25% 63% 12%
Peer Education reloaded: A reimagined model that empowers university students to be effective agents of sexual and reproductive health change in Kenya Karnad, SR ([email protected]) ; Dotson, MA ; Njiri, E, Ayuyo, C ; Omulokoli, E; Omutsani, J ; Lynam, P
Background
Results
Adolescent and youth pregnancy in Kenya is one of the leading causes of school and university dropout, with up to 13,000 adolescent girls dropping out of school every year as a result of unplanned pregnancies (1). While contraceptive awareness in Kenya has consistently improved, this change has affected adolescents and young women far less than any other group of women of reproductive age (2). Despite over 70% of men and women report having had first sexual intercourse by age 20 years (2) - family planning (FP) services remain difficult to access in practice, particularly for unmarried youth, and most significantly for unmarried women: only10.1% all 15-19 year old women and 46% of 20-24 year old women report using any contraceptive method (2). Decades of programming to address the challenge of unintended pregnancy amongst adolescents and youth have demonstrated that a range of social, cultural, and economic factors must be addressed alongside strengthening access to, and quality of, family planning service delivery in order to improve health outcomes (3). An Ecological Framework proposed by Svanemyr et al (3) proposes that programs targeting the individual, relationship (parents, sexual partners, and peers), and community (neighbourhoods, schools and workplaces) are necessary to improve youth sexual and reproductive health outcomes. Within this context, peer education was shown to increase sexual and reproductive health knowledge, use of condoms, and delayed first intercourse (3). To address the challenge of youth pregnancy amongst university students in Kenya, and building on Svanemyr’s Ecological Framework, Jhpiego’s Brighter Future program partnered with the public Jomo Kenyatta University of Agriculture and Technology (JKUAT) in Nairobi, Kenya to design and test an innovative approach to increasing demand for contraception. Working with the University as a proof-of-concept design laboratory, the Brighter Future used innovative user-centered approaches to engage student peer mentors in program design, creating a life planning program built on, and responsive to, the participants’ unique needs and concerns. Peer mentors then independently rolled out Brighter Futures life trainings across the university. Study Question1: Will increasing self-efficacy and future-orientation through life-planning increase uptake of modern contraceptives among university women?* Study Question 2: Could encouraging students to help their friends with life planning and goal-setting as role models, rather than “contraceptive experts” make them more effective agents of change?
• Peer Education programs often attempt to create “mini knowledge/ content experts” from peer educators. • Repositioning peer educators as peer mentors and role models with their own plans, and encouraging them to support their colleagues in exploring their own individual motivations and developing their own unique life plan (rather than lecturing or “educating” them), made other students more receptive to messages about contraception.
Figure 1: Brighter Future peer mentors
Intervention Methodology: Proof of concept study, multiple cross-sectional mixed methods. Figure 2: Funguo Life Planning work book June 2013
Funguo Knowledge, Attitudes and Perception surveys (Baseline)
JKUAT students engaged in creative partnerships to create life plan prototypes utilising user-centered design, building on students’ definition of a life plan: Career | Relationships | Health | Finance 80 peer mentors taken through life planning and trained to mentor Dec 2013
301 male and female JKUAT students enrolled in the study (cascadees)
Life Planning workshops and other Funguo activities conducted independently by JKUAT peer mentors
Jan 2015
Funguo Knowledge, Attitudes and Perception surveys + Focus Group Discussions conducted (Endline) Comparison group: 379 JKUAT students not enrolled in Funguo
• Peer Education programs are generally thought to be very labour- and resource- intensive, with significant investment (both time and money) going in to incentives and supervision to ensure peer mentorship is provided as planned. • In the Brighter Future model, enthusiasm for their own life plans and learning fueled a desire to share the program with others. The program never created an expectation of incentives, which appears to have encouraged self-motivation and engagement. • Having been engaged in program and product design from the outset (User Centered Design*), peer mentors demonstrated significant levels of inherent motivation.
“Since I joined them (the Brighter Futures program) I have had a lot of experience in different areas… I have been able to do a number of things because of this in an orderly manner and planned way. With regards to leadership, coordination and in life generally. Now I am able to balance what I do outside and integrate it. I have fully benefitted from the Brighter Future program. “ – PM2 (Peer Mentor)
Providing support and guidance to peer mentors through an online platform (WhatsApp) proved a low cost mechanism to facilitate very open discussions among the peer mentors, Brighter Future staff and youth-friendly facility staff. • Students do not want to be taught about contraceptives by people who are not using them. • Peer mentors who use a contraceptive method are themselves more credible promoters of contraceptive uptake.
