Table 6.
Group E: Community, afterschool, or extracurricular interventions that trained cross-age peers.
| Author, Year |
Intervention Name or Description | Population Characteristics: Grade Level/Age (Sample Size), Location |
Group Receiving Training | Training Design | Intervention Frequency and Duration | Evaluation Indicators and Notable Results |
|---|---|---|---|---|---|---|
| Gittelsohn, 2013 1 [40] |
Baltimore Healthy Eating Zones | 10–14 years old (n = 242) Baltimore, MD |
Cross-age peers, 13–18 years old. 2–3 applicants were selected by the director at each rec center site | Trained to assist interventionists (see Group D) in program delivery at rec centers prior to the start of the intervention and provided with a procedures manual. Cross-age peers were to accompany interventionists, assist in activities and communication with customers at corner stores and eventually be able to lead activities independently. Cross-age peers were provided with a $100 monthly honorarium. |
Four phases, each 10 weeks long. Interventionists and cross-age peers were to hold one session per week at rec centers. | Process: reach and dose measured against implementation standards developed by the research team. Results: 58% of rec center visits by interventionists had a cross-age peer also present for the activity. Cross-age peers averaged 0.2 rec center visits per week or 2.1 per phase (Standard was 1 visit per week or 10 per phase). |
| Gittelsohn, 2014 [41] +3 papers [42,43,44] |
B’More Healthy Communities for Kids | 10–14 years old (n = 508), Baltimore, MD |
Wave 1: College students (18–22 years) Wave 2: High school students (15–18 years) |
Interested cross-age peers had to complete an application and interview. For those selected, 12 training sessions were held prior to the start of the intervention (27 h of training), and bi-weekly booster training sessions were held throughout the intervention. Trained cross-age peers were grouped into 3–5 to deliver the program at rec centers. College students were paid for completion of the training program and time teaching sessions at rec centers. High school students received service learning hours and small financial incentives. Curriculum provided to cross-age peers included ice breakers, a script of questions to use during discussions. Leaders were combined into groups of 3–5 to deliver the intervention in rec centers. |
14 60-min sessions taught bi-weekly over 6 months | Outcomes for cross-age peers (n = 25): changes in anthropometrics, dietary intake, food behaviors, psychosocial factors, and leadership skills. Process: dose, reach, and fidelity; qualitative interviews with cross-age peers after Wave 1. Results: In open-ended comments, youth participants reported enjoying games and cooking lessons. Discussions were the most challenging element in terms of youth engagement. Level of interest in topics varied; using poster board for youth to write on topics increased engagement. In interviews, cross-age peers indicated more scenarios/role-playing during training would have been helpful, nutrition content for youth should not be overly complicated, and important that cross-age peers are representative of the community in which they are working. |
| Kohlstatdt, 2016 1 [52] +1 paper [53] |
NutriBee | 4th–7th grade (n = 170), New Mexico, Michigan, Maryland and Guam |
High school students | Cross-age peers worked with a subject matter expert coach to connect their interests with nutrition in the form of a project that would be part of the NutriBee intervention material. The projects and questions were incorporated into the curriculum as 1 of the 10 2-h modules of the program. Upon completion, cross-age peers received a stipend, certificate, and service learning credit. |
10 2-h modules delivered across varying time frames ranging from 4 days (in camp settings) to 1 month (club that met once/week). | Outcome: changes in dietary knowledge, intentions, outcome expectations, self-efficacy, and dietary intake. See Table 4 for results. |
| Saez, 2018 2 [65] |
Peer intervention was carried out within the larger PRALIMAP-INÈS (Promotion de l’ALIMentation et l’Activité Physique-INEgalité de Santé) | Grade 9 (last year of middle school) and Grade 10 (first year of high school) (n = 32), Vosges, France |
Cross-age peers (peer ambassadors) had participated in the program the previous year and were one year ahead of the target population in school (Intervention also used same-age peers; see Group F) To be eligible, peers had to have a demonstrated ability to control their weight and be of a similar socioeconomic background as the target population. |
Peers received a 2-h training session at the start of the school year, in groups of 2–4 at a time or individually if grouping was not possible. During the training, cross-age peers considered the strengths they would bring as intervention facilitators. They then brainstormed activities they could lead and practiced role-playing various scenarios they might encounter. Following role-playing, they received feedback and debriefing tips. Cross-age peers discussed their planned activities with the program coordinator; financial support was available if needed for the activities. They had regular contact with the program coordinator throughout the school year via phone and text messages for follow-up and support and had a mid-year face-to-face meeting. |
Target was for cross-age peers to plan and carry out four activities with their assigned small group of younger peers throughout the school year. The peer intervention was part of a larger health intervention in the school setting and was meant to be more informal in its approach, where activities could also be conducted outside of school. |
Outcome: changes in physical activity, mental health, and perceived health and quality of life Process: satisfaction, perceived appropriateness, dose received, and practicality Results: A total of 5 cross-age peers were trained and remained active out of 20 potential facilitators who initially accepted the invitation, and 1 successfully organized and implemented an activity. Youth were significantly more likely to accept the peer intervention when offered by the peer rather than an adult professional. Interestingly, though some youth reported mistrust of peers and concerns about social exclusion. Facilitators had a high need for support from the program coordinator and despite addressing this topic in the training, struggled to come of up with ideas for activities. Training feedback indicated that more than 2 h was needed, and more practical ideas for activities and interpersonal skills training would be helpful. |
1 Also included in Group D. 2 Also included in Group F.