Health Education Research, Vol. 15, No. 1, 85-96,
February 2000
© 2000 Oxford University Press
Understanding peer education: insights from a process evaluation
Research Unit in Health and Behavioural Change, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, and
1 Lothian Health Promotion, Deaconess House, 148 Pleasance,Edinburgh EH8 9RS, UK
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Abstract |
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In the UK, peer education has become an increasingly popular way of carrying out health promotion work with young people but evaluations of its effectiveness remain largely unpublished. In particular, illuminative evaluations using qualitative methods are rarely reported both in the UK and other countries. This paper presents insights from the process evaluation of a peer education project in Fife, Scotland which was funded to explore new ways of working with young people in the areas of sexual health, HIV/AIDS and drugs. The interactive approach of the evaluation and its responsiveness to the development of the project are outlined. Factors influencing the peer education process, such as recruitment, setting, organizational context and personal development of participants, are described. Aspects of the formal and informal work carried out by the peer educators are discussed. It is hoped that the paper may provide a starting point for developing more reflective understandings about the processes involved when peers educate peers.
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Introduction |
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TopAbstractIntroductionBackground: the peer education...The evaluation process: an...The processes involved in...Outcomes: the personal...Summary and conclusionsReferences |
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Peer education activities can involve a wide range of informal and formal influences that are difficult to capture using only questionnaires. Moreover, it is difficult to translate people's subjective thinking and feelings into quantitative variables that can be measured. [(Svenson, 1998a), p. 44]
During the 1990s peer education has become an increasingly popular way of carrying out health promotion work with young people. However, in the UK, with a few notable exceptions (Ford and Inman, 1992; Phelps et al., 1994; Mellanby et al., 1995; Frankham, 1998), evaluation of this work remains largely within the `grey literature' of unpublished reports of agencies and organizations (Svenson, 1998b). Similarly, although there is a considerable body of evaluative findings about peer education from the US, much of this relies on quantitative methods (Kelly et al., 1991), tends to investigate mainly short-term impacts and pays little attention to issues of process (Sciacca and Black, 1996). Although analysts have begun critically to assess theories, assumptions and processes underpinning peer education (Milburn, 1995; Frankham, 1998), illuminative evaluations using qualitative methods are rarely reported.
In this paper we present some insights from the process evaluation of a peer education project carried out in Fife, Scotland. The interactive approach taken by the evaluation and its responsiveness to the development of the project is described. Factors influencing the peer education process, such as recruitment, setting and organizational context, are discussed. We finish by considering some immediate outcomes of the Fife Project including the personal development of the peer educators, and aspects of the formal and informal work which they carried out.
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Background: the peer education project in Fife |
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TopAbstractIntroductionBackground: the peer education...The evaluation process: an...The processes involved in...Outcomes: the personal...Summary and conclusionsReferences |
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The peer education project in Fife (Fife Project) ran for 3 years, from 1993 to 1996. It arose from an initial concern in the early 1990s about the relatively high teenage pregnancy rate and increase in sexually transmitted diseases amongst young people in Fife (Director of Public Health, 1992/93
). It was felt that it was appropriate to consider new ways of working locally with young people in the areas of sexual health, drugs and HIV/AIDS, and that one such approach might be peer education in the educational setting.
The Project was a multi-sectoral alliance (Fife Healthcare NHS Trust, 1996). A formal Project Steering Group was set up including representatives from the Health Promotion Department, the Health Education Board for Scotland and Fife Health Board. The Project objectives were:
- To increase young people's knowledge about sexual health and drug use in the context of HIV/AIDS.
- To provide positive experiences for the young people which contribute towards their personal development.
- To support and enable young people to make more informed choices about their sexual behaviour and relationships through skills development
- To enable young people to become effective educators of their own peers.
- To monitor and evaluate processes and outcomes of the project.
- To strengthen links between the school and communities.
- To involve students who are not traditionally involved in school activities.
