Primary Prevention Is? A Global Perspective on How Organizations Engaging Men in Preventing Gender-Based Violence Conceptualize and Operationalize Their Work

Feminist Perspectives on Prevention

Early feminist scholars such as Yllo and Bograd (1988) and Schechter (1982) contended that gender needed to be situated at the center of our understanding of prevention and the root causes of violence against women. These antecedents include community-level factors such as narrow gender roles for men and women and social norms that are permissive of violence (Heise, 1998; Prothrow-Stith & Davis, 2010) as well as gendered distributions of economic and political power within communities (WHO, 2010). Furthermore, a feminist perspective on prevention calls attention to gender socialization and structural inequities based on gender as inherent in legitimate prevention endeavors. For example, in a critical examination of gender equity promotion programs globally, researchers for the WHO concluded that programs that are “gender-sensitive” and included explicit attention to gender roles and social constructions of masculinity were more likely than programs not deemed gender sensitive to be effective at influencing participants’ attitudes and behaviors (WHO, 2009). Specific strategies that hold potential for reducing and/or ameliorating violence against women include economic, social, and policy approaches to improving gender equality; challenging gender-based social norms by redefining negative masculine norms; school-based prevention activities with children and youth; strengthening the social safety net; and reducing poverty and preventing incidents of child abuse (WHO, 2009). Examples of effective primary prevention programs that are predicated on promoting gender equitable social norms and fostering attitudes that are intolerant to violence against women include the Safe Dates program in the United States (Foshee et al., 2004) and the Stepping Stones program in South Africa (Jewkes et al., 2008).

Public Health Perspectives on the Primary Prevention of IPV

Western public health prevention models have historically focused on infectious diseases and promoting general health (Silverman, 2003) and have more recently been applied to multi-dimensional social issues such as violence against women including IPV and sexual assault. The field of public health has been positioned as bringing “a perspective that has been missing from this field, that is, a multi-disciplinary scientific approach that is directed explicitly toward identifying effective approaches to prevention” (Hammond et al., 2006, p. 113). Public health prevention strategies are classified in two ways, the first being the point of intervention and the second being the target population. An intervention is considered primary prevention if it is targeted before onset, secondary prevention once early indicators have emerged, and tertiary prevention is rehabilitation to prevent reoccurrence (Chamberlain, 2008; Cohen & Chehimi, 2010; O’Connell, Boat, & Warner, 2009). The second system of classification is the population that is being affected: universal (everyone will benefit), selective (people at higher risk than average), and indicated (people with early, detectable signs of the problem; Chamberlain, 2008; O’Connell et al., 2009). As these distinctions were initially grounded in preventing health problems such as tobacco usage, there are inherent challenges in translating them to meet the “real-world” demands of complex social issues such as violence against women.

Ecological Perspectives on Primary Prevention

Increasingly, primary prevention has been conceptualized using ecological models, which assume that risks for and solutions to social and behavioral problems reside in nested and mutually influential layers of individuals’ environments (CDC, 2004; Heise, 1998). For example, the Prevention Institute’s “Spectrum of Prevention” is one tool that has been utilized to guide primary prevention activities at all levels of the ecosystem (Cohen & Chehimi, 2010). The Spectrum of Prevention is applied to a variety of social and health issues and is regularly used in the field of engaging men and boys in violence prevention (Flood, 2011). The six levels of strategy that make up Cohen and Chehimi’s (2010) Spectrum of Prevention include (a) strengthening individual knowledge and skills, (b) promoting community education, (c) educating providers, (d) fostering coalitions and networks, (e) changing organizational practices, and (f) influencing policy and legislation. In the context of engaging men and boys in violence prevention, the Spectrum of Prevention approach encourages organizations’ adoption of multiple approaches to engaging men and boys in violence prevention across multiple ecological levels. For example, Flood (2011) utilized the Spectrum of Prevention to categorize strategies for engaging men in violence prevention, from strengthening individual men’s knowledge and awareness of intimate partner and sexual violence to involving men in legislative advocacy efforts and reaching out to men in power.

