Workplace wellness solutions through peer educator training

Written by Dr Arien van der Merwe MBChB FRIPH FRCAM MISMA; medical doctor & workplace wellness & stress management consultant, author, director Centre for Health & Wellbeing in Pretoria.

As a workplace wellness consultant for the past 12 years, and having recently completed the first round of peer educator training as a workplace wellness intervention in a mining setting, I’ve come to realise again that peer educator training is probably the most effective way to spread the workplace wellness message, and the only effective way to ultimately change and maintain lasting health behaviour as successful workplace wellness solutions. Peer educator training has been used as a global strategy to address the HIV/Aids pandemic, especially in workplace wellness programs. It could, however, also be even more successfully and extensively used to change awareness and behaviour in all the chronic diseases of lifestyle (CDL’s), as workplace wellness interventions. The sooner HIV/Aids is globally regarded as one of the CDL’s, the sooner the stigma will disappear. Within the arena of workplace wellness, employees who are HIV+ will no longer feel marginalised and all employees will feel more positive towards a workplace wellness approach that addresses all of their health challenges and concerns.

Most workplace wellness interventions remain in the awareness phase with newsletters, posters, even talks and workshops. Workplace wellness programs seldom lead to lasting and sustainable health and wellness behaviour change.

The behaviour change model

When considering long term healthy behaviour change, it is important to use the behaviour change model to adapt workplace wellness interventions accordingly. Interventions have to be planned to accommodate employees at all levels of readiness:

the pre-contemplation (not yet ready) stage where an individual is not interested in health and wellness at all
the contemplation (thinking about it) stage where they’re starting to consider implementing some wellness principles into their lifestyle
the preparation (getting ready) stage where they’re getting ready to change behaviour
the action (doing it) stage where they’re actually living the changed behaviour
the maintenance (staying with it) stage where they’re felling so much better, or have been in action for long enough, to make the new behaviour their new lifestyle. This is of course where, ideally, one would like all employees to be!

Stages of change

This shows where awareness, behaviour change, supportive workplace wellness environment (workplace culture, management buy-in and active participation, willingness to adapt workplace to live the wellness philosophy) and sustained behaviour change interventions, will have most impact within the behaviour change model within workplace wellness.

Peer education involves training and supporting member of a given group, e.g. within a workplace wellness setting, to effect change among members of the same group. Peer education is used to effect changes in knowledge, attitudes, beliefs and behaviours at an individual and group level. It may (and often does) also create change at community or societal level by modifying norms and stimulating collective action that contributes to general positive changes in health and workplace wellness. It has most widely been used as a global strategy to address the HIV/Aids pandemic. It could, however, also be even more successfully and extensively used to change awareness and behaviour in all the chronic diseases of lifestyle (CDL’s).

Important statistics

The 2003/2004 South African Health Review report stated that the CDL’s are responsible for 37% of deaths in South Africa, second only to the 39% of HIV/Aids. Regarding all as CDL’s, brings it to a whopping 76% of all deaths in this country that can be managed and reduced through wellness interventions.

Chronic diseases of lifestyle (CDL’s) - in wellness terminology rather called HEALTH CHALLENGES

Heart disease, high blood pressure, high cholesterol, heart attack, stroke
Cancer
Diabetes mellitus
HIV / Aids
Depression
Lung diseases, e.g. asthma, bronchitis, emphysema, TB

The Medical Research Council (MRC) report released in May 2006, stated that by the year 2010, the CDL’s will kill 666 South Africans per day! Add to that an estimated 900 people dying from Aids related disease, in South Africa in 2005, and the picture looks even gloomier. Between the years 1995-2005, 6 million South Africans had diagnosed hypertension; 5 million high blood cholesterol; 1,5 million diabetes mellitus (high blood sugar), and there were more than 7 million smokers. Take into consideration that an estimated 25% of the general population has some form of heart disease. Diabetes mellitus and heart disease often go together. 32% of people with high blood pressure do not know that they have it and will only realise it once they either get a heart attack or stroke.

These disturbing statistics clearly show the importance of addressing all the CDL’s or chronic health challenges together. Peer educator training is an important and very effective way to do this.

Peer education is a popular concept that implies an approach, a communication channel, a philosophy and a strategy. The word ‘peer’ means ‘one that is of equal standing with another’; ‘one belonging to the same societal group especially based on age, grade or status’. The word ‘education’ means the development, training of, or the knowledge resulting from the educational process.

Peer education has been used in many areas of public health, including nutrition education, family planning, substance abuse and violence prevention. However, HIV/Aids peer education is most wellknown, owing to the number of articles and research reports, in recent international public health literature. Because of this, global efforts to further understand and improve the process and impact of peer education in the area of HIV/Aids prevention, care, and support have also increased. Again, this is easily adaptable to include all the other common chronic health challenges, or lifestyle disease.

Peer education is based on behavioural theory which asserts that people make changes not because of scientific evidence or testimony, but because of the subjective judgment of close, trusted peers who have adopted changes and who act as persuasive role models for change. Peer educators and their peers, can mutually identify with each other as individuals and as members of a specific socio-cultural or workplace environment. Peer educators are effective and credible communicators who have inside knowledge of the intended audience and use appropriate language and terminology, as well as non-verbal gestures to allow their peers to feel comfortable when talking about issues of health, wellness, sexuality and HIV/Aids.

Peer education is also a practical and cost-effective intervention strategy because using volunteers, makes it inexpensive to implement and/or expand and the number of employees ultimately reached, is unlimited.

In the workplace practical setting, peer education has taken on a range of definitions and implementations e.g. facilitating, counselling, drama, lecturing, distributing materials such as posters, manuals, newsletters, making referrals to services, providing support, etc.

