Peers may improve health outcomes more than professionals

Peers may be more effective than medical professionals when it comes to influencing behaviour in areas such as sexual health and breastfeeding, according to a systematic review carried out at the University of Dundee.

Keith Topping, Professor of Educational & Social Research at the University, analysed 58 research review papers to examine whether peer education and counselling was effective in relation to knowledge, attitude change, and behavioural change, and how they compared to professional intervention.

The review, believed to be the best analysis of peer education and peer counselling currently available, found that these methods were as effective than intervention by doctors and nurses for health and wellbeing in the case of some conditions.

The papers analysed evaluated the results of a wide variety of peer-led projects related to sexual health, drug use, obesity, smoking, alcohol, medical conditions, mental health, and breastfeeding.

Professor Topping found that many studies reported that peer education was more effective than professional-led education and preferred by clients. While promising results were found in every area reviewed, effectiveness was significantly influenced by management, the quality of training, supervision, support, monitoring and retention of peers as well as programme structure.

In peer education, there were many reviews of sexual health and of HIV/AIDS interventions, followed by reviews of various medical conditions and social issues. In peer counselling, reviews of breastfeeding and mental health were common.

Many early reviews complained of the lack of evaluation while later reviews found knowledge gains but not behaviour gains. Even more recent ones found both knowledge and behaviour gains, suggesting that peer education and counselling appear effective but only if organisational factors were well managed and the cultural context of the country respected.

The review, published in the International Journal of Environmental Research and Public Health, calls for peer education and counselling to be extended and more carefully researched in several areas.

“Peer education and counselling can reach where professionals cannot go and are much used in developing countries, but they require careful planning, training, monitoring, and resourcing, which does not always happen,” said Professor Topping.

“If these factors are addressed, peer education and counselling can have a major impact on widening the reach of health and wellbeing services and should be more widely used. In many cases, participants prefer to be educated about risky behaviours by their peers than medical professionals.

“In the West, we tend to rely on doctors, nurses, printed medical information and internet searches when it comes to our personal health and wellbeing. But what if we have little or no access to doctors and nurses, no access to printed information or we cannot read the language it is in, or no access to the internet? This is the case for many people at severe risk, and not just in developing countries.

“Peer education and counselling are now showing good evidence of effectiveness in relation to certain areas of human activity. This needs to be generalised to more areas of activity. More recent reviews have tended to find changes in both knowledge and behaviour, but that does not mean these methods will be effective in every instance.”

Peer education is defined as the provision of ‘credible and reliable information about sensitive life issues and the opportunity to discuss this in an informal peer group setting’ and peer counselling as ‘people from similar groupings who are not professionals who help to clarify life problems and identify solutions by listening; clarifying; feeding back; summarising; questioning and being positive, supportive and reassuring and then helping plan, organise and problem-solve’.

These methods have been recognised as complementary approaches to professional intervention in health and wellbeing for over 50 years, but it is relatively recently that research into effects has become adequate to allow for systematic reviews of the kind performed by Professor Topping to take place.