Some have claimed that there has been “a profound shift toward primary prevention, aimed at preventing violence before it occurs” (Flood, 2011, p. 360). Rather than focusing on tertiary prevention strategies (such as batterers’ treatment or therapeutic counseling for victims), a growing number of primary prevention models are being targeted at the population level (Graffunder, Cline, & Lane, 2011). Although ecological and primary prevention approaches have received considerable attention, they have emerged primarily from Western conceptualizations of prevention and have not been rigorously evaluated to determine whether they are germane internationally (WHO, 2007b). In addition, it is important to clarify that there is considerable overlap between these models. Ecological models of the prevention of violence against women, for instance, still predominantly situate the role of societal gender norms in their analyses, and public health models both integrate ecological models of risk and protective factors and include gender among risk factors for victimization. Therefore, rather than see these as stand-alone or independent discourses, they should provide context on the multiple, and often intersecting, threads that embody the larger dialogue on preventing violence against women.

Procedures

This study is part of a larger research project titled Mobilizing Men for Violence Prevention (MMVP), which aimed to describe the nature and extent of worldwide efforts to engage men in the prevention of violence against women through both a quantitative survey and more in-depth qualitative interviews. Additional articles from this same research project have outlined the social processes and strategies that have been utilized to engage men in anti-violence organizations, as well as the tensions inherent in a men’s engagement approach to anti-violence work. Please see Carlson et al. (2015) and Casey et al. (2013) for more in-depth descriptions of the findings that emerged from these prior analyses.

Generally speaking, we approached this article from an interpretivist epistemology, which constructs meaning as being co-created between the investigators and the research participants (Crotty, 1998). Our goal was to “understand, explain and demy-stify social reality” (Cohen, Manion, & Morrison, 2007, p. 19) rather than present an objective version of truth. Our research team was composed of faculty and doctoral student researchers at three universities in the United States. We all have worked in the field of domestic violence as researchers and practitioners in various locales throughout the United States.

Participants in this study were drawn from a larger pool of program representatives from around the world who responded to an earlier online, quantitative survey of organizations that engage men to end violence (see Carlson et al., 2015, for details regarding the first phase of this project). Respondents to the online survey were recruited via violence and prevention-related listservs, professional networks, and programs around the world. Eligibility was defined as having part or all of an organizational mission dedicated to engaging men in violence prevention (operationalized as “men taking action to stop violence against women and children before it begins by advocating for and creating respectful relationships”). Out of the 165 organizations responding to the online survey, 104 provided contact information and expressed a willingness to be re-contacted for future research phases. Of these, we contacted 48 organizations by email to invite a program representative to participate in our in-depth interview for this study, and 29 agreed to participate. The 104 organizations were reduced to the 48 invited in the following ways: All responding organizations that provided information from Africa, Asia, Europe, and Central and South America were re-contacted, with a goal of increasing global representation. In addition, a sample of organizations in Australia and North America, stratified for size and organization type, were re-contacted. Organizations indicating a willingness to participate in interviews completed an online consent form and were scheduled for a phone or Skype interview with one of the four interviewers on the research team.

Sample

Our final sample for this study consisted of 29 organizational representatives from programs in Australia, Brazil, Canada, England, Grenada, India, Kenya, New Zealand, Norway, Pakistan, Rwanda, Scotland, South Africa, Syria, Thailand, Uganda, and the United States. Of the 48 who initially expressed interest, 19 organizations either did not respond to the invitation to participate or did not follow up to schedule an interview. Participating organizations’ length of program history ranged from less than 2 years (7%, n = 2), 2-5 years (41%, n = 12), 6-8 years (14%, n = 4), and 8 or more years (38%, n = 11). Organizations also varied in identification of organizational structure. Thirteen (45%) were stand-alone programs, largely non-profits, with a primary focus on engaging men; 6 (21%) were units within larger agencies that sponsored a range of activities and services; 6 (21%) were regional or multi-country coalitions; 2 (7%) operated within university settings; and 2 (7%) were governmental organizations. Organizations reported a range of activities, including school-based prevention education, community education and mobilization, community-based men’s awareness or activist groups, and convening national or international anti-violence coalitions. In addition, although we recruited programs that work to stop violence before it begins, a handful of responding organizations could also be classified as fully or partially batterers’ intervention programs. These respondents positioned their work as falling within primary prevention, however. Given varied and blended perceptions among respondents of what constituted prevention, we retained these interviews for analyses.

Data Collection

We interviewed all organizational representatives over the phone or via Skype in English. Interviews varied from approximately 45-90 min in length. The interview guide was semi-structured, with broad questions designed to elicit information about the program’s strategies for engaging men, the frameworks that guide their work, the prevention approaches they use, and the challenges and barriers inherent in their work of engaging men. As an initial screening question, organizational representatives were specifically asked to describe how their organization understood primary prevention or violence before it begins and what approaches they used to meet these prevention goals. Topics particularly informing the analyses described here included questions regarding the program’s goals, definitions of prevention, and specific prevention activities. All interviews were digitally recorded and transcribed verbatim.

