Peer education

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Peer education is an approach to health promotion, in which community members are supported to promote health-enhancing change among their peers. Peer education is the teaching or sharing of health information, values and behavior in educating others who may share similar social backgrounds or life experiences. [1] [2] [3]

Contents

Rather than health professionals educating members of the public, the idea behind peer education is that ordinary lay people are in the best position to encourage healthy behaviour to each other.[ citation needed ]

Areas of application

Peer education has become very popular in the broad field of HIV prevention. It is a mainstay of HIV prevention in many developing countries, [4] among groups including young people, sex workers, people whom practice unprotected sex, or people who use intravenous drugs.[ citation needed ]

Peer education is also associated with efforts to prevent tobacco, alcohol and other drug use among young people. Peer educators can be effective role models for young adolescents by promoting healthy behavior, helping to create and reinforce social norms that support safer behaviors, and also serve as an accessible and approachable health education resource both inside and outside the classroom. [5]

Peer education is useful in promoting healthy eating, food safety and physical activity amongst marginalized populations. Peer education is also favorably used in medical education. [6] [7]

Some public school districts have implemented peer-education programs. For example, New York City schools implemented a peer-led sex education program in 1974. [8]

The process

A peer education programme is usually initiated by health or community professionals, who recruit members of the target community to serve as peer educators. The recruited peer educators are trained in relevant health information and communication skills. Armed with these skills, the peer educators then engage their peers in conversations about the issue of concern, seeking to promote health-enhancing knowledge and skills. The intention is that familiar people, giving locally-relevant and meaningful suggestions, in appropriate local language and taking account of the local context, will be most likely to be able to promote health-enhancing behaviour change.[ citation needed ]

There is a great variety in the support provided to peer educators. Sometimes they are unpaid volunteers, sometimes they are given a small honorarium, sometimes they receive a reasonable salary. The peer educators may be supported by regular meetings and training, or expected to continue their work without formal supports.[ citation needed ]

Theories

A variety of theories are offered regarding the question of how peer education is supposed to achieve positive results.

The popular opinion leader theory [9] suggests a parallel between peer education and the marketing of commercial products. Peer educators are seen as opinion leaders—respected and admired by other members of the community. These opinion leaders espouse a certain lifestyle (such as safer sex, or not smoking, etc.)—and their peers wish to emulate them.[ citation needed ]

Critical consciousness

Campbell argues that what peer education ought to do is to promote the kind of critical consciousness theorised by Paulo Freire. [10] This means that peers use the peer education process to critically discuss their circumstances, especially the social factors impacting upon their health. Becoming critically aware of these forces is the first step to tackling them. So, for instance, if local norms regarding sexuality and gender put people's health at risk, this approach argues that peers should critically discuss those norms, so that they can then collectively seek to establish new more health-enhancing norms.[ citation needed ]

Social learning theory

Based on the work of Bandura and colleagues, social learning theory claims that modelling is an important component of the learning process. In the most basic sense, people observe behaviour taking place and then go on to adopt similar behaviour. Participants require the opportunity to practice modelled behavior and positive reinforcement if it is to be adopted successfully. [11]

Differential association theory

Based on the work of Sutherland and Cressy, [12] differential association theory has been applied to the study of crime. Rather than the result of biological or psychological disorders, crime is a learned behaviour. This learning happens in social situations by associating with those who can teach the necessary skills and techniques needed. Through this theory it can be understood that peers can be very influential for both positive and negative behaviours. Young people can learn both good and bad habits from each other. In differential association theory the mere association with others provides a learning opportunity. If social learning theory is essentially psychological, differential association theory is essentially sociological.[ citation needed ]

Role theory

Sarbin argues that peer educators will adapt to the role expectations of a tutor and behave appropriately. Furthermore, through adopting a role, individuals develop a deeper understanding and commitment to it. The potential is that Peer educators can develop a stronger commitment and a greater appreciation of the relevance of the health topic. Role theory is also based on the premise that communication can be blocked by differences in culture between the teacher and learner. Peer educators who have a similar set of experiences and culture are therefore likely to be more effective in promoting learning. [13]

