The document discusses peer education for HIV/AIDS in Kenya. It summarizes that while peer education theories suggest it could be effective, in practice the health sector does not fully support or apply these theories. There is also little scientific evidence that peer education initiatives are actually effective. The document calls for bridging the gaps between theory and practice in peer education and using more rigorous scientific methods to properly evaluate peer education programs.
THE ROLE OF SCHOOL HEALTH COMMITTEES IN HIV PREVENTION
Learning from theory to practice peter oriare
1. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
NATIONAL
CONFERENCE ON PEER
EDUCATION, HIV AND
AIDS
JUNE14TH 2006
2. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
LEARNING FROM THEORY &
LINKING WITH PRACTICE IN
THE COMMUNITY
AIM
Critique Theoretical Foundations
of Peer Education and Practice
3. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CONTENT
Introduction
Theoretical foundations of PE
Rationale and Principles of PE
Gaps between theory and
practice of PE
Recommendations
4. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
INTRODUCTIONS
Peer education has grown in
popularity and practice in Kenya
and elsewhere
Unfortunately, scholars and
advocates of peer education
rarely make reference to
theories
5. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Examination of peer education
theories conclude that:
Most theories have something to
offer towards an explanation of
why peer education might be
effective
Health promotion practice does
not support these theories
Theories not put to use by health
sector practitioners
6. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Study by Turner & Shepherd
(199) revealed that:
The peer education practitioners
are not applying theory to
practice
7. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Some theories only have a
limited application to peer
education principles and
practice.
8. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
THEORETICAL
FOUNDATIONS
The theoretical roots of peer
education can be traced back to a
number of social theories. These
include:
Social learning theory
Social identity theory
Role theory
Social inoculation theory
Differencial Association theory
Subculture theories
Communication of innovations theory
9. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SOCIAL LEARNING THEORY
Pioneered by Albert Bandura
Peer education is social
learning.
Social learning through:
Observation
Imitation
Modeling.
10. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
DETERMINANTS OF SOCIAL
LEARNING
Characteristic of model
Attributes of observer
Perceived consequences of
adopting the behavior (Bandura,
1977)
11. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
RELEVANCE OF SOCIAL
LEANING TO PEER EDUCATION
Credibility
Empowerment
Role modeling
Reinforcement.
12. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF CREDIBILITY
CLAIMS
Many projects do not recruit PE
with high status
Claim that peer educators
automatically have credibility
within their peer groups not well
founded.
13. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF ROLE
MODELLING CLAIM
Theory demand that peers
observe role models
In practice, it is very difficult to
observe modeled behavior such
as safer sex
14. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Theory demands that role
models need to be successful
and competent in modeling the
desired behavior.
Unfortunately, evidence show
that peer educators may fail to
maintain the desired health
behavior (continue to have
unsafe sex)
15. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF
REINFORCEMENT
On-going contacts necessary for
reinforcement to take place
But many projects rely on only a
one-off sessions
16. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF SELF
EFFICACY
People do what is learned if they
know it is going to be effective
But many PE programmes do
merely provide information not
required skills that empower
17. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Example:
People learn safe sex but
cannot resist pressures to have
unsafe sex.
18. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Train on assertiveness skills to
build their confidence
19. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF
EMPOWERMENT
It is possible to provide people
with skills to say no to pressures
to have sex
But having safe sex thereafter
may merely be compliance with
programme goals rather than
from real empowerment
20. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
The drop out rates are high after
programme is over
21. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SOCIAL INOCULATOIN
THEORY
Emphasizes the role of social
pressures to adopt unhealthy
behaviour (Duryea, 1991 ;
McGuire 1968 , 1974 ).
22. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Based on the belief that young
people lack the negotiating skills
to resist unhealthy behavior
arising from peer pressure and
other influences
23. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SOCIAL INOCULATION
THEORY
Proposes a range of techniques
to `inoculate' young people from
such pressure.
24. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
RELEVANCE OF CLAIMS TO
PE
Peers as credible source of
information
Peers as role models
Education from peer are
acceptable
25. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF CLAIMS
Reliability of self-reported claims
about peer pressures
questionable. People blame
others for their own weaknesses
Individual Choice is more
powerful than peer pressure
26. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF CLAIMS
It is ironical that peers who
influence bad behavior are used
to combat unhealthy behavior
27. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
DIFFERENTIAL
ASSOCIATION THEORY
Pioneered by Sutherland and Cressy
1960
Young people learn `bad' habits,
such as stealing, unsafe sex by
associating with others who can
teach them.
Similarly young people can just as
easily teach each other `good' habits
which promote health (Morgan and
Eiser, 1990 ).
28. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
RELEVANCE TO PE
Peers are credible source of
information
It utilizes an already established
means of sharing information
and advice
Education by peers may be
acceptable
Used to educate those who are
hard to reach
29. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM OF THEORY
Limited to friendship and
network circles
Example: Use of popular
prostitutes to do peer counseling
among prostitutes
Stigma may make difficult to talk
to close friends
30. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SUBCULTURE THEORIES
Pioneered by Cohen (1955) and
Miller (1958)
That delinquents developed
subcultures opposed to
mainstream culture.
