EFFECTS OF PEER EDUCATION ON AWARENESS AND ATTITUDE TOWARDS HIV AND AIDS AMONG IN-SCHOOL ADOLESCENTS IN NSUKKA EDUCATION ZONE OF ENUGU STATE
This study was designed to determine the effects of peer education on awareness and attitude towards HIV and AIDs among in- school adolescents in Enugu State. To guide this study, six research questions were posed and six null hypotheses formulated and tested at 0.05 level of significance. The research design used in this study was non-equivalent control group Quasi-Experimental involving experimental treatment group and a control group. The sample for the study was made up of 231 students in SSII. A random sampling technique was used to draw two co-educational schools from each of the local government areas and they were randomly assigned to both experimental and control groups. Three trained research assistants were used for the experiment while the control group was not exposed to any treatment. A 20-item researcher designed questionnaire titled HIV and AIDS Awareness and Attitude Questionnaire (HAAAQ) was used for the study. The reliability of the instrument was determined using Cronbach Alpha statistic which yielded Alpha co-efficient values of 0.80 and 0.79 for the two clusters. Measures were taken to control the extraneous variables. A pretest of the questionnaire was administered before the treatment on peer education that lasted for six weeks. The data collected were analysed using Mean, and Analysis of Covariance.(ANCOVA) The Results revealed that: students exposed to treatment on peer education have higher awareness of HIV and AIDS when compared to those of the control group; gender is not a significant factor influencing students awareness towards HIV and AIDS, students exposed to treatment on peer education have a higher positive attitude towards HIV and AIDS compared to those of the control. Furthermore, gender does not significantly influence students’ attitude towards HIV and AIDS. Also, there is no interaction effect of gender and peer education on students’ awareness as well as attitude towards HIV and AIDS. It was recommended among others that school authorities should integrate play method in the teaching of sexuality issues as this will create room for students to utilize peer approach in learning; while federal and state ministries of Education should organize and sponsor workshops and seminars for school guidance counselors on how to implement peer education on awareness and attitude towards HIV and AIDS among in-school adolescents.
TABLE OF CONTENTS
TITLE PAGE I
APPROVAL PAGE III
TABLE OF CONTENTS VII
LIST OF TABLES X
LIST OF FIGURES XI
CHAPTER ONE: INTRODUCTION
Background of the Study 1
Statement of the Problem 11
Purpose of the Study 12
Significance of the Study 13
Scope of the Study 15
Research Questions 15
CHAPTER TWO: REVIEW OF LITERATURE
Conceptual Framework 18
Concept of peer education 18
Concept of awareness 20
Concept of attitude 20
Concept of HIV and AIDS 22
Concept of adolescence 24
Concept of gender 26
Conceptual relationship 27
Theoretical Framework 28
The social cognitive theory by Bandura 1977 28
Health belief model by Rosenstock et al 1950 30
Aids risk reduction model by Catania 1990 31
Theory of reasoned action by Fishbein and Ajzen 1975 32
Self perception theory of attitude by Bem 1967 34
Review of empirical studies 35
Studies on HIV and AIDS 35
Studies on awareness and attitude towards HIV/AIDS 38
Summary of Literature Reviewed 40
CHAPTER THREE: RESEARCH METHOD
Design of the study 42
Area of the Study 43
Population of the study 43
Sample and sampling techniques 43
Instrument for data collection 44
Validation of the instrument 45
Reliability of the instrument 45
Experimental Procedure 46
Treatment Procedure 47
Developing the instructional programme 48
Control of extraneous variable 49
Method of data collection 50
Method of data analysis 50
CHAPTER FOUR: RESULTS
Data analysis and presentation of data 52
Summary of findings 61
CHAPTER FIVE: DISCUSSION OF RESULTS, CONCLUSION, IMPLICATIONS, RECOMMENDATIONS AND
SUMMARY OF THE STUDY
Discussion of results 62
Educational implications of the findings 69
Limitations of the study 72
Suggestions for further studies 72
Summary of the study 73
Appendix A The Detail of Treatment Packages 79
Appendix B: Instrument 82
Appendix D: Reliability 85
Background of the Study
Adolescence period is characterized by emotional, intellectual, physical, social and sexual changes and the individual is faced with various challenges. Adolescence according to Conger, Kegan and Mussen (2004) is a period of transition between childhood and adulthood. It is considered to last from ages 10 to 19 and from puberty to full biological /physiological maturation. Within this time frame, adolescents are affected by various developmental transformations including physical, emotional, and social changes. With these changes come many responsibilities and privileges that are different from those of childhood or full adulthood, and these aspects ultimately define the period of adolescence.
