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Can Peer Education Make a Difference? Evaluation of a South African Adolescent Peer Education Program to Promote Sexual and Reproductive Health

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Abstract

Peer education is popular both with governments and with young people. The purpose of this quasi-experimental study was to evaluate the effectiveness of a government-led peer education program on the self-reported sexual health behavior and related psychosocial outcomes of adolescent students in public high schools in the Western Cape of South Africa. Grade 10 students (n = 3934), at 30 public high schools (15 intervention, 15 comparison) were recruited to the study. In the intervention schools, peer educators were recruited and trained to provide information and support to their fellow students. Sexual health behaviors and related psychosocial outcomes of students were measured at baseline and at follow up 18 months later. Comparisons were made between those in the intervention and comparison group schools. We were unable to detect a significant difference in the age of sexual debut, use of condoms at last sex, goal orientation, decision-making or future orientation for students in the intervention group as compared to students in the comparison group. The findings suggest that the peer education program was not effective in reducing the age of sexual debut or condom use. Issues around the implementation of the program suggested that this was sub-optimal. Governments who advocate widespread use of peer education as an approach need to recognise barriers to implementation and ensure ongoing monitoring and evaluation of effectiveness and cost effectiveness.

Resumen

La educación entre pares es muy popular tanto con los gobiernos y con los jóvenes. El propósito de este estudio cuasi-experimental fue evaluar la eficacia de un programa de educación entre pares dirigido por el gobierno sobre el comportamiento sexual auto-reportado y de los resultados psicosociales de los estudiantes adolescentes en escuelas secundarias públicas en el Cabo Occidental de Sudáfrica. Estudiantes en el grado 10 (n = 3934), en 30 escuelas secundarias públicas (15 intervenciones, 15 de comparación) fueron reclutados para el estudio. En las escuelas de intervención, educadores de pares fueron reclutados y entrenados para proveer información y apoyo a sus compañeros. Los comportamientos sexuales relacionados con la salud y los resultados psicosociales de los estudiantes se midieron al inicio y 18 meses después en seguimiento. Se realizaron comparaciones entre los estudiantes de las escuelas de intervención y las escuelas del grupo de comparación. No hemos podido detectar una diferencia significativa en la edad de iniciación sexual, el uso del condóns en la última relación sexual, la orientación de metas, la toma de decisiones o la orientación futura de los estudiantes en el grupo de intervención en comparación con los estudiantes en el grupo de comparación. Los resultados sugieren que el programa de educación entre pares no fue efectivo en la reducción de la edad de iniciación sexual o el uso del condóns. Cuestiones relacionadas con la implementación del programa sugirieron que la misma fue sub-óptima. Los gobiernos que abogan por el uso generalizado de la educación entre pares como un método posible necesitan reconocer los obstáculos a la implementación y garantizar un monitoreo y evaluación continua de la eficacia y viabilidad financiera del costo del mismo.

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Acknowledgments

This work was supported by the Western Cape Department of Health; the Medical Research Council (South Africa); the Centers for Disease Control (USA) [1U2GPS001137-01]; and the University of Cape Town. Thank you to Dr Kathy Pahl, Mrs Sandra de Jaager, Mr Peter Fenton, Mr Ronald S Cornellisen, fieldworkers, students, their teachers, principals and schools for assisting us in this research and to the Western Cape Department of Education for providing access to the schools.

We acknowledge the enormous contribution to this project by Professor Alan J Flisher who tragically passed away on 18th April 2010. His energy, sense of fun, great intellect and deep compassion will be sorely missed by all of us who have worked so closely with him over the years.

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Authors and Affiliations

  1. Adolescent Health Research Unit, University of Cape Town, Cape Town, 7700, Republic of South Africa

    Amanda J. Mason-Jones

  2. Health Systems Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, Republic of South Africa

    Amanda J. Mason-Jones

  3. School of Public Health and Family Medicine, University of Cape Town, Cape Town, Republic of South Africa

    Catherine Mathews

  4. South African Medical Research Council, Cape Town, Republic of South Africa

    Catherine Mathews

  5. Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, Republic of South Africa

    Alan J. Flisher

Authors
  1. Amanda J. Mason-Jones
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  2. Catherine Mathews
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  3. Alan J. Flisher
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Corresponding author

Correspondence to Amanda J. Mason-Jones.

Additional information

Professor Alan Flisher died on 18th April 2010.

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Mason-Jones, A.J., Mathews, C. & Flisher, A.J. Can Peer Education Make a Difference? Evaluation of a South African Adolescent Peer Education Program to Promote Sexual and Reproductive Health. AIDS Behav 15, 1605–1611 (2011). https://doi.org/10.1007/s10461-011-0012-1

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