Digital Peer Support Research Articles

Physical activity for the elderly: systematic review and synthesis of digital health interventions

Abstract Background Physical activity (PA) is key for the well-being of the elderly. Despite its proven efficacy, many older adults remain sedentary. Digital health interventions offer promising results. The study aimed to appraise scientific literature evidence regarding digital interventions to improve physical activity levels among community-dwelling adults aged 60 years or older. Methods A systematic review and semiquantitative analysis were performed. Digital interventions were included if using eHealth/mHealth tools, app-based technologies and text messaging. An intervention control was required. Main outcomes consisted in physical activity levels and related measures. A semiquantitative approach was chosen for evidence synthesis, using a harvest plot to visually facilitate the weighing of results with sample size and quality assessment. Results A total of 10 studies (13 publications) were included, from which five main intervention types were identified (2 studies per each intervention type). A semiquantitative evidence synthesis via a harvest plot was performed, to base the studies evaluation on the simultaneous consideration of sample size, study quality by type and effectiveness of intervention. Interventions adopting dynamically-adjusted exercise plans via wearables and app-based digital peer-support resulted the most successful, whereas PA digital coaching interventions resulted the least recommendable for adoption. Motivating interventions through digital platforms and digital diaries showed inconclusive results. Conclusions Personalized interventions using dynamically-adjusted wearable-based technology and app-based digital peer-support ones resulted as the most promising. Their ability to provide real-time, personalized feedback and foster social support is key for health promotion. It is crucial to leverage these promising tools for enhancing population health, integrating them into comprehensive, equitable, sustainable and engaging public health interventions. Key messages • Interventions using personalized and dynamically-adjusted plans result as the most effective to increase physical activity amond the elderly. • It is key to integrate effective digital health tools into comprehensive, equitable, sustainable and engaging public health interventions to enhance population health.

Smartphone-Based Digital Peer Support for a Walking Intervention Among Public Officers in Kanagawa Prefecture: Single-Arm Pre- and Postintervention Evaluation.

Digital peer support, defined as peer support delivered through technology such as smartphone apps, may be promising to promote activity in the form of step counts. Interactions among users have a positive impact on retention rates, and apps with social elements show significant improvements in daily step count. However, the feasibility of digital peer support in promoting physical activity (PA) is unknown; therefore, its effectiveness on step count and the clinical implications remain unconfirmed. This study aimed to assess the feasibility of digital peer support over a 3-month intervention period using the retention rate as the outcome. Moreover, changes in daily step count and physical measurements were compared between pre- and postintervention. The study design was a 3-month 1-arm intervention with participants from local government offices in Kanagawa, Japan. We used an available smartphone app, Minchalle, as the tool for the group intervention. Participants were required to report their daily step count to a maximum of 5 members composed exclusively of study participants. The primary outcome was the retention rate. Secondary outcomes included daily step count, the rate of achieving daily step goals, physical measurements, and lifestyle characteristics. Descriptive statistics and the Pearson coefficient were used to examine the relationship between goal achievement and step count, as well as changes in step count and various variables including physical measurements. Of the 63 participants, 62 completed the intervention. The retention rate was 98% (62/63). The average daily step count during the intervention was 6993 (SD 2328) steps, an 1182-step increase compared with the count observed 1 week before the intervention began. The rate of achieving the daily step count during the intervention was 53.5% (SD 26.2%). There was a significant correlation (r=0.27, P=.05) between achieving daily step goals and increasing daily step count. Comparative analyses showed that changes in weight (68.56, SD 16.97 kg vs 67.30, SD 16.86 kg; P<.001), BMI (24.82, SD 4.80 kg/m2 vs 24.35, SD 4.73 kg/m2; P<.001), somatic fat rate (28.50%, SD 7.44% vs 26.58%, SD 7.90%; P=.005), systolic blood pressure (130.42, SD 17.92 mm Hg vs 122.00, SD 15.06 mm Hg; P<.001), and diastolic blood pressure (83.24, SD 13.27 mm Hg vs 77.92, SD 11.71 mm Hg; P=.002) were significantly different before and after the intervention. Similarly, the daily amount of PA significantly improved from 5.77 (SD 3.81) metabolic equivalent (MET)-hours per day to 9.85 (SD 7.84) MET-hours per day (P<.001). This study demonstrated that digital peer support is feasible for maintaining a high retention rate and can, therefore, effectively promote PA. It can be a promising tool to improve daily step count, subjective PA, and clinical outcomes, such as weight and somatic fat rate. UMIN Clinical Trials Registry UMIN000042520; https://tinyurl.com/46c4nm8z.

Uptake and engagement of a clinically moderated digital peer support platform to support the mental well-being older adults: a qualitative investigation.