The word adolescence has it’s origin and meaning from Latin perspective. In Latin, it implies “to grow into maturity” (Eke, 1989). The author further noted that the common denominator in all adolescents experiences, irrespective of cultural variations, is the biological change from childhood into mature adult status capable of reproduction. According to Eke, during this period, remarkable physical changes take place. Boys and girls experience a spurt in growth. A sharp increase in height for girls at the ages of 11 and 13 and in boys between 13 and 15. There is the presence of growth spurt which leads to the development of primary and secondary sex characteristics. Nworah, (2004) has it that adolescence is a period of rapid transitional or developmental changes from childhood to adulthood. It is a period when the physical and physiological change that accompany the transition from childhood to adulthood become manifest and continues into adulthood. Adolescence as noted by Unachukwu and Ebenebe (2009) cover the age of 12 or 13 till the early twenties. They pointed out that in Nigeria, variations exist which may be longer or shorter than the above stipulated age range depending on the tradition or the modern outlook of those involved. In the view of Eze (2005), adolescence is a period or stage of life when an individual gradually moves from childhood to adulthood. It is a period of muratorium when the individual is in a state of abeyance, and so requires proper handling to avoid creating conflict since the individual is no longer regarded as a child, yet the individual is not accepted into full adult life. This is a period when individuals tend to adapt themselves to changing influences in their environment.
The adolescent’s environment constitutes to a large extent certain behavioural and health challenges. For instance, adolescents who live in densely populated areas are more prone to risky behavior as a result of exposure to a wide range different characters and backgrounds of the peer group. Besides, the presence of rapid hormonal development put them into a lot of exuberant behaviours. The period is characterized by sexual experimentation which is as a result of their physical changes or sexual maturation. Ngwoke and Eze (2004) pointed out that sexual experimentation, which is the physical readiness, is widely distanced from psychological readiness. In other words, the ability to copulate may not mean knowledge of sexual functions and reproduction. The upsurge of hormones during adolescents and its effect on their sexuality makes the adolescent easily sexually aroused, and being young, some of them get involved in sexual activities without taking necessary precautions. This may be the reason why there has been a consistent increase in prevalence of Human Immunodeficiency Virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS) (Akanwa 2008). Generally, the adolescents’ sexual behaviour increases their vulnerability to sexual infections and diseases including HIV and AIDS.
HIV stands for Human Immunodeficiency Virus and it affects only human beings. It attacks the human immune system, the body’s defence against invading diseases. It damages the immune system by systematically destroying an important type of white blood cell, CD4 cells or T4 cells (Williams, 2000). On the other hand, AIDS (Acquired Immune Deficiency Syndrome) is a term not often used by doctors today. They rather prefer to talk of advance or late HIV infection based on the outcome of damage to the immune system by HIV. When the body is severely weakened by HIV, it can be attacked by a number of serious conditions which is then referred to as AIDS (Kawanza, 1999).
