for FP Conversations
[factsheet (English | French) | video]

MobiSAfAIDS App for Sexual and Reproductive Health and Advocacy
[factsheet (English | French) | video]

Nivi: The Digital Health Marketplace
[factsheet (English | French) | video]

Provider Behavior Change: A Toolkit
[factsheet (English | French) | video]

Resources to Confront the Concerns of Long-Acting Reversible Contraception Users
[factsheet (English | French) | video (English | French)]

Together We Decide: Interactive Game for Male Engagement in Family Planning
[factsheet (English | French) | video]

Tradgame 4 Adolescents and Young Women: Family Planning and Sexual and Reproductive Health
[factsheet (English | French) | video]

ZanaAfrica’s Nia Program: Sexual and Reproductive Health and Life Skills Education through Comics and Magazines
[factsheet (English | French) | video (English | French]

Last modified: July 27, 2026

Language: English

Source: Johns Hopkins Center for Communication Programs

Year of Publication: 2022

Measuring Equity in SBC Programming for Family Planning and Sexual and Reproductive Health

Establishing a standardized monitoring and evaluation framework, this technical resource provides guidance on measuring equity within social and behavior change interventions for family planning and reproductive health. The brief outlines practical indicators and data collection approaches to track whether program reach, engagement, and behavioral outcomes are distributed fairly across diverse population segments. It offers step-by-step methods to disaggregate programmatic data by age, geographic location, socio-economic status, and gender. Program evaluators, researchers, and project managers can apply these measurement tools to identify underserved groups, address access disparities, and hold health initiatives accountable for equitable impact.

Recorded Webinars

Why Do We Need to Elevate the S in SBC to Improve FP/RH Outcomes?

This webinar made the case for explicitly considering and addressing equity and social determinants of health in social and behavior change programming for family planning and reproductive health.

How Can SBC Programming Address Equity and Social Determinants of Health?

This webinar focused on how social and behavior change programming is well suited to addressing equity and social determinants of health in family planning/reproductive health.

How can Incorporating Social Accountability Into SBC Improve Equity?

This webinar focused on social accountability as a critical process that can be further leveraged across social and behavior change programming to address equity and social determinants of health to shape and influence family planning and reproductive health outcomes.

RELATED RESOURCES

Expanding the “S” in SBC: Addressing Social Determinants of Health and Health Equity [ENGLISH / EN FRANÇAIS]

Intentionally Incorporating the Social Determinants of Health into SBC Programming for FP [ENGLISH / EN FRANÇAIS]

The Road to Equity in FP: Incorporating the Social Determinants of Health [ENGLISH]

Last modified: July 27, 2026

Language: English

Source: Johns Hopkins Center for Communication Programs

Year of Publication: 2023

The Road to Equity in Family Planning: Incorporating the Social Determinants of Health

Highlighting the intersection between structural factors and healthcare access, this technical resource provides a practical framework for integrating the social determinants of health into voluntary family planning programs. The document outlines how underlying socio-economic conditions, educational attainment, gender dynamics, and geographic barriers shape individual health choices and access to quality care. It presents operational strategies for program planners to design equitable behavioral interventions that address root systemic inequities alongside individual behavior change. SBC practitioners, global health advocates, and policy makers can utilize these insights to foster health equity and ensure voluntary family planning services reach underserved populations.

Recent Webinars

Why Do We Need to Elevate the S in SBC to Improve FP/RH Outcomes?

This webinar made the case for explicitly considering and addressing equity and social determinants of health in social and behavior change programming for family planning and reproductive health.

How Can SBC Programming Address Equity and Social Determinants of Health?

This webinar focused on how social and behavior change programming is well suited to addressing equity and social determinants of health in family planning/reproductive health.

How can Incorporating Social Accountability Into SBC Improve Equity?

This webinar focused on social accountability as a critical process that can be further leveraged across social and behavior change programming to address equity and social determinants of health to shape and influence family planning and reproductive health outcomes.

RELATED RESOURCES

Expanding the “S” in SBC: Addressing Social Determinants of Health and Health Equity [ENGLISH / FRANÇAIS]

Intentionally Incorporating the Social Determinants of Health into SBC Programming for FP [ENGLISH / FRANÇAIS]

Measuring Equity in SBC Programming for FP and SRH [ENGLISH]

Last modified: July 26, 2026

Language: English

Source: Johns Hopkins Center for Communication Programs

Year of Publication: 2023

National Multisectoral Strategic Plan for Nutrition Communication in the DRC

Despite several nutrition interventions, malnutrition is a significant public health problem and an underlying cause of many other health problems in the Democratic Republic of the Congo. Given the persistence of nutrition problems, with their multiple origins and impacts on different development sectors, the National Nutrition Program (PRONANUT) developed this social and behavior change (SBC) plan in collaboration with Breakthrough ACTION. SBC is critical for nutrition efforts at a national strategic level as it addresses the underlying social, cultural, and behavioral factors that influence dietary practices, breastfeeding, and the utilization of nutrition services, ensuring that interventions lead to sustained improvements in health outcomes. The plan allows agencies to intensify advocacy and adopt an improved and uniform approach to communication.


Banque d’Indicateurs de CSC dans le Cadre de la PF et la Prestation de Services

Malgré plusieurs interventions en matière de nutrition, la malnutrition est un problème majeur de santé publique et une cause sous-jacente de nombreux autres problèmes de santé en République démocratique du Congo. Compte tenu de la persistance des problèmes de nutrition, de leurs origines multiples et de leurs impacts sur les différents secteurs de développement, le Programme National de Nutrition (PRONANUT) a élaboré ce guide sur le changement social et comportemental, en collaboration avec Breakthrough ACTION. Le changement social et comportemental (SBC) est essentiel pour les efforts de nutrition à un niveau stratégique national car il aborde les facteurs sociaux, culturels et comportementaux sous-jacents qui influencent les pratiques alimentaires, l’allaitement et l’utilisation des services de nutrition, garantissant que les interventions conduisent à des améliorations durables des résultats en matière de santé. Ce plan stratégique national multisectoriel pour la communication sur la nutrition permet aux agences d’intensifier leurs activités de plaidoyer et d’adopter une approche améliorée et uniforme de la communication.

Last modified: July 26, 2026

Language: French

Source: Johns Hopkins Center for Communication Programs

Year of Publication: 2023

Together We Decide: A Game for Building Health and Harmony Within Families

In South Sudan, Breakthrough ACTION adapted a game designed by ideas42 and IntraHealth for use in Uganda to create “Together We Decide.” Using behavioral design theories, “Together We Decide” creates a safe space for participants to learn and discuss how to build health and harmony within their families. The game is designed to increase male engagement in the family planning process and build familiarity with child spacing methods while allowing couples to explore the outcome of various child spacing choices and gain comfort in discussing these topics within the family and with health workers. The game encourages participants to consider how child spacing methods might help them achieve their goals for their family and to make choices together for their families.

Objectives

  • Provide accurate health information on family planning to men and women.
  • Redefine roles and norms around decision-making and participation.
  • Demonstrate equitable communication and decision-making around family planning.
  • Encourage couples to seek advice on family planning from health care providers.

Resources

Game Guide [PDF]

Game Cards [PDF]

Child Spacing Planning Card [PDF]

Last modified: July 26, 2026

Language: English

Source: Johns Hopkins Center for Communication Programs

Year of Publication: 2024