The uptake of traditional mental health services among older adults remains low. Digital peer support offers older adults a resource for engaging with others to independently support their mental well-being. This qualitative study explored the uptake and engagement of a clinically moderated digital peer support platform (Breathing Space) for older adults with depressive symptoms and alcohol use concerns. Semi-structured interviews with 30 participants aged 60-80 years explored participants' uptake and engagement with Breathing Space, a novel, moderated, private, and anonymous peer support platform. Data were analysed using reflective thematic analysis and are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. Three themes were constructed to characterize participants' experiences: (i) navigating the complexities of peer-peer online engagement; (ii) the function of anonymity in online connection; and (iii) experiences of app features and content. Future development of digital peer support for older adults would benefit from the following: (i) co-design with older adults; (ii) providing choice over anonymity and increased options for interacting with peers; (iii) streamlining the basic functionality with popular platforms; (iv) providing options for users to curate their digital experience; and (v) providing telephone support for troubleshooting technical difficulties. Future research should explore the use of digital peer support among older adults who experience social exclusion challenges.

Young adults' experiences of using a young person's mental health peer support app: A qualitative interview study.

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.

Co-Design of a Digital Health Tool for Use by Individuals With Opioid Use Disorder: App4Independence (A4i-O).

Opioid use disorder (OUD) has arguably the highest mortality rate of mental health conditions; opiate-related deaths are identified as the number one cause of accidental deaths in Canada and the United States. Specialized care for OUD is often described as lacking, fractured, and with frequent periods of disengagement. Digital health strategies may support connection to evidence-based resources even during periods of disengagement. However, sustained engagement in digital interventions remains a barrier, and as such, experts recommend using co-design approaches to develop interventions. The current study outlines the results from a qualitative co-design project that engaged 6 lived experts and 8 clinical experts in a series of focus groups and interviews to adapt an existing intervention for use in OUD. Focus groups and interviews were recorded and transcribed before undergoing thematic analysis. This co-design process is the first stage of a larger project that will lead to the development of a novel digital health intervention for OUD populations. Transcripts underwent thematic analysis, and themes were divided into Crosscutting Themes, Feasibility and Engagement, and Specific Features. Each theme was divided into specific subthemes, which were reviewed by the design team and informed the design of the digital health platform. Key resulting directions included creating a psychologically safe digital space, curating resources for OUD as a multifaceted condition, and being mindful of barriers to implementation from both lived and clinical expert perspectives. Specific features are discussed in detail in the article. Lived experts and clinicians strongly supported integrating digital tools into OUD care. Ongoing work is needed to better understand the role of technology in existing OUD structures as well as the implementation of key features such as digital peer support and creating effective and safe social connections. This study also validates co-design as an essential step in digital health development.

"Instead, You're Going to a Friend": Evaluation of a Community-Developed, Peer-Delivered Online Crisis Prevention Intervention.

Online communities promote social connection and can be used for formal peer support and crisis intervention. Although some communities have programs to support their members' mental health, few programs have been formally evaluated. The authors present findings from a mixed-methods evaluation of the Stack Up Overwatch Program (StOP), a digital peer support intervention delivered in an online gaming community. Data were collected from members of the Stack Up Discord server between June and October 2020 and included chat messages, survey responses, encounter forms (documenting information from private interactions between users and peer supporters), and interviews with peer support team members. The authors analyzed data on demographic characteristics, mental health and crises, use of and experiences with StOP, and chat posts. Thematic analysis and descriptive statistics were combined in a joint display table, with mixed-methods findings explained in narrative form. The findings show that StOP provides users in crisis with a source of mental health support when other options have been exhausted and that military and veteran users valued the connections and friendships they formed while using it. Participants reported that StOP met needs for support and connection when formal services were inaccessible or did not meet their needs, and volunteer peer supporters detailed how StOP's design facilitates use of the intervention. Volunteering offered members of the peer support team a "family feeling" facilitated by the unique chat room structure. Community-based crisis prevention programs administered through chat rooms may provide valuable support to both users and peer support providers.