The Human Immunodeficiency Virus and Acquired Immune-deficiency Syndrome (HIV and AIDS) pandemic is one of the greatest humanitarian and developmental challenges facing the global community in recent times (Lloyd, 2004; MAP Report, 2004;& Osagbemi, Joseph, Adepetu, Nyong and Jegede, 2007). HIV and AIDS have brought unquantifiable suffering, confusion, dejection, uncertainty and hopelessness to humanity (Adekeye, 2005, 2009). The epidemiological survey of 2003 showed that an estimate of 3, 300, 000 adults were living with HIV and AIDS in Nigeria and 57% of this were women (Avert, 2007). The prevalence rates among the young people between the ages of 20 and 24 were 5.6%. In 2005, there were about 220, 000 deaths from AIDS and 930, 000 orphans living in Nigeria (Avert, 2007). Over 60% new infections with HIV are within the 15-25 year old age group or adolescents (Gunfire, 2005). In recent years, there had been an alarming increase in the number of HIV positive children and 90% of these children contracted the virus from their mothers. Apart from mother- child transmission, most of HIV and AIDS patients contact the disease though sexual intercourse, and may be other sexually related behaviours.
Sexual behaviour among youths has over the years become an issue of great concern particularly with the upsurge of the HIV and AIDS Pandemics. According to UNAID (2003), an increasing number of youths within the age of 15-25 years have continued to be infected with HIV. As reported by National AIDs Reproductive Health Survey (NARHS) (2003), youths are more vulnerable to sexual infection because of their age, gender and sexual orientations. UNAID (2003) reported that half of the entire world population whose ages are between 15-25 years are among the most vulnerable to HIV and AIDS infections. Awareness campaigns, lectures, seminars, rallies in schools have been organized to attract the attention of youths. In some States, teachers have been trained to carry out HIV and AIDS programmes. Civil society organizations and the private sector organizations have directly or indirectly contributed to the overall attempt to reduce the spread of HIV and AIDS. The process and aim of provision of information and education is to make youths perceive issues relating to HIV and AIDS, adopting the perception of their vulnerability to HIV and AIDS and develop positive attitude to sex. However, inspite of current efforts by governmental non-governmental organizations, and educational institutions, it seems that youths have not developed positive attitude to sex because many youths still express sexual intimacy which could carry the risk of transmission of HIV. Such may be in areas of casual sex, multiple sex, anal sex, covert and open prostitution. In other words, the attitudes of adolescents toward the dreaded HIV and AIDS is unencouraging. This implies that they may not be aware of the implication of their sexual behavior especially in relation to the contact of HIV and AIDS.
The inability of youths to control their sexual appetite, and the negative comments made by them about HIV and AIDS have been the major source of concern to the researcher. Youths have been reported in studies Kemiodu and Akanle (2006) and Olawale (2001) to express negative belief and knowledge which reflect on their attitude towards HIV and AIDS. Attitude is seen as a mental predisposition held towards ideas, objects or person. It is a combination of beliefs, feelings and evaluation and some predisposition to act in one way or the other. As noted by Agbaegbu (1997), attitudes are hypothetical constructs used in explaining consistencies in affective reaction. The scholar opined that the zeal or enthusiasm to move into science and succeed creditably in science subjects is dependent on the attitude of the person towards science. This implies that an attitude is a mental predisposition held towards ideas, objects or persons. Rosenberg and Hovland in Omeje (2007) defined attitude as a predisposition to respond in a particular way towards a specific class of objects. The scholars maintained that attitude is made up of three components-affective, cognition and behaviour. Affective is a component of attitude used to refer to emotion and feeling. Cognition refers to mental processes by which information is acquired, analyzed and synthesized while behaviour refers to any response or action of an organism to its feelings. Operationally, attitude is a favourable or unfavourable evaluation of something which generally in the positive or negative views of a person about place, a thing or an event. In the context of this study, it is adolescents relatively enduring way of thinking, feeling or behaving towards HIV and AIDS.
