Peer Facilitators Research Articles

“There’s hope and there’s a future for all of us”: co-design of a group cognitive behavioral therapy (CBT) intervention for trans young people (TAG TEAM)

Background Trans youth experience gender minority stress, which contributes to poor mental health outcomes. Previous studies have demonstrated that group cognitive behavioral therapy (CBT) interventions are effective in improving mental health and well-being in LGBTQ+ youth experiencing minority stress more broadly. At the same time, there is growing recognition of the importance of co-designing novel mental health interventions to improve their acceptability and relevance. Currently, there is a need for group CBT interventions that have been co-designed with trans youth to ensure such programs are tailored to their needs. Aim To develop a novel group CBT intervention for trans young people using co-design. Methods We conducted a co-design study with trans youth recruited from the Royal Children’s Hospital Gender Service in Victoria, Australia. Applying a participatory research approach, we held three online co-design workshops where participants designed the intervention’s structure, format, objectives and content. We recorded and transcribed the workshops and thematically analyzed the transcripts to develop the intervention. Results Eight trans young people aged 15–21 years participated in the study. Participants made recommendations for the intervention centering around: (1) trans community connection, positivity, and hope, and (2) accommodating diverse experiences, perspectives, and needs. TAG TEAM (Trans Adolescent Group ThErapy for Alleviating Minority stress) was developed on the basis of these recommendations, consisting of six two-hour sessions conducted weekly and facilitated by a psychologist and trans peer facilitator. Discussion The use of co-design to develop the TAG TEAM intervention is likely to improve its applicability to trans young people and their needs, which in turn increases its potential to improve their mental health.

Effect of peer facilitation in anatomy small group curriculum on academic performance and retention: A pilot study.

Peer-assisted learning and group facilitation have been proven to foster active participation in small-group learning, and these effective teaching modalities have been shown to enhance learning outcomes. This study introduced a student peer facilitator role in an anatomy small-group curriculum for pre-clerkship medical students and explored its impact on academic performance and retention. Students were required to rotate through this facilitator role and lead their small group during their designated sessions. Data collection methods included pre-course and post-course surveys, individual quiz grades, and retention quizzes sent 1 month after each quiz. Overall, the data revealed a significant increase in the overall combined quiz averages across the curriculum for facilitators compared to participants despite having no notable increase in preparation time (p = 0.004). While facilitators scored significantly higher on the course quizzes, the slight increase in their average retention quiz scores was not significant. This study was unable to identify any significant benefits to retention for either facilitators or participants. In all, this study suggests that a peer facilitation paradigm can be an effective educational modality for medical students, and future studies should explore ways to improve knowledge retention through this role.

Peer facilitation and teacher‐less pedagogy: A case study of a tertiary EFL listening course

AbstractThe benefits of peer facilitation on the development of students' skills in various fields have been widely discussed. However, we know very little about how teachers could draw on peer facilitation to improve pedagogical designs. This study aimed to investigate the influence of peer facilitation carried out in a tertiary EFL (English as a Foreign Language) listening course on students and teacher's pedagogical improvement. This qualitative case study collected data from four main sources: students' (n = 20) presentation slides; student feedback survey (n = 17) conducted at the end of the 4‐month listening project; teacher's reflective journal; teacher's observation notes. Two researchers adopted the approach of thematic analysis, following the six steps in the process of data analysis. On students' part, results indicate that pre‐facilitation training and teacher‐student communication in the preparation stage helped students improve linguistic, social and affective, cognitive and metacognitive skills. Learner autonomy was reflected in a good showcase of student personalities in peer facilitation and an awareness of demonstrating positionality when selecting materials and designing exercises for listening. On the teacher's part, by providing training for student peer facilitation, monitoring the preparation, observing the presentation, and giving feedback on the facilitation, the teacher gained a profound understanding of student needs, aspirations, and techniques adopted in their facilitation, which in turn helped the teacher improve pedagogical designs.

Peer-led recovery groups for people with psychosis in South Africa (PRIZE): Results of a randomized controlled feasibility trial.