Communication of innovations theory

Developed by Rogers and Shoemaker, the communication of innovations theory explains how innovations come to be adopted by communities and what factors influence the rate of adoption. These factors include the characteristics of those who adopt the innovation, the nature of the social system, the characteristics of the innovation and the characteristics of change agents. Rogers and Shoemaker argue that all innovations follow a similar pattern of adoption, with one group of people—the innovators—taking it up immediately. Then there are early adopters, the early majority, the late majority and finally the laggards, including some who never adopt the innovation. In this theory key people influence the opinion leaders within a community. Change agents can be viewed as health professionals while opinion leaders correlate with peer educators. Rogers and Shoemaker argue that effective communication occurs when the source and receiver are homophilous, that is, are similar in certain attributes. These include beliefs, values, education and social status. This would suggest that peers communicate better than those who are unequal or different. [14]

Support

Peer educators are seen as credible sources of information. [3] This has been shown to be particularly effective amongst the youth population. Peers and peer education are an important influence and approach in changing health behaviours. [2] [15]

One of the beliefs of peer education is that it is cost effective. Peer education has been identified as a more economical way to deliver health training. [1] [16]

A team of peer educators can extend health promotion outreach and be more accessible than paid health professionals. Peer educators help to bridge many of the gaps in service that occur through fear and suspicion of official health care providers, and to facilitate effective communication with community members and professional provider. [16] Engaging youth peer educators helps professionals to extend their outreach of programs and services to ensure their efforts are impactful.[ citation needed ]

Peer education is empowering from both the standpoint of the peer educator and the individual receiving service. Peer education has been operative in encouraging knowledge, attitudes and intention to change behavior in AIDS prevention. [15] Furthermore, nondirective peer support has been identified as the best way to motivate individuals in the preparation, action, or maintenance stages of readiness to change. [17] Researchers have acknowledged that trained peer tutors were more effective than the untrained peers in influencing positive health outcomes. [16] Peer education offers the educators the opportunity to benefit from taking on meaningful roles. Peer educators can act as enthusiastic advocates for the program and have a sense of purpose in their community outreach efforts. [18]

Peer education is sustainable. This has been found to be an important issue for community-based health promotion interventions to make a difference over time. [18] A grassroots initiative involving volunteers means that the health issue is reaching the target audience continuously with less of a threat of financial cutbacks impacting on their work. Research findings support the use of volunteer peer educators as a feasible and effective healthcare delivery strategy and as having promising indicators of sustainability over time. [18] Sustainability through the engagement of peer educators can strengthen the social environment so that it is supportive of healthy behaviors.[ citation needed ]

Debates

Despite its popularity, the evidence about peer education is mixed, and there is no consensus on whether it works or how it works. Researchers have questioned the validity of the assumption that peer education influences behavior. [3]

One important line of inquiry suggests that peer education may work in some contexts but not in others. [19] [20] A study comparing peer education among sex workers in India and South Africa found that the more successful Indian group benefited from a supportive social and political context, and a more effective community development ethos, rather than the biomedical focus of the South African intervention. [21]

A key issue concerns what a peer is and who defines this. In some instances age is a central factor but in other contexts, commonalities such as status may be more relevant. [2] Caution has been noted regarding selection of peer educators. Some argue that there can be a stigma held against peer educators who have faced adversities in their own lives, particularly by mainstream health service organizations and professionals. [3] Alternatively, peers educators would need to have high status within their social group to be effective. [2] Researchers have argued that peer educators sometimes receive inadequate training, which limits their ability to educate their peers effectively and further state that peer selection and training is very important. [2] [3]

An important analysis on the development of many peer education projects is that it is led by adult constructions of adolescence and adolescent health behaviour. A central question should therefore be whose agenda is being served by using peer education projects which manipulate and exploit the social worlds of young people? [2]

See also

Related Research Articles

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Juvenile delinquency Illegal behavior by minors

