Peer pressure as a positive reinforcement tool

Indian girls players of the Youth Football Club (YFC) practice at Rurka Kalan village, some 40 km from Jalandhar on June 9, 2018; Image: Shammi Mehra/AFP

Adolescence is one of the most critical periods in human development. One’s health during the teenage years determines health in the future. Risky behaviours and negligence in youth can have long-term consequences. Nearly two-thirds of premature deaths and one-third of the total disease burden in adulthood are associated with conditions or behaviours initiated in youth. Adolescence is, hence, a crucial phase for inculcating the appropriate health behaviour and attitudes. It could have large, long-term positive impacts.

This includes, widespread ignorance about menstruation and menstrual hygiene among girls and the next-to-nil awareness of sexual and reproductive health are leading to high-risk sexual behaviours at a very young age. Nutritional disorders such as anemia have been observed in over 60 percent adolescents, especially girls. Tobacco, alcohol and other substance use are widely prevalent in the young population.

Over the past few years, we have also noted a remarkable rise in obesity due to poor dietary habits, stress and mental health issues. What’s even more troubling is that these multiple behaviours and conditions often coexist in the same individual, adding a cumulative risk to their poor health into adulthood.

Taking cognisance of this alarming rise in health issues among adolescents, the central government developed a National Youth Policy (2014) highlighting the importance of empowering our adolescents to reach their full potential. Subsequently, a comprehensive national adolescent health programme—Rashtriya Kishor Swasthya Karyakram (RKSK)—was launched to improve the continuum of care for adolescent health and developmental needs.

An Adolescent Peer Educator stands proudly after attending her orientation and training

Critical habits and behaviours are formed during this phase largely in imitation of peers. Lack of awareness is the underlying root cause of these myriad health issues. One of the most important sources of information for adolescents, with regards to age-related concerns, is their peers. Thus, harnessing the power of peers through peer education has proven to be an effective health promotion strategy in creating awareness, changing attitudes and beliefs, and empowering the youth to live healthier lives. In fact, various studies have indicated it to be more effective than traditional methods, especially when dealing with sensitive subjects like sexual relationships and substance abuse. By building a strong peer relationship with the youth, peer educators can provide the very critical psycho-social support that the youth so desperately need—discussing concerns they consider a taboo to discuss with family and teachers.

As part of the APEKSHA program, young leaders educate adolescents on health

There are different peer education strategies that work in both formal and informal settings. Our experiences from the field suggest that informal, interactive strategies such as observing marker days (World Tobacco Free Day), competitions, and games work very effectively because they hold great appeal for the adolescents. These informal strategies, when coupled with the more formal strategies such as awareness sessions by doctors and follow up sessions by the peer educators, add depth to the program, greatly enhancing its impact.

Peer education works better when it is delivered through the school system. However, a large number of adolescents, especially girls, drop out of the school system at an early age and thus reaching this group becomes crucial. This bunch can be reached very effectively through WhatsApp groups and the other village level health functionaries. To ensure the sustainability of the program, it is important we link it with the public health system and the RSKS program wherever it is currently functional.

At the heart of the peer education program is the appropriate identification and selection of peer educators and the depth of training provided to them. There are certain universal qualifications and requirements for peer educators. They should have a socio-cultural background similar to target audiences and be respected by them. Equally essential qualities are a non-judgmental attitude towards others, self-confidence and leadership potential. Most importantly, they need to be positive and healthy role models themselves.

The training provided to peer educators is the other crucial element of a successful program. A variety of skills need to be provided: communication skills such as active listening, and exhibiting empathy are important. For peer educators to be effective and motivated, the training needs to be continuously reinforced.

The writer is a CEO of Ambuja Cement Foundation