Digital peer support and sexual well-being after gynaecological cancer

Evidence suggests that digital peer support can be valuable for individuals struggling with their wellbeing, particularly those who do not feel able to or do not want to engage with other services. The current study explores the experience of young adults engaging with a digital peer support smartphone app. Interviews were conducted with 11 young adults aged 18-25. Reflexive thematic analysis was used and five themes were developed from the data: 1) Finding comfort in familiar and friendly digital spaces; 2) Developing coping and support skills through digital peer support; 3) The value of shared experiences; 4) Needing to 'pull your weight' but being scared of causing harm; 5) The limits of digital peer support. We found that participants valued the sense of community and feelings of relief and validation elicited from sharing relatable experiences with peers. They also believed they had developed skills in supporting themselves and others both within and external to the app. However, it was mainly perceived as a space for venting and may not succeed in delivering benefits beyond this, such as in reducing symptoms of poor mental health or helping people get to the root of issues. Moreover, participants reported a pressure to respond and anxieties around exacerbating someone's difficult feelings. Providing training and supervision to peers to help them feel confident and safe when supporting others may help to further the benefits of peer support, and a greater emphasis on boundaries within digital peer support may alleviate some anxieties and pressure.

Digital peer support enhances engagement in mental and physical health services despite barriers such as location, transportation, and other accessibility constraints. Digital peer support involves live or automated peer support services delivered through technology media such as peer-to-peer networks, smartphone apps, and asynchronous and synchronous technologies. Supervision standards for digital peer support can determine important administrative, educative, and supportive guidelines for supervisors to maintain the practice of competent digital peer support, develop knowledgeable and skilled digital peer support specialists, clarify the role and responsibility of digital peer support specialists, and support specialists in both an emotional and developmental capacity. Although digital peer support has expanded recently, there are no formal digital supervision standards. The aim of this study is to inform the development of supervision standards for digital peer support and introduce guidelines that supervisors can use to support, guide, and develop competencies in digital peer support specialists. Peer support specialists that currently offer digital peer support services were recruited via an international email listserv of 1500 peer support specialists. Four 1-hour focus groups, with a total of 59 participants, took place in October 2020. Researchers used Rapid and Rigorous Qualitative Data Analysis methods. Researchers presented data transcripts to focus group participants for feedback and to determine if the researcher's interpretation of the data match their intended meanings. We identified 51 codes and 11 themes related to the development of supervision standards for digital peer support. Themes included (1) education on technology competency (43/197, 21.8%), (2) education on privacy, security, and confidentiality in digital devices and platforms (33/197, 16.8%), (3) education on peer support competencies and how they relate to digital peer support (25/197, 12.7%), (4) administrative guidelines (21/197, 10.7%), (5) education on the digital delivery of peer support (18/197, 9.1%), (6) education on technology access (17/197, 8.6%), (7) supervisor support of work-life balance (17/197, 8.6%), (8) emotional support (9/197, 4.6%), (9) administrative documentation (6/197, 3%), (10) education on suicide and crisis intervention (5/197, 2.5%), and (11) feedback (3/197, 1.5%). Currently, supervision standards from the Substance Abuse and Mental Health Services Administration (SAMHSA) for in-person peer support include administrative, educative, and supportive functions. However, digital peer support has necessitated supervision standard subthemes such as education on technology and privacy, support of work-life balance, and emotional support. Lack of digital supervision standards may lead to a breach in ethics and confidentiality, workforce stress, loss of productivity, loss of boundaries, and ineffectively serving users who participate in digital peer support services. Digital peer support specialists require specific knowledge and skills to communicate with service users and deliver peer support effectively, while supervisors require new knowledge and skills to effectively develop, support, and manage the digital peer support role.

