Peer Education Research Articles

A process evaluation of a family planning, livelihoods and conservation project in Rukiga, Western Uganda.

Although Population-Health-Environment (PHE) approaches have been implemented and studied for several decades, there are limited data on whether, how and why they work. This study provides a process evaluation of the 'Healthy Wetlands for the Cranes and People of Rukiga, Uganda' project, implemented by an NGO-local hospital consortium. This programme involved a research design element, testing two delivery modalities to understand the added benefit of integrating conservation, livelihoods and human health interventions, compared to delivering sector support services separately (as is more usual). The process evaluation sought to understand how the programme was implemented, the mechanisms of impact, how it was shaped by the context in which it was delivered and whether there were discernable differences across the two delivery arms. Methods involved key informant interviews with implementing staff and community educators, a review of programme documents and secondary qualitative analysis of interviews and focus groups with community members. The findings include a statistically significant increase in the reach of the programme, in both service delivery and sensitization activities, when the sectors were fully integrated. It appears that this comparative advantage of integration is because of the improved acceptability and motivation among stakeholders, and increased initiative (and agency) taken by community-based peer educators and community members. We argue that the 'software' of the programme underpins these mechanisms of impact: trust-based relationships embedded in the system enabled coordinated leadership, supported local staff agency and encouraged motivation.

HIV incidence and recreational drug use among men who have sex with men aged 18–24 years in Tianjin, China: a retrospective cohort study

BackgroundRecreational drug use has been identified as a significant risk factor for the transmission of human immunodeficiency virus (HIV). This behavior is particularly prevalent among young men who have sex with men (YMSM). However, limited research has been conducted to investigate the correlation between recreational drug use and HIV incidence within this population.ObjectiveTo examine HIV incidence and explore the association between recreational drug use and HIV incidence among YMSM.MethodsA retrospective cohort study was conducted by a local non-governmental organization (NGO) among MSM aged 18–24 years from October 2017 to December 2023 in Tianjin, China. Participants were included if they had at least two HIV test records during this period. HIV incidence density and its 95% confidence interval (CI) were calculated using person-years (PYs) with a Poisson distribution. Risk factors for HIV incidence were identified using univariable and multivariable Cox proportional hazards regression models.ResultsA total of 56 HIV seroconversions were reported with 2901.9 PYs, resulting in an overall incidence density of 1.9/100 PYs (95% CI: 1.4–2.4). Among YMSM who do not use recreational drugs (YMSM-URD), the incidence density was 1.1/100 PYs (95% CI: 0.5–1.6), while it was 2.8/100 PYs (95% CI: 1.9–3.7) among those who do use recreational drugs (YMSM-RD). Adjusted for confounders, factors associated with HIV infection included recreational drug use (adjusted hazard ratio = 2.6, 95% CI = 1.4–4.7) and unprotected anal intercourse in the past six months (adjusted hazard ratio = 2.3, 95% CI = 1.2–4.4).ConclusionsRecreational drug use and unprotected anal intercourse significantly increase the risk of HIV infection. To effectively mitigate the spread of HIV, interventions should focus on these risk factors by employing HIV counseling and testing clinics, collaborating with NGOs focused on MSM, and establishing peer education programs aimed at YMSM.

Benefits for peer educators in delivering wellbeing education to agricultural students

Benefits for peer educators in delivering wellbeing education to agricultural students

Adapting the Theory of Planned Behavior to Analyze Smoking Intentions Among Adolescents in Urban School