The aim of peer educator training is to facilitate interactive, innovative health and wellness educational programs to peer educators in an enjoyable, practical and even fun way, so that peer educators will be able to disseminate the knowledge throughout the workforce. Peer educators receive ongoing support and new program content for them to always have knowledge and information at their finger tips. As the program progresses, peer educators gain more self-confidence to really help and support their fellow workers. Training programs should also ideally be adapted to peer educators’ changing needs as the process evolves and develops as a dynamic, interactive intervention.

Peer educators are a special group among the workforce. They volunteer out of a heartfelt belief that they want to help their fellow human beings. They have an interest in health, in obtaining more knowledge and information and to use that to improve the situation for others. This will extend further than the workplace, of course; into the family and community. Peer educator trainers are there to impart knowledge and practical information, encourage, support, and promote healthy living, to create a ripple effect throughout the workforce, families and communities.

Peer educators are motivated by personal experience and/or the desire to improve lifestyles for themselves and their peers. They play a very active leadership role and learn a great deal from their volunteer participation. Not only do they become more educated on health and wellness issues, but they also develop self confidence, public speaking, group facilitation, and communication skills. They learn and practice effective problem-solving, decision making, and program planning skills - all important life skills. They also learn the importance of sharing ideas and learning from others.

Peer educators from Minopex during training session

Feedback from peer educators after recent sessions:

Peer educators were asked about some of their experience and feedback, also their personal growth and learning, over the past 2 months in between training sessions:.

Site rep: The safety manager said that we are always concerned with protecting ourselves from physical harm, but never realise the personal harm we do by wrong lifestyles and that wellness is just as important. He encouraged me. That felt good, as well as the fact that he saw the worth in what I, as peer educator was doing.
To summarise the peer educators’ comments on what they learnt:
- Most people don’t know how or what they should eat. The training taught us and now I can teach them.
- We also learnt the importance of emotional & mental “food” and wellbeing and how important the way we think, is for our wellness
- I know more about how my body works. How it all fits in together, and the importance of nutrition, exercise, meditation, and so on
- We learnt to check labels for nutritional value of food
- I’m more aware of healthy food choices and show it to others
- I’ve started to adapt my grocery list to make healthier food choices
- When our group eat together at work, I eat healthier and also then show others: cold drinks, pap with greasy gravy, and chips should be replaced by water, fruit, vegetables, peanuts and yogurt. And, it’s not more expensive! Even the woman who sells the food has been bringing healthier food to sell!
- We learnt about the importance of water and to drink clean water regularly
- We know now how important sleep is for our bodies to recover and rest. Also to sleep in darkness and quiet, even if we work night shift
- We think wellness should be a part of SHE as well
Most of the peer educators said the following:
- I’m now able to talk to others, approach people correctly, stay aware and not become involved in their story: if they’re negative, I can stay positive and help them to be more positive
- I was very shy to talk in front of others. This training has helped me overcome that. It feels good!
Site rep: I knew I had it in me, but this training has helped me develop to take a positive leadership role, gain knowledge, learn more about health & wellness, and to help others do the same. I want to spread this knowledge to my community.
All the peer educators had a chance to do a short presentation, and even Martha, who only joined the day before the actual 2^nd training session, had her say as the last presenter of 15 peer educators! Here is a transcript of her presentation:

‘Hi my name is Martha. Actually, I just want to say thank you to myself for joining as a peer educator, because you know what? According to my own point of view, I thought the word ‘peer educator’ was more about communication between your peers about AIDS, and I often became bored with these topics. Thank you all very much for the knowledge I’ve gained today, and about health. The only thing that I knew about health was to eat healthy food, HIV diseases and to exercise -that is the main thing I knew about health, but today I learnt a lot! How to make decisions and life choices is also health. I was so amazed. Happiness is also health. Wellness and lifestyles are also health. To lead by example, more especially we peer educators: you must always practice what you preach. You can’t tell somebody don’t smoke when immediately after the break you smoke, then they would say these people are just lying to us! To understand other people’s culture and religion, I was also not aware it was part of people’s health. To sleep enough, I thought maybe you should just sleep four hours as long as you have rest, I was unaware that this was part of health. I thank myself and all my fellow partners, to see myself being here today and become a peer educator, it means I gained a lot and can teach more and more. I study for my family and fellow workers, also my community. Thank you!’

Peer educators on the red carpet, on the way to receive their certificates during their inauguration ceremony

Peer educators and senior management from Minopex during graduation ceremony after completing their training course

Some comments from the recent peer educator training programs I facilitated, when asked why they chose to become peer educators:

I can influence others in positive ways
I can help my fellow human beings
I want to learn more about health and wellness
As part of a likeminded group, we can work on a common purpose and support and encourage each other
I have learnt how to listen, care and communicate better and gained more confidence
I really appreciate how complicated the human body and mind are and because I understand better how all the body’s organs and systems function, I can explain it to others. You must know a bit about anatomy and physiology for the whole health and wellness thing to make sense!
Being a peer educator makes me feel good about myself and my efforts to improve the lives of those around me.
It’s good that we’re also addressing the other diseases. Many employees will feel more comfortable with this approach. I find it a much more meaningful way to spread the wellness message.

Conclusion

Health risks are business risks. Employee wellness programs increase productivity and profit. Existing statistics can be used to show that peer education works: use existing healthcare claims, employee assessments and feedback, employee turnover, absenteeism, disability claims and productivity measures (quality/quantity). Do ‘before and after’ data. Take an employee survey for input. Providing appropriate program content through sufficient and appropriate training to encourage behaviour modification and sustained motivation through peer educator training, makes sound business sense.

Use skills and techniques to help people modify behavior - education, as an adjunct to behavior modification; motivation; enjoyment and maintenance. Wellness is a journey with proven return on investment through peer educator training.