Powerpoint presentation about sexual health promotion for young people. By Dr Simon Forrest, Durham University(http://www.dur.ac.uk/school.health/staff/?username=wsrg35).

1. ‘They treated us like one of
them really’: Peer education
as an approach to sexual
health promotion with young
people
Dr Simon Forrest
School of Medicine & Health
Durham University
Simon.forrest@durham.ac.uk

2. Overview
Explore the evidence base for the
efficacy and effectiveness of peer
education involving young people
Explore the potential strengths and
weaknesses of peer education with
young people.
Identify some of issues and outcomes
associated with peer-led programmes

3. Background
Monitorial system (Lancaster and Bell)
Management of large, mixed aged
groups
Peer tutoring (Vygotsky, 1962)
Learning support
Peer 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

4. 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 peers
support and bullies and provision of guiding and
friendship in victims advice and supporting
everyday together to counselling younger
interaction) 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

5. Rationale for peer-led
approaches
Mobilising communities to design and
implement interventions which are
responsive and receptive to social
and local norms and factors
Potentially ‘long’ reach to vulnerable
and inaccessible groups
‘Edgy’ and ideological congruent with
challenges to ‘top down’ health
promotion

6. Theoretical bases
Theories 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

7. 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 schools
Stephenson et al., (2004)
Reported results of a randomised controlled trial comparing
peer and teacher-led SRE impact on sexual knowledge,
attitudes and behaviour among
Borgia et al., (2005)
Reported results of an evaluation of the effectiveness of
peer education compared to teacher-led in AIDS
prevention

8. Results
(Harden et al & Mellanby et al.)
Small numbers of rigorous studies, most in the USA, most
school based, targeting range of behaviours
Harden et al (1999,2001)
12 studies of which
7 showed that peer education changed young
people’s behaviour
4 more studies showed either an increase in knowledge,
positive shifts in attitudes, behavioural intentions or
self-efficacy.

9. Mellanby et al., (2000)
13 studies of which
7 found peer eds. more effective than teachers in
the long term
4 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

10. 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 use
Delivered 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.

11. Stephenson et al (2004)
3 sessions 1 hours participative learning covering
sex values, decision-making, communication,
condom use
Delivered 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

12. Research limitations
Different kinds of intervention (duration, intensity,
different intervention groups and peer eds.
Differences in topics, methods)
Different comparators and equally successful
comparators
Peer led works for some groups (girls and young
women = outcomes young men = satisfaction))
Sufficient length of follow-up
Expecting too much of interventions and unable to
overcome socio-cultural factors

13. 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

14. 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

15. Conclusions
We 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
outcomes
Has some other characteristics and potential
advantages which may make it attractive as an
intervention
Needs a supportive context, organisational culture
, time and energy
Peer educators may be the primary target
audience

16. Resources
Resources
Forrest, S. and Lynch, J. (2002) SRE and peer support,
Peer Support Forum Briefing Paper, London: Sex
Education Forum.
http://peersupport.ukobservatory.com
Entre Nous: The european magazine for sexual and
reproductive health No 56 2003,
https://www.euro.who.int/document/ens/en56.pdf
Europeer UK,
https://projects.exeter.ac.uk/europeeruk/index.htm
Scottish Peer Education Network (SPEN)
http://www.fastforward.org.uk/peernetwork.html

17. References
Borgia 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: 508-516
Charleston 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 health
Fox J, Walker B, Kusher S (1993) 'It's not a bed of roses'; Young mother's 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): 339-353
Jacquet 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): 533-545
Schonbach 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: 338-346
Strouse 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.se
Vygotsky LS (1962) Thought and language. MIT Press, Cambridge, MA.