As with all alliances there were potentially different expectations of the project. However, all stakeholders were aware that, being an innovative, pilot project, the Fife Project would entail developing an illuminative understanding of this way of working with young people as much as demonstrating outcomes. Moreover, changes to the original set of objectives were anticipated and, indeed, this did happen. For example, in the Project's second year, largely because of the Coordinator's workload, a decision was taken to continue to focus the efforts in the formal setting of the schools rather than to start up an initiative in a community setting. In addition, although it had been an initial objective to involve young people `not traditionally involved in school activities', in practice those who became involved tended not to fall into this category. Therefore, through an altered recruitment strategy from Year 2 onwards (discussed later in the paper), it was decided to target young people with the greatest potential for becoming peer educators, rather than to work with more implicit criteria around academic success or lack of it.
The Project initially involved two schools and one further education college. However, the college withdrew from the Project during the second year because of personnel changes. Over the 3 years a total of 85 young people, aged 15/16 (fifth year pupils) and 17/18 (sixth year pupils), were involved as peer educators. They were diverse in terms of socio-economic background and academic achievements. Each year there were more girls than boys in each of the peer educator groups. In terms of academic achievement there were differences between schools and between groups, with mixes of academic achievers and early school leavers.
One of the criticisms of peer education is that it is not a long-term investment as young people may be involved for a certain time and then move on to other interests (Hill, 1993). However, an interesting feature of the Fife Project was the extent of changes in the adult personnel and stakeholder interests involved. There were management changes; changes of Project Coordinators (there were three coordinators over the 3 years, hereafter referred to as Coordinators 1, 2 and 3) and in the evaluation team; changes in the teaching staff liaising with the project; and in the personnel and attitudes of the commissioning and stakeholder bodies. By comparison, one of the more constant elements of the Project's working was the sustained and expanded interest each year from young people wishing to take part! Moreover, most of the young people saw out their commitment and involvement with the Fife Project, and some continued to work as peer educators after leaving school.
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The evaluation process: an interactive approach |
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TopAbstractIntroductionBackground: the peer education...The evaluation process: an...The processes involved in...Outcomes: the personal...Summary and conclusionsReferences |
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The evaluation was developed in conjunction with the Fife Project. In this sense, the evaluation itself was a developmental process since the methods of enquiry grew out of the questions raised by the dynamics of a pilot project as it evolved. Although outcomes, such as changes in knowledge and attitudes, were recorded (Fife Healthcare NHS Trust, 1996
), the evaluation focused more on process than outcome and this is the main focus of this paper. The evaluation was funded as a half-time post for almost the entire duration of the Project. This enabled the Evaluator to be in continuous and regular contact, formally and informally, with all aspects of the Project's workings. Overall, such contacts were too numerous and varied to warrant quantification. Each year, working sensitively with the Project so as not to disrupt its progress or everyday activities, the Evaluator used a variety of mainly qualitative methods. These included:
- Monitoring by the Project Coordinator and regular liaison interviews.
- Interviews with stakeholders and interested parties.
- Individual interviews and focus groups with peer educators.
- Observation and evaluation of peer education training sessions and the work carried out by the peer educators.
- Evaluation by peer educators themselves of these sessions and their formal and informal work.
- Participant observation at steering group meetings.
- Participant observation at three residentials and the recruitment workshops.
- Surveys of knowledge and attitudes.
One of the major challenges for the Evaluator was to establish the parameters of her own role in relation not only to project staff, but also to stakeholders, project participants and recipients. Consequently, setting clear objectives and boundaries regarding the purpose of the evaluation was vital. However, it was also important to establish that negotiation of the Evaluator's role and contribution had to be an ongoing process in keeping with a project which was continuously evolving.
The model of interactive evaluation adopted for the Fife Project required regular contact and feedback between the Evaluator and the Project. Also, given the basic aims of collecting information about the `competing versions of what is going on' (Scott, 1992), the Evaluator needed to involve other relevant individuals in decisions about the kind of questions to be asked, of whom and the most appropriate mechanisms for gathering these data. Such an approach does not indicate a lack of structure or clear purpose, rather it recognizes the value of processes and of feeding back important information at appropriate points. Again, to quote Scott [(Scott, 1992), p. 61]:
...the essential (documents) of everyday evaluation...become, not the truth enshrined, but the means through which changes, developments, problems and issues can be assessed and explored. ...If this process does not occur, the danger is that when an external Evaluation occurs, or time to write the final report comes around, what may have been valid shifts away from the original aims can appear as failures because the means of explanation and justification do not exist.
