A process evaluation of the Youth Educating About Health (YEAH) program: a peer-designed and peer-led sexual health education program.(SIECCAN NEWSLETTER)

ABSTRACT: Although youth are commonly included in delivering sexual health interventions via peer . education, youth seldom play an explicit role in designing the programs in which they participate. This article describes the results of a process evaluation of the Youth Educating About Health (YEAH) program-a unique sexual health intervention that was directly designed and led by youth in Saskatchewan, Canada. Researchers delineated a logic model of the YEAH program for the first stage of its evaluation. Components of the program logic model are discussed in terms of what makes this youth-designed program distinct from adult-designed programs. The findings can be applied to the design and process evaluation of peer sexual health education programs.

Key words: Peer education Sexual health Process evaluation Logic model

INTRODUCTION

The purpose of this article is to describe results of a process evaluation of the Youth Educating About Health (YEAH) Program--a sexual health education program that was designed and led by youth for their peers. Researchers evaluated YEAH after one year of operation using the Grounded Theory-Based Logic Model evaluation framework (Goertzen, Fahlman, Hampton & Jeffery, 2003). Contributions of this evaluation are: (1) description of the unique features of a peer-designed and peer-led sexual health education program; (2) use of the Adolescent Empowerment Theory to guide program development and delivery; and (3) discussion of the benefits of the logic model evaluation framework in process evaluation.

Sexual health promotion is an area in which the use of peer education is gaining popularity (Burrows & Olsen, 1998; Dunn et al., 1998; Elliott & Lambourn, 1999; Svenson et al., 1997). Internationally, peer education programs have been used with some success to target youth at risk for HIV/AIDS (Brieger et al., 2001; Campbell & MacPhail, 2002; Caron et al., 1998; Ozer et al., 1997; Villarreul et al., 1998). Critical evaluation of the outcomes of peer-led interventions suggest that peer-led versus adult-led education delivered to youth appear to be equally effective in increasing sexual health knowledge, but, for some variables, peer educators were rated as more effective (Dunn et al., 1998; Jemmott et al., 1999; Siegel et al., 1998). Although less effective than adults in imparting factual information, peer leaders have been rated as more effective in changing norms and attitudes (Mellanby et al., 2001).

Researchers have pointed to the need for increased input by youth in sexual health research and program design (Maticka-Tyndale, 2001; Milburn, 1995). Although youth input is occasionally gleaned through elicitation research intended to inform sexual health curricula development (McKay & Holowaty, 1997), the direct involvement of youth in the planning and design of sexual health interventions is rarely seen. The most common term used in peer education programs is "peer-led" rather than "peer-designed" (Elliot & Lambourn, 1999). Several programs have used youth input in design of their peer education programs, but are still mainly adult-controlled. The Cape Breton Wellness Centre (1999) followed youth ownership principles and involved youth in program planning. The Staff Outreach Services (SOS) project in Jasper, Alberta expects youth participants to come up with programming ideas they think will work effectively with their peers (Burrows & Olsen, 1998; Svenson et al., 1997). The program we present in this article differs from these in the total control given to the program's youth in designing all aspects of this peer education program.

There is a need for more published evaluations of peer education programs (Fennell, 1993). In a review of the few published peer education evaluations, 64 were considered to be methodologically sound: 49 were outcome evaluations that used quantitative methods and only 15 were process evaluations that used qualitative methods (Harden et al., 2001). Process evaluations have been shown to be useful for small community-based agencies to help them describe new, fledgling programs in detail and to understand the processes involved in the success or failure of a peer education program (Backett-Milburn & Wilson, 2000; Cunningham et al., 2000; Forrest et al., 2002). Our process evaluation of the YEAH program was conducted one year after receipt of funding to accomplish the following goals: (1) to specify and describe program components; and (2) to document whether the program was being implemented as intended, that is, did it successfully empower youth to design a sexual health peer education program in ways consistent with the Adolescent Empowerment Theory (Scheirer, 1994).