‘They treated us like one of them really’: Peer education as an approach to sexual health promotion with young people
‘They treated us like one ofthem really’: Peer educationas an approach to sexualhealth promotion with youngpeopleDr Simon ForrestSchool of Medicine & HealthDurham UniversitySimon.firstname.lastname@example.org
OverviewExplore the evidence base for the efficacy and effectiveness of peer education involving young peopleExplore the potential strengths and weaknesses of peer education with young people.Identify some of issues and outcomes associated with peer-led programmes
BackgroundMonitorial system (Lancaster and Bell) Management of large, mixed aged groupsPeer tutoring (Vygotsky, 1962) Learning supportPeer education (Clements and Buczkiewicz, 1993; Charleston et al., 1998; Svenson, 1998; Jaquet et al. (1996) Effecting change in attitudes, values, knowledge, awareness and behaviour through the benign influence of members of the group
Models and methods Peer involvement Approaches Peer Counselling Peer Education Peer Projects (one-to-one work between (one peer working with a (groups of peers working peers) group) with groups ) Befriending Mediation Counselling Mentoring (offering (bringing (structured (older peerssupport and bullies and provision of guiding andfriendship in victims advice and supporting everyday together to counselling youngerinteraction) resolve peers) disputes Pedagogic Outreach Diffusional Community-based (Presentation (Information/skills (Information /skills (Change affected by within formal sharing and disseminated via the formation of education settings discussion in social spontaneous and coalitions based ) settings) unstructured within communities) discussion between peers
Rationale for peer-led approachesMobilising communities to design and implement interventions which are responsive and receptive to social and local norms and factorsPotentially ‘long’ reach to vulnerable and inaccessible groups‘Edgy’ and ideological congruent with challenges to ‘top down’ health promotion
Theoretical basesTheories of health-related behaviour Knowledge, attitudes, self-efficacy, etc.Social learning Internalisation, age/status similarity etc.Diffusion Transmission of new ideas through (sub)cultures 6
Does it work?Harden et al., (1999, 2001)critically examined the claim that peer education is a more effective and appropriate way of promoting young people’s health than other traditional approaches.Mellanby et al., (2000)reviewed of studies comparing comparing peer-led and adult- led health education in schoolsStephenson et al., (2004)Reported results of a randomised controlled trial comparing peer and teacher-led SRE impact on sexual knowledge, attitudes and behaviour amongBorgia et al., (2005)Reported results of an evaluation of the effectiveness of peer education compared to teacher-led in AIDS prevention
Results (Harden et al & Mellanby et al.)Small numbers of rigorous studies, most in the USA, most school based, targeting range of behavioursHarden et al (1999,2001)12 studies of which7 showed that peer education changed young people’s behaviour4 more studies showed either an increase in knowledge, positive shifts in attitudes, behavioural intentions or self-efficacy.
Mellanby et al., (2000)13 studies of which7 found peer eds. more effective than teachers in the long term4 found no difference between peer educators and teachers.When peer-led and teachers both compared to other programmes: Peer-led more impact in 9 studies Teacher-led more impact in 4 studies
Results (Borgia et al & Stephenson et al)Borgia et al (2005)5 sessions 10 hours participative learning covering sex and drugs; values, decision-making, communication, condom useDelivered by 9th graders – 7th graders (14/15 – 12/13 yr old• Positive outcomes for knowledge, attitudes and behaviours for both groups.• Higher HIV knowledge among peer-led group.
Stephenson et al (2004)3 sessions 1 hours participative learning covering sex values, decision-making, communication, condom useDelivered by yr12 – yr9 (16/17 – 13/14 yr old• Higher satisfaction in peer-led groups• Girls in peer-led less likely to have sex by 16 years old, and see delaying sex as positive• Knowledge about STI prevention and HIV higher in peer-led group• No overall difference in condom use, sexual regret, pregnancy, relationships quality
Research limitationsDifferent kinds of intervention (duration, intensity, different intervention groups and peer eds. Differences in topics, methods)Different comparators and equally successful comparatorsPeer led works for some groups (girls and young women = outcomes young men = satisfaction))Sufficient length of follow-upExpecting too much of interventions and unable to overcome socio-cultural factors
Why might peer-led approaches be useful? Young people relate to peer educators credible, relaxed, non-judgmental, respectful of confidences Accessible and effective methods More active and participatory Peer educators’ development Increases in knowledge, attitudinal change, relationship competence, and confidence ‘Long reach’ of peer ed. Provides access to individuals and groups hard for traditional means to reach
What are the challenges?Gender and sexuality issues (Fox et al., 1993; Schonbach, 1995; Strouse et al., 1990) Recruiting young men; Breaking expectations about gender roles Heterosexuality and group dynamics Diffusional limits (Frankum, 1998) Peer eds can find it difficult to get beyond immediate social circles Organisational friction Peer ed. may conflict with dominant pedagogy, structure and relationships Cost Financial and labour costs may be high
ConclusionsWe can a qualified ‘yes’ to the question of whether peer education is effective as approach to health promotion BUT maybe no more effective than other approaches for behavioural outcomesHas some other characteristics and potential advantages which may make it attractive as an interventionNeeds a supportive context, organisational culture , time and energyPeer educators may be the primary target audience
ResourcesResourcesForrest, S. and Lynch, J. (2002) SRE and peer support, Peer Support Forum Briefing Paper, London: Sex Education Forum. http://peersupport.ukobservatory.comEntre Nous: The european magazine for sexual and reproductive health No 56 2003, https://www.euro.who.int/document/ens/en56.pdfEuropeer UK, https://projects.exeter.ac.uk/europeeruk/index.htmScottish Peer Education Network (SPEN) http://www.fastforward.org.uk/peernetwork.html
ReferencesBorgia et al., (2005) Is peer education the best approach for HIV prevention in schools? Findings from a randomized controlled trial, Journal of Adolescent Health 36: 508-516Charleston S, Oakley A, Johnson A, Stephenson J, Brodala A, Fenton K, Petruckevitch A (1998) Report on a pilot study for a randomised controlled trial of peer-led sex education in schools. Social Science Research Unit, Institute of Education, London.Clements I, Buczkiewicz M (1993) Approaches to peer-led healthFox J, Walker B, Kusher S (1993) Its not a bed of roses; Young mothers education project evaluation report. Norwich: Centre for Applied Research in Education, University of East Anglia.Frankham J (1998) Peer Education: the unauthorised version. British Educational Research Journal, 24(2): 179-193.Harden, A., Oakley, A. and Oliver, S. (2001) Peer-delivered health promotion for young people: A systematic review of different study designs, Health Education Journal 60(4): 339-353Jacquet S, Robertson N, Dear C (1996) The Crunch. Fast Forward Positive Lifestyle Ltd.Mellanby, A.R., Rees, J.B. and Tripp, J. H. (2000) Peer-led and adult-led school heath education: a critical review of available comparative research, Health Education Research 15(5): 533-545Schonbach K (1995) Health promotion and peer involvement for youth. Themen and Konzepte, Berlin.Stephenson et al., (2004) Pupil-led sex education in England (RIPPLE study): cluster-randomised intervention trial, The Lancet 364: 338-346Strouse JS, Krajewski LA, Gillin SM (1990) Utilzing undergraduate students as peer discussion facilitators in human sexuality classes. Journal of Sex Education and Therapy, 16(4): 227- 235.Svenson,G. (1998) European guidelines for youth AIDS peer education. Lund, Sweden: University of Lund. http://www.europeer.lu.seVygotsky LS (1962) Thought and language. MIT Press, Cambridge, MA.