Evaluation means different things to different people, and the idea of the Evaluator becoming involved in the process and development of a Project may generate alarm, perhaps because it runs counter to a perceived notion that `objectivity' can only be achieved through maintaining distance. Some of the real challenges in implementing this model of interactive evaluation are best illustrated through describing the practical workings of the evaluation methods in the Fife Project. For instance, monitoring by the Coordinator was necessary to gather baseline information about how the programme was developing in each group and each setting. This consisted of a sheet to be filled in by the Coordinator detailing basic information about each peer education session, such as content and numbers attending. This monitoring also provided the means for comparison between groups and the starting point for subsequent interviews between the Coordinator and the Evaluator about the progress and development of the Project. However, the accuracy and amount of detail with which the forms were completed varied over the 3 years, and was wholly dependent on the commitment and attitude to the evaluation of the three successive Coordinators.
Liaison with the Coordinator, in the form of regular briefing meetings and formal interviews, was also important. Here, the relationship between the Evaluator and the Coordinator emerged as crucial as the Evaluator relied on the Coordinator's good will and commitment to make the necessary time for such liaison. Negotiation was particularly important at times of rapid change or development when the Evaluator's need for information was high; but this was precisely when the Project's demands on the Coordinator made meeting difficult. Here, the advantage of a long-term evaluation also became clear in that it allowed the necessary time for interviews with the Coordinator to become part of a supportive and constructive rather than threatening process.
Contact with the peer educator groups themselves was an important component of the evaluation, but its organization presented problems. Initially the Evaluator spent time with the groups in peer education sessions. This was necessary in order to get to know the young people well enough for them to be prepared to meet at other times, but it curtailed the amount of time which they spent with the Coordinator. The Evaluator carried out some careful discussion sessions directly with the peer educator groups in which she sought to clarify her own role, and to make the purpose of an evaluation relevant and meaningful. Over time, the relationships which developed between the Evaluator and the peer educators allowed a move towards more illuminative methods of working, particularly informal interviews with groups and individuals outside classtime. Such relationship development might not be possible in a shorter-term project.
As well as evaluating their training experience and formal activities the Evaluator also explored different methods of recording data about the informal ways in which peer educators passed on information. The peer educators were asked to keep a diary, written or by dictaphone, of each incident which happened in a particular week. However, despite their initial enthusiasm, none of them actually recorded anything even when they had agreed to do this only for 2 days. There may be a number of reasons for this. Firstly, it may no longer have seemed relevant and, because it was not a priority, was simply forgotten. Secondly, it is possible that the incidents which the young people were being asked to describe and document were, from their point of view, almost too casual and too frequent to mention. For instance the Evaluator carried out a series of individual interviews with the sixth year pupils and asked them how often they talked to friends and others about the kind of subjects they covered in peer education and how frequently they gave information to others. The following responses were typical and suggested that the kinds of exchanges which did occur might often take the form simply of a throw away remark.
That's what you spend most of your time talking about. (Male respondent, sixth year, October 1995)It happens probably every couple of days, probably without realizing. (Male respondent, sixth year, January 1996)
Finally, representatives of the major `stakeholders', the funders and the employing organizations, were all interviewed, and regular liaison was maintained with school and college staff. This established the interdependence between the Project and its wider organizational context, and allowed the Evaluator to record the ways in which changes in personnel and in the sympathy and understanding of relevant individuals influenced Project development. It also highlighted fears and differences in expectations amongst school staff and `stakeholders' in a way which was crucial for identifying potential problems, feeding these back to the Project thus helping with their resolution.
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The processes involved in implementing the Fife peer education project |
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TopAbstractIntroductionBackground: the peer education...The evaluation process: an...The processes involved in...Outcomes: the personal...Summary and conclusionsReferences |
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Recruitment
Recruitment is an important issue to be considered when evaluating the processes which contribute to a successful peer education project. In the Fife Project recruitment procedures differed in each setting and from year to year. This was partly due to the different styles of the three Coordinators, but the changes to recruitment procedures were also a conscious attempt to address issues highlighted from the experiences during the first year.
