Working with the “hierarchy in the Underworld”: Insights for Communication Skills Training with Peer Educators

Abstract

Peer education programs emphasize training in communication skills but provide little direction on training content. This research examines the specific strategies used by people who inject drugs (PWID) when engaging peers in education to promote safer injecting and to prevent the transmission of blood-borne viruses. People who inject drugs (PWID) participated in a series of three focus groups to develop peer education messages and strategies which they then trialed in their networks. Participants' strategies for peer education were profoundly shaped by concerns about not offending or challenging others' perceived social status. Some participants preferred only to influence others' injecting practice using nonverbal strategies, such as modeling safer practice. Although peer education may be based on the notion of a shared social status among PWID, these results demonstrate the heterogeneity of social relations existing within networks of PWID. PWID trained as peer educators require a repertoire of communication skills to be deployed in appropriate circumstances.

‘It's Fast, It's Quick, It Stops Me Being Sick’: How to influence preparation of opioid tablets for injection

“…Participants indicated the value of credibility and experience in a source of information (such as another user) as well as trust in the source of information (such as the harm reduction worker). This is indicative in the literature regarding peer education among PWID . Research pertaining to the role of peer workers in health centres regarding HCV treatment access among PWID found that trust among peers was a valuable resource for harm reduction workers .…”

“…In a study pertaining to the delivery of peer education, timing was also found to be critical. Delivery of peer education was determined to be received best immediately following injection as users were then more ‘relaxed and perceptive’ and responsive to harm reduction information [22:649]. However, nonverbal education was effective immediately prior to injection, through role modelling safe injecting practices .…”

Peer education: From enduring problematics to pedagogical potential

“…While this study documents an important peer education dynamic, it does so without adequately theorising how social and affective elements influence the implementation of peer education. Other research (Treloar et al, 2010) has described some of the embodied (non-verbal) aspects of peer education but has not theorised these as an integral part of the educative process. It is our view that the uneven effects of peer education evident in the current literature can only be accounted for if the ethical, political, affective and embodied nature of the interactions of peer education are carefully documented, rigorously interpreted and adequately theorised.…”

“…In the field of peer education, the problem is particularly acute. Even the very few studies that have attempted to critically engage with peer education as a complex multimodal activity (Backett-Milburn and Wilson, 2000; Klein et al, 2014), or with its embodied, affective, ethical and power dimensions (Fields and Copp, 2015; Sarafian, 2012; Treloar et al, 2010), do not explicitly draw on educational and pedagogical theory. To date, only McInnes and Murphy (2011) have used an explicit pedagogical framework (from Bernstein) to unpack the ‘black box’ of gay men’s peer education, with Campbell and MacPhail (2002) enlisting Freireian critical pedagogy, to illuminate peer education among South African youth.…”