ABSTRACT
This study was designed to determine
the effects of peer education on awareness and attitude towards HIV/AIDs among senior
secondary school students in Education District I of Lagos 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 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 under Education District I 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. 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 and counselors on how to implement peer education on awareness and
attitude towards HIV and AIDS in basic and senior secondary schools.
TABLE OF CONTENTS
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGMENT iv
TABLE OF CONTENTS v
ABSTRACT vii
CHAPTER ONE: INTRODUCTION
Background of the Study 1
Statement of the Problem 7
Objectives of the Study 8
Research Questions 8
Hypotheses 9
Significance of the Study 9
Scope of the Study 10
CHAPTER TWO: REVIEW OF LITERATURE
Conceptual Framework 12
Concept of peer education 12
Concept of awareness 13
Concept of attitude 14
Concept of
HIV and AIDS 15
Concept of adolescence 16
Concept of gender 17
Conceptual relationship 18
Theoretical Framework 19
The
social cognitive theory by Bandura 1977 19
Health
belief model by Rosenstock et al 1950 20
Aids
risk reduction model by Catania 1990 21
Theory
of reasoned action by Fishbein and Ajzen 1975 21
Self-perception
theory of attitude by Bem 1967 22
Review
of empirical studies 23
Studies on HIV and AIDS 23
Studies
on awareness and attitude towards HIV/AIDS 25
Summary
of Literature Reviewed 26
CHAPTER THREE: RESEARCH METHOD
Design of the study 28
Area of the Study 26
Population of the study 28
Sample
and sampling techniques 28
Instrument for data collection 29
Validation of the instrument 29
Reliability of the instrument 30
Experimental Procedure 30
Treatment Procedure 31
Developing the instructional programme 32
Control of extraneous variable 32
Method of data collection 33
Method of data analysis 33
CHAPTER FOUR: RESULTS
Data
analysis and presentation of data 34
Summary of findings 41
CHAPTER FIVE:
DISCUSSION OF RESULTS, CONCLUSION, IMPLICATIONS, RECOMMENDATIONS AND SUMMARY OF
THE STUDY
Discussion of results 42
Conclusion 46
Educational implications of the findings 47
Recommendations 48
Limitations of the study 48
Suggestions for further
studies 49
REFERENCES 50
APPENDICES 54
CHAPTER ONE
INTRODUCTION
1.1 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 its 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 Lagos 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 Lagos 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 adolescent’s 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 Lagos State.
In Lagos 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 adolescent’s awareness and attitude towards HIV and AIDS.
1.2 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 Lagos 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 Lagos State, Nigeria.
1.3 Objectives
of the Study
The main aim of the study is to
determine the effect of peer education on awareness and attitude towards HIV
and AIDS among adolescents in Lagos State. Specifically, the study sought to:
1.
Find
out the effect of peer education on adolescents’ awareness of HIV and AIDS in Lagos 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 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 interactive effect of gender and peer education on adolescents’ awareness
of HIV and AIDS in Lagos State.
6.
Determine
the interactive effect of gender and peer education on students’ attitude
towards HIV and AIDS in Lagos State.
1.4 Research
Question
The following research questions
guided the study.
1.
What
is the effect of peer education on adolescents’ awareness towards HIV and AIDS
in Lagos State when compared with the control?
2.
What
is gender difference in the effect of peer education on the adolescents’
awareness towards HIV and AIDS?
3.
What
is the effect of peer education on adolescents’ attitude towards HIV and AIDS
in Lagos 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?
1.5 Hypotheses of the Study
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 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 adolescents 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.
1.6 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.
1.7 Scope of the Study
This study is delimited to in-school
adolescents in state owned co- educational secondary schools in Education
District I of Lagos State. Specifically, the study covered students in senior secondary
I, II and III (SS I, II and III) 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.
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