Juvenile delinquency, also known as juvenile offending, is the act of participating in unlawful behavior as a minor or individual younger than the statutory age of majority. In the United States of America, a juvenile delinquent is a person who commits a crime and is under a specific age. Most states specify a juvenile delinquent as an individual under 18 years of age while a few states have set the maximum age slightly different. In 2021, Michigan, New York, and Vermont raised the maximum age to under 19, and Vermont law was updated again in 2022 to include individuals under the age of 20. Only three states, Georgia, Texas, and Wisconsin still appropriate the age of a juvenile delinquent as someone under the age of 17. While the maximum age in some US states has increased, Japan has lowered the juvenile delinquent age from under 20 to under 18. This change occurred on April 1, 2022 when the Japanese Diet activated a law lowering the age of minor status in the country. Just as there are differences in the maximum age of a juvenile delinquent, the minimum age for a child to be considered capable of delinquency or the age of criminal responsibility varies considerably between the states. Some states that impose a minimum age have made recent amendments to raise the minimum age, but most states remain ambiguous on the minimum age for a child to be determined a juvenile delinquent. In 2021, North Carolina changed the minimum age from 6 years old to 10 years old while Connecticut moved from 7 to 10 and New York made an adjustment from 7 to 12. In some states the minimum age depends on the seriousness of the crime committed. Juvenile delinquents or juvenile offenders commit crimes ranging from status offenses such as, truancy, violating a curfew or underage drinking and smoking to more serious offenses categorized as property crimes, violent crimes, sexual offenses, and cybercrimes.

Risk compensation Behavioral theory

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Diffusion of innovations Theory on how and why new ideas spread

Diffusion of innovations is a theory that seeks to explain how, why, and at what rate new ideas and technology spread. Everett Rogers, a professor of communication studies, popularized the theory in his book Diffusion of Innovations; the book was first published in 1962, and is now in its fifth edition (2003). Rogers argues that diffusion is the process by which an innovation is communicated over time among the participants in a social system. The origins of the diffusion of innovations theory are varied and span multiple disciplines.

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Social cognitive theory Theory in psychology

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Initiatives to prevent sexual violence

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Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, transgender (LGBT) youth are significantly higher than among the general population.

Sex education in the United States is taught in two main forms: comprehensive sex education and abstinence-only as part of the Adolescent Family Life Act, or AFLA. Comprehensive sex education is also called abstinence-based, abstinence-plus, abstinence-plus-risk-reduction, and sexual risk reduction sex education. This approach covers abstinence as a choice option, but also informs adolescents about human sexuality, age of consent and the availability of contraception and techniques to avoid contraction of sexually transmitted infections. Every state within the U.S. has a mandated AIDS Education Program.

HIV-affected community Medical condition

The affected community is composed of people who are living with HIV and AIDS, plus individuals whose lives are directly influenced by HIV infection. This originally was defined as young to middle aged adults who associate with being gay or bisexual men, and or injection drug users. HIV-affected community is a community that is affected directly or indirectly affected by HIV. These communities are usually influenced by HIV and undertake risky behaviours that lead to a higher chance of HIV infection. To date HIV infection is still one of the leading cause of deaths around the world with an estimate of 36.8 million people diagnosed with HIV by the end of 2017, but there can particular communities that are more vulnerable to HIV infection, these communities include certain races, gender, minorities, and disadvantaged communities. One of the most common communities at risk is the gay community as it is commonly transmitted through unsafe sex. The main factor that contributes to HIV infection within the gay/bisexual community is that gay men do not use protection when performing anal sex or other sexual activities which can lead to a higher risk of HIV infections. Another community will be people diagnosed with mental health issues, such as depression is one of the most common related mental illnesses associated with HIV infection. HIV testing is an essential role in reducing HIV infection within communities as it can lead to prevention and treatment of HIV infections but also helps with early diagnosis of HIV. Educating young people in a community with the knowledge of HIV prevention will be able to help decrease the prevalence within the community. As education is an important source for development in many areas. Research has shown that people more at risk for HIV are part of disenfranchised and inner city populations as drug use and sexually transmitted diseases(STDs) are more prevalent. People with mental illnesses that inhibit making decisions or overlook sexual tendencies are especially at risk for contracting HIV.