BackgroundWhen the COVID-19 pandemic lockdown measures were instituted, the wide-scale necessity for remote mental health care increased among professional clinicians, such as psychiatrists, psychologists, social workers, and certified peer support (CPS) specialists. Factors contributing to increased demand include concern for the safety of loved ones, the safety of oneself, overall well-being, unemployment, and loneliness for older individuals. While demand continues to increase and a shortage of mental health professionals persists, understanding the training, technology, media, and delivery of digital peer support services can facilitate community-based support services to assist patients in coping with mental health symptoms between clinical encounters with licensed professionals. Digital peer support consists of asynchronous and synchronous, live or automated, peer support services such as applications, social media, and phone calls.ObjectiveThe purpose of this cross-sectional study is to determine how digital peer support is delivered, by which technologies it is delivered, and how certified digital peer supporters are trained within the United States to inform future delivery of digital peer support.MethodsWe used an online cross-sectional self-report survey developed alongside certified peer specialists. The study included questions regarding the types of peer support training and the delivery methods used within their practices. We advertised the survey through a certified peer support specialist listserve, Facebook, and Twitter.ResultsCertified peer specialists provide mutual social emotional support to those with a similar mental health condition. Of certified peer specialists trained in CPS, the majority of CPS specialists were trained in peer support (418/426, 98.1%). Peer support specialists deliver services via telephone calls (182/293, 62.1%), via videoconference-based services (160/293, 54.6%), via SMS text messages (123/293, 42%), via smartphone apps (68/293, 23.2%), and via social media (65/293, 22.2%). Certified peer specialists deliver services through virtual reality (11/293, 3.8%) and through video games (6/293, 2%). Virtual reality and video games may represent emerging technologies to develop and deliver community-based support.ConclusionsThis study examined the modes of digital peer support intervention as well as the training and demographic background of peer supporters. Given the demand for mental health care, digital peer support emerges as one option to increase access. These results suggest that CPS specialists commonly use SMS text messaging, phone calls, and videoconferences to engage in peer support. Less frequently, they may use diverse modes such as apps, social media, and video games. It is important to consider the backgrounds of peer supporters and the mediums of communication to best accommodate areas where access to peer support is emerging. Larger longitudinal studies and a variety of experimental designs may be considered to understand the efficacy of digital interventions and digital peer support training to direct optimal care.

BackgroundMental health issues among emerging adults (aged 19-25 years) on a global scale have underscored the need to address their widespread experiences of depression and anxiety. As a result of the COVID-19 pandemic, emerging studies are being directed toward the development and deployment of digital peer emotional disclosure and support for the psychological well-being of emerging adults. However, it is important to explore the implementation and clinical effectiveness, as well as associated mechanisms of change, for optimal approaches in conducting digital peer support interventions for emerging adults’ psychological well-being.ObjectiveWe describe a randomized controlled trial to evaluate the implementation and clinical effectiveness of Acceset, a digital peer support intervention to address emerging adult mental well-being. The intervention has 2 components. First, the digital peer support training equips befrienders (ie, peers who provide support) to harness 4 components of psychological well-being—mattering, selfhood, compassion, and mindfulness—to provide effective peer support for seekers (ie, peers who seek support). Second, Acceset incorporates psychological well-being digital markers and harnesses community engagement to drive emotional disclosure among peers.MethodsA total of 100 participants (aged 19-25 years) from the National University of Singapore will be recruited and randomized into 2 arms. In arm 1 (n=50), the seekers will use Acceset with befrienders (n=30) as well as moderators (n=30) for 3 weeks. Arm 2 comprises a wait-listed control group (n=50). A questionnaire battery will be used to monitor seekers and befrienders at 4 time points. These include baseline (before the intervention), 3 weeks (end of the intervention), and 6 and 9 weeks (carryover effect measurement). Implementation outcomes of the intervention will involve evaluation of the training curriculum with respect to adoption and fidelity as well as user acceptability of the Acceset platform and its feasibility for broader deployment. Clinical outcomes will include mattering, selfhood, compassion, mindfulness, perceived social support, and psychological well-being scores.ResultsThis protocol received National University of Singapore Institutional Ethics Review Board approval in October 2021. Recruitment will commence in January 2022. We expect data collection and analyses to be completed in June 2022. Preliminary findings are expected to be published in December 2022. The Cohen d index will be used for effect size estimation with a .05 (95% reliability) significance level and 80% power.ConclusionsThis protocol considers a novel digital peer support intervention—Acceset—that incorporates components and digital markers of emerging adult mental well-being. Through the validation of the Acceset intervention, this study defines the parameters and conditions for digital peer support interventions for emerging adults.Trial RegistrationClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676International Registered Report Identifier (IRRID)PRR1-10.2196/34602

