This review article questions the assumptions at the core of peer education interventions adopted in young people’s sexual and reproductive health programmes in developing countries. Peer education is a more complex and problematic approach than its popularity with development agencies and practitioners implies. Its rise to prominence is more indicative of the desire to find effective tools to address the HIV/AIDS pandemic, than of peer education’s proven effectiveness. The often simplistic model of social relations that underlies peer education interventions leads to the reinforcement of gendered power relations, and a failure to take account of the social dynamics of poverty. The dominant rationales for peer education are examined and contested. In spite of the mismatch between rhetoric and experience, the appeal of the approach remains powerful, stemming largely from the objective of engaging young people in health interventions in a way that increases their autonomy and capacity.
This article analyses in detail the impact and effectiveness of peer-education projects implemented in Cambodia under the Reproductive Health Initiative for Asia (RHI), in an attempt to provide important lessons for the design and implementation of such interventions and to contribute to the development of best practice. Under RHI, which was the first programme in Cambodia designed specifically to address the sexual and reproductive health needs of young people, peer education was implemented as if it were a directly transferable method, rather than a process to be rooted in specific social and political contexts. Consequently, peer-education concepts of empowerment and participation conflicted with hierarchical traditions and local power relations concerning gender and poverty; peer educators were trained to deliver messages developed by adults; and interventions were not designed to reflect the social dynamics of youth peer groups. IntroductionPeer health-education interventions with young people are often divorced from the social and political context in which they are implemented (Turner and Shephard 1999). Power relations that form an important part of the social dynamics among young people, such as those relating to gender and poverty, are regularly overlooked in many peer-education programmes and interventions. Despite the mismatch between the rhetoric and the reality of peer education, and a distinct lack of evidence-based planning, engaging young people in interventions concerning sexual and reproductive health in a way that aims to increase their autonomy remains attractive to development-assistance agencies.In this article, after briefly setting the scene and outlining our research methodology, we present the findings from primary and secondary research into the impact and effectiveness of peer-education projects implemented over a five-year period in Cambodia.
The new PREMs will provide children and young people receiving care in specialist paediatric hospitals with the opportunity to provide feedback on their experience. Sustainability and ensuring that feedback results in improvements need to be addressed in future work.
IntroductionPregnancy and the first few years of a child’s life are important windows of opportunity in which to equalise life chances. A Better Start (ABS) is an area-based intervention being delivered in five areas of socioeconomic disadvantage across England. This protocol describes an evaluation of the impact and cost-effectiveness of ABS.Methods and analysisThe evaluation of ABS comprises a mixed-methods design including impact, cost-effectiveness and process components. It involves a cohort study in the 5 ABS areas and 15 matched comparison sites (n=2885), beginning in pregnancy in 2017 and ending in 2024 when the child is age 7, with a separate cross-sectional baseline survey in 2016/2017. Process data will include a profiling of the structure and services being provided in the five ABS sites at baseline and yearly thereafter, and data regarding the participating families and the services that they receive. Eligible participants will include pregnant women living within the designated sites, with recruitment beginning at 16 weeks of pregnancy. Data collection will involve interviewer-administered and self-completion surveys at eight time points. Primary outcomes include nutrition, socioemotional development, speech, language and learning. Data analysis will include the use of propensity score techniques to construct matched programme and comparison groups, and a range of statistical techniques to calculate the difference in differences between the intervention and comparison groups. The economic evaluation will involve a within-cohort study economic evaluation to compare individual-level costs and outcomes, and a decision analytic cost-effectiveness model to estimate the expected incremental cost per unit change in primary outcomes for ABS in comparison to usual care.Ethics and disseminationEthical approval to conduct the study has been obtained. The learning and dissemination workstream involves working within and across the sites to generate learning via communities of practice and a range of learning and dissemination events.
BackgroundDespite the focus on patient experience in recent Department of Health policies and the fact that every year 7%– 10% of children are admitted to hospital and/or attend hospital outpatient clinics, children and young people (CYP) are rarely surveyed about their experience of care. Of those surveys that do exist about CYP’s experiences, most have been developed by adults and/or are completed by adults, with little direct input from CYP themselves. Our aim, therefore, was to develop patient reported experience measures (PREMs) with CYP for CYP.MethodsThe PREMs were developed over a number of stages, each of which involved extensive patient engagement to ensure that the CYP PREMs reflected those elements of their hospital experience that were most important to CYP. Elements of the PREMs development included focus groups to determine the aspects of care which are the key drivers of patient experience, cognitive testing to ensure that CYP understood the questions as intended, the language is appropriate and the response options are comprehensive, and focus groups to determine the most appropriate mode through which to administer the CYP PREMs and to gain an understanding of patients’ design preferences.ResultsInpatient and outpatient PREMs were developed for three age groups – 8–11 years, 12–13 years and 14–16 years. Three clear themes were evident from the initial focus groups and provided the structure to the questionnaires – hospital facilities, hospital staff and treatment and tests. During cognitive testing questions were generally understood but needed some clarification, and questionnaires were identified as being too long. Some questions were therefore removed or reworded, questionnaire navigation was improved and response scales amended. During the subsequent focus groups CYP indicated that they preferred tick-box questions with a non-standard layout and that the design should not be themed around hospital. Paper rather than an electronic format was preferred by many but depended on personal experience. Two questionnaire designs were selected. In total 229 CYP participated in the PREMs development.ConclusionCYP wanted to engage in the development of the CYP PREMs and clearly expressed a wish to be able to report meaningfully on their hospital experience.
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