Abstract
Funding from the Commonwealth Department of Health and Ageing was secured to develop Keep It Simple (KIS), a pilot peer education project targeting recreational drug users in the club, festival & events context. The evaluation report had some significant outcomes, and as a result, the KIS project won the National Award for Excellence in Prevention at the 2006 National Drug and Alcohol Awards. Ironically, the project went unfunded for some time after the pilot year. Peer educators stayed involved in the project after their contract was finished, which enabled the project to be maintained until a one-off grant was provided after the local Independent MP, David Barr, lobbied for KIS in parliament. The KIS project was then funded by the National Illicit Drug Community Partnerships Initiative of the Australian Government Department of Health and Ageing for 2006/07- 2007/08.
Objectives were to:
- Select and recruit 25 peers to the project, who would form a representative sample of the dance/club scene (from beats to trance to house),
- Provide comprehensive drug information and skills based training to peer workers (volunteers)
- Attend at least 10 club nights/dance festivals or events per year in Sydney
- Reach at least 2,000 members of the dance public with drug information and advice via conversations and provision of written materials at a shop front
- Promote and support the project through the development of a project website
- Evaluate and improve the project
- Informally identify drug trends and related issues in the dance-scene.
The intervention is lead by trained, credible peer educators who have an affinity with the people they are educating. The project philosophy is one of harm minimsation. The KIS website provides harm minimisation tips regarding drug use, mental and sexual health issues. Peer educators provide information in structured settings ie at events, clubs, festivals, and raves. Peer educators provide information in informal settings ie talking to friends, family and work collegues. KIS project operates in partnership with event promotors, first-aid services and research institutions. The project is evaluated and improved upon by following key recommendations after each peer intake and subsequent report. Peer educators stay linked in with the project after their contract period.
Qualitative and quantitative research methods were used to externally evaluate the project and the following outcomes were concluded from the data. Peer knowledge increased after training and increased knowledge was retained after one year of being involved in the project. Most partnerships have been maintained and new ones formed. Peer confidence in conducting peer education increased. As in previous years the training was highly rated by the KIS peers. Over 50% of questions answered by the target group were incorrect showing that factual information was passed on. Young males are more likely to make contact with the intervention - an encouraging result as males are traditionally harder to reach than females.
In summary, the KIS project has met all of its stated aims and objectives. Twenty two KIS peers were trained with credible, reliable and comprehensive drug information with the understanding that they would educate their friends and other peers regarding harm prevention strategies. A solid base has been created to expand on and further funding will ensure that the project continues to provide the hidden populations that attend clubs, raves and events with education, harm reduction information and health services if needed.
Credibility of the project is well known and the KIS peers have been consulted for two government secondary school drug and alcohol internet based projects. The KIS project was featured as a best practice model for peer education in the chapter Faith, Love and Theory: peer led interventions for 'party drug' users, Annie M Bleeker and Edmund Silins, in Drugs and Public Health by Moore and Dietze.
Intervention details
Clubbers/partygoers aged 18-25 years, male and female (often information is passed on to people younger and older than that age group depending on the event).
Clubbers/partygoers aged 18-25 years, male and female (often information is passed on to people younger and older than that age group depending on the event), Peer educator recruited from Sydney dance scene, Club managers and personnel (bar staff, security etc) and entertainment and event organisers.
Actions include:
- Distribute and promote the project through a website, emails, flyers in ticketing locations, record shops, etc. This strategy was used to recruit peers to the project and also to promote the project outside of dance events;
- Recruit and select appropriate peers;
- Re-develop and implement an education and training package for peers;
- Continue to develop and maintain good relations with a network of festival, event and party promoters;
- Set up an information stand at events and provide drug information to the target group;
- Develop drug information flyers;
- Complete stage three of the KIS website to support the project;
- Provide supervision to peers in the field;
- Record trends in drug use through observations and data collection sheets;
- Record and monitor the project.
Many studies have documented that once people have begun using drugs they gain most information about the harms and effects from their peers (Korf, 2000; Odgers 1998; Ward et al. 1997; Grund et al. 1993; Parker et al 1998). As Odgers (1998) states, young people consider their friends as legitimate authorities in regulating substance use behaviour. As well as providing a legitimate and credible source, peer leaders enhance the project applicability by modelling appropriate behaviours. Faupel (1987) and Kaplan et al. (1990) have found that drug users engage in many common activities and spend considerable time in social and other conventional settings.
Research conducted in the Netherlands by Korf (2000), found that as young people become older, they tend to consult their friends outside of the school setting for information about drugs (despite the fact that their friends were not always seen as the most credible source of information when compared to information from a leaflet). Research also revealed that drug users see their drug using peers as important and reliable sources for providing information about drugs. Furthermore, harm reduction information delivered informally by peers at festivals and parties (that is also supported by the distribution of written information) is seen as an appropriate method to educate recreational drug users (Korf, 2000).
A process evaluation of Crew 2000 (an Edinburgh based peer education project which aimed to provide advice and information regarding recreational drug use and harm reduction information for those in the dance scene found that the service had access to young people in venues and locations that are normally hidden to other drug services. Further, the service was seen as credible and accessible to young people with many respondents reporting that they had never approached a drugs agency prior to their contact with Crew 2000 (Parkin, 1998).
An independent evaluation of Unity (an Amsterdam based peer education project) conducted by Geraci (2000), found that attendees at dance parties in Amsterdam preferred to receive information about drugs from someone who had experience with drugs and who also came from the house scene. The research also revealed that friends were seen as the most important source for drug information, followed by information brochures. It is important to note however, that drug information brochures were still regarded as the most trustworthy/credible source for receiving accurate knowledge about the effects of drugs (Geraci, 2000). One of the most important aspects of Geraci's research was that 88% of those surveyed found that the drug education provided by Unity was seen as credible (Geraci, 2000).
