PEER:
Peer education, Exercising and Eating Right
Training Manual
Table of Contents
Introduction------2
Day-by-Day Curriculum
Day 1------3
Day 2------5
Day 3------6
Day 4------8
Day 5------9
Day 6------10
Day 7------13
Day 8------13
Appendix A: Pass the Beat ------14
Appendix B: Reviewers Checklist ------15
Appendix C: Outcome Expectations for Exercise ------18
Appendix D: Exercise Self-Efficacy ------20
Appendix E: Weight Efficacy Lifestyle Questionnaire ------22
Appendix F: Outcome Expectations for Nutrition ------25
Appendix G: Goodin Leisure-Time Exercise Questionnaire ------28
Appendix H: 30 Seconds of Fame ------29
References ------30
Introduction
Obesity in the United States population has increased steadily over the past 40 years and across all educational, ethnic, age, and gender groups. The National Health and Evaluation Study (NHANES) reported that obesity doubled from 15 to 35% in the last 20 years. The college-aged population has seen some of the highest increases in the prevalence of overweight and obesity. Translational research efforts are needed to develop and evaluate nutrition and exercise behavioral interventions in this population.
Peer Education, Exercising and Eating Right (PEER): An Undergraduate Faculty Teaching Partnership was a 1-semester feasibility study to support undergraduate general education course development. The first 8-week session focused on training Peer Educators (PEs); the second 8-week session reflected a trial general education course with a faculty-led lecture and a PE-led discussion for tandem concepts in nutrition and kinesiology.
Six PEs were recruited from upper level undergraduate dietetics and kinesiology classes. Acceptance into the peer training program depended on the instructor’s impression of the candidate’s leadership skills, motivation, and work ethic. Peer training was conducted weekly for 8 weeks in 1-hour sessions and was led by 2 Graduate Assistants.
The training model that follows was developed using the World Health Organization (WHO): Training of Trainers Manual (ToT).1 The ToT manual addresses the major aspects of peer education with a focus on sexual health education. Modifications were made to incorporate nutrition and physical activity content for the purposes of the PEER pilot study.
The overall objective of the peer training is to provide PEs with the skills needed in designing and delivering a peer education program.
Specific Objectives
1. Help PEs better understand the concepts of skill-based health education
2. Provide accurate information about nutrition and exercise issues with emphasis on obesity and osteoporosis
3. Develop communication skills
4. Provide PEs with skills needed for facilitation of group activities
Description of Training Curriculum
Day 1
ITEM / OBJECTIVESWorkshop opening / Thank the PEs for volunteering
Introduction of trainers and PEs / To allow PEs to get to know each other
Training overview
Introduction to self-efficacy / To explain the training methodology to PEs
To introduce concept of self-efficacy
To introduce the concept of experiential learning
Activity: Pass the beat
(5-10 min) (Appendix A) / To begin getting to know the other PEs
To allow PEs to understand the purpose of icebreakers
Peer expectations / To clarify trainer expectations of PEs and their expectations of trainers
Wrap-up
Workshop Opening
The workshop should begin with the trainers welcoming PEs. This is also allows the trainers to thank the PEs for volunteering for the project. Although not necessary, having snacks and beverages could make the introduction more welcoming and refreshing!
Introduction of Trainers and PEs
This segment allows the trainers to get to know basic information about the PEs and learn of their motivation for the project.
Possible questions to ask during the introduction:
· What is your name and where are you from?
· Why are you interested in Peer Education?
· What is your major and what kind of career would you like to pursue?
Training Overview
The trainers at this point elaborate on the overall training process. This should include a brief introduction to the concept of experiential learning. PEs should also be informed of the faculty-student collaborative nature of the project. They should also know that the training is designed to be interactive and PEs will be involved in course curricula development as well as the planning of the class structure.
Experiential Learning
Experiential learning could be defined as learning through action. It is a philosophy and methodology in which educators purposefully engage with learners in direct experience and focused reflection in order to increase knowledge, develop skills and clarify values. 2 One of the keys to the success of this project is the participation of the students in class discussions and activities. PEs will be facilitating these and will be engaging their peers in the learning process through participation.
