The study aimed to investigate the contribution of PEs, under the RKSK during the COVID-19 pandemic in India. To the best of our knowledge, this is the first study in the region to document the role of PEs in numerous initiatives during the COVID-19 response, using rigorous scientific methodology. Our study findings spotlight the substantial contribution of PEs during the COVID-19 pandemic and all their efforts were far beyond their intended roles and responsibilities in RKSK.
Hand hygiene, physical distancing, use of face masks, and avoiding greetings through physical contact are the major COVID-19-appropriate behaviours promoted during this pandemic [28]. In concordance with this, our study findings highlighted that the PEs wholeheartedly embraced this mission and sensitised the members of their community, resulting in visible impacts such as improved adherence to recommended practices. While the existing literature highlights the success of Peer Education programmes implemented during COVID-19 in generating awareness in countries like Poland [29] and Washington DC for promoting adherence to COVID-19 appropriate behaviour [30]. However, we cannot compare our study findings with these because the role performed by the PEs of RKSK during COVID-19 went beyond their intended roles and responsibilities. The programme aims to improve adolescent health related to nutrition, sexual reproductive health, mental health, injuries and violence, substance misuse and non-communicable diseases. To the best of our knowledge, none of the studies conducted thus far has reported unintended outcomes stemming from a national programme like the one performed by PEs under RKSK. The role undertaken by PEs during the COVID-19 pandemic was not originally intended or anticipated, making it a unique and unprecedented contribution that has not been previously documented in the existing literature.
Our study findings highlighted that PEs strongly resonated with the quote “Periods don’t stop during a pandemic” [31]. They stepped up during this crisis period and provided menstrual hygiene products to girls and contributed to maintaining menstrual hygiene practices. PEs also helped adolescents by acting as the first point of contact for resolving their health-related queries and also acted as a bridge to the health system, highlighting the success of the RKSK. Literature also reiterates that Peer Educators/Facilitators have a better ability to communicate with adolescents than older adults, and they are perceived as more credible sources of information [32, 33].
Vaccine hesitancy emerged as an important topic that hinders global efforts to control the COVID-19 pandemic. Our study showed that PEs played a substantial role in promoting COVID-19 vaccination by raising awareness, conducting role plays, wall painting, folk songs, traditional gestures and creating slogans for community members and adolescents. The traditional gesture i.e. invitation by offering yellow rice, wall painting, street shows and slogans was done by PEs in the other 13 districts of Madhya Pradesh to overcome vaccine hesitancy. The significance of these initiatives was acknowledged by government officials, as highlighted in a scientific publication [34].
In our study state, PEs gave high priority to the vaccination campaign and enthusiastically engaged by being among the first to receive the vaccine during the early phases of adolescent vaccination. This not only set an example but also led to an increase in vaccination uptake within their age group, highlighting the PEs fostered changes in community behaviour. This likely stemmed from the rapport building by PEs and the trust built by respecting their community’s cultural context[35].
Overall study findings emphasised that PEs affiliated with RKSK stepped up during this grim time and acted as innovators, communicators and navigators to contribute to the well-being of the adolescents and the community as a whole. Although PEs did not undergo any formal training in handling COVID-19 response activities, they still exhibited effective communication and leadership skills. PEs would have gained the skills from various activities conducted as part of the programme like six-day Peer Educator training, monthly Adolescent Friendly Club Meetings and continuous engagement with the health and community workers. The situational analysis conducted by the authors of i-Saathiya study also highlighted that health workers stayed connected to PEs through WhatsApp and phone and disseminated knowledge related to COVID-19 appropriate behaviours apart from RKSK themes[16]. Furthermore, amidst the lockdown period, the PEs demonstrated their connectedness and support by actively engaging with both their fellow PEs and group members through phone calls and WhatsApp, offering support whenever required.
Going forward, a system of rewards and encouragement for PEs of RKSK. They may be encouraged through possibilities for public recognition, awards, skill enhancement (computer course) and rewards; social and recreational activities; exchange opportunities and programmes (travel); educational credits, and, as necessary, promotion within the programme. An example of this is the Family Planning Programme by the Ministry of Health Zanzibar [36], which provides bicycles and other equipment to PEs to support their work as community-based distributors. As an incentive, they are permitted to rent out the equipment when it is not in use to supplement their income. In Kenya, another peer educator initiative called Y-PEER [37] has created annual awards to promote and honour them. Moreover, it is imperative to establish effective mechanisms to ensure continuous monitoring, evaluation, and knowledge acquisition from the experiences of PEs. Regular assessments of the interventions' impact should be conducted to identify potential areas for improvement. Furthermore, integrating the valuable inputs furnished by PEs into the development and refinement of adolescent health programmes and policies holds paramount importance. To maximise the performance of PEs, support mechanism should be implemented to provide them with the necessary knowledge and skills required for success in their roles.
One notable strength of our study was the engagement of numerous stakeholders, comprising both programme implementers and beneficiaries, in understanding the role of peer educators in the context of the COVID-19 pandemic. This approach enabled the gathering of diverse perspectives on the subject matter. This is a novel study that focuses on relatively unexplored topics, the role of PEs beyond their programme role (i.e., role in the RKSK), and their role in mitigating the impact of COVID-19 in India and their support to other national health programmes. Despite the substantial findings in this work, a few study limitations must be taken into consideration. Firstly, there can be reporting bias on the side of the participants due to their varied levels of involvement in the implementation of the programme. Secondly, there may also be self-reporting bias as they relied on self-reported data from implementers of the RKSK, which may be subject to social desirability effects. Finally, as the study relied primarily on qualitative data, it may be less generalizable.