Human resources (Co-ordinator, peer coach) training program, educational resources
Evaluation details
Process indicators:
- Peer education in structured settings, club conversation data. An easy-to-use template was designed to collate and record the information which peers collected in the field and also details of their conversations. As this was used by KIS peers at dance events, the template was designed in consultation with the KIS peers to ensure that all information was recorded accurately.
- Peer education in informal settings, personal conversation data. There are many unintended effects of a peer led intervention that are often not measured by health promoters. In order to further approximate the reach and efficacy of a peer led intervention, data on conversations the KIS peers had with their friends, families, co-workers, etc. were also collected at each monthly follow-up session/training/meeting. Satisfaction survey of peer training program.
- Documentation of observations and project development.
Outcome indicators:
- Project pre-training, post training and one year post training questionnaire to evaluate knowledge retention, confidence in implementing the project, health and wellbeing & views on the project
- Peer educator focus group led by independent evaluator.
The KIS project reached 1,415 punters face to face during 11 event interventions. KIS peers used the quiz to educate as per usual. This year quizzes were made drug specific to keep information less complicated and easier to remember. Peers also trialled the new resource they produced in response to the key recommendations of 2007.
The KIS peers also had 1,086 recorded conversations with friends, family, workmates and randoms in their personal time. This year was even more of a struggle to chase up peers to fill out their hitsheets. Even though they had no trouble with having the conversations, writing them up was a problem. I talk a lot so it was very easy for me to get my hits up when I first started KIS. I had more trouble remembering to record them after. The KIS website hits quadrupled from 1,350 in 2007 to approximately 5,700 over a slightly longer period in 2008-09.
An important part of being a KIS peer is not to fall into the role of expert and being able to admit lack of knowledge if they don't have all the answers. Having the website card as a back up resource to hand to punters was an excellent support for them. Punters obviously see the project as credible as many have bookmarked the site. KIS quizzes show that many misconceptions still circulate with 54% of questions being answered incorrectly. Quizzes were refined and simplified again this year, with the topics being methamphetamine, pills, PMA, poly drug, GHB, cannabis and drug driving.
The following are some of the most often incorrectly answered questions in the quizzes and are similar to previous years:
- What drugs are being tested for at the road-side drug test?
- cones of marijuana cause similar damage of how many cigarettes?
- The main risk from taking pills is?
- Are the main drugs used for drink spiking Benzos like Rohypnol?
- Does psychosis from ice use usually end in violent behaviour and a trip to the hospital?
Many young people had no idea about the roadside drug testing so all education around this matter was very beneficial. There was much confusion over which drugs would be tested and how long after use it was safe to drive. Many people underestimated the damage caused by smoking marijuana compared to cigarette smoking so good information around inhalation of substances was passed on. Most people said that death was the main risk associated with taking pills so this implies that social risks are not given much thought. The psychosis and violence question gave opportunity for education around the early signs of psychosis and the frequency at which mini-episodes can occur without users actually being aware that it has happened.
KIS peers recorded all conversations including what drugs were discussed. This data clearly shows that amphetamines including ecstasy (n=696), methamphetamine (n=879), ice (n=585) and cannabis (n=506) were drugs most commonly talked about. There was an even spread of interest in alcohol (n=287), tobacco (n=283), GHB (n=217) and benzos (n=173).
A larger sample size was recruited for the peer training as costs stay fairly much the same and evaluation results can be statistically significant. Twenty two peers were recruited from all over Sydney to attend a two day training workshop. The importance of attending follow-up sessions was emphasised at the recruitment stage as there has been issues with attendance at these in the past.
The demographic of KIS peers was different this intake in that they were either friends of previous peers or interested punters that had contact with the project out in the field. Previously there were more peers that had an interest in the drug and alcohol field and so were motivated to make connections and/or to enhance their CV. Seven peers from previous years attended KIS events this year and more still contributed via email on occasion, so the peer network is growing and strengthening which is a credit to the program.
KIS peer educators were involved in a study titled 'The feasibility of peer-led interventions to deliver health information to ecstasy and related drug (ERDs) users' NDARC Technical Report 299. The study examined whether health messages can effectively to ecstasy and related drug (ERDs) users using a peer led intervention. A quasi experimental study design was utilized where some participants received unique messages about serotonin syndrome and the need to rehydrate before you dehydrate, and others under the same conditions did not. Participants were followed up with an interview 3 months after baseline. A total of 661 valid interviews were completed for the study.
The results of the study indicate that there was good recall of health messages by ERDs users using a peer led methodology. Information provided by peer educators was perceived as very credible by the target group.
Participants believed that an important quality of a peer educator was that they had used illicit drugs. Approximately half the sample reported they increased their water consumption as a result of talking to a peer educator at a party/event. This is a positive result supporting the efficacy of peer led interventions in providing harm reduction information to ERDs users. An important finding was a significant reduction in the use of pharmaceutical stimulants with ecstasy, meth/amphetamine and cocaine by the whole sample but with significantly greater reductions seen with the group who received the serotonin message.
The KIS peers recorded face to face conversations with over 2500 people. In addition over 5, 700 unique visitors logged onto the KIS website. This shows that peer education is a cost-effective solution to managing illicit drug use and related issues. Funding went directly to achieving a greater level of knowledge and more informed perception around drug use and harms. Further more this information went directly to the target groups, drug users or people who have direct contact with potential drug users.Peer education has a snowballing effect and has far-reaching potential showing that it is a cost-effective means of providing drug prevention.
