Peer Education is an approach to health promotion, in which community members are supported to promote health-enhancing change among their peers. Rather than health professionals educating members of the public, the idea behind peer education is that ordinary lay people are in the best position to encourage healthy behaviour to each other.
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Peer education has become very popular in the broad field of HIV prevention. It is a mainstay of HIV prevention in many developing countries,[1] among groups including young people, sex workers, men who have sex with men, or intravenous drug users.
Peer education is also associated with efforts to prevent tobacco, drug or alcohol use among young people.
A peer education programme is usually initiated by health or community professionals, who recruit members of the ‘target’ community to serve as peer educators. The recruited peer educators are trained in relevant health information and communication skills. Armed with these skills, the peer educators then engage their peers in conversations about the issue of concern, seeking to promote health-enhancing knowledge and skills. The intention is that familiar people, giving locally-relevant and meaningful suggestions, in appropriate local language and taking account of the local context, will be most likely to be able to promote health-enhancing behaviour change.
There is a great variety in the support provided to peer educators. Sometimes they are unpaid volunteers, sometimes they are given a small honorarium, sometimes they receive a reasonable salary. The peer educators may be supported by regular meetings and training, or expected to continue their work without formal supports.
A variety of theories are offered regarding the question of how peer education is supposed to achieve positive results.
The popular opinion leader theory [2] suggests a parallel between peer education and the marketing of commercial products. Peer educators are seen as ‘opinion leaders’ – respected and admired by other members of the community. These opinion leaders espouse a certain lifestyle (such as safer sex, or not smoking, etc) – and their peers wish to emulate them.
Campbell argues that what peer education ought to do is to promote the kind of critical consciousness theorised by Paulo Freire [3] This means that peers use the peer education process to critically discuss their circumstances, especially the social factors impacting upon their health. Becoming critically aware of these forces is the first step to tackling them. So, for instance, if local norms regarding sexuality and gender put people’s health at risk, this approach argues that peers should critically discuss those norms, so that they can then collectively seek to establish new more health-enhancing norms.
Despite its popularity, the evidence about peer education is mixed, and there is no consensus on whether it works or how it works.
One important line of inquiry suggests that peer education may work in some contexts but not in others.[4][5] A study comparing peer education among sex workers in India and South Africa found that the more successful Indian group benefited from a supportive social and political context, and a more effective community development ethos, rather than the biomedical focus of the South African intervention.[6]