Introduction: The prevalence of smoking among adolescents continues to increase each year. The Theory of Planned Behavior states that behavior is preceded by intention. Objective: This study aims to identify the factors associated with and most dominant in influencing smoking intentions among adolescents. Method: This research is quantitative with a cross-sectional study design. The study was conducted at State Junior High School 3 in South Tangerang City, which is located in an urban area. The research sample consisted of 276 adolescents who were non-active smokers, selected using a proportional stratified sampling technique, and data collection was carried out through a questionnaire. Data analysis included univariate analysis, bivariate analysis using the chi-square test, and multivariate analysis using multiple logistic regression. Result: The results showed that most adolescents had strong smoking intentions (56.5%), supportive attitudes toward smoking (52.2%), negative subjective norms (54.7%), and weak perceived control over smoking behavior (55.8%). There was a significant relationship between smoking attitudes (PR=2.658; 95% CI=2.028-3.485; P<0.05), subjective norms (PR=3.338; 95% CI=2.439-4.568; P<0.05), and perceived control over smoking behavior (PR=2.739; 95% CI=2.046-3.666; P<0.05) with smoking intention. Subjective norms were identified as the dominant variable influencing the intention. Conclusion: There is a relationship between attitude, subjective norm, and perceived behavioral control with respect to smoking intention, with subjective norm being the dominant variable influencing intention. Therefore, it is essential to intensify peer education programs to influence peers to avoid smoking, as well as to conduct a deeper analysis of the factors shaping subjective norms and design school-based interventions specifically targeting changes in these norms.

From “helping peers succeed” to “struggling to develop research questions”: factors that contribute to and detract from science identity in undergraduate learning assistants

Science identity impacts undergraduates’ persistence in their science courses and careers. Here, we investigated science identity in learning assistants, undergraduate peer educators who provide academic and social support in science courses. Understanding learning assistants’ science identities has particular value because of their dual role as science students and peer educators. While previous research has investigated disciplinary identity among physics learning assistants, we extend that work by investigating science identity among students who served as learning assistants in six different science courses, seeking to understand the ways in which they characterize their science identity and the experiences they describe as important in its development. Analysis of twelve interviews revealed three distinct groups of learning assistants: those with lower, intermediate, and high science identities. Recognition by important others, research experiences, and constrictive definitions of science were salient for science identity across all groups, while other experiences had varied salience. Notably, learning assistants with lower science identity described learning to use scientific language as critical for identity development, while learning assistants with the highest science identity found helping others to be an important contributor. Surprisingly, learning assistants with intermediate science identity cited uncertainty about their ability to develop research projects as important for determining their science identity. To communicate the variation in and factors relevant to science identity among learning assistants, we have developed three personas that can serve as tools to help programs and instructors develop robust support for learning assistants’ science identity.

Effectiveness of Peer-Led Education in Reducing HIV Transmission among Youths in Urban Areas: A Comprehensive Review

HIV transmission among urban youths remains a significant public health concern, driven by factors such as risky sexual behaviors, limited access to healthcare, and high social connectivity. Peer-led education has emerged as a promising intervention to reduce HIV transmission by utilizing the influence of social networks and delivering relatable, accessible information on HIV prevention. This review assessed the effectiveness of peer-led education programs in urban areas by examining their impact on HIV-related knowledge, behavior change, and HIV testing rates. Studies revealed that peer-led education significantly improves HIV knowledge, promotes condom use, and encourages HIV testing among urban youths, contributing to a reduction in high-risk behaviors. Additionally, the social and emotional benefits of peer-led education create supportive environments for discussing sexual health, reducing stigma, and fostering empowerment among participants. However, challenges such as variability in program quality, sociocultural barriers, and sustainability issues limit the long-term success of these interventions. To address these challenges, future strategies should focus on integrating digital health platforms, personalizing peer education, and employing rigorous program evaluation methods. The methodology for this review included a comprehensive analysis of existing literature, including randomized controlled trials, systematic reviews, and observational studies, to provide a holistic understanding of peer-led education’s effectiveness in reducing HIV transmission among urban youths. Keywords: Peer-led education, HIV prevention, Urban youths, Behavioral change, HIV transmission.

