Learning from theory to practice peter oriare

PETER ORIARE, UNIVERSITY OF NAIROBI,
EMAIL: poriare@yahoo.com
NATIONAL
CONFERENCE ON PEER
EDUCATION, HIV AND
AIDS
JUNE14TH 2006

LEARNING FROM THEORY &
LINKING WITH PRACTICE IN
THE COMMUNITY
 AIM
 Critique Theoretical Foundations
of Peer Education and Practice

CONTENT
 Introduction
 Theoretical foundations of PE
 Rationale and Principles of PE
 Gaps between theory and
practice of PE
 Recommendations

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

 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

 Study by Turner & Shepherd
(199) revealed that:
 The peer education practitioners
are not applying theory to
practice

 Some theories only have a
limited application to peer
education principles and
practice.

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

SOCIAL LEARNING THEORY
 Pioneered by Albert Bandura
 Peer education is social
learning.
 Social learning through:
 Observation
 Imitation
 Modeling.

DETERMINANTS OF SOCIAL
LEARNING
 Characteristic of model
 Attributes of observer
 Perceived consequences of
adopting the behavior (Bandura,
1977)

RELEVANCE OF SOCIAL
LEANING TO PEER EDUCATION
 Credibility
 Empowerment
 Role modeling
 Reinforcement.

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.

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

 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)

CRITICISM OF
REINFORCEMENT
 On-going contacts necessary for
reinforcement to take place
 But many projects rely on only a
one-off sessions

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

 Example:
 People learn safe sex but
cannot resist pressures to have
unsafe sex.

 Train on assertiveness skills to
build their confidence

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

 The drop out rates are high after
programme is over

SOCIAL INOCULATOIN
THEORY
 Emphasizes the role of social
pressures to adopt unhealthy
behaviour (Duryea, 1991 ;
McGuire 1968 , 1974 ).

 Based on the belief that young
people lack the negotiating skills
to resist unhealthy behavior
arising from peer pressure and
other influences

SOCIAL INOCULATION
THEORY
 Proposes a range of techniques
to `inoculate' young people from
such pressure.

RELEVANCE OF CLAIMS TO
PE
 Peers as credible source of
information
 Peers as role models
 Education from peer are
acceptable

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

CRITICISM OF CLAIMS
 It is ironical that peers who
influence bad behavior are used
to combat unhealthy behavior

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 ).

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

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

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.

 Subcultures promote particular
behaviors
 E.g.:
 Gays subculture
 Lesbians subculture
 Prostitutes subculture
 Chokora subculture

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

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

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'.

RELEVANCE TO PE
 Peer credibility
 Reinforcement of learning
through interpersonal networks
 Recognizes social
communication networks

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

SOCIAL IDENTIY THEORY
 States that an individual has
multiple “social identities”
 Derived from a sense of
membership of a group.

 For example:
 Individuals are more likely to be
influenced by people from their
group, than by those who are
“out-group” members.

 Kisii by Kisii than Luos
 Student by class mate than
students from other classes

ROLE THEORY
 States that selected individuals
will adapt to the role of group
facilitator
 Will behave as the facilitator

ROLE THEORY
 Significant cultural differences
makes communication less
effective
 Useful only in formal education
institutions

PE RATIONALE
 Rationale for PE initiatives not
clear

PE RATIONALE
 Peers are more credible sources
of information
 Cheaper than other methods
 More empowering to educators
 Uses already established means
of sharing information

PE RATIONALE
 More successful than
professionals in passing on
information due to identification

PE RATIONALE
 Positive role models
 Benefits peers educators
 More acceptable education than
others
 Reaches the hard to reach
 Reinforces learning

PE RATIONALE
 Credibility:
 People learn better if peer
educator is similar to them
 People learn better when peer
educator faces similar concerns

 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

ADVERSE EFFECTS FOR
PEER EDUCATORS
 Anxiety to become an expert
source of information
 Lack of ongoing support
 Lack of payment.
 Undermines frequency of
contracts

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

 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

 Need of broader and
effectiveness-focused
evaluation
 Example:
 Use reach, efficacy, adoption,
implementation, maintenance
models of evaluation

PEER EDUCATION
APPROACHES
 Methods vary:
 Formal tutoring
 Group discussions
 Informal tutoring
 One-to-one discussions
 Counseling
 Theatre
 Stalls and exhibitions


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

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.

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

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

 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.

 http://her.oxfordjournals.org/cgi/
content/full/14/2/235

Learning from theory to practice peter oriare

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