‘Touch’: A Club-Based Peer Education & Outreach Programme
Mark Dooris and Maggie Plum
Mark Dooris: Director, Healthy Settings Development Unit, University of Central Lancashire, Preston, PR1 2HE, UK, Phone no +44 (0)1772 893765 Fax no +44 (0)172 894989
Maggie Plum: Student Services, University of Central Lancashire, Preston, PR1 2HE, UK. Phone no: +44 (0)1772 892574 Fax no: +44 (0)1772 892939
In September 1998, the University of Central Lancashire launched ‘Touch’: a peer education project focusing on sexual health promotion and safer drug use within the setting of Feel, one of the UK’s top student club nights. The project forms part of the Health Promoting University initiative, established in 1995, which has led to the collaborative development and adoption of a Corporate Policy on Health and Procedural Guidelines on Drugs.
‘Touch’ has been developed as a multi-disciplinary and multi-agency venture, with the Students’ Union, the Feel club promoter, Student Services, the Health Promoting University co-ordinator, Drugline and the local Health Promotion Unit as key actors. Drawing on positive evaluations of both peer education and outreach projects, ‘Touch’ has merged these two approaches to create a highly visible, developmental and sustainable initiative which prioritises person-based, experience-based and message-based credibility.
Characterised by the use of indigenous volunteering, harm reduction approaches and value-free information, ‘Touch’ has developed a successful programme of recruitment; training [including sexual health, drug use, legal context, listening skills, confidentiality and outreach skills]; implementation; action research; monitoring and evaluation. Volunteers are supported in their work by qualified Drugline counsellors, and provision is made for regular debriefing and support meetings. Following the completion of its first year, ‘Touch’ is planning to increase the use of existing peer educators in future recruitment and training and is exploring with the University the development of an academic module in health-focused peer education.
In this paper, we want to do three main things:
- Provide some background information on the University of Central Lancashire and give an overview of its Health Promoting University initiative [HPU] - summarising the background, context and development;
- Introduce the University’s Procedural Guidelines on Drug Misuse, outlining the process of formulating them and their key values;
- Describe and discuss the establishment, implementation and future development of the club-based peer education programme, ‘Touch’.
The Health Promoting University: Background, Conceptual Framework and Organisational Structure
By way of background, the University of Central Lancashire is a large forward-looking higher education institute with 22,000 students, which over recent years has undergone a period of rapid expansion, development and change. It has a strongly developed policy framework and a strong commitment to working in active partnership with local agencies. Its main campus is located in Preston, a town with a population of 130,000, situated in Lancashire in the North West of England.
In 1995 the University of Central Lancashire became one of the first few universities in Europe to establish a Health Promoting University [HPU] initiative (1). In doing so, it became part of what has become known as 'settings-based health promotion': an emergent movement which has its roots in the World Health Organisation [WHO] Health for All [HFA] initiative (2) and Ottawa Charter for Health Promotion (3). The latter stated that:
"Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love."
Following the appointment of a Co-ordinator, based within the Department of Health Studies, the first task was to develop a conceptual framework which defined the essential characteristics of the settings-based approach and enabled this to be applied to the University (4). Drawing on a sparse but growing body of literature (5), a number of defining characteristics were agreed.
- Firstly, underpinning principles and perspectives were identified - such as holism, participation, equity, sustainability, co-operation and consensus.
- Secondly, it was acknowledged that the settings-based approach is characterised by a focus on organisational development - concerned with identifying why and how a 'healthy' organisation can perform better and how a commitment to and investment in health can be embedded within the structures, mechanisms, culture and routine life of the institution.
- Thirdly, it was recognised that whilst the University has a number of functions common to any large organisation, it also has roles which infuse it with a distinctive culture and mission, which should inform the initiative's development. Of particular importance - and reflected in the University's mission statement - is a belief that universities are concerned with enabling students to explore and develop an understanding of themselves as whole people and with empowering them to develop their full potential - within, outside and beyond the University setting. This approach draws on the Ottawa Charter’s five-fold focus on (2):
- building healthy policy,
- creating supportive environments,
- strengthening community action,
- developing personal skills,
- reorienting service provision.