A Qualitative Program Evaluation of a Digital Peer Support Group for Formerly Incarcerated People

A Qualitative Program Evaluation of a Digital Peer Support Group for Formerly Incarcerated People

A Qualitative Program Evaluation of a Digital Peer Support Group for Formerly Incarcerated People

Abstract: Objectives: A qualitative program evaluation of the Formerly Incarcerated Peer Support (FIPS) group, a peer-led mutual support group for formerly incarcerated people, was conducted to understand participant perceptions of (1) digital delivery via Zoom, (2) curriculum content, (3) roles of group participants, and (4) therapeutic value of FIPS group as it relates to traumatic experiences in prison and ongoing challenges after release. Methods: Using a community-based participatory action research approach, a qualitative evaluation was conducted with participants in either the 2020 or 2021 curriculum. Semi-structured interviews were conducted via Zoom, transcribed, de-identified, coded, and analyzed via applied thematic analysis and results reviewed with participants. Results: Of 75 formerly incarcerated participants, 20 interviews were conducted and recorded ( n = 20). All participants were male, 85% were Black, and the average age was 54.8 years old. Zoom delivery was not preferred, but feasible. Most appreciated the comprehensive and holistic curriculum that enabled peers to gain practical and emotional social support in different areas of life after release. The facilitator’s experience with prison programs and relationships within peer networks was essential for recruitment and retention. Participants described (1) feelings of acceptance, (2) examples of teaching and learning from peers’ improved insight, trigger management, response modification to stressors, and (3) improved understanding within relationships with those who have not been incarcerated. Conclusions: Digital delivery of peer-led psychosocial support groups for formerly incarcerated people is feasible and impactful. Future research can further characterize the lingering impacts of institutional traumas and quantify changes.

Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial.

The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support-based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials.

Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study.

Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users' autonomy, competence, and relatedness. This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism. Participants were each prompted with a single question: "What's your struggle?" Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts. Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively. Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options.

Temporalities of peer support: the role of digital platforms in the ‘living presents’ of mental ill-health

ABSTRACT This paper considers matters of time in online mental health peer support. Significant evidence of the value of peer support exists, with new digital platforms emerging as part of the digitisation of mental health support. This paper draws from a project exploring the impact of digital platforms on peer support through interviews with users of a major UK-based online peer support platform. Drawing on Gilles Deleuze’s concept of the ‘living present’, the paper highlights how notions of past, present and future operate as co-existing dimensions of the present. The analysis highlights how the immediacy of digital platforms elicits expectations of peer support being ‘on tap’, which creates challenges when support is not received synchronously. Unlike in-person support, digital platforms facilitate the archiving of support, which can (re)enter the present at any moment through asynchronous communication. Anticipations of the future feature as dimensions of the present in terms of feelings regarding when support may no longer be needed. The paper offers potential implications for social scientific understanding of digital peer support, which include valuable insight for mental health services designing and delivering digital peer support.

Digital peer support for ICU survivors (icuRESOLVE): A pilot randomised controlled trial

Digital peer support for ICU survivors (icuRESOLVE): A pilot randomised controlled trial

Digital Tools in the Service of Peer and Social Support for Perinatal Mental Health.

This study is critically evaluating the current status of digital tools for perinatal mental health, specifically focusing on how these tools can enhance peer and social support. Digital tools could be used to: (1) identify individuals in need and guide them towards appropriate human-supportive care; (2) autonomously train and allocate peers to aid women experiencing perinatal mental health challenges; and (3) amplify support from their natural social network. Despite clear evidence supporting the significance of social support for perinatal mental health, there is a dearth of studies on digital tools aimed at boosting such support, leaving a gap in the evidence. Findings underscore the necessity of developing digital initiatives that explicitly aim to augment social support as an active ingredient of therapeutic change for women's perinatal mental health. To establish clear evidence of digital tools' value in providing digital peer-support, further development and research are indispensable.

Evaluating a Peer-Support Mobile App for Mental Health and Substance Use Among Adolescents Over 12 Months During the COVID-19 Pandemic: Randomized Controlled Trial.

Although it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. The aim of this study was to evaluate the efficacy of the Mind your Mate program, a digital peer-support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help seeking. The Mind your Mate program consists of a 40-minute web-based classroom lesson and a companion smartphone mobile app. The active control group received school-based health education as usual. A cluster randomized controlled trial was conducted with 12 secondary schools and 166 students (mean age 15.3, SD 0.41 years; 72/166, 43.4% female; and 133/166, 80.1% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use), and help-seeking measures at baseline and at 6-month and 12-month follow-ups. Students who received the Mind your Mate program had greater reductions in depressive symptoms over a 12-month period than controls (b=-1.86, 95% CI -3.73 to 0.02; Cohen d=-0.31). Anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No differences were observed in relation to psychological distress or help-seeking. Small to moderate reductions in depression symptoms were observed among students allocated to receive the Mind your Mate intervention. Although the current results are encouraging, there is a need to continue to refine, develop, and evaluate innovative applied approaches for the prevention of mental disorders in real-world settings. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000753954; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000753954. RR2-10.2196/26796.

Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders.

Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) "progress" is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians.

Introduction to the Coproduction of Supervision Standards for Digital Peer Support: Qualitative Study.

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.

A Randomized Controlled Trial for a Digital Peer Support Platform to Translate Online Peer Support for Emerging Adult Mental Well-being.