For instance, in the first year it became apparent to the Evaluator that, for a number of pupils, the main attraction of joining the project was the prospect of the forthcoming residential and the statement made by Coordinator 1 that they would be able to earn money from giving peer education sessions in the future. The Evaluation had also indicated that the way in which peer educators had been recruited was a contributory factor to the disintegration and instability of some of the groups in the first year. It was the wish to counter such misinformation about payment, which was never an agreed component of the Project, as well to give potential participants a realistic idea of what the Project would involve, that prompted Coordinator 2 to take a completely different approach to recruitment in the second year.
The recruitment process became much more formalized and structured. Coordinator 2 gave a presentation to school assembly and invited interested pupils to attend a workshop. Large numbers attended this session, which was videoed. They carried out various exercises enabling them to express views on a variety of issues, spoke their names into a video camera, and filled in questionnaires about themselves and why they wanted to do peer education. On the basis of this varied information the Coordinator then assessed and selected the peer educators using criteria identified in the Model, which is described below.
This selective approach, however, also encountered problems of implementation. Firstly, it only proved viable in one of the schools as the others were unable to provide the time or room. Secondly, some of the selected pupils were unable to participate subsequently because of timetable clashes. Finally, although the Coordinator tried to ensure that pupils were not selected on the basis of academic criteria, those who eventually took part were, on the whole, at the higher end of the scale of academic achievement. The Evaluator concluded that, perhaps, the mere setting of any criteria implied that peer education might seem to involve passing academic hurdles simply because of the culture of the school setting in which the project was operating.
The role of Project Coordinator and the life cycle of the project
As is the case in many pilot or small-scale projects, the Fife Project relied on one staff member to administer and carry out the whole initiative. This entailed an enormous variety of tasks such as: setting up the peer educator groups; delivering the training programme; liaising with school and college staff; organizing residentials; supporting the young people in devising their own training sessions within and outwith the school (sometimes even after they had left the Project); and, when necessary, dealing with individual personal problems and referring on to appropriate helping agencies. The Coordinator, therefore, needed to possess a wide range of attributes and skills, and perhaps one of the most difficult demands was the need to display different ones at different stages in the project. Coordinator 2 referred to the fact that her role in relation to the peer educators would change from that of trainer to supportive advisor, perhaps even co-worker, as they developed their own training skills. This transition for the young people was obviously also one for the Coordinator, who faced further changes in role and circumstances as the project drew to the end of its formally funded phase, and preoccupations shifted from direct work with the young people to dissemination and future funding.
The changing situations faced by the Coordinators highlight that each peer education project has its own life cycle and that everyone involved is part of a dynamic process. Coordinators 2 and 3 were, therefore, taking charge of a project with a history and, consequently, needed to deal with the influence of past developments as well as current issues. One of the Coordinators, for example, felt frustrated that what she perceived as the young people's legitimate attempts to strike out and act independently to set up a `peer-helping' scheme were blocked by the Steering Group (see next section). This could not have been an issue in the first year of the project when the peer educators had not yet developed enough confidence to consider such an initiative.
At the same time, there were challenges facing all three Coordinators but which only emerged as concerns at certain points in the Project. For example, one Coordinator felt unsupported in doing the job; another had difficulty in balancing the relationships with the young people and those with school personnel; while another took over the Coordinator role as part of an existing post in the Health Promotion Department and therefore had to balance both sets of demands. This highlighted the fact that, although there are principles and issues which are likely to surface in any project, these are unlikely to manifest themselves in the same way. Thus, the issue of support is one for all workers, but specific needs may vary and vary over time.
The influence of the setting and organizational context
The educational setting
The Fife Project demonstrated the over-riding importance of the setting for peer education. Outwardly, the school environment may present difficulties for undertaking peer education work. The formality of the daily timetable and the classroom set-up of desks in rows reflect an atmosphere somewhat out of step with the values of peer education, with its emphasis on an open debate and the challenging of assumptions.
