In new research in BMC Public Health, SPHR researchers have reviewed the effectiveness of peer education interventions, whereby students teach their peers about various aspects of health. Just over half of the papers showed evidence of effectiveness, suggesting peer education may be a promising strategy for health improvement in schools. However, authors call for more robust methods and reporting to make more confident conclusions.
A global public health priority is ensuring good health and wellbeing amongst school-aged children and the contribution schools can make to this is increasingly recognised. The ‘peer education’ approach typically involves the selection and training of ‘peer educators’ or ‘leaders’ who communicate health-related information to similar or younger aged students in their schools, known as ‘peer learners’. Peer-led interventions are growing in popularity across many school contexts, and interventions often cover a wide range of health areas such as mental, physical and sexual health and a general promotion of healthy lifestyles such as healthy eating and smoking prevention.
While we know that peer education interventions have been widely used in schools for a number of years, their overall effectiveness remains unclear. Here, authors conducted the first ever global systematic review of school-based peer education interventions to promote health in 11–18 year olds. 73 studies from 19 countries were included in the review. Of these, 67 reported peer learner outcomes.
Researchers found that just over half (52%) of school-based peer education interventions to improve young people’s health were found to be for peer learners, whilst just over a third (35.8%) were found to have a positive impact for peer educators.
Results by health area
- Sex education/ HIV prevention – 8/23 studies showed evidence of effectiveness ; 4/23 rated high in quality
- Healthy lifestyles (exercise, nutrition, oral health, health information) – 7/17 studies showed evidence of effectiveness ; 9/17 rated high in quality
- Alcohol, smoking, substance use – 8/16 studies showed evidence of effectiveness, 6/16 rated high in quality
- Mental health and wellbeing – 5/6 studies showed evidence of effectiveness ; 2/6 rated high in quality
- Disease prevention – 3/4 studies showed evidence of effectiveness ; 0/4 rated high in quality
- Asthma – 4/5 studies showed evidence of effectiveness ; 5/5 medium quality
- Bullying – 1/2 studies showed evidence of effectiveness ; 1 high quality 1 medium quality
While many studies demonstrated positive results, findings overall were mixed and several studies were of poor quality. Of the 35 papers that demonstrated effectiveness, only 9 were rated as high quality. A key aspect in studies that found positive results was how peer educators were selected and trained with particular benefits seen for peers being involved in the selection process, although many papers lacked methodological detail about how this was done. Some common measures were used across the studies, but many used novel or unvalidated measurements, indicating a need for more standardised health literacy measures.
Emily Widnall, co-lead author on the study says:
“Although school-based peer education interventions show promise and have been found to be effective in many contexts, we really need to further our understanding on what components of peer education interventions work and what components may be less helpful or less important for health improvement in young people. It is likely that this may look different for different areas of health, for example what may work well in peer-led smoking prevention interventions may not work so well in peer-led sexual health interventions”
The findings from this review highlight the importance of thoroughly evaluating school-based interventions before they are rolled out more widely across schools. Many studies within this review were of poor quality and there remains a lot of inconsistency in how peer-led interventions are evaluated and how health improvement is measured. This review therefore calls for more robust evaluation and standardised measures of health knowledge, attitudes and behaviours. As well as understanding whether an intervention works or not, we also need to know why the intervention works and in what context which is an important area for future research to explore.