Emerging adulthood (ages 19 to 25) 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. These is burgeoning interest among healthcare 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. This randomized controlled trial (RCT) examined the effectiveness of digital peer support intervention over a digital platform-Acceset-for emerging adult psychological well-being with three primary aims. First, we evaluated the implementation effectiveness of digital peer support training for individuals providing support (befrienders), and 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 digital peer support intervention to emerging adult psychological well-being. The RCT involving 100 emerging adults from the National University of Singapore follows the published protocol on this trial [29]. The RCT found effectiveness of digital peer support training-specifically, befrienders' peer support responses demonstrating significantly higher post- than pre-training scores in selfhood (post-training: M = 62.83, SE = 10.18; pre-training: M = 54.86, SE = 7.32), t(34) = 3.88, P < .0001. The digital peer support intervention demonstrated clinical effectiveness in enhancing selfhood, compassion and mindfulness, and in lowering depressive and anxiety symptoms among seekers in the intervention group at post intervention (M = 7.15, SE = 0.88) than seekers in the waitlist control group prior to intervention (M = 11.75, SE = 0.89), t(89) = 3.44, P = 0.0009. 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 of the intervention had both immediate and prospective implications for their psychological well-being. This RCT on digital peer support intervention for emerging adult psychological well-being harnesses the interventional potential of four 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 provide the parameters and conditions in deploying effective and novel digital peer support intervention for emerging adult psychological well-being in real-world settings. ClinicalTrials.gov NCT05083676.

The Role of Moderators in Facilitating and Encouraging Peer-to-Peer Support in an Online Mental Health Community: A Qualitative Exploratory Study.

Online peer support platforms have gained popularity as a potential way for people struggling with mental health problems to share information and provide support to each other. While these platforms can offer an open space to discuss emotionally difficult issues, unsafe or unmoderated communities can allow potential harm to users by spreading triggering content, misinformation or hostile interactions. The purpose of this study was to explore the role of moderators in these online communities, and how moderators can facilitate peer-to-peer support, while minimizing harms to users and amplifying potential benefits.Moderators of the Togetherall peer support platform were recruited to participate in qualitative interviews. The moderators, referred to as 'Wall Guides', were asked about their day-to-day responsibilities, positive and negative experiences they have witnessed on the platform and the strategies they employ when encountering problems such as lack of engagement or posting of inappropriate content. The data were then analyzed qualitatively using thematic content analysis and consensus codes were deduced and reviewed to reach final results and representative themes.In total, 20 moderators participated in this study, and described their experiences and efforts to follow a consistent and shared protocol for responding to common scenarios in the online community. Many reported the deep connections formed by the online community, the helpful and thoughtful responses that members give each other and the satisfaction of seeing progress in members' recovery. They also reported occasional aggressive, sensitive or inconsiderate comments and posts on the platform. They respond by removing or revising the hurtful post or reaching out to the affected member to maintain the 'house rules'. Lastly, many discussed strategies they elicit to promote engagement from members within the community and ensure each member is supported through their use of the platform.This study sheds light on the critical role of moderators of online peer support communities, and their ability to contribute to the potential benefits of digital peer support while minimizing risks to users. The findings reported here accentuate the importance of having well-trained moderators on online peer support platforms and can guide future efforts to effectively train and supervise prospective peer support moderators. Moderators can become an active 'shaping force' and bring a cohesive culture of expressed empathy, sensitivity and care. The delivery of a healthy and safe community contrasts starkly with non-moderated online forums, which can become unhealthy and unsafe as a result.

Preparing for online peer support for Punjabi men's mental health

In the context of the COVID-19 pandemic, some Punjabi men have supported their mental health through digital peer support interventions. However, there is little research which reflects upon the impact of peer support education for people who identify as culturally, linguistically, or geographically Punjabi. This review aims to map, discuss and appraise the scholarly literature concerning Punjabi communities and peer support education. Open-source articles published in English were sought through Google Scholar due to broadest accessibility. Screened articles were analysed for common themes, summarised, and critically appraised alongside a case study reflection. The findings show that there is a distinct lack of literature which could help to develop and evaluate digital peer support education for Punjabi populations and that future research is warranted. Despite this, some existing research can provide scholarly foundations for such work. Further practice and evaluation is required to understand the potential possibilities and pitfalls for peer support education in Punjabi and racialized communities more broadly. Future research should take a specific focus on the potential for impact in peer support for Punjabi communities to explore the unique needs of the population. Without such research we risk being unable to develop precise and specific peer support interventions which may exacerbate existing inequities within mental health more widely.

"As soon as I start trusting human beings, they disappoint me, and now I am going to get on an app that someone could hack. I really do not want to take that chance": barriers and facilitators to digital peer support implementation into community mental health centers.

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.