"The number of manuscripts (peer-reviewed articles and grey literature) related to the use of C4D approaches to address VAC has steadily increased each year since 2000. Of the 302 manuscripts that were coded, 44 per cent discuss an intervention implemented in a developing country, which speaks to the geographic robustness of this review. A greater proportion of manuscripts discuss interventions in urban contexts as compared to rural contexts. Roughly half of the interventions reviewed do not explicitly reference a conceptual model to underpin the interventions. Those that do, typically cite individual or cognitive conceptual models and a majority (over 80 per cent) focus on the individual level of change. About 11 per cent use community approaches and slightly less than 10 per cent report using an ecological approach. While cognitive and individual-based behaviour change approaches are valid and useful in certain contexts, there is a growing realization that individuals are embedded within a larger social system. Effective interventions must keep in mind the interactions between levels in order to effectuate sustainable change. The social ecological model provides a framework to address the interactions between levels. Interventions that cut across the levels of the social ecological model should work towards addressing social, emotional, and behavioural skills (for example, self-efficacy) of individuals and groups, as well as norms, instead of only addressing individual knowledge and attitudes. Manuscripts reviewed did not necessarily explicitly state the use of C4D approaches. However, upon closer examination, it became apparent that the majority of responses to VAC were inherently communicative. Programmes addressing VAC often use C4D approaches to reduce harmful practices using a ‘harm reduction’ framework. Often in these cases, programme objectives focus on the negative, whereas C4D messages for the same intervention focus on positive changes. Overall programme objectives should be linked to communication objectives, which in turn yield C4D messages." (Executive summary, page 9)