Self-Efficacy
Self-efficacy is one of the consistent determinants of behavior and is framed within Albert Bandura’s social cognitive theory. 3 Self-efficacy expectations reflect the beliefs of individuals in their ability to overcome challenges or meet their goals. Self-efficacy expectations influence many aspects of behavior including the effort that individuals put forward and the activities they chose, and how long they persist when faced with difficulties and/or challenges. Individuals with a high sense of self-efficacy for weight management are likely to chose healthier exercise and nutrition behaviors and maintain those behavioral changes. At this point it should also be emphasized that PEs are in an ideal position to influence self-efficacy by serving as role models and training their peers in skills that lead in confidence in being able to carry out behavioral change.
Activity/Icebreakers
This begins the process of getting to know each other in this workshop, and to allow participants to understand the purpose of icebreakers and to get experience in using them. The trainer first introduces the icebreaker (Pass the Beat) (Appendix A).
A group discussion on the use of icebreakers is conducted at the end.
Questions to Discuss after the Icebreaker
•What was the most challenging part of the activity?
•What can the activity teach us about communication and teamwork?
Every week, 2 PEs are assigned the duties of selecting and facilitating a team-building activity for the following week.
Peer Educator Expectations
It is very important at this point to clarify the instructors’ expectations of the PEs and vise versa.
Trainer/ Faculty Expectations of Peer Educators
· As a PE, the dignity and welfare of the student must be the primary concern.
· PEs must be knowledgeable about campus and community resources regarding nutrition and physical activity.
· PEs must be able to recognize their own limitations and make appropriate referrals when necessary.
· PEs must operate within the framework of general university policies and procedures.
· As a PE, the confidentiality of the student must be respected.
· PEs are required to be present at all training sessions, lectures, and discussions unless a valid excuse is presented to the trainer/ faculty.
Peer Educator Expectations of Trainers/ Faculty
· Trainers/ faculty are responsible for adequately training PEs for all duties that they will be required to perform.
· PEs can expect the trainers/ faculty to provide the financial and structural resources necessary for the project.
· Trainers/ faculty must view PEs as students first and consider their personal academic responsibilities when delegating duties.
· Trainers/ faculty must be available to the PEs before and during the training and implementation phase of the project to provide support for any expected and unforeseen challenges.
Wrap-Up
Thank the PEs for the day’s work and give them a brief description of what to expect in the coming weeks. This is also an opportunity to reaffirm the important messages of the training.
Day 2
ITEM / OBJECTIVESStretching / To provide participants with experience of energizers and warm-up activities
Course review:
Evaluate exercise and nutrition Power Point slides and hand-out materials using course evaluation forms (Appendix B) / To receive feedback from peers regarding the proposed course content
To provide peers with an opportunity to increase ownership of the course material
Participatory Programming
Wrap-up
Stretching and Warm-Up (Icebreaker/ energizer)
Every week, one PE should be assigned the duty of leading the group into a 5 minute stretching activity before the training gets underway. This can be done with the group in a circle or standing behind the leader.
Course Review
Peer Educators evaluate class content that they will be expected to teach and are allowed the entire duration of the training session to assess the material. The time allotted to the evaluation process will depend on the depth of the content. It can be done outside of the training schedule by allowing the evaluators to complete the evaluations from home.
Participatory Programming
One of the strengths of this project is the involvement of PEs in not only course delivery but also in course development and assessment. Having the PEs evaluate the course material allows them to provide valuable feedback to increase their ownership of the education process.
