Objectives of the review

1. Peer education as a viable strategy: school and out-of-school youth Sheri BastienPhD Candidate, UiO24.01.08

2. Peer Education for Adolescent Reproductive Health: An Effective Method for Program Delivery, a Powerful Empowerment Strategy, or Neither?Sheri Bastien, Alan J. Flisher, Catherine Mathews, Knut Inge Klepp

3. Objectives of the review • Assess: • to what extent the widespread use of peer education in SSA is reflected in the research literature; • describe the varying approaches to peer education; • whether evaluation results appear to support the widespread use of peer educators; and • based on available literature identify gaps and areas for future research.

4. Method • search of published work carried out electronically using key word searches: “peer education”, “peer leader/s” and “peer training” in combination with “Africa”. • Inclusion criteria: written in English, conducted in an African country and focused on adolescents or young adults (10-24 years).

5. Method • number of articles rose from 38 between the years 1981-85, to 229 by the year 2000 and 306 by 2005 • restricted to the African context, there was a rise from 0 articles by 1985, to 19 articles by 2000 and 31 articles by 2005. • only 15 papers based on 12 African studies published between 1990 and 2005 fulfilled the criteria.

6. Structure of the review Turner and Shepherd (1999) used as a point of departure. They identified 10 of the most frequently cited benefits of peer education: • It is more cost-effective than other methods; • Peers are a credible source of information; • Peer education is empowering for those involved; • It utilizes an already established means of sharing information; • Peers are more successful than professionals in passing on information because people identify with their peers; • Peer educators act as positive role models; • Peer education is beneficialto those involved in providing it; • Education presented by peers may be acceptable when other education is not; • Peer education may be used to educate those who are hard to reach through conventional methods, and; • Peers can reinforce learning through ongoing contact.

7. Main findings • Majority of the identified studies have a number of methodological limitations, including weak research designs • Most focus on measures such as knowledge, attitudes, and beliefs, or outputs such as the number of peer educators trained, self-reported behavior change • Few RCTs or evaluations which use biological markers such as STI/HIV incidence or pregnancy rates as outcome measures

8. Main findings • Studies often lacking information specifying theoretical grounding of the intervention, selection methods, training, including the length, who it was conducted by and what it comprised of • Peer education often used as one of multiple educational strategies (info dissemination, drama, sport, condom distribution) so it is not possible to assess the effects due specifically to peer education

9. Need for further research • Overall lack of conceptual clarity, diversity in stated aims, methods and strategies, implementation, evaluation and findings of peer education programs. • As a consequence of the lack of well-designed evaluation studies, new programs are continually developed which do not capitalize on the successes of others, and the scaling up of successful interventions is impeded.

10. Need for further research • Comparisons of peer versus adult-led programs and mixed approaches should be undertaken and the need for long-term follow up studies of cohorts is also crucial • Further research into the recruitment, selection and training of peer educators, and the activities they engage in is necessary to understand how these factors influence the outcome of a program

11. Concluding remarks • Stronger evidence-based than is currently available is critical for peer education to be prioritized by those in charge of funding

12. HIV Prevention among Young People In- and Out-of-School in Kilimanjaro • Aim: investigate and compare self-reported exposure to information and communication about AIDS, perceived credibility and preferences • Self-administered questionnaire completed by 1007 students in Standard 7 and Form 1, same questionnaire completed with assistance of trained interviewers of same sex by 993 young people who had not attended formal education in the past 6 months • Respondents between the ages of 13 and 18

13. Main Findings • Radio ranked as most frequent source of AIDS information and friends as most frequent source of communication about AIDS in both samples • Students reported significantly more frequent exposure to and communication about AIDS than those out of school • Exposure to AIDS information occurs more frequently than discussing it • Doctors, radio and parents ranked most credible by those in-school while mass media sources ranked highest among those out-of-school • Both samples ranked friends, parents and doctors as the preferred communicators

14. Conclusions • Innovative approaches are needed to improve access to health information by hard to reach groups such as young people who do not attend school, interventions are needed which focus on stimulating discussion and developing interpersonal communication skills • Use of peer educators may be one strategy to reach young people who do not attend school • Mobile VCT units may be well suited for primary prevention activities including provision of information, referral, condom distribution and testing • Preferences and credibility rankings suggest evidence-based programs utilizing peers and promoting the involvement of parents and doctors are needed.

15. Next steps… • Follow-up interviews among young people to investigate how those in-school and those out-of-school experience and perceive communication about AIDS differently, and how having personal experience with AIDS impacts communication

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