Data Analysis

We used a directed thematic content analysis approach that proceeded in two phases. First, we identified and created a list of sensitizing concepts connected to extant definitions of prevention that we anticipated might exist within the data (Hsieh & Shannon, 2005). Examples of the types of sensitizing codes we utilized included primary prevention (before onset) and universal (available for the whole population). This step served to reflect on pre-existing notions of what we expected to find in the data and to be clear how we collectively understood and applied prevention concepts. Second, we inductively identified codes representing concepts and themes within the data (Saldana, 2009), only keeping sensitizing concepts that emerged from the data. For example, we initially included universal, indicated, and selective prevention programs as a priori codes; however, as these concepts never inductively emerged, they were discarded. Codes emerging from the data were later organized into non-hierarchical categories; for example, within the category “Goals of Prevention Efforts,” some of the codes were public awareness, long-term social change, and promoting healthy masculinity. We generated a codebook that was continually amended and updated to reflect additional codes and themes.

To solicit a diversity of interpretive viewpoints and strengthen the overall analysis of the data, the first author shared her thoughts on emerging codes, categories, and themes with the research team throughout the analysis process. Only minor discrepancies in interpretation emerged, and we were able to discuss and incorporate divergent interpretations into the final analysis. For example, the larger theme related to community awareness included both general awareness and skill building, but these concepts were later disaggregated as a result of analysts’ discussions. In addition to facilitating reflexivity, we used memos to identify relationships and patterns in the data which helped us refine themes. Once we applied codes to all the transcripts, we generated tables that compared codes both within and across the interviews (Ayres, Kavanaugh, & Knafl, 2003) and focused on the themes that surfaced across all of the interviews. Divergent cases were noted and considered in the analysis, as well. It was through this process of “codeweaving” (Saldana, 2009) that we collaboratively identified the key processes and prominent themes presented in this article. All data were stored and organized using ATLAS.ti version 6.

Preventing New Incidents of Abuse

Beginning on the left side of the prevention continuum illustrated in Figure 1, organizational representatives who could primarily or partially be classified as staffing batterers’ intervention programs envisioned their work as prevention focused because it was transforming perpetrator mind-sets and reinforcing perpetrator accountability which would ideally prevent new incidents of abuse. The corresponding prevention approaches included therapeutic support groups for men, men’s “healing circles,” and voluntary or mandated batterers’ treatment programs. As Organizational Representative 76, who coordinates multi-dimensional men’s groups from North America, elucidated, “we’re not only doing prevention, we’re doing healing. You have to do healing because all of the men and boys we deal with have wounds.” Although some organizational representatives acknowledged that their work could be seen as “primarily working with the men who use violence after the violence has been occurring” (Representative 12, Europe), and thus not primary prevention by public health definitions, they still conceptualized their work as being prevention focused because it could prevent additional incidents of abuse. Representative 18 from an organization in Australia that coordinates batterers’ intervention programs and school-based prevention programs noted, “So the prevention part . . . is to put some strategies into place so that there are no further incidents, that men are accountable for their behavior.” The focus is still on preventing an individual perpetrator from reoffending; however, these therapeutic groups were also seen as mechanisms to prevent the intergenerational continuity of interpersonal violence. That is, by preventing men from re-abusing, they were reducing the likelihood that their children would become abusers. Therefore by interrupting the cycle of violence, future generations would not model their abusive parent’s behaviors.

Generating Individual and Community Awareness and Providing Education About Violence Against Women

Primary prevention programs and events were also seen as tools for raising awareness about violence against women and educating individuals about the frequency and dynamics of domestic violence. The types of organizational activities or forums used to achieve these educational and awareness goals often include one-time events such as walks or campaigns; community, campus and school-based presentations; and tabling at community events such as health fairs. As one organizational representative from Africa stated, “But most of our prevention work revolves around raising levels of awareness, because we believe [people] have very little information” (Representative 30), illustrating that the distribution of information is seen as an important component of a prevention agenda. For some programs, the activities associated with information sharing and community awareness were not explicitly or conceptually linked to longer-term objectives related to prevention. For example, an organizational representative from North America who provides consulting and organizational support around primary prevention relayed a conversation he had with another anti-violence program to whom he was providing technical assistance:

I was talking to the [domestic violence program] coordinator and I said: “So what’s the purpose behind your education events?” She’s like, “Well, what do you mean?” [I asked,] “Why do you want people to be aware of domestic violence? What’s your intent? What are you trying to change?” And she only thought of it as just telling people it’s a problem. She never really thought about saying why am I organizing? What am I trying to get out of this awareness? (Representative 97)

In this example, the organization’s prevention agenda centers around sponsoring activities that have a primary intent of raising awareness about the existence of domestic violence, but displays a disconnect between how this increased community awareness could eventually translate to preventing violence against women. Rather than nesting increased awareness into a broader multi-level prevention agenda, the sole focus of this type of prevention effort is to increase the visibility of violence against women. What is missing is an articulation of the specific mechanisms that connect the activity to the overarching outcome of preventing violence against women.

Fostering Individual Competencies and Skill Building

Beyond raising awareness that violence against women is a significant social issue, there was a related theme that primary prevention involves tangible skill building and the nurturing of individual competencies to enact community-level changes. In other words, beyond just educating community members about the existence of domestic violence, there is a distinct goal “to develop . . . skills in people to actually make a change” (Representative 47, Africa). The programmatic activities that correspond with these goals can include campus- and community-based bystander programs and more intensive multiple-session trainings. Organizational representatives emphasized that individual skill building as advocates and allies enabled them to become active change agents in their own communities. As Organizational Representative 108 who is employed at a multi-service, ecologically oriented non-profit from Africa states,

We enable them to understand . . . the root cause of violence against women, as well as also help them to develop skills around how to prevent violence in their relationships, how do they prevent violence in their own communities, as well as they are taking action.

More specifically, these skills can include knowing how to confront male peers making sexist comments, learning how to be empathetic and support survivors of violence, and talking to one’s male children about positive masculinity. Beyond just strengthening these individual competencies, there is the implicit goal that these individuals will take the skills and tools they learned and bring them back to their own social networks. As Organizational Representative 34 who coordinates community education efforts with young men in Asia articulated,

Our strategy is that we’ll get people trained up and educated in the next ten months. [Then] we’ll have people who will get the tools and information and then hopefully they can replicate that within their small groups. So, hopefully in their families or in their group of friends, do some of the similar work.

This quote illustrates a desired diffusion effect whereby the nurturing of individual skills can spread back to the individual men’s social networks.

Redefining Masculinity at the Individual and Community Level

Another distinct conceptualization of prevention regards challenging dominant gender norms or notions of masculinity that both foster communities that are permissive to violence against women and that position men as inherently “violent.” As Organizational Representative 61 from North America stated,

What we say is men are naturally loving, caring and sensitive with women, children and other men . . . [it] is based on the assumption that . . . we’re not born with the violence genes or whatever . . . that we are taught and trained. The experiences that we have teach us to use violence as an acceptable and appropriate way to react to certain situations.

The goal, in other words, is to help nurture a new kind of healthy masculinity that negates dominant social stereotypes about men’s biological or genetic propensity for violence. The types of programs used to achieve this goal include universal school- and community-based bystander education programs, community education presentations, and campus- and community-based men’s groups. The goal of these programmatic interventions is to go beyond just raising awareness about domestic violence and to focus on dismantling the roots of violence against women—unhealthy gender norms. This approach is focused on “liberating” individual men from “the chains of masculinity and patriarchy” (Representative 30, Africa) and in turn transforming broader social norms about masculinity. This is illustrated by the following two quotes:

We’re looking at our own tendency of sexism as individuals. . . . So engaging them in a way they can identify their participation or recognize how some kind of normal male interactions are supportive of violence of women, subordination of women and then . . . challenge them to step up and become active in confronting the . . . sexism in the culture. (Representative 96, North America)

We’re fairly focused on targeting men and youth and campaigns that promote healthy ways to be men that try to recast some of the more prevalent notions of masculinity that are associated with men. (Representative 106, Asia)

Although individual men are still very much the vehicle for achieving social change, the emphasis on transforming the sexist underpinnings of violence against women underscores that these prevention approaches are interrelated with the broader social change approaches discussed in the next section.