Social and behavior change communication

Social and behavior change communication (SBCC), often also only "BCC" or "Communication for Development (C4D)" is an interactive process of any intervention with individuals, group or community to develop communication strategies to promote positive behaviors which are appropriate to their settings and thereby solving the world's most pressing health problems. This in turn provides a supportive environment which will enable people to initiate, sustain and maintain positive and desirable behavior outcomes.

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

A behavior change method, or behavior change technique, is a theory-based method for changing one or several determinants of behavior such as a person's attitude or self-efficacy. Such behavior change methods are used in behavior change interventions. Although of course attempts to influence people's attitude and other psychological determinants were much older, especially the definition developed in the late nineties yielded useful insights, in particular four important benefits:

  1. It developed a generic, abstract vocabulary that facilitated discussion of the active ingredients of an intervention
  2. It emphasized the distinction between behavior change methods and practical applications of these methods
  3. It included the concept of 'parameters for effectiveness', important conditions for effectiveness often neglected
  4. It drew attention to the fact that behavior change methods influence specific determinants.

Adolescent sexuality in Canada is not as well documented as adolescent sexuality in the United States; despite the proximity of the two nations, Canada has its own unique culture and generalizations about Canadian adolescent sexuality based on American research can be misleading. Because of this, several surveys and studies have been conducted which acquired information on Canadian adolescent sexuality. Surveys which provide this information include the Canadian Community Health Survey (CCHS), the National Population Health Survey (NPHS) and the National Longitudinal Survey of Children and Youth (NLSCY). According to information drawn from the Canadian Community Health Survey and the National Population Health Survey, in 2005 43% of teens aged 15 to 19 reported that they had had sexual intercourse at least once.

Sean Young (psychologist) Psychologist

Sean D. Young is an American social and behavioral psychologist. He is a medical school and Computer and Information Sciences professor with the University of California, Irvine (UCI). He serves as the Executive Director of the University of California, Institute for Prediction Technology (UCIPT) and the UCLA Center for Digital Behavior (CDB).