However, the Evaluation also highlighted how every school is different and that an initiative which works well in one school or college is not guaranteed to succeed in another. Moreover, changes occurred within the same school—staff members left, others incurred extra or new responsibilities, curriculum developments meant increased pressure on timetables. All of these changes caused difficulties in maintaining protected time for peer education. On the other hand, personnel changes within the school or the project were sometimes beneficial and it was certainly the case that, in all three settings, the Project fared more or less well at different times. The main factors at play in these situations were the level of enthusiasm and interest from the main contact teacher, and the level of support and understanding of the Project at the most senior level within the school. These affected the ability of participants to raise the profile of peer education within the school and overcome obstacles.
Close liaison between the Coordinator and school staff involved was essential, and entailed more than simply keeping teachers informed. The enthusiasm and commitment of the school is bound to be encouraged through the evidence of tangible results, and the Evaluation found that the earlier staff saw some impact within the wider school environment, the more advantageous this was likely to be for the Project. However, the needs of the school could conflict with those of the young people in this respect. For example, some peer educators said that they did not want to work with young people in their own school during the first year. The Coordinator respected their wishes, since involving the young people in negotiating the content, context and delivery of peer education sessions was a key principle of the Project. The perception of school staff, however, was that the Project made little or no contribution to pupils outside the peer educator groups for a year.
Some of the school personnel expressed awareness of the differences between the peer education approach and conventional teaching methods. For instance, the Assistant Head at one school pointed out that, although teachers may have training in the skills appropriate to guidance work, they usually have little experience of working with small groups on issues identified by young people themselves. Coordinator 3 also commented that the teachers who occasionally sat in on the training sessions were more concerned to observe and take notes on his approach to the `subject', rather than to participate and engage with the young people in any way or run the group jointly.
The peer educators themselves also expressed strong views about the differences between the peer education training and conventional teaching, and these often took the form of comments about the status and position of teachers. For example, in a group interview some sixth year pupils voiced their concerns about a teacher from the school taking over the Coordinator's role once the Project ended. It would seem that, even if the young people thought highly of some teachers, they still saw the position occupied by a teacher within the school as problematic. Their main anxiety was that it would be impossible to share with a teacher their own information and experience to the depth which they believed was necessary, because they felt they would then be looked down on. For example:
...if you were talking to your maths teacher in peer education about drugs then once you got in to the maths class the teacher would be thinking `that's a wee junkie over there in the corner'. (Male respondent, December 1995)
Pupils' anxieties centred on two main issues: (1) that the teacher would be unable to change their role or personality as necessary and (2) that, because of professional obligations, s/he would be unable to maintain confidentiality. Typical comments were:
...[the teachers] preach to you in a subject, they would want to do the same to us in peer education. (Female respondent, December, 1995)It won't work because the teachers can't look down on us one minute [in class] and then want to be on our wavelength the next [in peer education]. (Female respondent, December 1996).
The organizational context
The running of the Project at day-to-day operational level was also affected in different ways by the organizational context. The Steering Group comprised stakeholder representatives, the Coordinator, the Evaluator and their respective Managers. It met regularly, and had a major role in debating the practice and consequently in both supporting and shaping the development of the Project. This contribution was significant in a situation where little was mapped out from the beginning. It also played a key role in making decisions about particular developments, which, at times, created difficulties and tensions with the Coordinator and raised questions about whether decision-making powers should lie with the Steering Group, the Coordinator or the peer educators.
Two incidents from year 2 of the Project are illustrative. In the first case Coordinator 2 had worked with a sixth year group of peer educators who wished to organize an exchange trip abroad. However, the Steering Group members felt it would be more appropriate for these sixth year pupils to organize a trip within the UK and preferably Scotland. The Coordinator had to inform the sixth year pupils of the need to change their plans. In the second case three girls separated from the rest of the sixth year peer educators group and wanted to set up a `peer helping' service (which they referred to as buddying). However, Steering Group members felt this development should not be pursued as an active part of the Project because of issues around young people becoming involved in counselling others with potentially serious problems, without adequate training or support. They also felt that this was not strictly speaking peer education as defined within the Project and was therefore outside the Coordinator's remit.
The difficult position Coordinator 2 found herself in as a result was, no doubt, exacerbated by the strength of her relationships with the peer educators and the fact that from their point of view she now had to withdraw her support for these particular ventures. These events raised the question of how `peer-led' the Project should be; and demonstrated the perhaps inevitable tension between maintaining the work of the Project within a set of parameters acceptable to funding bodies and stakeholders, and supporting the development of young people whose enthusiasm may lead them down some unpredicted paths.
