There are currently no lectures in schools or universities that educate people on how to reduce the risks of illegal drug taking/experimenting, no public libraries on illegal drug use, and no public gatherings where novices and masters in illegal drug use exchange information and/or techniques.  People today informally exchange information, share experiences, and learn from each other’s knowledge and experiences on what works, and what does not.

But how does this actually work? How do adults learn?  The fields of health psychology and public health provide relevant behavioural theories to help us understand the process.  Peer work can also be understood with help of a range of social and psychological theories, each of which is now briefly discussed in turn:

  • Theory of reasoned action
  • Social learning theory
  • Health belief model
  • Information, Motivation, Behavioural Skills and Resources  (IMBR) model
  • Social ecological model for health promotion
  • Diffusion of innovations theory
  • Theory of participatory education


Theory of reasoned action
This theory states that the intention of a person to adopt a recommended behaviour is determined by their beliefs and attitudes towards the  behaviour and that these beliefs and attitudes are largely influenced by his/her  peers and direct surroundings (Fishbein and Ajzen, 1975).;a1975.html
For example, a young woman who thinks that using contraception will have  positive results for her will have a positive attitude towards contraceptive use.


Social learning theory
This theory states that people learn:

  • Through direct experience.
  • By observing and modelling the behaviour of role models and people with whom he/she identifies.
  • Through practice, that can lead to confidence in being able to carry out specific behaviour (self-efficacy).

For example, using role-play to practice how and when to introduce a condom can be important in developing the self-confidence to talk about safer sex methods with a partner.

Health belief model
The health belief model was developed in the early 1950s by social psychologists and was used to explain and predict health behaviour, mainly through perceived intentions, perceived barriers, and perceived benefits.
This model does explain people’s motives - why they want to behave in a certain way or to change their behaviour - but it does not consider environmental factors such as legal, social or economical barriers to the actual implementation of their intention.

Information, Motivation, Behavioural Skills and Resources (IMBR) model
The IMBR model addresses health-related behaviour in a way that can be applied to and across different cultures.  It focuses largely on the information (the ‘what’), the motivation (the ‘why’), the behavioural skills (the ‘how’), and the resources (the ‘where’) that can be used to target at-risk behaviours.

For example, if a young man knows that using condoms properly may prevent the spread of HIV, he may be motivated to use them and know how to do so correctly, but he may not be able to obtain them. Thus, the availability (or otherwise) of resources is crucial to this model.

Social ecological model for health promotion
According to this model, behaviour is viewed as being determined by the interplay of the following factors:  personal characteristics (knowledge, attitudes, self-efficacy and skills);  social influences (from peers, relatives, community);  and public policy (which sets laws, regulations and policies that support or hamper certain behaviour).

Diffusion of innovations theory
This theory addresses how social practices and ideas spread among communities.  The role of opinion leaders in a community, acting as change  agents, is a key element of the theory.  Their indirect or direct influence on group norms or customs is predominantly seen as a result of person-to-person exchanges and discussions (Rogers, 1983).

Theory of participatory education
This theory argues that powerlessness at the community or group level, and the economic and social conditions that shape that powerlessness are major risk factors for poor health.  Thus empowerment and full participation of the people affected by a problem is a key to sustained behaviour change (Freire, 1970).

The theory of participatory education suggests that people are empowered to make the changes to achieve good health by collectively discussing and planning a response to a problem or health condition.  It is widely accepted that this dialogue between peers (equals), talking among themselves and determining a course of action, is key to the impact of peer education on behavioural change.