Presently, the attitude of adolescents towards HIV and AIDS is that of “it doesn’t concern me” or “man must die of something someday”. Many studies had been carried out in Nigeria on the knowledge of adolescents about HIV and AIDS. For instance, Odujinrin and Akinkuade (1999) found that the adolescents have poor knowledge of HIV and AIDS, while Harding, Anadu, Gray and Champeau (1999) indicated that their respondents were knowledgeable about transmission of HIV but had some misconceptions about the mode of transmission which affect their attitude. There are no consensuses on the group of adolescents whether male or female that have favourable or unfavourable attitude towards HIV and AIDS. Onoja (2004) studied gender influence on the level of awareness of HIV and AIDS among adolescents in Otukpo, Benue State, and came up with the conclusion that the females’ level of awareness is more than that of the males. This, according to the author, may be due to time given to them in enlightening them on safe health method. Eze (2006) revealed in her study on strategies for empowering in school female adolescents against sexual behaviour related to HIV and AIDS Transmission in Enugu State that male adolescents are more aware of the existing phenomena than the females. This present study will try to clarify the controversy of issue of gender on awareness and attitude.
In Nigeria, there is no formal HIV and AIDS education in the school curriculum; the main strategies for empowerment used are mass media campaigns and condom promotion. More often than not these are merely superficial panaceas that have little effect on the infection prevalence. In the same vein, in Enugu State, there is no strategy that is exclusively directed towards HIV and AIDS prevention among secondary school students. Whatever awareness or skill they have, they acquired through televisions and radios for those who have access to them. With the epileptic power supply, the maximum benefits from the use of mass media, as a medium for HIV educational prevention strategy is greatly hampered. As a result of the above, the adolescents might be depending greatly on the views of their peers. Their knowledge level and awareness are would be enhanced through peer education.
Education generally gives the beneficiary opportunity for informed or reasoned actions and the upliftment of personal welfare. Therefore, by educating an individual, one acquires desirable knowledge, understanding, skills, interest, attitude and critical thinking. In any case, education seeks to develop the innate capacities of man. Peer education means “to lead forth” or “to come out” and take decisions about themselves being free from bias, prejudices, superstitions and blind beliefs. Thus, they have to learn all the qualities of complex human relations, the cause and effect relationships as equipment for survival strategy (Onoja, 2004).
Essentially, peer education provides veritable intervention strategy through which members of peer group positively or negatively influence the thoughts, actions, inclinations and aspirations of individuals of close age group. In many cases, peer education may be used to effect positive changes at the group level for social transformation through modifying behaviours, norms and stimulating collective actions to improve welfare and health conditions of peer group. Green (2001) perceived peer education as an approach to health promotion in which community members are supported to encourage health enhancing changes among peers. Cornish and Campbell (2009) posited that peer education is a voluntary counseling and information support service rendered by one or a group towards helping another to imbibe positive attitude and behaviour over an issue of collective concern . In a similar vein, Boyle (2011) sees peer education as an encouragement or advice from members of a peer group to effect positive behavioural outcome on issues of common interest or threats by doing or not doing a particular thing even if one personally wants it. In essence, peer education approach to health matters is the teaching or sharing health information, values and behaviour among members of a peer group who may share similar views, social backgrounds or life experiences. The idea is that, rather than health professionals educating members of the public, peer educators are in the best position to encourage healthy behaviour of one another.
Peer education has become very popular in the broad field of HIV prevention. It appears to be a potent mechanism for HIV and AIDs prevention and control among vulnerable groups including adolescents, sex workers, people who often use intravenous drugs and men who have unprotected sex with men and all those involved in unsafe casual sex. In secondary schools, peer educators are role models of young adolescents leading healthy behaviours and helping to create and reinforce social norms that support safer behaviours inside and outside classrooms (Mattern, 2010). Peer educators are typically the same age or slightly older than the group with whom they are working with. Peer education gives adolescents legitimacy to talk about sex without the risk of being stigmatized as sexually promiscuous which the adolescents are mostly characterized with doing this developmental period.
