Adolescent Peer Supporters

Peers are the single greatest influence on the lives that adolescents lead and on the adults that they turn out to be. Understanding the peer context is fundamental to understanding adolescents.

Adolescence, the period of life between ages 10 and 24 years, is often associated with increased risk taking, an increased need for social connection and peer acceptance, and a heightened sensitivity to peer influence. This phenomenon occurs because fulfilling one of the key developmental tasks of adolescence is to individuate from parents and this greatly elevates the importance of peers relative to family relationships.

Peer contexts

Adolescent peer contexts consist of multiple, overlapping layers of social relations, ranging from close friends to larger peer crowds that share common characteristics, social spaces and identities. Social relations are critical to the developmental task of adolescents as they individuate away from their parents, a process that makes peers increasingly important in their lives. However, adolescent behaviour is often seen by adults as dangerous, inappropriate and immoral. The general category of risky adolescent behaviour includes many health-related behaviours, such as unprotected sex, drinking, smoking, drug use, reckless driving, delinquency, and violence.

The term, “peer” refers to people who are equal in some or other way. This equality can be defined by age, gender, socio-economic and/or socio-cultural background background, geographic location or health status. Peer support is generally a broader term that encompasses the psycho-social support, education and health services navigation peers can provide, which is particularly relevant applications for adolescents’ health, development and well-being.

Peer supporters, who are also known as peer educators and or peer navigators in a health care setting, are people who have a similar condition such as being HIV positive, who provide support to those that are newly diagnosed and struggling with managing their condition. For example, clinic clients that have accepted their HIV positive diagnosis and are embracing a new lifestyle including lifelong treatment adherence are often recruited and trained to become peer supporters.

Role of peer supporters

The role of peer supporters is to promote healthy lifestyle options through sharing of information and experiences with other young people who have a similar condition. The point of working through peer supporters instead of adult clinic staff is to assist young people in acquiring the right information and developing positive attitudes and skills that are necessary for positive behaviour modification, through someone to whom they can relate (through shared personal experiences) and trust.

Peers are significant for adolescent health in that they can lead adolescents into a variety of behaviours that have short and long-term consequences for physical and mental functioning.

Peer supporters as educators

Peer education is education delivered by young people to their peers. Peer education has had moderate success in lower and middle income countries in influencing adolescent choices.

Peer supporters can assist with health literacy. Poor health literacy is a major reason why adolescents and adults do not seek health assistance. Health literacy is commonly defined as ‘the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Benefits of peer supporters in education

Peer supporters are able to:

  • Improve the acceptability of health services to the target audience, that is, the adolescents by creating adolescent friendly spaces
  • Reduce fear of health services
  • Reduce concerns about confidentiality
  • Reduce stigma and shame of seeking SRH and STI services.

However, ongoing training, mentorship and support for peers should be considered as part of ongoing resource development (See peer navigation training guidelines below)

Peer navigators

Peer navigation is an intervention that is dependent on community participation to achieve positive biomedical behavioural changes like treatment adherence, and therefore researchers should invest in a Peer Navigation Training that entails:

  • A community assessment to get an understanding of the community needs and other service providers that can be used as referral points
  • A peer navigation training programme that is sensitive to cultural beliefs and value systems, in particular the nature of sexual health information that aims to prevent unplanned pregnancies and HIV prevention
  • Proper preparation, training, supervision, and a plan to evaluate the intervention

A successful peer navigation programme in South Africa embedded the HIV treatment and patient retention programme on the social learning and modelling approach by designing a clear pathway that leads to a desired patient behaviour:

  • Rapport: Common experiences of adolescents promote trust
  • Social support: Peer navigator inspires the client and the client shares problem with the navigator
  • Skills building: Navigator’s past experiences and ongoing approaches to managing HIV used as a guide in discussing with the clients to develop action plans to tackle barriers to care
  • Client behaviour change: Improved adherence to treatment

Stages to establishing a peer navigation system

  • Designing a peer navigation programme for adolescents and young people
  • Integrating young peer supporters within a clinic / health care setting
  • Creating pathways between youth in communities and their local clinics
  • Links to training programmes that can be used by research organizations that want to train young peer supporters and integrate them into their research.
  • Effective collaborations with young people in the communities to create pathways to health care services.

Building an effective peer support and peer health navigation system

Young peer supporters are able to provide health information to their peers and are able to assist their peers to address personal barriers to accessing health care services.