The HPU thus rejects the view that health promotion should be about persuading people to adopt certain 'healthy' behaviours. Instead, it seeks to develop an appropriate policy context and provide a supportive environment which enables students to gain knowledge and understanding, to explore possibilities, experiment safely and make their own informed choices.
It was agreed that the overarching aims of the HPU initiative should be --
- to integrate within the University's structures, processes and culture a commitment to health and to developing its health promoting potential;
- to promote the health and well-being of staff, students and the wider community.
Within these overall aims, six objectives were set, forming a broad 'agenda for action' [see Fig. 1]:
- to integrate a commitment to and vision of health within the University's plans and policies;
- to develop the University as a supportive, empowering and healthy workplace;
- to support the healthy personal and social development of students;
- to create health promoting and sustainable physical environments;
- to increase understanding, knowledge and commitment to multi-disciplinary health promotion across all University faculties and departments;
- to support the promotion of sustainable health within the wider community.
Figure 1: Agenda for Action
A flexible organisational structure was subsequently established [see Fig. 2], comprising a senior-level Steering Group, able to establish working groups and short term sub-groups as necessary. These have been set up over a period of time, in response to identified need, interest and motivation, harnessing and focusing enthusiasm and available resources and utilising real-life entry points within the constraints of the existing organisational culture. Priority focus areas include sexual health and drugs.
Figure 2: Organisational Structure
The University’s Procedural Guidelines on Drug Misuse
The Drugs Working Group [and indeed, other working groups] have developed their work programmes within the philosophical and conceptual framework outlined above.
In response to concern about the lack of clear guidance on how to respond to drug-related incidents within the University context, it was decided that consultative training should take place with key staff, aimed at raising awareness and identifying issues of concern. The information gathered through this training was then used over a period of 15 months to inform the inter-departmental and multi-agency consultative development of procedural guidelines, prior to adoption by the University in July 1999 (6). The intensive process of engaging with the diversity of ‘sub-cultures’ within the University and liasing with external agencies such as the police, the Health Promotion Unit and voluntary drug organisations proved to be a worthwhile investment, securing widespread legitimacy, ownership and support within and outside the organisation.
The Guidelines are understood to be dynamic and responsive to future contextual changes and learning. They seek to take account of and balance the full range of legal, welfare, educational, health and safety, and customer care/professional conduct responsibilities and concerns that the University faces in addressing and responding appropriately to drug-related incidents. Thus, they embrace rather than ignore the paradox presented by illegal drugs: that the University will not tolerate drug use on its premises; but that recreational drugs form part of youth and student culture - and that many students do use drugs and that furthermore, they choose to take them and enjoy taking them. The challenge is to combine clear communication of the 'zero tolerance' message - the University does not and legally cannot condone use of illicit drugs - with effective harm minimisation strategies.
Such an approach requires substantial investment in supportive structures, systems and processes. The University of Central Lancashire has, over a number of years, expressed its commitment to such investment. Of particular note are --
• Student Services, which provides a comprehensive range of services and facilities aimed at supporting all-round personal and social development. These include a Health Centre, an Advisory and Counselling Centre, a Multi-Faith Centre, Sports and Recreation Centre and Pre-School Centre;
• Students' Union, which through its Advice Centre, annual ‘Well-Fayre’ and other services, works closely with the University in promoting health and well-being.
‘Touch’: A Club-Based Peer Education and Outreach Programme
A specific initiative established under the auspices of the HPU with the aim of developing effective harm minimisation strategies is ‘Touch’ - a peer education and outreach programme established in 1998, focusing on safer drug use and sexual health promotion within the setting of the club night Feel, held in the University’s Students’ Union building.