Promoting Long-Term Gender Transformation and Social Change

The last prevention approach that emerged includes a broad category of promoting long-term social change. While some organizations defined prevention as promoting gender equality and others use language around the human rights of women, the core goal of these approaches was to focus on upstream or macro-level approaches that challenge the institutional and social norms that reinforce violence against women and girls. The following two organizational representatives capture the tenor of these approaches:

Primary prevention is about preventing violence before it occurs in the first instant. So, it’s about systems and structures and understanding the key determinants of what can lead to violence, certain attitudes and behaviors are supportive of violence. I am working very much down at that end. (Representative 10, Australia)

Our mission is to build a movement to prevent violence against women and we are focusing more our own social transformation, we are working towards changing norms, beliefs and attitudes that perpetuate violence against women because for us, our analysis of all kinds of violence is really about the root causes of violence, which is imbalance of gender between men and women. So, we are fostering a process of social change to create more equitable social norms and processes and relationships between men and women. (Representative 108, Africa)

Organizational Representatives 10 and 108, both of whom engage in upstream activities such as community capacity building and coalition building, are emphasizing the benchmarks of primary prevention, which is to focus on the antecedents of violence against women and the social institutions that reinforce these dominant social norms.

There are additional noteworthy characteristics of organizations working at this level, including engaging in multi-level prevention efforts and devising a diversity of approaches to prevent violence. In general, the work reported by these organizations focuses on upstream activities such as community capacity building; training other non-profits; media and policy advocacy and policing; and local, national, and international coalition building. At the same time, these organizations incorporated more grassroots activities such as hosting community theater events, anti-violence murals, and sponsoring informal “chats” in marketplaces about violence against women and girls. Organizational Representative 32 from Africa emphasized how the utilization of multiple prevention approaches can help reach larger audiences. She states,

So we do a whole range of things. So, there’s drama, there’s soap opera, a whole range of things recognizing that we have to reach people in many different ways, over many different times and many different people . . . [We do a] whole range of different tools because what’s going to speak to somebody is not probably going to speak to somebody [else].

In terms of engaging in multi-level prevention approaches, Organizational Representative 47 from Africa underscored that there is a diversity of ways to get at the root causes of violence against women. She goes on to say,

One of the things we try to do is not focus on manifestations of violence. But actually the core issue and for us that is the power imbalance between men and women . . . kind of big picture. So, not just working with a set of survivors or a group of perpetrators, or a group of just regular community members, but everybody at the same time.

Therefore, working with victims, perpetrators, bystanders, and larger institutions in concert with one another can help chip away at the underlying issue of gender inequality that contributes to violence against women.

Burgeoning Understandings of Primary Prevention

Although the majority of organizational representatives interviewed in this study conceptualized prevention somewhere along the continuum presented in Figure 1, it should be noted that a minority of interviewees provided emerging, though currently underdeveloped articulations of primary prevention. For instance, some responded to the question about defining prevention by describing specific activities the organization uses, rather than articulating the activities’ intended goals or the larger organizational perspective on prevention. One expressed skepticism about whether prevention was even possible: “Prevention is something which is not going to happen. It’s just a form of justifying ourselves to the funders, [to] the government . . . ” (Representative 49, Europe). Others noted that allowing prevention to be community-driven sometimes meant that goals shifted fluidly with the needs and context of a dynamic and changing population: “ . . . our programming is very fluid, meaning we design programs on identified need and most of the time, the need arises from experiences, from our network” (Representative 30, Africa). Similarly, Organizational Representative 27 from Asia stated plainly that he is so consumed with the day-to-day operations of the program that he does not “have much time to think about the philosophical aspect of our program,” and Interviewee 49 from Europe concurred that rather than having a guiding prevention framework that their work is “tugged in the direction” of “people’s requests.”

Exposing a Translational Gap: Blending of Prevention Approaches

While all of the interviewees contended that they were conducting primary prevention activities to engage men in violence prevention, it became clear that the majority of organizations were blending various primary, secondary, and tertiary approaches in organizationally specific ways. The language of universal, selective, and indicated prevention efforts did not appear to infuse interviewees’ perspectives on primary prevention. We saw organizations that were engaging with men in single-service prevention activities such as batterer’s treatment, as well as multi-service agencies that conducted men’s groups in combination with community-level education and media campaigns. Interestingly, interviewees included all of these activities under a broad banner of primary prevention. While there was some consistency with the WHO’s (2007a) description of types of primary prevention activities currently being conducted, the breadth of conceptualizations and activities revealed in this analysis expands the more finite distinctions between levels of prevention discussed in the existing literature. On the ground, these finite distinctions are broadened to include multi-level and tailored approaches.