Adolescents can learn a great deal through joint effort and communication with peers. However, little is known about how peer education affects their awareness and attitudes most especially as they relate to HIV and AIDS. Peer education is a situation whereby pupils learn from each other as they act as teachers and co-learners. In peer education, a pair of relatively novices work together to solve task that neither of them could do previously. In this approach, they begin at roughly the same level of competence and learn from each other (Ames & Murray, 2012). Peer education can be seen as a developmental process occurring in social activities through interaction. It stimulates the challenges of discovery learning by placing these challenges in a context of peer assistance and support (Obah 1992).
In a survey of peer effects on adolescent girls’ sexual debut and pregnancy risk among 3015 sexual active girls in America, Bearman and Bruckner (2008) found that peer education among adolescents is a significant factor that influence their sexual behavour and that peer influence operates at multiple level of peer context and the level of social scientists have spent the most time on-best friends-is the least important. Much more important influences arise from the network of close friends and the larger group in which adolescents are embedded. Liu, Kilmarx, Jenkins, Manopiabon, Mock, Jeeyapunt, Uthaivrauit and Van Griensven (2006) found that peer education was a significant factor for males for whom the presence of a close friend as a confidant was associated with earlier sexual initiation. They concluded that peer group exerts a great deal of influence over the young male’s sexual experience and exploration. The question now is whether peer education has any effect on adolescents awareness and attitude towards HIV and AIDS. Based on the fact that adolescents learn a lot from their peers as they discuss their romantic interest and experiences with friends, consider and construct sexual roles, interpret the meaning of the roles and make decisions regarding their acceptability, could their awareness and attitude to HIV and AIDS be affected by peer education in Enugu State.
In Enugu State, most adolescents behaviour increases their vulnerability to HIV and AIDS. Lacking the judgment that comes with experience, adolescents often cannot appreciate the adverse consequence of their actions. The risks of HIV and AIDS may be particularly hard for them to grasp. Hence, the need to determine the effect of peer education on adolescents awareness and attitude towards HIV and AIDS.
Statement of the Problem
Adolescence is a period when individuals become socially responsible for themselves and for their actions. At this stage, they are affected by various developmental transformations including physical, emotional and social changes. With these changes come many responsibilities and privileges that are different from those of childhood or adulthood as they try to discovery by themselves against the wish of the adult. This experimentation subjects them to risky sexual behaviour that may expose them to HIV and AIDS. Generally their risky behaviour increases their vulnerability to HIV and AIDS. Lacking the judgment that comes with experience, adolescents often cannot appreciate the adverse consequences of their actions. The risks of HIV and AIDS may be particularly hard for them to grasp.
The adolescents are usually in different levels of schools such as secondary schools and tertiary institution. However in Nigeria, there is no formal HIV and AIDS education in the school curriculum. The main strategies for creating awareness about the dreaded disease are mass media campaigns and condom promotion. In Enugu State, there is no strategy also that is exclusively directed towards HIV and AIDS prevention among secondary school adolescents. This therefore makes them to rely on peer education information as a source of empowerment.
Although adolescents learn a lot through peer group influence their awareness level as well as their attitude to HIV and AIDS is influence by their relationship with peers but is not yet known. It is on this background that the present study is focused on determining what is the effect of peer education on awareness and attitude of adolescents towards HIV and AIDS in Enugu State, Nigeria.
Purpose of the Study
The major purpose of the study is to determine the effect of peer education on awareness and attitude towards HIV and AIDS among adolescents in Enugu State. Specifically, the study sought to:
1. Find out the effect of peer education on in-school adolescents’ awareness of HIV and AIDS in Enugu State.
2. Determine gender differences in the effect of peer education on the adolescents’ awareness towards HIV and AIDS.
3. Determine the effect of peer education on in-school adolescents’ attitude towards HIV and AIDS
4. Find out the gender differences in the effect of peer education on the attitudes of adolescents towards HIV and AIDS
5. Determine the interaction effect of gender and peer education on in-school adolescents’ awareness of HIV and AIDS in Enugu State.
6. Determine the interaction effect of gender and peer education on students’ attitude towards HIV and AIDS in Enugu State.
