Learning from theory to practice peter oriare

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Learning from theory to practice peter oriare

  1. 1. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com NATIONAL CONFERENCE ON PEER EDUCATION, HIV AND AIDS JUNE14TH 2006
  2. 2. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com LEARNING FROM THEORY & LINKING WITH PRACTICE IN THE COMMUNITY  AIM  Critique Theoretical Foundations of Peer Education and Practice
  3. 3. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CONTENT  Introduction  Theoretical foundations of PE  Rationale and Principles of PE  Gaps between theory and practice of PE  Recommendations
  4. 4. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com INTRODUCTIONS  Peer education has grown in popularity and practice in Kenya and elsewhere  Unfortunately, scholars and advocates of peer education rarely make reference to theories
  5. 5. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Examination of peer education theories conclude that:  Most theories have something to offer towards an explanation of why peer education might be effective  Health promotion practice does not support these theories  Theories not put to use by health sector practitioners
  6. 6. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Study by Turner & Shepherd (199) revealed that:  The peer education practitioners are not applying theory to practice
  7. 7. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Some theories only have a limited application to peer education principles and practice.
  8. 8. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com THEORETICAL FOUNDATIONS  The theoretical roots of peer education can be traced back to a number of social theories. These include:  Social learning theory  Social identity theory  Role theory  Social inoculation theory  Differencial Association theory  Subculture theories  Communication of innovations theory
  9. 9. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SOCIAL LEARNING THEORY  Pioneered by Albert Bandura  Peer education is social learning.  Social learning through:  Observation  Imitation  Modeling.
  10. 10. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com DETERMINANTS OF SOCIAL LEARNING  Characteristic of model  Attributes of observer  Perceived consequences of adopting the behavior (Bandura, 1977)
  11. 11. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com RELEVANCE OF SOCIAL LEANING TO PEER EDUCATION  Credibility  Empowerment  Role modeling  Reinforcement.
  12. 12. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF CREDIBILITY CLAIMS  Many projects do not recruit PE with high status  Claim that peer educators automatically have credibility within their peer groups not well founded.
  13. 13. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF ROLE MODELLING CLAIM  Theory demand that peers observe role models  In practice, it is very difficult to observe modeled behavior such as safer sex
  14. 14. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Theory demands that role models need to be successful and competent in modeling the desired behavior.  Unfortunately, evidence show that peer educators may fail to maintain the desired health behavior (continue to have unsafe sex)
  15. 15. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF REINFORCEMENT  On-going contacts necessary for reinforcement to take place  But many projects rely on only a one-off sessions
  16. 16. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF SELF EFFICACY  People do what is learned if they know it is going to be effective  But many PE programmes do merely provide information not required skills that empower
  17. 17. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Example:  People learn safe sex but cannot resist pressures to have unsafe sex.
  18. 18. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Train on assertiveness skills to build their confidence
  19. 19. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF EMPOWERMENT  It is possible to provide people with skills to say no to pressures to have sex  But having safe sex thereafter may merely be compliance with programme goals rather than from real empowerment
  20. 20. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  The drop out rates are high after programme is over
  21. 21. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SOCIAL INOCULATOIN THEORY  Emphasizes the role of social pressures to adopt unhealthy behaviour (Duryea, 1991 ; McGuire 1968 , 1974 ).
  22. 22. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Based on the belief that young people lack the negotiating skills to resist unhealthy behavior arising from peer pressure and other influences
  23. 23. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SOCIAL INOCULATION THEORY  Proposes a range of techniques to `inoculate' young people from such pressure.
  24. 24. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com RELEVANCE OF CLAIMS TO PE  Peers as credible source of information  Peers as role models  Education from peer are acceptable
  25. 25. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF CLAIMS  Reliability of self-reported claims about peer pressures questionable. People blame others for their own weaknesses  Individual Choice is more powerful than peer pressure
  26. 26. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF CLAIMS  It is ironical that peers who influence bad behavior are used to combat unhealthy behavior
  27. 27. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com DIFFERENTIAL ASSOCIATION THEORY  Pioneered by Sutherland and Cressy 1960  Young people learn `bad' habits, such as stealing, unsafe sex by associating with others who can teach them.  Similarly young people can just as easily teach each other `good' habits which promote health (Morgan and Eiser, 1990 ).
  28. 28. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com RELEVANCE TO PE  Peers are credible source of information  It utilizes an already established means of sharing information and advice  Education by peers may be acceptable  Used to educate those who are hard to reach
  29. 29. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM OF THEORY  Limited to friendship and network circles  Example: Use of popular prostitutes to do peer counseling among prostitutes  Stigma may make difficult to talk to close friends
  30. 30. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SUBCULTURE THEORIES  Pioneered by Cohen (1955) and Miller (1958)  That delinquents developed subcultures opposed to mainstream culture.  Miller argued that working class culture is oppositional to middle class culture.