THE EFFECT OF PEER EDUCATION ON SLEEP HYGIENE ON SLEEP QUALITY AND PSYCHOLOGICAL RESILIENCE IN UNIVERSITY STUDENTS LIVING IN DORMITORIES

This study was conducted to examine the effect of peer education on sleep hygiene sleep quality and psychological resilience in university students living in dormitories. In the study, a quasi-experimental method with a pretest-posttest control group was used. 240 university students staying at Akyazı Credit and Dormitories Institution in Akyazı district of Sakarya province participated in the study. Half of the students (n=120) formed the intervention group and the other half (n=120) formed the control group. Before the study, 20 students were given sleep hygiene training by the research team. The training group provided peer education to the intervention group on sleep hygiene. No intervention was made in the control group. Student diagnostic form, Sleep Hygiene Index, Pittsburgh Sleep Quality Index, and Brief Psychological Resilience Scale were used as data collection tools. There was no statistically significant difference between the Sleep Hygiene Index and Brief Psychological Resilience Scale score averages of the intervention and control group students included in the study at the beginning and the last interview (p>0.05). However, it was determined that there was an improvement in the sleep hygiene and psychological resilience levels of the students in the intervention group (p0.05). In addition, it was determined that the intervention group had a significant improvement in subjective sleep quality and sleep latency, which are sub-dimensions of the Pittsburgh Sleep Quality Index (p

ESPRIT study, analysis of the results of the pre-intervention survey in upper secondary schools

Abstract Background Sexually transmitted infections are a major public health problem, and their number is increasing in Italy. However, affective sexuality education is not yet part of the curricula. Therefore, a project entitled ESPRIT was launched, involving 3 regions (Friuli-Venezia Giulia, Lazio and Sicily), the IRCSS ‘Burlo Garofolo’ and the Istituto Superiore di Sanità, and implemented with the technical and financial support of the Ministry of Health - CCM. Methods A multicenter prospective intervention study was designed involving public upper secondary school students (grade 10-11). All target groups completed a KAP (knowledge, attitude, practice) questionnaire before and after participation in the educational intervention to measure its effectiveness. The questionnaires from the first phase were collected between January and April 2024, and the results were analyzed using R statistical software. Results The analysis of the overall results (463 students in total; female 58%, male 39%, other 2%; FVG 49%, Lazio 25%, Sicily 26%) showed that the group of upper secondary school students, targeted by peer education answered the knowledge part correctly by 56.6±13.8% on average. Applying the Kruskal-Wallis test showed that the percentage was significantly higher for females than males (p-value=0.005) and for licei students compared to technical and vocational schools (p-value=0.000). In terms of to attitudes, only 17% of students talked at length about sexually transmitted infections, and in 86.6% of cases, the interlocutors were friends or peers. Conclusions The results of the first phase show differences between the sexes and between the different types of educational institutions. The current level of knowledge still leaves much room for intervention and improvement. Analyzing the results of the follow-up phase will allow us to understand the effectiveness of the peer education intervention. Key messages • Adolescents’ knowledge of sexually transmitted infections needs to be improved. • Gender and the type of school attended affect the level of knowledge.

HIV and sexual health needs of young key populations in Papua New Guinea: results of biobehavioural surveys (2016–2017)

ABSTRACT Papua New Guinea lacks data characterising the sexual health needs of younger key populations (KP): female sex workers (FSW) and commercially and sexually exploited girls (CSE), men who have sex with men (MSM), and transgender women (TGW). Biobehavioural surveys among KP were conducted in three cities. We conducted unweighted and weighted analysis for sample and population proportions, respectively. Variables associated with younger versus older age (15–24 versus ≥25 years) were included in the multivariable analysis. Younger FSW/CSEG had greater odds of having both Neisseria gonorrhoea and Chlamydia trachomatis (aOR:3.2, 95%CI 2.0–5.0), or having either infection (aOR:2.2, 95%CI 1.2–4.1) than older peers. They also had lower odds of having tested for HIV (aOR: 0.6, 95%CI 0.4–0.8). Younger MSM/TGW had greater odds of paying for sex in the <6 months (aOR:2.2, 95%CI: 1.5–3.1) and of having been paid for sex (aOR:1.6, 95%CI 1.1–2.4) than their older peers (≥25 years). Younger MSM/TGW had lower odds of having contact with a peer educator ≤12 months (aOR:0.6, 95%CI 0.4–0.9) and having tested for HIV (aOR:0.6, 95%CI: 0.4–0.9). All key populations have substantial sexual health needs, but those of younger members are greatest. Younger key populations would likely benefit from health services designed specifically for them.

Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study.

Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects. We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study. ImPrEP CAB Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minority (SGM) groups (aged 18-30 years) in 6 existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB Brasil through community mobilization, process mapping with HCPs with experience in CAB-LA, and focus group discussions (FGDs) with young SGM groups (n=92) and HCPs (n=20) to identify initial perceptions of facilitators and barriers for CAB-LA PrEP implementation, refine the mobile health (mHealth) educational tool, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp. FGDs were recorded, transcribed, systematically coded, and analyzed with thematic categorization by trained researchers using a qualitative data analysis program ATLAS.ti (version 7). A community mobilization team comprising 34 SGM community leaders collaborated in creating a prototype for an mHealth educational tool and contributed to the planning of peer education activities. We created 3 process maps for each site to describe the initial visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the extended duration of clinic visits due to the numerous laboratory tests and HIV counseling steps required. Proposed solutions included having point-of-care HIV rapid tests instead of laboratory tests and additional counseling staff. Barriers for CAB-LA PrEP implementation identified through FGDs were the training of HCPs, support for adherence to injection appointments, and stigma or discrimination against SGM groups and persons using PrEP. The mHealth educational tool and WhatsApp reminders were highly acceptable by SGM groups and HCPs, indicating their potential to support PrEP choice and adherence. Content analysis on the cultural appropriateness of the language and overall clarity of the material contributed to the refinement of the mHealth tool. Structured formative work with SGM persons and HCPs generated important refinements to context-specific materials and plans to launch ImPrEP CAB Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to same-day delivery of CAB-LA PrEP. Summative evaluations are needed to measure the effectiveness of the mHealth educational tool to support PrEP choice and the use of WhatsApp appointment reminders.

Communication Channels, Community Engagement and Access to Healthcare Services in Tanzania

Abstract This study assessed the impact of different communication channels on community engagement and healthcare access in Tanzania. It was conducted in Makambako District Council in Njombe Region. The study employed a mixed methods approach with data collected from 503 respondents through questionnaires, interviews, and focus group discussions. The communication channels analyzed included mobile phones, community health workers, peer educators, radio, village meetings, TV, and social media. Findings indicate that these channels have significantly increased community engagement and access to health services. The study further found that these channels facilitate the dissemination of health information and promote healthy behaviors by providing educational resources and community outreach programs. These findings offer valuable insights into the effective use of various communication channels to improve community engagement and access to health care services in Tanzania, providing a model that can be replicated or adapted globally in similar contexts.

Youth-led Mental Health Promotion in South Africa

Globally, youth have high rates of unmet mental health needs, especially in Majority World contexts. Youth themselves are well positioned to engage their peer group in mental health provision. The aim of this study was to explore how peer educators could co-produce and deliver mental health promotion in resource-constrained South Africa communities. Six peer educators aged 18 to 24 initially co-facilitated consultation with 209 youth, before designing and delivering three mental health promotion workshops to 179 youth. Peer educators and 21 workshop beneficiaries participated in focus groups on their experiences. Key findings related to involving youth by integrating mental health to community activities, using participatory approaches, applying and transferring knowledge, signposting for further help, and putting support mechanisms in place. In conclusion, youth hold unique expertise in mobilizing their peer group and promoting mental health. Peer educators should be incorporated in service systems, with allocated budgets, training, supervision.

Return-on-Investment Analysis of an Enhanced Community Doula Program: Pre- and Post-COVID-19 Considerations.

Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real-world data and a return-on-investment (ROI) analysis approach. We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post-COVID-19 program costing estimates were also performed. Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per-person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not. The BBB-enhanced community doula program was cost-saving to payers and increased access to doula support for low-income people. Even with post-COVID-19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget-conscious Medicaid payers that doula services are affordable.