The aims of this feasibility trial were to assess the acceptability and feasibility of peer-led recovery groups for people with psychosis in a low-resource South African setting, to assess the feasibility of trial methods, and to determine key parameters in preparation for a definitive trial. The design was an individually randomised feasibility trial comparing recovery groups in addition to treatment as usual (TAU) with TAU alone. Ninety-two isiXhosa-speaking people with psychosis and forty-seven linked caregivers were recruited from primary care clinics and randomly allocated to trial arms in a 1:1 allocation ratio. TAU comprised anti-psychotic medication delivered in primary care. The intervention arm comprised six recovery groups including service users and caregivers. Two-hour recovery group sessions were delivered weekly in a 2-month auxiliary social worker (ASW)-led phase, then a 3-month peer-led phase. To explore acceptability and feasibility, a mixed methods process evaluation included 25 in-depth interviews and 2 focus group discussions at 5months with service users, caregivers and implementers, and quantitative data collection including attendance and facilitator competence. To explore potential effectiveness, quantitative outcome data (functioning, relapse, unmet needs, personal recovery, stigma, health service use, medication adherence and caregiver burden) were collected at baseline, 2months and 5months post randomisation. Trial registration: PACTR202202482587686. Qualitative interviews revealed that recovery groups were broadly acceptable with most participants finding groups to be an enjoyable opportunity for social interaction, and joint problem-solving. Peer facilitation was a positive experience; however a minority of participants did not value expertise by lived experience to the same degree as expertise of professional facilitators. Attendance was moderate in the ASW-led phase (participants attended 59% sessions on average) and decreased in the peer-led phase (41% on average). Participants desired a greater focus on productive activities and financial security. Recovery groups appeared to positively impact on relapse. Relapse occurred in 1 (2.2%) of 46 participants in the recovery group arm compared to 8 (17.4%) of 46 participants in the control arm (risk difference -0.15 [95% CI: -0.26; -0.05]). Recovery groups also impacted on the number of days in the last month totally unable to work (mean 1.4days recovery groups vs 7.7days control; adjusted mean difference -6.3 [95%CI: -12.2; -0.3]). There were no effects on other outcomes. Peer-led recovery groups for people with psychosis in South Africa are potentially acceptable, feasible and effective. A larger trial, incorporating amendments such as increased support for peer facilitators, is needed to demonstrate intervention effectiveness definitively.

Personil Sekolah yang Memberi Kenyamanan untuk “Curhat”

Mental health problems in students require good support from all school personnel. However, not all students who have problems are comfortable talking to others about their problems. The purpose of this study is to describe school personnel who can make students feel comfortable to tell their story. Through this research, it is hoped that data can be obtained to serve as a basis for utilizing school personnel in providing guidance and counseling services. The study used a quantitative approach of descriptive survey type. The research sample was taken from 179 vocational school students in Yogyakarta City randomly. Data collection was conducted using an open-ended questionnaire to obtain who the school personnel were most comfortable talking to. Data analysis was done by calculating the percentage of the results of filling out the questionnaire. The results showed that the majority of students felt comfortable talking to friends, with teachers coming second and other school staff. The results of this study emphasize the chances of success of guidance and counseling services by utilizing peers, such as group-based services and peer facilitator services

The effectiveness of Hope Groups, a mental health, parenting support, and violence prevention program for families affected by the war in Ukraine: Findings from a pre-post study