Disparities in Oncofertility: Assisted reproductive technology utilization and fertility-sparing oncology care in women with a history of breast, ovarian, cervical or endometrial cancer (094)

Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train peer support specialists for rapid uptake in providing digital peer support during the COVID-19 crisis. The purpose of this study was to examine the impact of the 4-h DPS course for peer support specialists. Surveys were administered to examine pre-post changes in DPS course for participants (N = 75) related to attitudes/ beliefs towards DPS, ability to use/ engage in DPS, and organizational readiness to implement DPS. Data were analyzed by conducting paired samples t-tests. Linear mixed models were used to explore significant results further. Statistically significant (< .05) changes were observed related to readiness to use DPS, attitudes/ beliefs towards DPS, and ability to use/ engage in DPS. The 4-h DPS course may be beneficial in providing diverse groups of peer support specialists with a standardized training framework. Widespread dissemination of the DPS short course may be beneficial in rapidly equipping peer support specialists with the skills and resources needed to expand the reach of peer support services during the COVID-19 crisis and beyond.

Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train peer support specialists for rapid uptake in providing digital peer support during the COVID-19 crisis. The purpose of this study was to examine the impact of the 4-h DPS course for peer support specialists. Surveys were administered to examine pre-post changes in DPS course for participants (N = 75) related to attitudes/ beliefs towards DPS, ability to use/ engage in DPS, and organizational readiness to implement DPS. Data were analyzed by conducting paired samples t-tests. Linear mixed models were used to explore significant results further. Statistically significant (< .05) changes were observed related to readiness to use DPS, attitudes/ beliefs towards DPS, and ability to use/ engage in DPS. The 4-h DPS course may be beneficial in providing diverse groups of peer support specialists with a standardized training framework. Widespread dissemination of the DPS short course may be beneficial in rapidly equipping peer support specialists with the skills and resources needed to expand the reach of peer support services during the COVID-19 crisis and beyond.

Certified peer support specialists often use technologies such as smartphone applications to deliver digital peer support in community mental health centers. Certified peer support specialists are individuals with a mental health diagnosis, trained and accredited by their state to provide mental health support services. Digital peer support has shown promising evidence of promoting recovery, hope, social support, and medical and psychiatric self-management among patients with a diagnosis of a serious mental illness. Interest in digital peer support as part of the patient experience has grown. Understanding barriers and facilitators to the implementation process of digital peer support into community mental health centers is a critical next step to facilitate uptake. Semi-structured qualitative interviews were conducted with 27 patient participants (N = 17 persons with serious mental illness; N = 10 certified peer support specialists) from an urban community mental health center. Participants responded to open-ended questions on the barriers and facilitators of engaging with digital peer support technologies within community mental health centers. The interview guide and the responses were categorized according to the Consolidated Framework for Implementation Science Research (CFIR) constructs. Nine barriers and two facilitators were identified for the implementation of digital peer support in community mental health centers. The overarching domains for the identified barriers included (1) intervention characteristics (i.e., adaptability, complexity, and cost), (2) inner settings (i.e., implementation climate, readiness for implementation, and access to knowledge and information), and (3) characteristics of individuals (i.e., knowledge and beliefs about the intervention and other personal attributes). The two facilitators identified included (1) intervention characteristics (i.e., relative advantage) and (2) outer setting (i.e., patient needs and resources). The identified barriers and facilitators represent a starting point for developing or modifying digital peer support technology requirements to ease implementation in community mental health centers. Building technology requirements and implementation processes based on these findings may facilitate uptake of digital peer support technologies by people with serious mental illness and certified peer support specialists in community mental health centers.