Rather than critique some of these global efforts to engage men in violence prevention as “not primary prevention,” the blended approaches and broader organizational definitions of primary prevention raise important questions about how relevant clearly delineated Western public health frameworks, with prescribed definitions of primary, secondary, and tertiary prevention approaches, are to the field of violence against women both globally and domestically. In this sense, it could be fair to say that there is a translational gap or mismatch between public health models of primary prevention and anti-violence organizations that are partnering with men in violence prevention. For example, while a batterers’ intervention program could easily be classified as a tertiary prevention program in terms of hoping to reduce recidivism among perpetrators, if successful in reducing further perpetration, such an intervention can also be a tool of primary prevention by limiting the exposure of participating men’s children to additional violence as well as reaching broader audiences of men in the larger community.

What Lessons Can Be Learned From Global Multi-Level Prevention Efforts?

While certainly not all organizations were engaging in multi-level prevention efforts to engage men and boys, those that were offer a potent place for learning how to move organizations beyond individual-level prevention agendas. There were a number of organizations that were modeling ecological prevention agendas consistent with public health prevention models, as well as some who blended prevention approaches in unique and organizationally specific ways.

As was consistent with the literature (Graffunder et al., 2011; WHO, 2010), there was a perception among some interviewees that organizations cluster their prevention efforts around raising awareness about the existence of violence against women, challenging individual attitudes and providing general community education. In many ways, these activities to transform individual mind-sets and attitudes can be seen as an entry-point for more expansive and multi-level prevention agendas. Rather than de-emphasizing or viewing individual-level change efforts as “less than,” these findings suggest that individual approaches have the potential to diffuse across generations and social networks. Efforts to transform individual attitudes via community education, skill building, or consciousness raising can be seen as a foundation from which to build larger, multi-level approaches that foster the development of more social change-oriented prevention agendas.

We learned from the varied organizational activities presented in interviews that strategies to engage men and boys in multi-level violence against women prevention efforts can be blended and adapted to meet unique organizational and community needs. Adaptable prevention approaches offer the hope of reaching diverse audiences and satisfying different programmatic aims. Traditionally individual-level strategies, such as batterer’s intervention programs, could be reconstituted to become spaces for challenging individual gender norms and attitudes, creating new visions of masculinity, and helping program participants become better fathers and family members. Similarly, community-level approaches could be strengthened by focusing on individual men’s skill building such as found in young men’s bystander programs, so they can become active, knowledgeable, and trained agents of social change within their family, social, and community networks. In addition, as we heard from some of our organizational representatives engaging in multi-level change activities, hosting interactive theater events, creating community murals, and sponsoring dialogues about healthy masculinity and gender equality can be important tools for addressing some of the root causes of violence against women and capturing the attention of audiences of young men who may not participate in traditional community education forums. A number of organizational representatives also discussed the importance of fostering community-level coalitions for both information sharing and for engaging non-traditional allies such as elected officials, clergy members, and local business leaders. This approach also makes it possible for communities, as a whole, to engage in more expansive and interdisciplinary multi-level prevention efforts, that a smaller non-profit could not do in isolation.

Supporting Organizations in Enhancing Understandings of Prevention

Beyond fostering the development of multi-level prevention agendas, our interviews also surfaced some organizational needs related to conceptualizing and programmatically operationalizing prevention. A small number of interviewees struggled to articulate their conceptualization of prevention or expressed some skepticism about the project of prevention entirely. Others demonstrated difficulty linking their designated program activities to larger aims focused on reducing violence or to the mechanisms that would link their activities to individual or community change. For instance, some interviewees responded that primary prevention was hosting a single-session awareness event or workshop, but were less clear about how this activity was “preventing violence before it began” or “challenging dominant masculine norms.” Primary prevention, in this instance, took the form of workshops. Both challenges of having an unclear understanding of prevention, and of conflating activities and objectives, could be addressed with more in-depth, theory-driven, contextualized, and culturally relevant training or technical assistance that links agencies’ deep knowledge about their communities and culturally compelling approaches with strong theories of change.

Limitations

We must note here a number of significant limitations to this project. This research project was not designed to be a thematic analysis on the varying conceptualizations of primary prevention; this was an unexpected finding that we thought warranted further exploration. The MMVP project was a larger effort to describe global efforts and strategies for engaging men. Therefore, our interview questions and research design reflect the original purpose of the study. In addition, all of these interviews were conducted in English, which was not the majority of the interviewees’ first language. All of the interviews only occurred at one time point and not in person, which could hinder the development of a deep engagement between the interviewer and the interview participant (Stige, Malterud, & Midtgarden, 2009). Also, the nature of thematic content analysis can result in an attention to what is common rather than the unique features of individual cases (Ayres et al., 2003).