BackgroundNearly one in six children lived in war zones in 2023. Evidence-based psychosocial and parenting support has potential to mitigate negative impacts for parents and children co-exposed to war and displacement, especially in relation to mental health and harsh parenting reactions. In the current war in Ukraine, local mental health experts co-created and evaluated, with global experts, the effectiveness of psychosocial and parenting support groups, called ‘Hope Groups’ on improvements in mental health, positive parenting, and violence against children. This paper aimed to assess the effectiveness of psychosocial and parenting support groups, called 'Hope Groups,' on improvements in caregiver mental health, positive parenting, and prevention of violence against children, for families affected by the war in Ukraine, using a pre/post study design. MethodsParticipants (n = 577) included Ukrainian caregivers, 66% (381) of whom were parents and co-residing caregivers of children ages 0–17, while the remaining 34% were non-resident informal caregivers. Internally displaced, externally displaced, and those living at-home in war-torn regions were invited to groups by trained Ukrainian peer facilitators. Using a pre-post design, we compared individual level frequency measures at three time-points – baseline, midline, and endline, to assess changes in 4 mental health, and 9 parenting and child health outcomes. We analyzed these outcomes using paired t-tests to compare outcomes at baseline-to-midline (after 4-sessions) and baseline-to-endline (after 10-sessions), which estimated the mean changes in days per week and associated percent change, during the respective periods; we quantified uncertainties using bias-corrected and accelerated (BCa) bootstrapping with 95% uncertainty ranges for baseline-midline and baseline-endline estimates. We used this same approach for stratified analyses to assess potential effect modification by displacement status and facilitator type. We further used linear models to adjust for age and sex. FindingsCompared to baseline, every mental health, parenting, and child health outcome improved significantly at midline and endline. Mental health ratings showed endline reductions in depressive symptoms of 56.8% (95% CI: -59.0,-54.3; -1.8 days/week), and increases in hopefulness, coping with grief, and self-care, ranging from 62.0% (95% CI: 53.6,71.3; 2.2 days/week) to 77.0% (95% CI: 66.3,88.3; 2.2 days/week). Significant improvements in parenting and child health outcomes included monitoring children, reinforcing positive behavior, supporting child development, protecting child, nonviolent discipline, and child verbalizing emotions. By endline, emotional violence, physical violence, and child despondency had dropped by 57.7% (95% CI: -63.0%,-51.9; -1.3 days/week), 64.0% (95% CI: -79.0,-39.5; -0.22 days/week), and 51.9% (95% CI: -45.1,-57.9; -1.2 days/week), respectively. Outcomes stratified by displacement status remained significant across all groups, as did those according to facilitator type (lay versus professional). InterpretationThis study demonstrates preliminary evidence, using a brief survey and pre-post design as is appropriate for acute and early protracted emergency settings, of the feasibility and effectiveness of Hope Groups for war-affected Ukrainian caregivers, on improved mental health, positive parenting, and reduced violence against children.

Hope Groups: a protocol for a cluster randomized controlled trial of psychosocial, mental health, and parenting support groups for Ukrainian caregivers during war and conflict

BackgroundIn 2021, more than two-thirds of the world’s children lived in a conflict-affected country. In 2022, 13 million Ukrainians were forced to flee their homes after Russia’s full-scale invasion. Hope Groups are a 12-session psychosocial, mental health, and parenting support intervention designed to strengthen parents, caregivers, and children affected by war and crisis. The primary objective of this study is to evaluate the effectiveness of Hope Groups among Ukrainians affected by war, compared to a wait-list control group. This protocol describes a promising decentralized intervention delivery model and an innovative research design, which estimates the causal effect of Hope Groups while prioritizing prompt delivery of beneficial services to war-affected participants.MethodsThis protocol describes a pragmatic cluster randomized controlled trial (RCT) among Ukrainians externally displaced, internally displaced within Ukraine, and living at home in war-affected areas. This study consists of 90 clusters with 4–7 participants per cluster, totaling approximately n = 450 participants. Intervention clusters will receive 12-session Hope Groups led by peer facilitators, and control clusters will be wait-listed to receive the intervention after the RCT concludes. Clusters will be matched on the facilitator performing recruitment and intervention delivery. Primary outcomes are caregiver mental health, violence against children, and positive parenting practices. Secondary outcomes include prevention of violence against women and caregiver and child well-being. Outcomes will be based on caregiver report and collected at baseline and endline (1-week post-intervention). Follow-up data will be collected among the intervention group at 6–8 weeks post-intervention, with aims for quasi-experimental follow-ups after 6 and 12 months, pending war circumstances and funding. Analyses will utilize matching techniques, Bayesian interim analyses, and multi-level modeling to estimate the causal effect of Hope Groups in comparison to wait-list controls.DiscussionThis study is the first known randomized trial of a psychosocial, mental health, and parenting intervention among Ukrainians affected by war. If results demonstrate effectiveness, Hope Groups hold the potential to be adapted and scaled to other populations affected by war and crisis worldwide. Additionally, methodologies described in this protocol could be utilized in crisis-setting research to simultaneously prioritize the estimation of causal effects and prompt delivery of beneficial interventions to crisis-affected populations.Trial registrationThis trial was registered on Open Science Framework on November 9, 2023. Registration: OSF.IO/UVJ67.