Significance of the Study
This study hopefully would be significant both theoretically and practically. Theoretically, the study is hinged on Health Belief model which hypothesizes that an individual will not make the decision to undertake a health action aimed at avoiding a specific disease threat unless he or she is psychologically ready to act. Readiness to act is brought about by the person’s perception of his or her susceptibility to the health threat, and the perceived severity of the threat among others. The findings would help to explicate the functionality of the theory on adolescents’ awareness and attitudes towards HIV and AIDS through peer education.
Practically, the findings of this study would be useful to policy makers, counsellors, adolescents, curriculum planners, researchers and the society at large. This study will furnish counsellors as well as adolescent psychologists with essential information on the effect of peer education on adolescent awareness and attitudes towards HIV and AIDS. It will also make available to them empirical information on interaction effect of gender and peer education on adolescent awareness and attitude towards HIV and AIDS. These data provided will enable counselors and psychologists to carry out more research that will help in better understanding of adolescents’ awareness and attitudes toward HIV and AIDS. An understanding of the finding would further assist the counselors on how to guide adolescent to get aware of HIV and AIDS towards the virus and disease. The study would help policy makers to see the need for fashioning out a means of empowering the adolescent with the knowledge of HIV and AIDS as they are at the risk of being infected with the dreaded disease if not well informed. The Government will be aptly armed with the useful information from this research to form more effective broad-based HIV and AIDS policies that will impact positively on the HIV and AIDS awareness programmes. This would help in making the adolescents to acquire a positive attitude towards HIV and AIDS. Through the policies, government would assist school to manage adolescent to gain from peer education and influence.
The adolescents themselves harnessing the findings of this study will deepen their appreciation of the need for self awareness, self-confidence, strengths and weakness in the face of HIV and AIDS. Based on this they will be in a position to fashion positive attitudes toward HIV and AIDS.
The findings will enable curriculum planners to perceive the need to integrate HIV and AIDS awareness programme on school curriculum. This equally will enhance the use of peer education to increase the awareness level of adolescents and appropriate attitudes towards HIV and AIDS. Finally, the findings of this study will be of help to prospective researchers in the field of education and sexuality education, they will become aware of adolescents awareness level as well as attitudes towards HIV and AIDS and can get more facts that will help them in developing their research works.
Scope of the Study
This study is delimited to in-school adolescents in state owned co-educational secondary schools in Nsukka Education Zone of Enugu State. Specifically, the study covered students in senior secondary II (SS II) to determine the effect of peer education on their awareness and attitude towards HIV and AIDS. The study was finally looked at the interaction effect of gender and peer education on awareness and attitude of adolescents towards HIV and AIDS education.
The following research questions guided the study.
1. What is the effect of peer education on in-school adolescents’ awareness towards HIV and AIDS in Enugu State when compared with the control?
2. What is gender differences in the effect of peer education on the adolescents’ awareness towards HIV and AIDS?
3. What is the effect of peer education on in-school adolescents’ attitude towards HIV and AIDS in Enugu State when compared with the control?
4. What is the gender difference in the effect of peer education on the attitudes of adolescents towards HIV and AIDS?
The following null hypotheses were postulated and tested at p<0.05 level of significance
Ho1: There is no significant difference in the mean scores of in-school adolescents exposed to peer education and those exposed to conventional counseling on their awareness towards HIV and AIDS.
Ho2: There is significant difference in the scores of male and female adolescents exposed to peer education on their awareness towards HIV and AIDS.
Ho3: There is no significant difference in the mean scores of in–school adolescent exposed to peer education and those exposed to conventional counseling on their attitudes towards HIV and AIDS.
Ho4: There is no significant difference in the mean scores of male and female adolescents exposed to peer education on their attitude towards HIV and AIDS
Ho5: There is no significant interaction effect between gender and peer education on adolescent awareness towards HIV and AIDS.
Ho6: There is no significant interaction effect between gender and peer education on adolescents’ attitude towards HIV and AIDS..