Day 3
ITEM / OBJECTIVESStretching and warm-up / To provide PEs with experience of energizers and warm-up activities
Peer led team-builder (10 min) / To provide PEs with experience in icebreakers, warm-up activities and team-building exercises
Recap of week 1
Participants’ self efficacy questionnaires (Appendix C-H) / Introduce evaluation tools of the program
Discussion:
Exercise:
• Peer education: what and why? / To allow PEs to define peer education and identify its advantages and disadvantages
Wrap-up
Participants’ self-efficacy and outcome expectations Questionnaires
The PEs are asked to answer self-efficacy and outcome expectation questionnaires that are the forms that their future audience/class would fill out (Appendices C-H). These forms are adopted from a previous study that examined the utility of a Social Cognitive Theory model for explaining physical activity and nutrition behaviors in college students. It helps the PEs become familiar with their own thought process regarding nutrition and physical activity. It also familiarizes them with the evaluation/measurement tools for the class.
EXERCISE: PEER EDUCATION, WHAT AND WHY? 1
(Adopted from WHO: ToT Manual)
The objective of this activity is to have a common understanding of the concept of peer education and to identify its benefits and limits. The facilitator stands asks the group a set of questions which can be answered individually or in groups of no more than 3.
Questions
• What do we understand by peer education?
• What are the possible advantages of peer education?
• What are the possible disadvantages of peer education?
All responses are recorded on blackboard.
When agreeing on a working definition, it is important to come as close as possible to
the following description:
“Peer (health) education is the process whereby well-trained and motivated young people undertake informal or organized educational activities with their peers (those similar to themselves in age, background or interests) over a period of time, aimed at developing their knowledge, attitudes, beliefs and skills and enabling them to be responsible for and protect their own health.”
When discussing major advantages and disadvantages of peer education over other forms of education it might be useful to have the following at hand to add:
Advantages
• Young people taking responsibilities
• PEs gain skills that are important for their further personal development
• Peer education can supplement other educational interventions, such as the work of teachers, social workers, health service providers, etc.
• Peer education is a community-level intervention that can provide a link to other community services
• PEs can gain access to groups that are otherwise difficult to reach
• Peer education is relatively cost effective
Disadvantages
· As PEs age, they grow out of their role; so new people always have to be recruited and trained
· It is difficult to evaluate the impact of peer education
· If educators are not well trained, peer education can have a harmful effect (misinformation, unprofessional advice, etc.)
· Target audience might not regard PEs as experts
Wrap-up
At the end of this activity, the trainers should summarize the challenges that the PEs will face in the coming weeks. This is also the time to reemphasize the important role they play in influences behavioral choices in their peers.
Day 4
AGENDA ITEMS / OBJECTIVESStretching and warm-up
Recap of week 2
Peer led team-builder (10 min) / To provide participants with experience in icebreakers, warm-up activities and team-building exercises
Group discussion:
Motivation and barriers to change in exercise and nutrition behavior / To provide participants with experience in motivational techniques
To consider the potential contribution of self efficacy in creating motivation for behavior change
Wrap-up
Group Discussion
Peer Educators and trainers are asked to sit in a circle. The group is allowed to select a facilitator of the discussion. The discussion questions are designed to get the participants to start thinking about the motivational tools and the barriers involved in bringing about behavioral change. Trainers should encourage sharing of personal experience with behavioral changes attempted in the past. This exercise also gives the PEs an opportunity to learn how to communicate in a discussion setting. The discussion questions are listed below.
Motivation in Peer Education
There are various factors that affect food choices. These include family, economic, and cultural background. College is a period when individuals are often independent from parental involvement. This creates the need for nutrition and exercise education to provide them with the knowledge to make healthier choices. However, PEs need skills to motivate behavioral change in their peers. This requires an understanding of the barriers that make changing dietary and exercise habits challenging. The motivation activity is structured in a simple round table structure. The facilitator asks a set of questions that allow PEs to express their personal opinions on the topic. It is also encouraged to share personal experiences that relate to motivation and barriers to change that have been overcome by individuals in the group.
Discussion Questions
1. What does the term motivation mean to you?
2. Are there some behaviors/ habits you adopted from your family? Do you still engage in those behaviors? Are there any habits you have had to change?
3. Talk about a personal behavior you have tried to change in the past. Why did you want to change that behavior? Why did you fail or succeed?