EFL students’ critical thinking in asynchronous online discussions: A perspective of peer facilitation

With the widespread application of technology in various learning communities, asynchronous online discussions (AODs) have been repeatedly reported as important for exchanging and constructing knowledge and fostering critical thinking (CT). Nevertheless, the specific conducive processes in AODs are yet to be further identified. This study explored the effects of peer facilitation on enhancing CT by tracking the peer facilitation strategies and the corresponding CT episodes in AODs. Forty-five Chinese college students in an English for Academic Purposes (EAP) course participated in a three-phase online discussion task: Stating, Commenting, and Responding. Upon completion of the discussion, all interactive postings were retrieved verbatim and coded for peer facilitation instances and CT episodes in MAXQDA 2022. Seven peer facilitation strategies emerged from 105 peer facilitation instances at the Commenting phase and revealed a frequency-based three-tier peer facilitation pattern, with the bottom-tier, middle-tier and top-tier peer facilitation strategies correspondingly playing the bonding, engaging and monitoring functions in AODs. Such peer facilitation effectively triggered 78 CT episodes, with higher-level CT episodes aggregating on Analyze and Evaluate along an ascending CT level scale from Recognize, Understand, Analyze, Evaluate to Create. This study further identified stem and branch peer facilitation strategies that students employed in AODs, among which the single-strategy and double-strategy structures were more effective in triggering higher-level CT such as Analyze and Evaluate. In light of these findings, pedagogical implications are discussed for employing AODs as a learning community to foster CT in EFL classes.

Problem-Based Teaching: An Exploratory Analysis of Discourse Methods of Peer Facilitators in a Summer Engineering Bridge Program

Problem-Based Teaching: An Exploratory Analysis of Discourse Methods of Peer Facilitators in a Summer Engineering Bridge Program

A great way to bring up health behaviour topics at playgroup: a qualitative evaluation of the Healthy Conversations @ Playgroup program

BackgroundThe early years is a critical stage to establish optimal nutrition and movement behaviours. Community playgroups are a relaxed environment for parents with a focus on social connection and supporting parents in their role as ‘First Teachers’. Playgroups are therefore an opportunistic setting to promote health behaviours in the early years. To support parents with young children around healthy lifestyle behaviours, the Healthy Conversations @ Playgroup program was delivered in urban and regional areas, across three Australian jurisdictions between 2021–2023.ObjectiveThis qualitative evaluation aimed to understand how the Healthy Conversations @ Playgroup program was experienced by parents, playgroup coordinators and peer facilitators.DesignSemi-structured virtual interviews and focus groups were conducted with parents, playgroup coordinators (i.e., person responsible for coordinating the playgroup) and peer facilitators (i.e., trained facilitator for the program) that participated in the Healthy Conversations @ Playgroup study. Transcripts were analysed following a thematic analysis approach.ResultsTwenty-eight playgroup parents, coordinators or peer facilitators participated in one of 8 focus groups or 5 interviews. Four themes were developed: Program strengths and challenges; Setting strengths and challenges; Factors that impact program delivery; Participant’s suggestions for future program delivery.ConclusionsThe Healthy Conversations @ Playgroup program was valued by parents, providing validation and normalisation of parenting practices, and fostering a shared experience of parenting. Playgroups are a convenient setting for families to attend. The dynamic and distracting nature of the playgroup setting were carefully considered when designing the program. Strategies to further enhance program engagement could include use of coordinator or parent champions, tailored delivery, and extending the reach to other family members.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12621000055808, registered 22 January 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380890

CyberRwanda's Pathway to Impact: Results From a Cluster-Randomized Trial of Adolescent Family Planning Knowledge, Beliefs, Self-Efficacy, and Behavior