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Outcomes: the personal development and work of the peer educators |
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TopAbstractIntroductionBackground: the peer education...The evaluation process: an...The processes involved in...Outcomes: the personal...Summary and conclusionsReferences |
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Personal development of the peer educators
At the beginning of the second year of the project Coordinators 2 and 3 worked together to develop a theoretical basis for their work (Figures 1 and 2
) (Miller and MacGilchrist, 1996). This Model set out the principles which underpinned their approach to peer education and defined the parameters within which the Project would develop over the subsequent 2 years. A key aspect was its focus on the personal and skills development of the young people being trained as peer educators, as well as their acquisition of factual information. In fact, one of the main benefits of the Project from the peer educators' point of view appeared to be an increase in their self confidence and their ability to voice their own thoughts and opinions. Typical comments from the interviews and discussions were:[You learn] you can make up your own mind sort of thing. It's not just what your parents say or teachers say goes. (Male respondent, sixth year, December 1995)
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Fig. 1. `A model for peer led work' (Miller and MacGilchrist, 1996
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Fig. 2. `A model for peer led work' (Miller and MacGilchrist, 1996
Before I started peer education I wouldn't have been able to say no but now I can. I can speak up about my feelings. (Female respondent, sixth year, January 1996)
Most of the young women identified this ability to be assertive about their own feelings as something important they learned from the Project. However, there were differences in relation to some of the boys involved in peer education. For instance, Coordinator 3 commented that, although some boys had not yet been able to run the risk of abandoning a self image based on banter, jokes and superficial attitude of not taking anything very seriously, others had indeed been able to acknowledge and talk about their own feelings both within and outwith the group.
There were not only some differences in apparent benefits for young women and young men, but the Evaluator observed that individuals also developed different aptitudes and abilities, and at different speeds. Again, this was in keeping with the Project's approach, which, according to one Coordinator, was to help young people realize their own potential, rather than to clone a series of identical trainers. Some young people, for example, enjoyed the direct contact with others during organized sessions, while others were happier to work behind the scenes in organizing resources and planning the sessions. Working in groups enabled all the peer educators to learn to work together and to complement each others skills.
The peer educators developed a range of skills in presenting and communicating information. During discussions with the Evaluator about their formal work the peer educators demonstrated that they were developing an awareness of why certain activities had worked and others had not. Importantly, in their work and subsequent reflections they showed a readiness to adapt or change the content of subsequent sessions; a resilience to difficult group members and a capacity to face up to the resulting problems; and the ability to change tack if necessary at short notice. They also demonstrated, very clearly, increased teamworking skills through their ability to support each other, work together and play to each other's strengths in the face of any difficulties or challenges. Linked to this, the peer educators developed sophisticated skills in targetting their message, i.e. delivering it in a way which was appropriate to the audience and setting. Girls, for example, expressed awareness that many boys disliked being told anything by girls, and boys also acknowledged the influence of gender, power and hierarchy which resulted in their tailoring information to an individual or group in a non-threatening manner
Defining peer education work: formal and informal
In terms of the actual work carried out by the peer educators, the first challenge was to establish what peer education actually is. The Model referred to earlier was invaluable in setting up the underlying principles of the training approach. However, the definition of what constitutes peer education between peers, at the point of exchange as it were, is a different issue. For instance, one of the stakeholders voiced concern that, `any chat in the playground could be described as peer education'.
The dilemma arises because a basic ethos of peer education is that it is designed to be by and for young people; they themselves largely determine what is relevant in terms of information and how it is to be delivered. This can be disconcerting for adults who, like the Youth Club staff at one venue for a peer education workshop, were dismayed to find that they were asked to leave. Equally, if young people are left in control of what is happening, they can much less easily be made the mouthpiece for adult messages or exhortations. Consequently, whilst many health educators would espouse the theory that knowledge must be packaged and targetted according to its audience or it will have less relevance, the Evaluation found that the fear that inaccurate information or the `wrong message' will be given was a real concern for adult stakeholders. It is possible that such fears may fuel an often implicit assumption that `real' or `proper' peer education only takes place in a formal session.
