The Suitability of Peer Supporters Identified to Informally Promote a Smoke-Free Message to Their Peers

Introduction: The ASSIST Programme is an informal school-based peer-led intervention aimed at reducing the uptake of weekly smoking amongst 12-13 year olds. Based on diffusion theory, the intervention relies on peer socialisation and the diffusion of smoke-free messages by ‘peer supporters’ through informal conversations. Peer supporters are nominated using a whole-community approach. The intervention was evaluated in the UK using a randomised controlled trial (ASSIST), which demonstrated a 22% reduction in the odds of being a regular smoker [odds ratio 0.78 (95% CI 0.64-0.96)] in intervention compared with control schools.

Diffusion theory suggests that community norms are shaped by credible and influential individuals (‘opinion leaders’) within their community, and that diffusion will be facilitated if opinion leaders are similar to the target population and represent a range of social groups. So whilst the Programme is effective, it is important to examine whether the nomination process used achieved its aim of identifying peer supporters with these characteristics. This study therefore explores if the peer supporters were similar to other Year 8 (Aged 11-12) students, were located in a range of social groups, and were considered suitable by their peers.

Methods: Data were collected immediately post-intervention during ASSIST. Semi-structured individual interviews and discussion groups were conducted with students in four schools selected for an in-depth process evaluation study. Social network data and quantitative data on suitability were obtained from questionnaires completed by all students in intervention schools. Network data from the four in-depth process evaluation study schools are used.

Quantitative data underwent descriptive analysis. Qualitative transcripts were subjected to thematic analysis. Social network data were analysed using Kliquefinder.

Results: The nomination process successfully identified a diverse group of peer supporters, broadly representative of their year group. 81-92% of clusters were single sex and 48-60% of these clusters contained at least one peer supporter. 4,387 of 5,066 intervention school students indicated that they knew at least one peer supporter.

 Respondents gave mixed opinions about the performance of peer supporters. Some students were thought to be responsible and confident whereas others were seen as shy or not taking it seriously. Smoking status was identified as one of the major threats to the credibility of peer supporters.

Conclusions: This study confirms that the nomination process successfully achieved its intended outcomes. The peer supporters were broadly similar to their year group and represented different clusters within the year group, complying with recommendations that opinion leaders should represent a diversity of social groups.

While views regarding peer supporter suitability were mixed, since opinion leaders are not always credible across communities, attaining a range of peer supporters, credible with different groups is likely to have contributed to the success of the intervention.  However, developing communication skills, facilitating smoking cessation and encouraging students to embrace their role may enhance intervention outcomes.