Feel was launched in 1994 and, rapidly becoming one of the UK’s top student club nights, was voted top student night by ‘The Observer’ newspaper in 1996. It has an excellent record in anticipating and complying with legislation, in pioneering a ‘safe’ environment [e.g. free water readily available] and in working closely with the local police force and health-related agencies.
The rationale for establishing ‘Touch’ was threefold:
- firstly, the acknowledgement that, despite continuing debate about the difficulties of proving effectiveness, peer education and outreach projects are widely believed to be valuable in communicating harm reduction and safer sex messages to young people (7, 8);
- secondly, the recognition that a large number of students and others are regular ‘clubbers’ at Feel and the knowledge that the context had already proved to provide a worthwhile setting for drug-related outreach work with trust having been established with the promoter, but with Drugline’s capacity having been reached;
- thirdly, the interest expressed within the HPU sexual health working group in exploring peer education as an approach, and the recognition that Feel offered an ideal opportunity to develop a highly visible and credible programme combining peer education and outreach approaches focusing on both substance use and sexual health.
‘Touch’ has been developed as a multi-disciplinary and multi-agency venture, with the Students’ Union, the Feel club promoter, Student Services, the Health Promoting University co-ordinator, Drugline and the local Health Promotion Unit as key actors who recognised the value of investing in a peer education approach. This widespread ownership has been instrumental in legitimising and establishing the sustainability of the initiative. Funding for materials and other expenses has been provided by the Health Promoting University initiative and the Students’ Union, and North West Lancashire Health Promotion Unit and Drugline [Lancashire] have both built the work into their staff-time contracts.
Drawing on the experience of other peer education and outreach initiatives (7), the following characteristics were understood to be important in establishing the person-based, experience-based and message-based credibility of ‘Touch’:
- Use of Indigenous Volunteering: Volunteers are students who are familiar with and comfortable in the Feel/clubbing context;
- Commitment to Harm Reduction: ‘Touch’ rejects the ‘just say no’ approach as inappropriate and counter-productive, and is committed to communicating clear ‘harm reduction’ messages;
- Value-free Information: Linked to this, ‘Touch’ seeks to develop a culture of communication that is respectful and treats clubbers as active agents in a two way educational process. Information must be accurate and accessible, but value-free;
‘Touch’ has developed a successful programme of recruitment, training, implementation, support, action research, monitoring and evaluation:
- Recruitment: For its launch, a distinctive and attractive logo was designed and flyers were distributed around campus, inviting students interested in becoming volunteers to meet for a free drink. Following initial recruitment, volunteers told their friends, and ‘word of mouth’ recruitment, together with publicity through targeted academic courses, resulted in a core group of 12 volunteers being established for the year 1998-99. A second round of recruitment has just taken place. Throughout the recruitment process, attention was paid to the importance of establishing a clear and appropriate image and person-based and experience-based credibility (7). Whilst the peer educators are not paid, their value is acknowledged, and they are ‘rewarded’ in a number of ways - through free entrance to Feel nights [with their work largely finishing at 12.30] and selected Students’ Union nights and ‘thank you’ social events and meals.
- Training: The training programme was designed and facilitated by ‘Touch’ co-ordinators - Sharon Doherty, a Health Promotion Specialist working with educational settings who had previous experience in peer education, and Lee Harrington, a Community Development Worker for Drugline Lancashire, who had experience in drug-related outreach work. Drawing on and adapting existing training materials (9), with the intention of merging peer education and outreach approaches into an ongoing and sustainable programme, the training comprised five sessions focusing on sexual health, drug use, the legal context, listening skills, confidentiality and outreach skills.
- Implementation: The involvement of the Feel promoter in early discussions ensured that ‘Touch’ volunteers would be welcomed and able to work within the club setting. Volunteers operate a rolling programme, with a team of four to six working on any one Feel night. Tee shirts and badges with the Touch logo ensure visibility, and volunteers work until 12.30am - handing out a mix of condoms, ice-pops, sweets, stickers, interactive cards, ‘lucky dip’ bags, talking with clubbers and looking out for people who need specialist help or support. At the end of the night, information and educational materials relating to drug use and safer sex [both pre-existing and developed specifically for the HPU’s work] are handed out.
