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A peer-education model of health promotion for children of West African refugees

Researcher Professor Peter Drummond and Dr Bernadette Wright

Partnerships The project was run in partnership with the West African Women’s Association in Perth.

Date: 31st December, 2010

In 2006, our research group completed a study of health knowledge and beliefs in West African refugee women and Australian women, matched for age and educational background. We found that the West African women held negative attitudes towards condom use and had misconceptions about the spread and methods of protecting against sexually transmitted infections and HIV. Barriers to exercise and misconceptions about the nutritional value of certain foods were also identified. In addition, a number of psychological and social barriers to seeking medical and psychological assistance for a range of common medical and psychological problems were found.

With support from Healthway and the WA Department of Health, this research was extended in 2007 with the implementation of a peer education training programme that focused on improving the deficits in health knowledge identified in the survey. This involved training facilitators from within the West African community on sexual health practices, coping with stress, and physical activity and diet. The trained facilitators then passed this information on to other members of their community in a structured classroom format (as deemed culturally-appropriate by the community). We found significant increases in the participants’ knowledge of sexually transmitted infections and HIV, how they are spread, how to protect against infection, and positive attitudes towards condom use. Knowledge of stress and depression, diet and nutrition, and benefits of exercise also increased.

Importantly, the parents who participated in the project requested that the same program be run with their children. Therefore, in the project supported by Healthway in 2008-9 we adapted the training programme for use with West African adolescents. Training sessions were run for a team of 12 youth leaders, and leaders were encouraged to pass on information covered in the training sessions to their peers. Topics covered included sexual health issues, depression, anxiety, and stress.

Changes in health knowledge were evaluated in the youth leaders and their adolescent peers (N = 20). Preliminary findings indicate that sexual health knowledge increased in the youth leaders, and knowledge about mental health increased in the youth leaders and their peers. In addition, attitudes toward condom use changed in youth leaders, and attitudes that reflected the importance of sexual health in intimate relationships changed in both groups.

Objectives:

The principal purpose of this project was to investigate the utility of a peer-education model of health promotion among youths in a new and emerging community in Western Australia. Our specific objectives were to evaluate the delivery of modules on sexual and mental health issues to West African adolescents, and to evaluate changes in attitudes and stigma towards these issues from before to after the intervention.

Progress:

Workshop materials were assembled, elders within the community were trained in the delivery of the workshops, and 12 youth leaders were invited to participate in the training. Each of the youth leaders recruited 1-2 friends (N=20) to represent the community. The youth leaders and their peers filled out questionnaires on knowledge about and attitudes towards sexual and mental health practices before and after the series of workshops. Changes after the workshops have been investigated in preliminary analyses. The findings will be analysed further and a manuscript will be submitted to a scientific journal within the next 12 months.

Results:

Sexual health knowledge increased in the youth leaders, and knowledge about mental health increased in the youth leaders and their peers. In addition, attitudes toward condom use changed in youth leaders, and attitudes that reflected the importance of sexual health in intimate relationships changed in both groups. In particular, after the workshops the youth leaders thought that:

  • their friends approving of what they did was less important than before
  • if their long-term boyfriend or girlfriend refused to use protection they would now be less likely to have a physically intimate relationship
  • they rated the chances of getting an STI during unprotected sex with a long-term boyfriend or girlfriend as higher than before
  • they also rated the chances of getting an STI during unprotected sex with a long-term boyfriend or girlfriend as higher than before, compared with someone of their age and gender
  • they would now be more concerned than they had been before about catching an STI if they had a physically intimate relationship without protection

In addition, the peer group reported that:

  • they now talked to their friends about problems to do with their physically intimate relationship more than before the workshops
  • they were now less likely to have a physically intimate relationship with their long-term boyfriend or girlfriend if they were not ready
  • they were now more likely to talk about using protection (e.g., a condom) with their long-term boyfriend or girlfriend before starting a physically intimate relationship
  • if their long-term boyfriend or girlfriend refused to use protection they would now be less likely to have a physically intimate relationship

Feedback - Community Working Team

  • The feeling within the community toward the workshops before they started – for example: were the parents and children generally enthusiastic, disinterested, anxious about being involved, resistant, or some other attitude?

COMMENTS: The feeling within the community prior to the workshops was different (reluctant). They iterated that in the past many agencies have consulted them on many occasions, information extracted; workshops conducted; recommendations made and nothing has changed. Members of the community (parents in particular) were very sceptical about the project although the community was initially enthusiastic about having educational/information training workshops for their children (the young people) in the community. However, when facilitators explained the importance of the workshops and reminded parents of their suggestion in 2007 and also provided them some detailed overview of the project and highlighted some of the topics of the workshops, families were happy for their children to be involved. The community at large was finding it difficult to educate their children or discuss matters regarding physical intimate relationships. The community was very happy about the workshops.

  • Can you give some examples of discussions that you and the other facilitators had with parents and children about being involved in the workshops?

COMMENTS: Discussions with parents and children centred on: community’s concerns about teenage pregnancy; children’s schooling and education and their future; the workshops were intended to provide appropriate information to youth as a preventive measure against sexual related problems and sickness; discussed about law and the consequences of breaking it; participants’ compensation by the organisers of the workshops; participants’ names will not appeared on any documents to be published in the future and all information would be kept confidential.

  • What proportion of families did not want to be involved? What reasons were given for not wanting to be involved?

COMMENTS: A great significant number of parents at first were reluctant for their children to take part in the workshops until after some meetings with Ms Ruth and worked out approaches of reaching the parents that the parents of the children who attended the workshops approved of their children’s participation. The reasons of parents being reluctant at first are that many times they or their children are just used to collect information from them and then nothing significantly come out of the workshops and they are still experiencing the same problems over and over without any concrete ways of assisting the community to address their own issues.