Two important points flow from this observation. Firstly, the fear that someone might get the wrong information about something as vital as contraception, for example, should not be confused with the fear that, left to their own devices, young people may not talk about sex in the way that adults might wish them to. In the first instance, the calibre of the peer educators in the Fife Project, the depth of their training and the quality of the sessions observed by the Evaluator provided reassurance that, on those occasions when adults were not present, the likelihood of their giving out incorrect information was slight. The Evaluator concluded that the need for adults to relinquish some control over what the peer educators did, precisely in order to enable them to deliver the information in appropriate and relevant ways, was difficult to accept because it was tied in with the need to allow young people in general the space to make their own choices and mistakes—even, or especially—in sexual matters.
Secondly, it was evident that the Project elicited a great deal of interest from the peer educators' schoolmates, and from family and friends, and that they talked informally to all these people about what they were learning. For example, one peer educator group of girls talked about the different contexts in which the subject of AIDS might come up, such as watching TV with the family. One girl told her grandmother the facts about HIV transmission following a misinformed comment from the latter about a character in EastEnders. Another had disagreed with her boyfriend who had said that: `only gay men catch AIDS'. A third talked to her little brother who wanted to know the difference between HIV and AIDS.
There are obvious difficulties in assessing the extent and frequency of such informal contacts, while the impact of the information upon the recipients is even more difficult to assess. In a group interview some peer educator girls themselves raised some of the issues when they spoke about the problems of giving information to others who may not be receptive because they think they already have the answers or they are not in the right frame of mind (e.g. when they have had too much to drink). They spoke about power issues between the sexes, and the importance of choosing the right moment and adopting an appropriate manner, particularly in relation to boys, who: `think they know everything' (Female respondent, fifth year, April 1995). These girls described how they made subtle judgements about the best `teaching line' to take and how they decided when the person they were talking to was likely to be most responsive to what they had to say. In so doing they were bringing to bear their own knowledge of the situation and their peers, exactly as their training had anticipated they should.
During the third year of the Project the Evaluator explored the nature of informal contexts for peer education and views of the peer educators themselves about the most advantageous situations for giving information. The peer educators felt that there were advantages in the use of informal approaches in that they, as individuals, could tailor what they said specifically to the other's experience, whilst the recipient could ask exactly what they want to know and as many questions as s/he liked. They compared formal presentations with more informal exchanges as follows:
Say you are sitting in a class with folk and not everybody can ask everything they want to know, whereas if people are one to one they can ask because you are giving them all your attention. (Male respondent, sixth year, October 1995)When you are talking to a group you have to be selective in what you say because you don't know what different people's reactions are going to be like, whereas if you are talking to a friend on a one-to-one basis you know what their reaction will be so you know what you can say. I could probably say a lot more on a one-to-one basis than what you can in a group because of different people, different opinions. (Female respondent, sixth year, October 1995).
Three important conclusions can be drawn from the Evaluation about the quantity and quality of the peer educators' work. Firstly, it appears that the number of young people who go through the Project and emerge able to run formal sessions as trainers in their own right may be quite small. However, the amount of work they undertake and the numbers of educational contacts they make may be quite considerable. For example, two of the young people from the first intake of peer educators continued to run peer education sessions at youth clubs throughout Fife on a fortnightly basis, although technically they had left the Project. Secondly, it seems likely that the practical experience of running formal sessions is the foundation which gives them the skills and confidence to work informally on their own. Thirdly, the information given out at a display stand, to a group of acquaintances or even in a class session is restricted by time and the presence of others, whilst the opportunity for more detailed and in-depth discussion is greater on a one-to-one basis with one or a few good friends. Consequently, the real benefits and outcomes of the Project may only become evident after the end of the 2 year training programme.
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Summary and conclusions |
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TopAbstractIntroductionBackground: the peer education...The evaluation process: an...The processes involved in...Outcomes: the personal...Summary and conclusionsReferences |
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Process evaluation aims to illuminate how an intervention or initiative actually works in practice and helps to make sense of the successes and the problems. In this paper we have highlighted the following issues arising from the evaluation and development of a peer education project in Fife, Scotland.
