Peer education as a strategy to promote positive behaviour change among adolescents: Evidence or fallacy?

2020-07-03 blog informs learns
Peer education as a strategy to promote positive behaviour change among adolescents: Evidence or fallacy?


Peer education is a popular concept whose history can be traced back as far as the history of Aristotle and there have been many peer education initiatives throughout history. It is worthy to highlight the monitorial system introduced by the English educator Joseph Lancaster in the 1800s where the superior or senior students will learn their lessons from the adult teacher in charge of the school and then go on to cascade or transmit their knowledge to the inferior or junior students. A similar initiative to peer education was the student immunisation initiative at the University of Nebraska in America in 1957. The World Health Organisation commissioned the global review of peer education HIV prevention initiatives in 1991.

Peer education is an approach to health promotion in which community members and or groups are supported to promote health-enhancing change among their peers. Peer education is the teaching or sharing of health information, values, and behaviour in educating others who may share similar social backgrounds, geographical settings, age or life experiences. It is argued that 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 others of a similar age, background, and social circumstances. It is supported by the adage ‘send a thief to catch a thief’.

It is evident that peer education has become a popular prevention strategy in the broad field of HIV prevention especially in developing countries and among special groups like adolescents, sex workers, injecting drug users, and members of the LGBTQAI community. 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 behaviour and serving as an accessible and approachable health education resource among the youths’ networks. According to Advocates for Youths, peer education draws on the credibility of young people among their peers, leverages the power of role modelling, and provides flexibility in meeting the diverse needs of other youths.

In analysing the evidence on the effectiveness of peer education or lack of it in promoting positive behaviour change, I consider theoretical perspectives underpinning the concept of peer education.  The first theoretical underpinning is Albert Bandura social learning theory which claims that modelling is an important component of the learning process. It is based on the notion that people observe behaviour taking place and then go on to adopt similar behaviour. In this context, youths will observe the behaviour of peer educators and learn the behaviour as well as adopting that positive behaviour. Another theoretical underpinning for peer education concept is the role theory by Sarbin and Allen (1968) which is based on the concept of social roles and role expectations where peer educators will adapt to the role expectations of a tutor and behave appropriately as tutors and then develop a deeper understanding and commitment to the role of a tutor. A third theoretical perspective on peer education is Sutherland differentiation association theory which posits that through interaction with others, individuals learn the values, attitudes, techniques, and motives for behaviour, positive or negative.

I worked as a youth health advisor for a joint Zimbabwe National Family Planning Council and Global Fund youth Adolescence, Sexual and Reproductive Health (ASRH) project anchored on the peer education as an HIV Prevention Strategy in Zvishavane district of Zimbabwe (2006-2007). The project proved effective in disseminating HIV/AIDS information and providing diversional therapy using sports and peer education sessions. However, its success might have been influenced by confounders and there might have been a coincidence.

 As part of analysing the likely effectiveness of peer education concept, a joint UNICEF-UNAIDS project, in collaboration with Ministry of Health Jamaica, concluded that peer education is effective in promoting the adoption of preventive behaviour with regard to HIV/AIDS. Peer education was recommended as a cost-effective intervention strategy because of the use of volunteers makes it inexpensive to implement and scale-up. According to Advocates for Youths, people are more likely to hear and personalise messages, and thus to change their attitudes and behaviours, if they believe the messenger is similar to them and faces the same concerns and pressures as in peer education.

In support of the effectiveness of peer education, a systematic review by public health researchers concluded that peer education has been employed in India and around the world in a variety of ways that brought changes in the knowledge, attitudes, and behaviours of adolescents and young people. A randomised control trial in Iran showed that with at least 80% of participants in the intervention and control groups completing the study, there was a statistically significant increase of knowledge and attitude improvement as well as a decreased tendency to do risky sexual behaviour among the intervention subjects. It concluded that peer education was an effective and easy-to-apply educational method that increased knowledge and improved attitudes about HIV/AIDS among foreign-origin street children.

A systematic review also concluded that peer education as an intervention stands out as being more effective than other psychosocial regimens, like life skills, in facilitating HIV risk reduction but they also recommended further research. An additional study evaluated the effectiveness of peer education in improving HIV knowledge, attitudes, and preventive practices among in-school adolescents in Osun State, Nigeria. It also showed that, if provided with adequate training and supportive supervision, students can be agents of change in the school environment using the peer education approach.

It is evident that to some extent peer education has proved to be effective in improving knowledge levels, promoting positive behaviour change and dissemination of information in a cost-effective way. However, it is difficult to apply a one-size-fits-all approach and a look at other contextual, social, geographical and socio-economic factors is critical because these factors are likely to be confounders that can influence effectiveness in one way or the other.

About the author

Enock Musungwini is a Public Health and Policy Specialist, Management and Development practitioner who holds an MSc Public health (London School of Hygiene and Tropical Medicine); Master’s in Business Administration (MSU); BSc Hons Psychology (ZOU) and Diploma in Nursing Science (NCZ). Enock is a member of Africa Evidence Network Reference Group and a Chevening Alumni.

***** The views expressed in this article are mine*****

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