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Theories & Approaches

All Theories & Approaches

Peer Education in Teen Pregnancy Prevention

With a Little Help From My Friends: Peer Education in Teen Pregnancy Prevention

by Nicole Lezin

Welcome to the Theories and Approaches section on Peer Education in Teen Pregnancy Prevention! In this section, you will find the following:

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Adolescents live in one of the most intense social networks they will ever experience: a cocoon, for better or worse, of like-minded peers. From best-friend duos to broader circles of close friends, acquaintances, cliques, and the cross currents of youth culture in general, teens are literally surrounded by a world in which adults seem less and less relevant.

Many adults view this trend with alarm, especially when it occurs within their own families. "Peer pressure" is the catch-all term (used by many a concerned parent) that captures the negative side of the world of peers — pressure to wear certain clothes, listen to certain music, engage in certain sexual behaviors, do certain drugs, or adopt certain beliefs, all under what many adults see as a type of peer duress.

But, in fact, the ways that peers influence one another are much more complicated, subtle, and positive than the "group think" that seems, to the outside observer, to dictate everything from fashion to friendships. While peers may indeed steer each other in dangerous directions, their social interaction also fuels other types of influence: support for each other, modeling of different behaviors, rapport that adults can rarely equal, and trust that is more freely given.

Peer education — tapping adolescents to help educate one another — is one way that health and youth development professionals try to harness the many positive aspects of peer influence. If teens really do exist mostly in a world of their own making, why not make that an informed, educated world, from within?

Definition: What is — and isn't — Peer Education?

Peer education programs have been in place for at least 30 years in various forms. Originally used as support mechanisms in delinquency and drug and alcohol treatment programs, peer education programs have emerged more recently as a way to address other health issues that affect teens, especially HIV, sexually transmitted infections (STIs), and pregnancy prevention.

Typically, the term "peer educator" refers to someone who shares characteristics of his or her peers but receives special training to function in a different way. As Susan Philliber points out in her review of the effectiveness of peer education programs, there are many types of peer-based interventions, but they generally can be grouped into two major categories: peer support and peer leadership.1

In peer support programs, peers interact as equals — for example, in support groups that seek to reinforce or sustain behavior change (like avoiding drug or alcohol relapse) or help members cope with a traumatic event (like sexual abuse or treatment for an illness). In peer leadership programs, the peers still interact with one another, but some are designated leaders because of their training and the roles they take within the group.

Peer education programs tend to follow the peer leadership model, with some peers acting as assistants to adult trainers or facilitators (for example, by modeling role plays) or by leading sessions themselves.

Just because a program involves teenagers in some way does not necessarily make it a peer education program. Peer education programs are distinguished by careful planning about how peer educators will participate, relatively intensive training, and monitoring. The New York State Youth Council distinguishes peer education from peer helping, peer tutoring, youth advocacy, and youth involved in advisory or policy roles. They define peer education as:

"Youth educate their peers or younger children on personal/life skills or on pertinent societal issues such as drug abuse, HIV/AIDS, or prejudice. Youth learn important skills related to designing and delivering effective presentations or workshops, ranging from one-time presentations to intensive, semester-long programs."2


Rationale: Why Turn to Peer Education?

The logic behind peer education makes sense: if peers listen so much to one another, why not make the content of what they hear from each other as accurate and helpful as possible? Ideally, peer education helps the peer leaders themselves. They learn new skills and gain knowledge and confidence. At the same time, it helps those with whom the peer educators interact and for whom they model positive, protective behaviors. These could include not only their immediate peers but also others in the community.

In their guide to peer health education programs, Goldsmith and Reynolds quote Canadian research R. A. Carr's list of the four primary motivating needs of adolescence:

  • Competence — feeling increasingly qualified and skilled in school and extracurricular activities

  • Autonomy — gaining a sense of independence

  • Recognition — getting positive feedback from those around you, and

  • Fun — enjoying what you do3

These needs, they point out, can be met in two very different ways: through either negative or positive peer experiences. Peer education is one way to offer competence, autonomy, recognition, and fun in a positive way — with potential ripple effects beyond the peer educators themselves.

Peer education is also tempting as a type of short-cut — in hiring, training, costs, and especially in building trust and rapport. Peers may indeed enjoy more instant credibility with one another than adults can, especially if they share a common language and other characteristics with the peer group. For the same reason, peers may also create a more comfortable environment for questions and discussion — especially for a subject like sex, which is not easy for most people to discuss.

Clearly, there are many valid reasons for using peer educators to give teens new skills and confidence, model positive behaviors, and so on. Saving time and costs, however, is not a good reason for pursuing this type of program. For one thing, peer educators may seem cheaper than adults, but if they are properly trained, supervised, and monitored, they may not be. (See Challenges for some other cautions!)

Also, several studies suggest that it doesn't really make a difference whether peers receive information from each other or from adults. Even when teens reported liking their peer facilitators more than adult facilitators, the impact on their intended and actual behaviors was similar. As discussed in the following section on the effectiveness of peer education, teens may like peer educators and find them more accessible than adults, but it is not a given that teens will automatically respond more positively to peers, nor is it particularly meaningful, at least in terms of behavioral outcomes.


Effectiveness: Do Peer Education Programs Work?

Even though the idea of peer education makes a lot of sense, its positive effects have been hard to detect — at least in terms of behavior change related to safer sex or teen pregnancy. As Susan Philliber notes in her review of the effectiveness of peer education programs, "Enthusiasm for peer-based programs runs ahead of the research on their effectiveness."4

In her analysis of four studies that compared peer and adult leaders in terms of their effects on pregnancy-related outcomes, Philliber found no differences based on whether groups were led by peers or by adults. Successful interventions, she points out, were successful no matter what, reflecting factors such as better planning, training, and implementation. The flip side was also true. Unsuccessful programs "were equally ineffective, regardless of the age of the group leader."

Several studies have noted positive effects for peer leaders themselves, but these too showed some inconsistencies. In at least one study of HIV-positive youth leading groups for their peers, for example, some of the leaders reported relapses in unprotected sex and drug-using behavior while they were serving as peer educators; many experienced difficulties balancing their roles as leaders and peers.

The bottom line? Peer education — through support groups and peer-led groups — can have some positive outcomes (such as reduced substance abuse and delinquency) if the programs are well-designed. However, so far, these effects do not include preventing pregnancy, nor does the presence of peers in a program automatically confer a strong advantage over adult educators. Philliber thinks the jury is still out in many ways because there have been few good studies, and these effects are so difficult to measure. Her conclusions: there is "yet much to learn about using peers in programs for adolescents," and programs can use this potentially powerful tool in more sophisticated ways.

Next: Characteristics of Effective Peer Education Programs

Nicole Lezin, a technical writer based in Aptos, California, consults regularly with ETR Associates. Ms. Lezin has researched and written about many different aspects of public health and is the co-author, with Marshall Kreuter, Matt Kreuter, and Larry Green, of Community Health Promotion Ideas that Work: A Field-book for Practitioners.