The process evaluation was interactive, and relied for its success on clearly defined objectives and sensitive use of methods which were responsive to the needs of Project participants and stakeholders.Recruitment procedures benefited from being clearly articulated and theoretically based.
The Project Coordinators needed to employ a broad base of personal attributes and skills to work with adult stakeholders as well as the young people.
The Fife Project illustrated the dynamic nature of peer education which relies for success on tapping into existing processes and structures.
Consequently the support needs of the peer educators and the Coordinators varied over time.
The success of the Project was influenced by particular settings, and the personnel and programme outcomes varied over time even in the same setting.
Management, organizational and support structures exerted important influences over the form and content of the Project, sometimes at odds with its participants' wishes.
Peer educators developed a variety of personal and teamworking skills but at different rates and with differing aptitudes.
Such skills and aptitudes appeared to increase the peer educators' confidence for informal ways of working, and were particularly shown by their socially sensitive ways of communicating information.
From this it is evident that the progress of the Project (and its eventual outputs) were intimately bound up with the contexts and cultures in which it operated. Peer education is itself a social process, the development of which is influenced, sometimes radically, by its setting, organizational context, key personnel, and the values and expectations of all its participants. In this paper we have only begun to scratch the surface of what needs to be understood about the process of peers educating peers. However, we hope that this may provide a starting point for more reflective debates in health promotion about the complexity and efficacy of this method of practice.
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We would like to express our appreciation to everyone involved in the Fife Project. We are also grateful for the helpful comments of three anonymous referees. The views expressed here are those of the authors alone and may not necessarily reflect those of their employing or funding organizations.
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TopAbstractIntroductionBackground: the peer education...The evaluation process: an...The processes involved in...Outcomes: the personal...Summary and conclusionsReferences |
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Director of Public Health (1992/93) Director of Public Health Annual Report. Fife Health Board, Cupar, UK.
Fife Healthcare NHS Trust (1996) Peer education HIV/AIDS evaluation report 1, 2 and 3. Health Promotion Department. Fife, UK.
Ford, N. and Inman, M. (1992) Safer sex in tourist resorts. World Health Forum, 13, 77–80.[Medline]
Frankham, J. (1998) Peer education: the unauthorised version. British Educational Research Journal, 24, 179–193.
Hill, F. (1993) HIV/AIDS Education in Six Colleges. Report to the Health Education Authority. HIV/AIDS and Sexual Health Programme Paper 14. HEA, London.
Kelly, J. A., St Lawrence, J. S., Diaz, Y. E., Stevenson, L. Y., Hauth, A. C., Brasfield, T. R. R., Kalichman, S. C., Smith, J. E. and Andrew, M. E. (1991) HIV risk behaviour reduction following intervention with key opinion leaders of population: an experimental analysis. American Journal of Public Health, 81, 168–171.
Mellanby, A. R., Phelps, F. A., Crichton, N. J. and Tripp, J. H. (1995) School sex education: an experimental programme with educational and medical benefit. British Medical Journal, 311, 414–417.
Milburn, K. (1995) A critical review of peer education with young people with special reference to sexual health. Health Education Research, 10, 407–420.
Miller, W. and MacGilchrist, L. (1996) A model for peer-led work. Health Education, 2, 24–29.
Phelps, F. A., Mellanby, A. R., Crichton, N. J. and Tripp, J. H. (1994) Sex education: the effects of a peer programme on pupils (aged 13–14 years) and their peer leaders. Health Education Journal, 53, 127–139.
Sciacca, J. P. and Black, D. R. (1996) A critical review of peer education with young people with special reference to sexual health: are we throwing the baby out with the bath water. The Peer Facilitator Quarterly, 14, 17–19.
Scott, S. (1992) Evaluation may change your life but it won't solve all your problems. In Aggleton, P., Young, A., Moody, D., Kapila, M. and Pye, M. (eds), Does it Work? Perspectives on the Evaluation of HIV/AIDS Health Promotion. HEA, London, pp. 57–75.
Svenson, G. (1998a) European guidelines for youth AIDS peer education. European Commission, Brussels.
Svenson, G. (1998b) Annotated bibliography about youth AIDS peer education in Europe. European Commission, Brussels.
Received on January 24, 1999; accepted on May 30, 1999
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