“I like the contraceptive talk but I like it when someone comes to talk to me about it and they tell me that they have used a contraceptive method. Then, I will be able to relate because then you are telling me of your experience. If you tell me you hear, you are scaring me but if you talk to me out of experience then I get more comfortable and that is the first step for me to take a contraceptive and then I can say that this person has used it and I can too. And we can then go on with the conversation.” – PF8 “They talked about sex openly where no one does. It gave me so much courage and I started talking about it and I was interested in knowing more … What motivated me most to participate in the Brighter Future activities was the fact that they talked about the facts of life that no one else talks about. Not even your mum, best friend, talks about it and these are the people you expect to talk to you about this.” – PF2
“On the contraceptives topic? It helped me and my friends talk more on contraceptives and more openly. It’s a rare topic to be discussed and so not many people discuss contraceptives and so after going through it I remember we had a very interesting topic discussion on it and nowadays none of us is truly shy to talk about it.” – CF4 Cascadee’s reported the following changes in behaviours following conversations with peer mentors:
12
25
%
started using a contraceptive method
%
said they intend % to start using a contraceptive method initiated a discussion about contraception with their partner
63
References 1. Ikamari L, Izugbara C, Ochako R. Prevalence and determinants of unintended pregnancy among women in Nairobi. Kenya BMC Pregnancy Childbirth. 2013;13:69. Figure 3: Peer Mentor in action
“It was a bit difficult to understand how you would have a life plan and yet it is all in your mind. After I talked to peer educator about it I was convinced to write it down as I want to do something. There are steps in a life plan and I had a problem of prioritization.” – CM1
2. Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Control Council/Kenya, Kenya Medical Research Institute, and National Council for Population and Development/ Kenya. 2015. Kenya Demographic and Health Survey 2014 3. Svanemyr J, Amin A, Robles OJ, Greene ME. Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches. Journal of Adolescent Health. 2015; 56; 7-14 * See poster EP004
Background
Results
Adolescent and youth pregnancy in Kenya is one of the leading causes of school and university dropout, with up to 13,000 adolescent girls dropping out of school every year as a result of unplanned pregnancies (1). While contraceptive awareness in Kenya has consistently improved, this change has affected adolescents and young women far less than any other group of women of reproductive age (2). Despite over 70% of men and women report having had first sexual intercourse by age 20 years (2) - family planning (FP) services remain difficult to access in practice, particularly for unmarried youth, and most significantly for unmarried women: only10.1% all 15-19 year old women and 46% of 20-24 year old women report using any contraceptive method (2). Decades of programming to address the challenge of unintended pregnancy amongst adolescents and youth have demonstrated that a range of social, cultural, and economic factors must be addressed alongside strengthening access to, and quality of, family planning service delivery in order to improve health outcomes (3). An Ecological Framework proposed by Svanemyr et al (3) proposes that programs targeting the individual, relationship (parents, sexual partners, and peers), and community (neighbourhoods, schools and workplaces) are necessary to improve youth sexual and reproductive health outcomes. Within this context, peer education was shown to increase sexual and reproductive health knowledge, use of condoms, and delayed first intercourse (3). To address the challenge of youth pregnancy amongst university students in Kenya, and building on Svanemyr’s Ecological Framework, Jhpiego’s Brighter Future program partnered with the public Jomo Kenyatta University of Agriculture and Technology (JKUAT) in Nairobi, Kenya to design and test an innovative approach to increasing demand for contraception. Working with the University as a proof-of-concept design laboratory, the Brighter Future used innovative user-centered approaches to engage student peer mentors in program design, creating a life planning program built on, and responsive to, the participants’ unique needs and concerns. Peer mentors then independently rolled out Brighter Futures life trainings across the university. Study Question1: Will increasing self-efficacy and future-orientation through life-planning increase uptake of modern contraceptives among university women?* Study Question 2: Could encouraging students to help their friends with life planning and goal-setting as role models, rather than “contraceptive experts” make them more effective agents of change?
