Pilot peer health education for noncommunicable disease prevention in Bangladesh, Ethiopia, and Palau

Abstract

# Background Noncommunicable diseases (NCDs) are growing health threats in developing countries. We previously conducted epidemiological and qualitative ethnographic studies on NCD risk factors in Bangladesh, Ethiopia, and Palau, and found that NCD risk factors were significantly prevalent. Although people had some knowledge of NCDs, they had no clue to change their daily risky behaviour, revealing urgent needs for developing appropriate health education programs. Peer health education is a strategy widely applied in developing countries for infectious disease control and maternal and child health, and known to be effective to change behaviour. This article aims to describe the experience of developing peer health education modules and evaluating the trials. # Methods We conducted pilot peer health education in three different settings: women in an urban slum community in Bangladesh; workers in a regional city in Ethiopia; and young adults in Palau. We modified commonly used education tools according to local socio-cultural context. Then we conducted three-day peer educator training workshops and evaluated the workshops. # Results i\) Bangladesh. We developed education tools including role plays and gamification, modifying a popular local board game. This motivated the peer educators and nurtured ownership of the module. ii) Ethiopia. We chose topics about dietary habit. We developed an education module including role plays and demonstration of sugar amount in popular beverages. Participants were impressed with such visualized education tools. iii) Palau. As they had some knowledge of NCD risks, we focused on changing attitude. We chose topics about diet, such as reading nutrition labels of canned processed meat. # Conclusion We found that peer education is a useful option for NCD prevention in resource-limited settings in developing countries. It is important to take into account of the local priority issues, the level of knowledge of the audience, and the socio-cultural context in each setting. It is also very important to identify who are the peers of the target group. Using locally available and culturally acceptable resources and local language enhances participation and ownership of the people. Peer education for NCD prevention should be integrated into existing primary health care programs.