Peers play a critical role in the psychosocial development of adolescents which makes peer interaction and education an effective health promotion strategy.

  • Adolescents recently diagnosed with HIV need more information and support on how they are going to live with HIV
  • As they transition from childhood to adolescence, young people are expected to take responsibility for their health care such as visiting the clinic on their own
  • Peer supporters send text / social media /personal reminders to the adolescents who are learning to independently balance their academic, sport and health commitments

Young peer supporters mostly assume the peer educator role and therefore as young people should receive sufficient training that enables them to understand the purpose of the HIV health programme, improve their listening skills, be equipped to provide encouragement and motivation to their peers; as well as support healthy decisions and HIV prevention behaviours. Young peer supporters should also be able to identify other sources of support in the community as their clients may present other personal challenges that are not related to the services provided in the peer navigation training and programme.

Things to consider when developing an effective peer support and navigation system

The many years of working with peer supporters in the field of HIV care, treatment and support has enabled the collection and collating of best practice models for recruiting, training and integrating peer supporters into various HIV teams. From experience it is recommended that when starting or expanding a peer navigation programme the following steps must be followed:

  • Design and implement a system that supports peer navigation in the HIV care team
  • Identify priority populations for peer supporters to serve
  • Peer navigation programme best practice checklist
  • Establish a standardised title and position for peer supporters in the context of integrated HIV care team
  • Establish protocols and procedure for peer navigation programme

Peer navigation training guidelines

The Peer Navigation Training guidelines emphasize a need for ensuring that all peer supporters be trained and regularly reminded of the following issues:

Confidentiality and setting boundarieswhile peer supporters consider the clinic patients as their peers and leverage on this aspect to develop relationships that grant them access to their private space and information, young peer supporters need to remember to keep professional boundaries and be cautious about sharing confidential patient information.

Ethics in providing peer servicesRefer to the Code of ethics and professional conduct

Positive and healthy lifestylesPeer supporters model a healthy lifestyle not only to their clinic patients, but to the community at large.

Adherence to treatmentThe primary role of the peer navigator is to ensure that the clinic patients understand when and how to take the medication. Patients need reminders and encouragement to collect their medications and have regular clinical assessments of their condition.

The life steps approach – “Is a brief, evidence-based intervention to improve HIV medication adherence that integrates informational, problem-solving, and cognitive behavioural techniques through the … “steps” (e.g., psychoeducation, attending appointments, obtaining medications, communicating with providers, coping with side effects, formulating a daily medication schedule, storing medications, utilizing cue-control strategies for pill-taking, responding to slips, etc.)”.

Communication skillsPeer supporters need to have the basic verbal and writing skills that will enable them to learn during training and assist the clinic patients with basic adherence tasks such as checking appointment dates on the clinic cards, sorting pills and communicating with the clinic patients.

Listening and counsellingYoung peer supporters might take for granted the need to present a body language that communicates interest and presence to the peer patient.

BY YOLISWA NTSEPE (MA, PhD)
ADOLESCENT PROGRAMMES MANAGER

UPDATED NOV 22, 2023

TABLE OF CONTENTS:

REFERENCES & ADDITIONAL RESOURCES:

Andrews, J. L., Foulkes, L., & Blakemore, S. J. (2020). Peer Influence in Adolescence: Public-Health Implications for COVID-19. Trends in cognitive sciences, 24(8), 585–587. https://doi.org/10.1016/j.tics.2020.05.001

Newton-Levinson, A., Leichliter, J. S., Chandra-Mouli, V., Sexually Transmitted Infection Services for Adolescents and Youth in Low- and Middle-Income Countries: Perceived and Experienced Barriers to Accessing Care. Journal of Adolescent Health, Volume 59, Issue 1, 7 – 16

Engaging HIV positive clients in care: Acceptability and mechanisms of action of a peer navigation program in South Africa https://doi.org/10.1080/09540121.2017.1363362

Best practices for integrating peer navigators into HIV models of care: Lessons learned from peer navigation programs. https://www.aidsunited.org/data/files/Site_18/PeerNav_v8.pdf

Facilitator’s Guide: Peer navigation training core module. https://www.fhi360.org/sites/default/files/media/documents/resource-linkages-peer-navigation-facilitators-guide.pdf

The peer education approach in adolescents – Narrative review article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499060/

Thetha Nami: Participatory development of a peer navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11399-z

Integrating peer support into service delivery: A good practice guide