A significant number of gynecologic and breast cancer survivors report chronic issues with pain during sexual activity. The fear-avoidance (FA) model of chronic pain provides a potential framework for addressing chronic sexual pain. The purpose of this study is to investigate the relationships among components of the FA model (acute pain, anxiety, avoidance, and distress) among gynecologic and breast cancer survivors to help identify those who may be at risk for chronic sexual pain. Gynecologic and breast cancer patients (n = 97) completed baseline questionnaires as part of a psychosexual intervention. Linear regression model was used to test components of the FA model. Overall, 17–34% of female cancer survivors experienced pain related to sexual activity in the month prior to enrolling in a psychosexual intervention trial. Further, 51% of participants reported clinically significant levels of sexual distress. Results of a multiple linear regression show that sexual distress was significantly associated with acute sexual pain (Standardized β = 0.34, p <.01), anxiety (Standardized β = 0.28, p <.05), and avoidance of sexual activity (Standardized β = 0.28, p <.01) when controlling for sexual activity. Survivors of breast and gynecologic cancer entering a sexuality treatment study reported pain with sexual activity. Further, sexual distress was significantly associated with acute sexual pain, anxiety, and avoidance of sexual activity, pointing to contributions each of these FA model components have on sexual distress in this population. These findings point to the need for interventions to explicitly address anxiety and avoidance of chronic sexual pain among female cancer survivors.

BackgroundEmerging adulthood (ages 19 to 25 years) is a developmental phase that is marked by increased mental health conditions, especially depression and anxiety. A growing body of work indicates that digital peer emotional support has positive implications for the psychological functioning of emerging adults. There is burgeoning interest among health care professionals, educational stakeholders, and policy makers in understanding the implementation and clinical effectiveness, as well as the associated mechanism of change, of digital peer support as an intervention.ObjectiveThis randomized controlled trial (RCT) examined the effectiveness of a digital peer support intervention over a digital platform—Acceset—for emerging adult psychological well-being with 3 primary aims. First, we evaluated the implementation effectiveness of digital peer support training for individuals providing support (befrienders) and of the digital platform for peer support. Second, we assessed the clinical outcomes of digital peer support in terms of the intervening effect on emerging adult psychological well-being. Third, we investigated the mechanism of change linking the digital peer support intervention to emerging adult psychological well-being.MethodsThis RCT involving 100 emerging adults from the National University of Singapore follows the published protocol for this trial.ResultsThis RCT found effectiveness in digital peer support training—specifically, befrienders’ peer support responses demonstrating significantly higher post- than pretraining scores in selfhood (posttraining score: mean 62.83, SD 10.18, and SE 1.72; pretraining score: mean 54.86, SD 7.32, and SE 1.24; t34=3.88; P<.001). The digital peer support intervention demonstrated clinical effectiveness in enhancing selfhood, compassion, and mindfulness and lowering depressive and anxiety symptoms among seekers in the intervention group after the intervention (mean 7.15, SD 5.14; SE 0.88) than among seekers in the waitlist control group before the intervention (mean 11.75, SD 6.72; SE 0.89; t89=3.44; P<.001). The effect of the intervention on seekers’ psychological well-being was sustained beyond the period of the intervention. The mechanism of change revealed that seekers’ engagement with the intervention had both immediate and prospective implications for their psychological well-being.ConclusionsThis RCT of a digital peer support intervention for emerging adult psychological well-being harnesses the interventional potential of 4 components of psychological well-being and elucidated a mechanism of change. By incorporating and validating the digital features and process of a peer support platform, our RCT provides the parameters and conditions for deploying an effective and novel digital peer support intervention for emerging adult psychological well-being in real-world settings.Trial RegistrationClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676