  • How did attitudes change once the workshops got underway?

COMMENTS: The participants took every topic seriously, especially when emphasis were placed on their future. They became interested and focused. They interact with one another and in fact felt some relief as what to do with sexually related issues /problems. Parents too were impressed about what their children are learning during the workshops and would want more of these workshops to be conducted by the community from time to time. The community members were pleased to note that issues of great concern about youth and early pregnancy were addressed during the workshops by a professional body including stakeholders of the community. So from the community perspective, it gives the community and parents as well as Elders to be able to educate their young ones to focus on their schooling rather than be involved in sexually relations issues.

  • How did the workshop participants respond to the workshops?

COMMENTS: Participants appreciated the quality of materials or information provided them during the workshops. They responded positively to the information and see it as important as to their parents’ concerns about their schooling, health and future. They learnt about the positive and negative aspect of life in relationships and communicating with other people and how to protect themselves and maintain a healthy lifestyle.

  • Did they join in discussions, participate reluctantly, turn up on time, listen to what was being said or play up and talk among themselves?

COMMENTS: All participants took part in the group discussions and were pleased to freely give their different opinions about how they see things. They were also good listeners. Some participants turned up late – but this had nothing to do with the workshops. This was due to family weekend arrangements prior to the workshops. For example, some participants had to attend soccer practise before the workshops time.

  • Which topics seemed to be well-received, and which topics did the participants have more difficulty with?

COMMENTS: The quality of information and the manner of team work in which it was presented contributed to participants receiving the workshops material well. From all indications all topics were well received. Participants learned a lot of new good things about how to communicate – to express their feelings without being aggressive; how to protect themselves from STI and value education. So all topics were very important and all were inter-related and as such all were meaningful to participants and parents.

  • Please include any other observations that you would like to make on how the workshops were conducted and their value to the community, and suggestions for improvement if the workshops were repeated.

COMMENTS: It was observed that the workshops materials were culturally appropriate. Some of the words that would not be used or said before the participants in our culture were well put in place. For example, “having physical intimate relationship” help us not to feel embarrassed to explain the workshops materials to participants. This was expressed in good and respectful manner. It was observed however that the workshops materials were not given to participants to take home for future as study notes after each section. Otherwise, the workshops were conducted in a good environment and there existed good relationship among team members. There was no tension among participants and the training team. So we had great time together as organizers, facilitators and participants.

Another observation was the difficulty to get participants on site and back to their various homes because of transportation difficulties. This was very inconvenient for some team members who had to continue picking many participants from their various homes and transporting them back after sessions as well as staying behind at the workshop venue to protect children. More hours unpaid for were spent on this aspect so next time proper planning should be made to address the issue of transportation. Also any material collected from the community should be sent to the community through the community research coordinator for us to go through it first just as the family/domestic community research we did with ASSeTTS.

Feedback - Community Parents

  • Can you please provide us information on how the workshops affect your child or children?

COMMENTS: Ways in which the workshops affect our children is that some of them have been telling us that the workshop was very good and educative for them. The children have learned a lot from the workshops. They have been able to know a lot of thngs on how to be in control of their body. They said they were very much happy to have taken part in the workshop; and that they will pass information they gained on to their friends that were not able to be part of the workshops. Also the children learned to be responsible; respect the law; know how to express themselves even if they feel angry or not feeling good. They also learnt how to take care of themselves from man/woman sicknesses. They are able to know the differences between rights and opportunities or rights and responsibilities. The workshops information provided more education for our children. The workshops have positive impacts on our children attitudes and behaviours. They made our children to develop high self esteem and help them to focus on their schooling. The children appreciate the workshops because the training they received encouraged them to avoid unwanted pregnancy which is good.

  • What feeling or feelings did you have toward the workshops before they started – for example, were you or your children generally enthusiastic, disinterested, anxious about being involved, resistant, or some other attitude?

COMMENTS: We actually thought the workshops were about training our children how to have physical intimate relationships but, when it was explained to us how it will benefit our children for them to get good health and take care of themselves, we allow our children to attend. And our children are more concerned about their health and study.

  • Do you think these type of workshops are useful for your children? Please explain how do you think they are useful.

COMMENTS: The workshops are useful for our children in many ways in that the children will not allow themselves to be fooled by their peer groups. The children know the difference between healthy and unhealthy relationships; the consequences of unprotected physical intimate relationships; who they should talk to when they have health or other issues; who to contact to address problems of STIs or unwanted pregnancy; and what are the consequences of disobeying the law. These types of workshops are absolutely good for our children.

  • Will you want similar workshops to be conducted for your children in future and how will you want them to be conducted?

COMMENTS: Similar workshops would be good in future for our children. If not, the peer pressure would destroy whatever good the workshops have built in our children. So we need more of these type of workshops in our community, and they should be conducted in a good place as these past workshops. It would be good also to help the children with transport because some of them live very far from the place were the workshops are conducted. We would want, for example, the following topics to be covered in the next workshops – if you are going to conduct similar workshops like the ones that just been completed: Crime prevention; Improving high self-esteem without being arrogant; complications of unwanted pregnancy; Drug and alcohol prevention including others you will think useful for our children in the community. We are pleased with the way the organisers have Ms Ruth and other members of our community to work with the organisers to carry out the workshops for our children; and the organisers should make provision to facilitate the children to attend the workshops by having transportation facility for the participants.

Implications for Health Promotion / Translation of Research into Practice:

The findings indicate that the peer education approach was successful in spreading knowledge about sexual and mental health issues through an adolescent cohort of a minority community. This approach may assist health promotion practice both in minority and mainstream groups.