- Support: High priority is given to the provision of support. The peer educators work in pairs and at least one trained Drugline volunteer or one of the two ‘Touch’ co-ordinators is always present at Feel, to support new peer educators. Furthermore, Feel staff are fully briefed on ‘Touch’ and are able to offer additional support where necessary. Provision is also made for regular debriefing and support meetings with the ‘Touch’ co-ordinators.
- Action Research: The ‘Touch’ programme has enabled informal action research to be practised by encouraging volunteers to experiment with different approaches and note their success or failure. The debriefing meetings provide an opportunity for the volunteers and co-ordinators to reflect on and learn from these experiences, ensuring that the work is developmental and praxis-based.
- Monitoring and Evaluation: Evaluation has been built into the various stages of ‘Touch’. Facilitators and peer educators evaluate the training and recruitment processes, and the debriefing meetings facilitate a continuous programme of monitoring and evaluation of the peer education approach and the materials used. An annual report is currently being produced which will explore the potential for developing a more comprehensive evaluative process through the HPU’s Curriculum Development Working Group, taking account of recommendations in the literature (8).
Following the completion of its first year, ‘Touch’ is planning to increase the use of existing peer educators in future recruitment and training and is exploring with the University the development of an academic module in health-focused peer education.
As it enters its second year, ‘Touch’ has proved to be an effective method of communicating harm reduction and safer sex messages to students and others in a club setting. Its development within the framework of the HPU has ensured that it is rooted in ‘Health for All’ values such as inter-agency working, participation and respect. This has enhanced its sustainability through building widespread ownership amongst key stakeholders and facilitating an understanding of the holistic nature of health and well being.
Key challenges for the year ahead include:
- maintaining the continued interest and motivation of the peer educators;
- keeping the approach ‘fresh’ and new within the Feel context, on an ongoing basis;
- attracting male students as peer educators;
- developing an appropriate and comprehensive evaluation process.
1. Dooris M  Working for sustainable health: University of Central Lancashire health promoting university phase I progress and evaluation report, Preston, University of Central Lancashire
2. See for example:
WHO  Targets for health for all, Copenhagen, WHO Regional Office For Europe
WHO Europe  The health policy for Europe: targets for health for all [revised], Copenhagen, WHO Regional Office For Europe
WHO  Health 21 - the Health for All Policy for the WHO European Region, Copenhagen, WHO Regional Office for Europe http://www.who.dk/cpa/h21/h21long.htm
3. WHO Europe , Ottawa charter for health promotion. In: Health Promotion 1  ppiii-v
4. Tsouros A, Dowding G, Thompson J & Dooris M  Health Promoting Universities, Copenhagen, WHO Regional Office for Europe
5. See for example:
Baric L  The settings approach - implications for policy and strategy, in: J. Institute of Health Education, 31  pp17-24
Baric L  Health promotion and health education in practice: module 2 - the organisational model, Altrincham, Barns
Kickbusch I  An overview to the settings-based approach to health promotion, in: Theaker T & Thompson J  The settings-based approach to health promotion: report of an international working conference, 17-20 November 1993
Grossman R & Scala K  Health promotion and organisational development: developing settings for health, Copenhagen, WHO Regional Office for Europe
6. University of Central Lancashire, Health Promoting University Website http://www.uclan.ac.uk/hpu.htm [drugs] , Preston, University of Central Lancashire
7. Shiner M & Newburn T  Young People, Drugs and Peer Education: An Evaluation of the Youth Awareness Programme, London, Home Office
8. Svenson G  European Guidelines for Youth AIDS Peer Education http://www.europeer.lu.se/html/engchoose.html
9. Harvey M  A Framework for Peer Learning: A Workers’ Guide to the Training and Support of Peer Educators, London, Youth Clubs UK