PurposeCyberRwanda is a digital health intervention designed to increase knowledge of family planning and reproductive health (FP/RH) and access to youth-friendly services in Rwanda. MethodsSixty schools in eight districts were randomized 1:1:1 to one of two CyberRwanda implementation models—self-service (tablet-only) or facilitated (tablet, activity booklet, peer facilitators)—or to control. Students aged 12–19 years were randomly selected to participate. Baseline and 12-month midline surveys assessed intermediate (secondary) outcomes of FP/RH and HIV knowledge, attitudes/beliefs, self-efficacy, and behavior. Prevalence differences (PDs) were estimated using generalized linear mixed models. ResultsThere were 5,767 midline participants (51% female, mean/median age: 16 years, 29.9% sexually active). Those in CyberRwanda schools had higher knowledge of emergency contraception (57.3% vs. 47.5%, PD: 0.09, 95% confidence interval [CI]: 0.05–0.13); greater confidence in providing consent (73.3% vs. 68.1%, PD: 0.05, 95% CI: 0.01–0.08), negotiating partner's contraceptive use (88.3% vs. 85.0%, PD: 0.03, 95% CI: 0.01–0.06), and accessing/using contraceptive services (95.6% vs. 91.8%, PD: 0.03, 95% CI: 0.02–0.05); and more favorable views on FP/RH services (54.5% vs. 48.5%, PD: 0.06, 95% CI: 0.02–0.11) and condoms (76.9% vs. 71.3%, PD: 0.06, 95% CI: 0.03–0.08) compared to control. No significant differences in HIV/fertility knowledge, confidence in accessing HIV testing, or condom use were observed. DiscussionCyberRwanda increased FP/RH knowledge, supportive attitudes/beliefs, self-efficacy, and behavior at 12 months. The 24-month endline analysis will reveal whether CyberRwanda's benefits on intermediate outcomes result in changes to the primary outcomes, including contraception use and childbearing.

A Pilot of a Chronic Disease Self-Management Programme in Moldova

ABSTRACT Over half of the world’s mortality is associated with chronic diseases. Living with chronic diseases can significantly affect patients’ quality of life. The daily management of these diseases falls mostly on patients themselves. Self-management interventions have become increasingly used as a complementary intervention to treatment and care. The Chronic Disease Self-Management Programme (CDSMP) is the most widespread self-management intervention. It aims to empower patients and provide them with the skills to manage their disease and prevent complications. A locally adapted CDSMP was piloted in the Republic of Moldova in 2018/2019 in five villages across three rural districts. In five groups led by peer facilitators, 63 participants were enrolled in the programme. Four participants were lost to follow-up. To evaluate the intervention, we used the Self-Efficacy for Managing Chronic Diseases six-item scale questionnaire with participants before and after the programme, along with a questionnaire to assess satisfaction with the programme. Additionally, we conducted a focus group discussion (FGD) with the 10 programme facilitators. We found that, not only did participants’ self-efficacy significantly increase between baseline and follow-up (from mean score of 5.3 to 8.3; t(58) = -12.2, p < 0.001), they also improved their knowledge on every individual item on how to manage a chronic disease (p < 0.001). Participants’ satisfaction was high, with 96% of respondents satisfied with content, format and delivery elements of the intervention. Hence, we believe the CDSMP is locally acceptable and effective at least in the short-term, and offers promises for scale-up in the Republic of Moldova.

Coproduction with peer support groups: A new approach to culturally responsive social services.

The disparity of access to suitable social services for people from culturally diverse backgrounds is receiving increased attention. Coproduction between service users and providers has the potential as an approach to improve the cultural responsiveness of social services. What remains unknown is how social service organizations can facilitate and support coproduction with people from culturally diverse backgrounds. This article examines how three disability support organizations in Australia worked with peer support groups run by people with disability and their families from Chinese background to improve the organizations'service provision. We collected qualitative data through observations of activities in the groups and semistructured interviews with group members and organization staff. We found that organizing peer support groups facilitated knowledge exchange between people from culturally diverse backgrounds and organizations to inform practice development. Five contributors to the knowledge exchange were as follows: (1)assigning staff responsibility for exchange and trust with the group; (2)encouraging the group to challenge practice and cultural norms; (3)identifying and supporting the capacity of peer facilitators; (4)fostering trust within the group; and (5)collaborating with other organizations. Cultural responsiveness means incorporating people's cultural preferences in support provision and addressing the negative influences of cultural norms on people.