Evaluation of the Sources of Sexual Knowledge and Information among Men in Kenya

AbstractSources of sexual knowledge and information among men have impact on quality of their sexual literacy and decision making. Sexual knowledge impacts on sexual attitudes, which underpin sexual behaviours and in turn impacts the sexual health outcomes of men. A cross-sectional quantitative survey was used to assess the sources of sexual knowledge and information among 484 Kenyan adult men aged 18–54. Data analysis was performed with STATA-16. Results showed that 79% of men learned about sex from school-based sex education, 75% and 72% from peers and mass media respectively while healthcare professionals (35%) and parents (28%) had the lowest influence on sexual knowledge and information. Understanding men’s sources of sexual knowledge and information that informs their sexual decision making can influence sexuality education planning and sexological practice policies targeted to out of school youths and older men. Hence, appraising formal peer educator’s knowledge could provide transformative sexual and reproductive health support services to men.

Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review.

Adolescent health literacy is critical for navigating the complex landscape of modern healthcare and making informed decisions that influence long-term health outcomes. This comprehensive review synthesizes current research on integrating digital tools and interactive learning approaches to enhance health literacy among adolescents. We explore the use of digital technologies, such as mobile apps and virtual reality, which cater to the preferences of this tech-savvy generation, offering personalized and accessible health information. The effectiveness of interactive learning methodologies, including simulations and role-playing, is also examined, highlighting their potential to increase engagement and retention of health-related knowledge. We address the importance of mental health literacy and the role of social media and peer education in disseminating health information effectively. Our review identifies gaps in the current literature, particularly the need for studies that consider long-term outcomes and the impact of socioeconomic and cultural factors on health literacy initiatives. We propose a multidimensional approach to health literacy education that incorporates innovative technologies and interactive methods to meet the diverse needs of adolescents in various contexts. The findings suggest that an integrated approach, including digital and critical health literacy, is essential for developing comprehensive health education programs that are both informative and engaging for adolescents.

Comparing the Effects of Healthy Lifestyle Education Through Peer Group and mHealth App on Self-esteem in Patients with Diabetes Mellitus: A Randomized Controlled Trial

Background: The increasing prevalence of diabetes mellitus has become a global public health challenge in recent decades. However, disease-related complications can be minimized through innovative educational programs. Objectives: This study aimed to compare the effects of healthy lifestyle education delivered via peer group and the mHealth app on self-esteem in patients with type 2 diabetes mellitus (T2DM). Methods: This three-group randomized controlled trial was conducted in 2022. A total of 135 patients living with T2DM were recruited using purposive sampling from two hospitals in Kermanshah Province, Iran, and then divided into three groups: Peer education, virtual education, and control groups, via replacement randomization. Peer patients with T2DM, previously trained by the researchers, provided education to those in the peer education group in four 35-minute sessions over two days. Simultaneously, patients in the virtual education group were trained by the researchers using the mHealth app, specifically designed for this purpose, in three 1-hour sessions over three days. Data were collected using the Patient Profile Form and the self-reported Rosenberg’s Self-Esteem Scale. The data were analyzed using IBM SPSS Statistics software, employing paired-sample t-tests, chi-square tests, Fisher’s exact tests, and one-way analysis of variance (ANOVA) for comparisons. Results: Before the intervention, there were no significant differences in the self-esteem mean scores between the study groups (P = 0.665). However, post-intervention, the self-esteem scores differed significantly between all groups (P = 0.002). The self-esteem mean scores of patients in the peer education group (100.36 ± 15.9 vs. 106.87 ± 9.08, P = 0.011) and the virtual education group (100.80 ± 24.72 vs. 116.91 ± 10.67, P = 0.018) significantly increased after the intervention, while no significant difference was observed in the control group (106.87 ± 9.08 vs. 105.60 ± 10.84, P = 0.134). Virtual education via the mHealth app was more effective than peer education in improving self-esteem in patients with T2DM. Conclusions: The healthy lifestyle education program delivered through virtual education via the mHealth mobile app led to higher self-esteem among patients with T2DM compared to peer education. It is suggested that future studies investigate the impact of virtual education using mobile-based apps and artificial intelligence capabilities on self-esteem in other patient populations. These results can serve as guidelines for the optimal use of distance education and educational apps for patients with chronic diseases.