BackgroundAs digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies.ObjectiveThe goal of this study is to introduce the coproduction of core competencies that can guide digital peer support.MethodsPeer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries.ResultsAnalysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes.ConclusionsThe introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The number of UK university students reporting mental health problems is increasing. Cognitive-behavioural therapy (CBT) is evidence based for treating mental health problems, but waiting lists restrict access to this face-to-face intervention. Digital mental health packages (DMHP) increase access to evidence-based interventions and allow individuals to access support anonymously. Two common DMHP are computerised CBT (cCBT), CBT delivered with limited therapist involvement, and digital peer support, where individuals with shared lived experience support each other. These are increasingly available in universities despite a lack of research into students’ experience using them. This study explores university student’s experiences of using DMHP. Eleven participants from UK universities took part in semi-structured interviews, which explored their experiences using DMHP. Qualitative data was analysed using Reflexive thematic analysis. Five themes were generated: ‘Signposted to self-reliance’, ‘It’d be nice to talk to someone’, ‘It’s a community, but not a true community’, ‘Easy in, easy out’ and ‘It’s a safe space’. There was a wealth of information available to participants via DMHP, but some felt forced to use it, or did not feel staff support was sufficient. Reading similar experiences normalised some student’s distress but made others feel worse. Some students queried whether they should be supporting other students, considering they are seeking support themselves. Further research should explore how to best create online peer support communities for university students, and to explore which students would most benefit from DMHP, as they do not appear suitable for all.

Background:Primary Sjögren’s Disease (pSjD) has a major impact on sexual functioning, which is associated with anxiety, depression, relationship dissatisfaction and a lower mental quality of life.1 However, sexual functioning has...

Objective To assess the feasibility, acceptability, and preliminary effectiveness of digital peer support integrated medical and psychiatric self-management intervention (“PeerTECH”) for adults with a serious mental illness. Methods Twenty-one adults with a chart diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or treatment-refractory major depressive disorder) and at least one medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 18 years and older received the PeerTECH intervention in the community. Nine peer support specialists were trained to deliver PeerTECH. Data were collected at baseline and 12-weeks. Results This pilot study demonstrated that a 12-week, digital peer support integrated medical and psychiatric self-management intervention for adults with serious mental illness was feasible and acceptable among peer support specialists and patients and was associated with statistically significant improvements in self-efficacy to manage chronic disease and personal empowerment. In addition, pre/post non-statistically significant improvements were observed in psychiatric self-management, medical self-management skills, and feelings of loneliness. Conclusions This single-arm pre/post pilot study demonstrated preliminary evidence peer support specialists could offer a fidelity-adherent digital peer support self-management intervention to adults with serious mental illness. These findings build on the evidence that a digital peer support self-management intervention for adults with serious mental illness designed to improve medical and psychiatric self-management is feasible, acceptable, and shows promising evidence of improvements in clinical outcomes. The use of technology among peer support specialists may be a promising tool to facilitate the delivery of peer support and guided evidence-based self-management support. People with serious mental illness (SMI; defined as individuals diagnosed with schizophrenia spectrum disorder, bipolar disorder, or treatment-refractory major depressive disorder) are increasingly utilizing peer support services to support their health and recovery. Peer support is defined as shared knowledge, experience, emotional, social, and/or practical assistance to support others with similar lived experiences (Solomon, 2004). Most recently the definition also includes the provision of evidence-based peer-supported self-management services (Fortuna et al., 2020). Mental health peer support can augment the traditional mental health treatment system through providing support services to maintain recovery between clinical encounters (Solomon, 2004) and is classified by the World Health Organization as an essential element of recovery (World, Health, and Organization, About social determinants of health, 2017).

The effectiveness of online interventions for patients with gynecological cancer: An integrative review