• Peer Education programs often attempt to create “mini knowledge/ content experts” from peer educators. • Repositioning peer educators as peer mentors and role models with their own plans, and encouraging them to support their colleagues in exploring their own individual motivations and developing their own unique life plan (rather than lecturing or “educating” them), made other students more receptive to messages about contraception.
Figure 1: Brighter Future peer mentors
Intervention Methodology: Proof of concept study, multiple cross-sectional mixed methods. Figure 2: Funguo Life Planning work book June 2013
Funguo Knowledge, Attitudes and Perception surveys (Baseline)
JKUAT students engaged in creative partnerships to create life plan prototypes utilising user-centered design, building on students’ definition of a life plan: Career | Relationships | Health | Finance 80 peer mentors taken through life planning and trained to mentor Dec 2013
301 male and female JKUAT students enrolled in the study (cascadees)
Life Planning workshops and other Funguo activities conducted independently by JKUAT peer mentors
Jan 2015
Funguo Knowledge, Attitudes and Perception surveys + Focus Group Discussions conducted (Endline) Comparison group: 379 JKUAT students not enrolled in Funguo
• Peer Education programs are generally thought to be very labour- and resource- intensive, with significant investment (both time and money) going in to incentives and supervision to ensure peer mentorship is provided as planned. • In the Brighter Future model, enthusiasm for their own life plans and learning fueled a desire to share the program with others. The program never created an expectation of incentives, which appears to have encouraged self-motivation and engagement. • Having been engaged in program and product design from the outset (User Centered Design*), peer mentors demonstrated significant levels of inherent motivation.
“Since I joined them (the Brighter Futures program) I have had a lot of experience in different areas… I have been able to do a number of things because of this in an orderly manner and planned way. With regards to leadership, coordination and in life generally. Now I am able to balance what I do outside and integrate it. I have fully benefitted from the Brighter Future program. “ – PM2 (Peer Mentor)
Providing support and guidance to peer mentors through an online platform (WhatsApp) proved a low cost mechanism to facilitate very open discussions among the peer mentors, Brighter Future staff and youth-friendly facility staff. • Students do not want to be taught about contraceptives by people who are not using them. • Peer mentors who use a contraceptive method are themselves more credible promoters of contraceptive uptake.
“I like the contraceptive talk but I like it when someone comes to talk to me about it and they tell me that they have used a contraceptive method. Then, I will be able to relate because then you are telling me of your experience. If you tell me you hear, you are scaring me but if you talk to me out of experience then I get more comfortable and that is the first step for me to take a contraceptive and then I can say that this person has used it and I can too. And we can then go on with the conversation.” – PF8 “They talked about sex openly where no one does. It gave me so much courage and I started talking about it and I was interested in knowing more … What motivated me most to participate in the Brighter Future activities was the fact that they talked about the facts of life that no one else talks about. Not even your mum, best friend, talks about it and these are the people you expect to talk to you about this.” – PF2
“On the contraceptives topic? It helped me and my friends talk more on contraceptives and more openly. It’s a rare topic to be discussed and so not many people discuss contraceptives and so after going through it I remember we had a very interesting topic discussion on it and nowadays none of us is truly shy to talk about it.” – CF4 Cascadee’s reported the following changes in behaviours following conversations with peer mentors:
12
25
%
started using a contraceptive method
%
said they intend % to start using a contraceptive method initiated a discussion about contraception with their partner
63
References 1. Ikamari L, Izugbara C, Ochako R. Prevalence and determinants of unintended pregnancy among women in Nairobi. Kenya BMC Pregnancy Childbirth. 2013;13:69. Figure 3: Peer Mentor in action
“It was a bit difficult to understand how you would have a life plan and yet it is all in your mind. After I talked to peer educator about it I was convinced to write it down as I want to do something. There are steps in a life plan and I had a problem of prioritization.” – CM1
2. Kenya National Bureau of Statistics, Ministry of Health/Kenya, National AIDS Control Council/Kenya, Kenya Medical Research Institute, and National Council for Population and Development/ Kenya. 2015. Kenya Demographic and Health Survey 2014 3. Svanemyr J, Amin A, Robles OJ, Greene ME. Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches. Journal of Adolescent Health. 2015; 56; 7-14 * See poster EP004
