Backgrounder: Evidence Bases for Effectiveness of Peer-Led Interventions

Selected studies from the literature

Background

(From Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years: a systematic review and meta-analysis (2016))

  • Peer education has been defined as ‘the teaching or sharing of health information, values and behaviours between individuals with shared characteristics’. Such an approach may involve the delivery of part or all of an intervention by same age or older peers in informal or formal settings, such as community centres, street settings, nightclubs, school classrooms or youth clubs, using pedagogical or ‘diffusional’ methods (i.e. where peer-led education occurs as part of the normal communication within social groups).
  • To date, peer-based programmes have been employed to target substance use, sexual risk behaviour, HIV prevention and psychosocial wellbeing among young people, and there is promising evidence from existing intervention models. Earlier systematic reviews suggest that there was evidence that peer interventions could change behaviour, as well as improve knowledge. Notably, process evaluations show that young people report positive views towards peer interventions, such as: finding peer-led sessions fun, feeling that peers are credible sources of information and preferring peer-led sessions over teacher-led sessions.

 

Selected Studies from the Literature

Preliminary Evidence of an Adolescent HIV/AIDS Peer Education Program (2008)

  • Results showed a significant difference in HIV knowledge between the peer education group and traditionally educated group, with peer educated group showing an increased knowledge.
  • Students in the peer education group were more likely to engage in safe sex as compared to those in the traditionally educated group.

Effects on High School Students of Teaching a Cross-Age Alcohol Prevention Program (2005)

  • Those exposed to the peer education model gained a knowledge of the effects of alcohol, had increased perceptions of risk associated with high levels of alcohol use, acquired teaching skills, and had less episodes of binge drinking.

An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial (2008)

  • This study found that smoking prevalence was lower in the intervention groups than in the control groups: there was a 22% reduction in odds of being a regular smoker in an intervention group as compared to the control group.
  • However, the study also suggests an “attenuation of this intervention effect over time”. This particular program found a “sustained reduction in uptake of regular smoking in adolescents for 2 years after its delivery”

Peer-led and adult-led school health education: a critical review of available comparative research (2000)

  • This study is a review of available research on peer-led health education (as of 2000). It concludes that peer leaders are at least as, or more, effective than adults in delivering health education.
  • Out of eleven studies that compared adult-led and peer-led health education programs, seven found that peer-led programs were more effective.
  • The review concludes that peer-led education may result in greater positive changes in health behaviour as compared to adult-led interventions.

Friends: The Role of Peer Influence Across Adolescent Risk Behaviors (2002)

  • Results found that a random same sex peer predicts a teen’s risk behavior initiation; there is influence only to initiate cigarette and marijuana use; and that there is influence to initiate and stop alcohol and chewing tobacco use. This finding suggests that friends may protect adolescents from risk activities

Peer-led interventions to reduce HIV risk of youth: A review (2010)

  • This paper critically reviews and synthesizes the results and lessons learned from 24 evaluated peer-led programs with an HIV/AIDS risk reduction component that target youth in the communities where they live and are delivered in low- and middle-income countries.
  • The synthesis of study results finds that these programs have demonstrated success in effecting positive change in knowledge and condom use and have demonstrated some success in changing community attitudes and norms.

The feasibility of peer-led interventions to deliver health information to ecstacy and drug users (2009)

  • The aim of this study was to see if health messages can be effectively delivered to ERDs users utilising a peer-led intervention. The experimental group had significantly reduced their ecstasy and meth/amphetamine use at follow-up.
  • The peer educators were also seen as very credible by the majority of participants in this study, with the experimental group significantly more likely to find the peer educator more credible than the control group.
  • The study‘s findings support the use of peers in the dissemination of health-related messages to ERDs users and suggests that peer-led interventions are a valuable medium to use in conjunction with other methods of drug education for this difficult to access group.

A peer-led approach to promoting health education in schools: The views of peers (2015)

  • This study aimed to evaluate the views of the peer educators in implementing a health education programme using a qualitative approach.
  • This article concludes that “the role of peer educators in peer-led school interventions can contribute to an effective prevention strategy. However, in planning these peer-led interventions, it is crucial to the success of the programmes that the peer educators are equipped and supported throughout the process”.

Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years: a systematic review and meta-analysis (2016)

  • Peer-led interventions may offer a beneficial approach in preventing substance use, but their impact has not yet been quantified. This is a systematic review of 17 studies that investigates and quantifies the effect of peer-led interventions that seek to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years.
  • Conclusion: Peer interventions may be effective in preventing tobacco, alcohol and possibly cannabis use among adolescents, although the evidence base is limited overall, and is characterized mainly by small studies of low quality.

 

 

Toolkits

Peer Education Builds Skills, Assets and Connectedness – Community Tool Box from University of Kansas

  • The community toolbox is a useful resource detailing the benefits, types and ways to optimize peer-education programs through proper evaluation and refinement.
  • This resource also gives tips for structuring peer education programs, training peer educators, supporting educators, and advertising services.
  • It defines ‘peer’ as meaning, “equal, someone of the same condition as oneself.” Teacher and learners may switch roles from time to time as part of the process. By learning along side the learner, peer educators teach how to negotiate new learning.

Peer to Peer; using peer to peer strategies in drug abuse prevention (United Nations Office On Drugs And Crimes)

  • This report by the Untied Nations Office On Drugs And Crimes, is a thorough manual for peer education programming. It covers topics such as how to pick peer educators, characteristics of a good peer education program, how to design and plan a good peer education program, how to make sure you have the capacity to deliver the program, how to get funding, how to know if your program is working and several case studies of model peer-education programs.
  • This report asserts that peer education is an effective way of sharing knowledge. This kind of knowledge is credible because it is based on real experiences.

 

Conclusion

  • The evidence shows that peer-led interventions can have positive outcomes, especially when compared to ‘traditional’ approaches to teaching health promotion topics. Specifically, peer-led interventions in the area of youth substance use have shown promising results. The ASSIST model in particular has been very effective.
  • More research is needed with longer follow-up duration to quantify the effectiveness of peer-led approaches.
  • One of the reasons peer-led approaches have been impactful is that “peers are likely to be embedded in social groups and communities, may share social status and cultural background and may have greater credibility than adults or professionals, such that behaviour change messages may resonate to a greater extent with young people”.

 

To download a PDF of this backgrounder, click here.

Parent Action on Drugs, 2016.