  31. 31. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Subcultures promote particular behaviors  E.g.:  Gays subculture  Lesbians subculture  Prostitutes subculture  Chokora subculture
  32. 32. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com RELEVANCE TO PE  peers are a credible source of information  Uses already established means of sharing information and advice  Education by peers may be acceptable  Reaches those hard to reach
  33. 33. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM  Most of the peer education projects paid little or no attention to sub cultural factors.  Most people at risk refuse to be part of these subculture initiatives
  34. 34. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com COMMUNICATION OF INNOVATIONS THEORY  Explains how innovations come to be adopted by communities and what factors influence the rate of adoption [Rogers and Shoemaker (Rogers and Shoemaker, 1971 ), ( Rogers (Rogers, 1983-Diffusion of Innovations)  Discusses:  Characteristics of innovation adopters  the nature of the social system  The characteristics of the innovation  The characteristics of `change agents'.
  35. 35. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com RELEVANCE TO PE  Peer credibility  Reinforcement of learning through interpersonal networks  Recognizes social communication networks
  36. 36. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com CRITICISM  Limited to uptake of health innovations  Limited use in behavior change  Opinion leaders may be inhibitors of innovation  Example: MPs have opposed anti-FGM as HIV reduction strategy
  37. 37. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SOCIAL IDENTIY THEORY  States that an individual has multiple “social identities”  Derived from a sense of membership of a group.
  38. 38. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SOCIAL IDENTIY THEORY  For example:  Individuals are more likely to be influenced by people from their group, than by those who are “out-group” members.
  39. 39. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SOCIAL IDENTIY THEORY  Kisii by Kisii than Luos  Student by class mate than students from other classes
  40. 40. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com ROLE THEORY  States that selected individuals will adapt to the role of group facilitator  Will behave as the facilitator
  41. 41. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com ROLE THEORY  Significant cultural differences makes communication less effective  Useful only in formal education institutions
  42. 42. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com PE RATIONALE  Rationale for PE initiatives not clear
  43. 43. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com PE RATIONALE  Peers are more credible sources of information  Cheaper than other methods  More empowering to educators  Uses already established means of sharing information
  44. 44. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com PE RATIONALE  More successful than professionals in passing on information due to identification
  45. 45. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com PE RATIONALE  Positive role models  Benefits peers educators  More acceptable education than others  Reaches the hard to reach  Reinforces learning
  46. 46. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com PE RATIONALE  Credibility:  People learn better if peer educator is similar to them  People learn better when peer educator faces similar concerns
  47. 47. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Peer educators get more credibility if:  Speak similar language as students  Interact a lot with the peers  Has a history of sharing info with peers
  48. 48. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com ADVERSE EFFECTS FOR PEER EDUCATORS  Anxiety to become an expert source of information  Lack of ongoing support  Lack of payment.  Undermines frequency of contracts
  49. 49. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com EVALUATING PEER EDUCATION  Lack of methodologically sound studies and a limited evidence- base  he evidence base for peer education is weak outcomes of peer education.  Claims of effectiveness not empirically studied
  50. 50. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Most evaluations do not use high-quality evaluation research, including controlled experiments  The intuitive appeal of peer- delivered health promotion is not matched by much hard evidence
  51. 51. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Need of broader and effectiveness-focused evaluation  Example:  Use reach, efficacy, adoption, implementation, maintenance models of evaluation
  52. 52. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com PEER EDUCATION APPROACHES  Methods vary:  Formal tutoring  Group discussions  Informal tutoring  One-to-one discussions  Counseling  Theatre  Stalls and exhibitions 
  53. 53. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SUMMARY  Most theories have something to offer towards an explanation of why peer education might be effective  But promotion practice does not support these theories
  54. 54. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com SUMMARY  There is evidence that what is put on paper is not adopted in practice  Theories not put to use by health sector practitioners and promoters  Evaluation of their effectiveness also lack scientific basis.
  55. 55. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com RECOMMENDATIONS  There is need to domesticate theories to Peer Education  There is need to bridge theory and practice  There is need to use scientific methods to measure efficacy and effectiveness of PE initiatives
  56. 56. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com REFENCES & BIBLIOGRAPHY  G. Turner and J. Shepherd, A method in search of a theory: peer education and health promotion in Health Education Research, Vol. 14, No. 2, 235- 247, April 1999
  57. 57. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  Australian Injecting and Illicit Drug Users League (AIVL) 2006 A framework for peer education by drug-user organisations, Sydney: AIVL  Damon Brogan and Jennifer Kelsall used the AIVL document as background for their presentation with permission from AIVL.
  58. 58. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com  http://her.oxfordjournals.org/cgi/ content/full/14/2/235
  59. 59. PETER ORIARE, UNIVERSITY OF NAIROBI, EMAIL: poriare@yahoo.com

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