References

  1. 1 2 Boyle, J.; Mattern, C. O.; Lassiter, J. W.; Ritzler, M. S. (2011). "Peer 2 peer: Efficacy of a course-based peer education intervention to increase physical activity among college students". Journal of American College Health. 59 (6): 519–529. doi:10.1080/07448481.2010.523854. PMID   21660807. S2CID   39923580.
  2. 1 2 3 4 5 6 Green, J (2001). "Peer education". Promotion and Education. 8 (2): 65–68. doi:10.1177/102538230100800203. PMID   11475039. S2CID   45132844.
  3. 1 2 3 4 5 Sriranganathan, G.; Jaworsky, D.; Larkin, J.; Flicker, S.; Campbell, L.; Flynn, S.; Janssen, J.; Erlich, L. (2010). "Peer sexual health education: Interventions for effective program evaluation". Health Education Journal. 71 (1): 62–71. doi:10.1177/0017896910386266. S2CID   72983724.
  4. ↑ Kelly, J. A.; St Lawrence, J. S.; Stevenson, L. Y.; Hauth, A. C.; Kalichman, S. C.; Diaz, Y. E.; Brasfield, T. L.; Koob, J. J.; Morgan, M. G. (1992). "Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities". American Journal of Public Health. 82 (11): 1483–1489. doi:10.2105/ajph.82.11.1483. PMC   1694607 . PMID   1443297.
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  6. ↑ Gibson, Kyle R.; Qureshi, Zeshan U.; Ross, Michael T.; Maxwell, Simon R. (2014-01-01). "Junior doctor-led 'near-peer' prescribing education for medical students". British Journal of Clinical Pharmacology. 77 (1): 122–129. doi:10.1111/bcp.12147. ISSN   1365-2125. PMC   3895353 . PMID   23617320.
  7. ↑ Yeung, Eugene Y. H.; Alexander, Megan (2017-08-11). "Use of junior doctor-led peer education to improve antibiotic stewardship". British Journal of Clinical Pharmacology. 83 (12): 2831–2832. doi:10.1111/bcp.13375. ISSN   1365-2125. PMC   5698584 . PMID   28799275.
  8. ↑ Anderson, Lisa F. (November 2019). ""Kids Know What They Are Doing": Peer-led Sex Education in New York City". History of Education Quarterly. 59 (4): 501–527. doi: 10.1017/heq.2019.41 .
  9. ↑ Kelly, J.A. (2004). "Popular opinion leaders and HIV prevention peer education: resolving discrepant findings, and implications for the development of effective community programmes" (PDF). AIDS Care. 16 (2): 139–150. doi:10.1080/09540120410001640986. PMID   14676020. S2CID   959171.[ permanent dead link ]
  10. ↑ Campbell, Catherine; MacPhail, Catherine (2002). "Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth". Social Science and Medicine. 55 (2): 331–345. doi:10.1016/s0277-9536(01)00289-1. PMID   12144146.
  11. ↑ Bandura, A. (1977) Social Learning Theory. Prentice-Hall, Englewood Cliffs, NJ.
  12. ↑ Sutherland, E. H. and Cressy, D. R. (1960) Principles of Criminology. Lippincott, Philadelphia.
  13. ↑ Sarbin, T. R. and Allen, V. L. (1968) Role theory. In Lindzey, G. and Aronson, E. (eds), Handbook of Social Psychology, Vol. 1. Addison-Wesley, Reading, pp. 488–567.
  14. ↑ Rogers, E. M. and Shoemaker, F. F. (1971) Communication of Innovations. New York, Free Press.
  15. 1 2 Cui, Z.; Shah, S.; Yan, L.; Yongping, P.; Gao, A.; Shi, X.; Wu, Y.; Dibley, M. J. (2012). "Effect of a school-based peer education intervention on physical activity and sedentary behavior in Chinese adolescents: A pilot study". BMJ Open. 2 (3): e0000721. doi: 10.1136/bmjopen-2011-000721 . PMC   3358620 . PMID   22586284.
  16. 1 2 3 Wiskochil, B.; Lieberman, L.; Houston-Wilson, C.; Petersen, S. (2007). "The effects of trained peer tutors on the physical education of children who are visually impaired". Journal of Visual Impairment & Blindness. 101 (6): 339–350. doi:10.1177/0145482X0710100604. S2CID   145782882.
  17. ↑ Richert, M. L.; Jones Webb, A.; Morse, N.A.; O'Toole, M. L.; Brownson, C. A. (2007). "Move more diabetes: Using lay health educators to support physical activity in a community-based chronic disease self-management program". The Diabetes Educator. 33 (6): 179–184. doi:10.1177/0145721707304172. PMID   17620399. S2CID   4575727.
  18. 1 2 3 Kim, S.; Koniak-Griffin, D.; Flaskerud, J. H.; Guarnero, P. A. (2004). "The impact of lay health advisors on cardiovascular health promotion". Journal of Cardiovascular Nursing. 19 (3): 192–199. doi:10.1097/00005082-200405000-00008. PMID   15191262. S2CID   10075839.
  19. ↑ Hart, G., Williamson, L., & Flowers, P. (2004). Good in parts: the Gay Men's Task Force in Glasgow - a response to Kelly. AIDS Care, 16(2), 159-165
  20. ↑ Elford, J.; Bolding, G.; Sherr, L. (2004). "Popular opinion leaders in London: A response to Kelly". AIDS Care. 16 (2): 151–158. doi:10.1080/09540120410001640995. PMID   14676021. S2CID   24338257.
  21. ↑ Cornish, F.; Campbell, C. (2009). "The social conditions for successful peer education: A comparison of two HIV prevention programs run by sex workers in India and South Africa". American Journal of Community Psychology. 44 (1–2): 123–135. doi:10.1007/s10464-009-9254-8. PMID   19521765. S2CID   511350.
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