Miller argued that working class
culture is oppositional to middle
class culture.
31. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Subcultures promote particular
behaviors
E.g.:
Gays subculture
Lesbians subculture
Prostitutes subculture
Chokora subculture
32. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
RELEVANCE TO PE
peers are a credible source of
information
Uses already established means
of sharing information and
advice
Education by peers may be
acceptable
Reaches those hard to reach
33. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM
Most of the peer education
projects paid little or no attention
to sub cultural factors.
Most people at risk refuse to be
part of these subculture
initiatives
34. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
COMMUNICATION OF
INNOVATIONS THEORY
Explains how innovations come to be
adopted by communities and what
factors influence the rate of adoption
[Rogers and Shoemaker (Rogers
and Shoemaker, 1971 ), ( Rogers
(Rogers, 1983-Diffusion of
Innovations)
Discusses:
Characteristics of innovation adopters
the nature of the social system
The characteristics of the innovation
The characteristics of `change agents'.
35. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
RELEVANCE TO PE
Peer credibility
Reinforcement of learning
through interpersonal networks
Recognizes social
communication networks
36. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
CRITICISM
Limited to uptake of health
innovations
Limited use in behavior change
Opinion leaders may be
inhibitors of innovation
Example: MPs have opposed
anti-FGM as HIV reduction
strategy
37. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SOCIAL IDENTIY THEORY
States that an individual has
multiple “social identities”
Derived from a sense of
membership of a group.
38. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SOCIAL IDENTIY THEORY
For example:
Individuals are more likely to be
influenced by people from their
group, than by those who are
“out-group” members.
39. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SOCIAL IDENTIY THEORY
Kisii by Kisii than Luos
Student by class mate than
students from other classes
40. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
ROLE THEORY
States that selected individuals
will adapt to the role of group
facilitator
Will behave as the facilitator
41. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
ROLE THEORY
Significant cultural differences
makes communication less
effective
Useful only in formal education
institutions
42. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
PE RATIONALE
Rationale for PE initiatives not
clear
43. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
PE RATIONALE
Peers are more credible sources
of information
Cheaper than other methods
More empowering to educators
Uses already established means
of sharing information
44. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
PE RATIONALE
More successful than
professionals in passing on
information due to identification
45. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
PE RATIONALE
Positive role models
Benefits peers educators
More acceptable education than
others
Reaches the hard to reach
Reinforces learning
46. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
PE RATIONALE
Credibility:
People learn better if peer
educator is similar to them
People learn better when peer
educator faces similar concerns
47. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Peer educators get more
credibility if:
Speak similar language as
students
Interact a lot with the peers
Has a history of sharing info with
peers
48. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
ADVERSE EFFECTS FOR
PEER EDUCATORS
Anxiety to become an expert
source of information
Lack of ongoing support
Lack of payment.
Undermines frequency of
contracts
49. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
EVALUATING PEER
EDUCATION
Lack of methodologically sound
studies and a limited evidence-
base
he evidence base for peer
education is weak outcomes of
peer education.
Claims of effectiveness not
empirically studied
50. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Most evaluations do not use
high-quality evaluation research,
including controlled experiments
The intuitive appeal of peer-
delivered health promotion is not
matched by much hard evidence
51. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Need of broader and
effectiveness-focused
evaluation
Example:
Use reach, efficacy, adoption,
implementation, maintenance
models of evaluation
52. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
PEER EDUCATION
APPROACHES
Methods vary:
Formal tutoring
Group discussions
Informal tutoring
One-to-one discussions
Counseling
Theatre
Stalls and exhibitions
53. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SUMMARY
Most theories have something to
offer towards an explanation of
why peer education might be
effective
But promotion practice does not
support these theories
54. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
SUMMARY
There is evidence that what is
put on paper is not adopted in
practice
Theories not put to use by
health sector practitioners and
promoters
Evaluation of their effectiveness
also lack scientific basis.
55. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
RECOMMENDATIONS
There is need to domesticate
theories to Peer Education
There is need to bridge theory
and practice
There is need to use scientific
methods to measure efficacy
and effectiveness of PE
initiatives
56. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
REFENCES &
BIBLIOGRAPHY
G. Turner and J. Shepherd, A
method in search of a theory:
peer education and health
promotion in Health Education
Research, Vol. 14, No. 2, 235-
247, April 1999
57. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
Australian Injecting and Illicit Drug
Users League (AIVL) 2006 A
framework for peer education by
drug-user organisations, Sydney:
AIVL
Damon Brogan and Jennifer Kelsall
used the AIVL document as
background for their presentation
with permission from AIVL.
58. PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
http://her.oxfordjournals.org/cgi/
content/full/14/2/235