Development and feasibility of the peer and nurse-led HIV Self-Testing Education and Promotion (STEP) intervention among social networks of men in Dar es Salaam, Tanzania: application of the ADAPT-ITT model

BackgroundAccording to the 2016–2017 Tanzania HIV Impact Survey, only 45% of men living with HIV (MLWH) were aware of their HIV status. In an effort to increase HIV testing in Tanzania, including among men, the Government of Tanzania passed a law in December 2019 allowing HIV self-testing (HIVST) to be included in the national testing strategies. The objective of this paper is to describe the development and pilot feasibility assessment of the Self-Testing Education and Promotion (STEP) intervention, which includes male peer education and demand creation for HIVST, and nurse-led distribution of HIVST kits in a community setting.MethodsThe development and piloting processes were guided by the ADAPT-ITT model and informed by a national PEPFAR/USAID-funded HIV implementation science project called Sauti.The adapted STEP intervention included the following two components: 1) peer-based HIVST promotion; and 2) nurse-led HIVST distribution. For the feasibility assessment, 25 men were selected and trained as peer educators in 2019 to promote HIVST among their peers before recruiting 253 men who received instructions and an HIVST kit from a nurse at a community-based study tent site.ResultsOf the 236 participants who completed the 1-month follow-up survey, 98.3% reported using the kit. The majority (92.4%) of participants reported a negative HIVST result while 4.2% (n = 10) received a positive result. Most (70%, n = 7) of the participants with a positive result sought follow-up services at a healthcare facility while 40.3% (n = 95) of the participants with a negative self-test result visited the community-based project site. Most of the men (53%, n = 129) did not visit a healthcare facility or the study site.ConclusionThe findings demonstrate that the combined peer-based promotion and nurse-led distribution of HIVST intervention was acceptable and feasible, though seeking follow-up services at healthcare facilities remained low. Future research should evaluate the effectiveness of offering nurse-led community-based clinical follow-up services in addition to HIVST rather than referral to facilities.

Comparison of the effects of nursing and peer education on quality of life and resilience in patients with multiple sclerosis: A randomized clinical trial

BackgroundMultiple sclerosis (MS) is a prevalent disease of the central nervous system that often leads to diminished resilience and quality of life in affected individuals. This study aims to compare the effects of nursing and peer education on improving the quality of life and resilience in patients with multiple sclerosis. Materials and methodsThis three-group clinical trial study was conducted before and after interventions at the MS Society in Hamedan, Iran. In this study, 120 patients with MS were randomly selected and assigned to three groups: nurse education, peer education, and control. Quality of life and resilience questionnaires were self-reported before and two months after the completion of the intervention. The educational sessions were conducted over five meetings, each lasting between 45 and 60 min, held every two days. Group one received education led by nurses, while group two participated in peer-led education sessions. ResultsThe results indicated that before the intervention, there were no significant statistical differences in demographic variables, resilience, and quality of life among the three groups (p > 0.05). However, after the intervention, both the peer and nurse groups showed a significant increase in quality of life and resilience compared to the control group (p < 0.05). Nevertheless, no differences were observed between the nurse and peer groups regarding these variables (p > 0.05). ConclusionsBoth nursing and peer education methods had an equal impact on enhancing the resilience and quality of life of patients with MS. It is recommended that peer support be utilized to empower MS patients, especially in contexts where there is a shortage of nurses.

Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial

Undiagnosed HIV and schistosomiasis are highly prevalent among fishermen in the African Great Lakes region. We aimed to evaluate the efficacy of lakeside interventions integrating services for HIV and male genital schistosomiasis on the prevalence of schistosomiasis, uptake of antiretroviral therapy (ART) for HIV, and voluntary male medical circumcision (VMMC) among fishermen in Malawi. We conducted a three-arm, cluster-randomised trial in 45 lakeshore fishing communities (clusters) in Mangochi, Malawi. Clusters were defined geographically by their home community as the place where fishermen leave their boats (ie, a landing site). Eligible participants were male fishermen (aged ≥18 years) who resided in a cluster. Clusters were randomly allocated (1:1:1) through computer-generated random numbers to either enhanced standard of care (SOC), which offered invitation with information leaflets to a beach clinic offering HIV testing and referral, and presumptive treatment for schistosomiasis with praziquantel; peer education (PE), in which a nominated fisherman was responsible for explaining the study leaflet to promote services to his boat crew; or peer distribution education (PDE), in which the peer educator explained the leaflet and distributed HIV self-test kits to his boat crew. The beach clinic team and fishermen were not masked to intervention allocation; however, investigators were masked until the final analysis. Coprimary composite outcomes were the proportion of participants who had at least one Schistosoma haematobium egg observed on light microscopy from 10 mL of urine filtrate and the proportion who had self-reported initiating ART or scheduling VMMC by day 28. Outcomes were analysed by intention to treat; multiple imputation for missing outcomes was done; random-effect binomial models adjusting for baseline imbalance and clustering were used to compute unadjusted and adjusted risk differences, risk ratios (RRs) and 95% CIs, and intracluster correlation coefficients for each outcome. This trial is registered with ISRCTN, ISRCTN14354324. Between March 1, 2022, and Jan 29, 2023, 45 (65·2%) of 69 clusters assessed for eligibility were enrolled in the trial, with 15 clusters per arm. Of the 6036 fishermen screened at baseline, 5207 (86·3%) were eligible for participation: 1745 (87·6%) of 1991 in the enhanced SOC group, 1687 (81·9%) of 2061 in the PE group, and 1775 (89·5%) of 1984 in the PDE group. Compared with the prevalence of active schistosomiasis in the enhanced SOC group (292 [16·7%] of 1745), 241 (13·6%) of 1775 fishermen in the PDE group (adjusted RR 0·80 [95% CI 0·69-0·94]; p=0·0054) and 263 (15·6%) of 1687 fishermen in the PE group (0·92 [0·79-1·07]; p=0·28) had schistosomiasis at day 28. 230 (13·2%) in the enhanced SOC group, 281 (16·7%) in the PE group, and 215 (12·1%) in the PDE group initiated ART or were scheduled for VMMC. ART initiation or VMMC scheduling was not significantly increased with the PDE intervention (0·88 [0·74-1·05); p=0·15) and was marginally increased with the PE intervention (1·16 [0·99-1·37]; p=0·069) when compared with the enhanced SOC group. No serious adverse events were reported in this trial. We found weak evidence for the use of peer education to increase uptake of ART and VMMC, but strong evidence for the added distribution of HIV self-test kits to promote high engagement with services and reduce the prevalence of active schistosomiasis, suggesting a high potential for scale-up in hard-to-reach communities across Malawi. Wellcome Trust and the UK National Institute for Health Research.

Investigating the effect of peer-led educational intervention on behaviors related to pubertal health and its determinants in high school girls of Genaveh, Iran: Application of social cognitive theory

Background Empowering adolescents in the field of puberty health is one of the important goals of public health programs. The present study was carried out with the aim of determining the effect of peer-led training on puberty-related behavior and its determinants using social cognitive theory. Methods: A total of 245 teenage girls were randomly divided into two groups: the intervention group and the comparison group. The questionnaire measuring puberty-related behavior and its determinants was self-administered and completed before and 2 months after training in the two groups. One session for parents, four sessions for peer educators, and four sessions for participants were conducted for 1 month. Results: In the intervention group, unlike the comparison group, the mean scores of knowledge, outcome expectations, self-efficacy, self-control, social support, and behavior increased significantly after training (p <0.05). Based on regression analysis, outcome expectations and social support were the main determinants of puberty-related behavior (adjusted R2 = 0.464). Conclusion: The findings of this study support the effectiveness of the peer-led educational intervention based on social cognitive theory in the improvement of puberty-related behavior and its determinants, which can be used in the design of puberty-related health promotion programs. Further research to assess the longer-term outcomes and to examine other theories of behavior change are suggested.