Peer Facilitator Training for Diabetes Prevention in a Nigerian Drug Treatment Center.

Individuals with substance use disorders (SUDs) are at an increased risk of developing comorbid medical conditions, including Type 2 diabetes. Although the diabetes prevention program (DPP) is efficacious and cost-effective, there is no published evidence to support its implementation in Nigeria or within SUD treatment settings. In this first known DPP within an SUD treatment program, we implemented a multiphased, nurse-led DPP at a small outpatient drug treatment center in Nigeria. The aim of this article was to describe only the processes utilized for the initial peer facilitator (PF) training (Phase 1). In Phase 1, a diabetes prevention master trainer delivered a virtual DPP training to the facility's lead nurse, who return-demonstrated the DPP workshop skills and competencies over four 4-hour sessions. The lead nurse then independently delivered four 8-hour training sessions to a small number of client volunteers (n = 4) who subsequently delivered the DPP lifestyle interventions to their peers in the outpatient treatment program. The client volunteers attended all PF workshop sessions and were observed to be proficient in all aspects of implementation. They indicated that the training objectives were easily achieved and expressed enthusiasm for delivering DPP content to their peers. The need to better contextualize the DPP curriculum specific to Nigerian food preferences was identified. The Phase 1 training process appears to be an appropriate and effective approach for preparing PFs to deliver health programs, like the DPP, in environments with limited resources for populations facing numerous challenges.

Walking through the Fire

Women involved in sex work experience high rates of abuse often from multiple perpetrators. This study examined the impacts of a novel community-based program addressing the intersecting issues of sex work and abuse using a coercive control framework. Five years of qualitative data from 88 women and 20 peer facilitators revealed complex histories of trauma that deeply impacted women’s capacity for healing. Results also showed that the group program created opportunities for shared learning, a sense of community and relationship equity. Follow-up supports are necessary to sustain and build on the program successes and for long-term safety-related empowerment.

Effectiveness of group problem management plus in distressed Syrian refugees in Türkiye: a randomized controlled trial.

Despite high levels of psychological distress, mental health service use among Syrian refugees in urban settings is low. To address the mental healthcare gap, the World Health Organization developed group problem management plus (gPM+), a scalable psychological intervention delivered by non-specialist peer facilitators. The study aimed to evaluate the effectiveness of gPM+ in reducing symptoms of depression and anxiety among Syrian refugees in Istanbul, Türkiye. A randomized controlled trial was conducted among 368 distressed (Kessler Psychological Distress Scale, K10 > 15) adult Syrian refugees with impaired functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16). Participants were recruited between August 2019 and September 2020 through a non-governmental organization providing services to refugees. Participants were randomly allocated to gPM+ and enhanced care as usual (gPM+/E-CAU) (184 participants) or E-CAU only (184 participants). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist (HSCL-25)) at 3-month follow-up. Secondary outcomes were post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5; PCL-5), functional impairment (WHODAS 2.0), and self-identified problems (psychological outcome profiles). Intent-to-treat analyses showed no significant effect of gPM+ on symptoms of anxiety, depression, PTSD and self-identified problems. Yet, there was a significant reduction in functional impairment in gPM+/E-CAU compared to E-CAU at 3-month follow-up (adjusted mean difference 1.66, 95 % CI 0.04, 3.27, p = 0.045, d = 0.19). Post-hoc subgroup analyses among participants with probable baseline depression or anxiety showed that there was a small but significant reduction in depression (adjusted mean difference -0.17, 95 % CI -0.32, -0.02, p = 0.028, d = 0.27) and anxiety (adjusted mean difference -0.21, 95 % CI -0.37, -0.05, p = 0.009, d = 0.30) symptoms comparing gPM+/E-CAU to E-CAU only at 1-week post assessment, but not at 3-month follow-up. There was a significant difference between conditions on functional impairment at 3-month follow-up, favouring gPM+/E-CAU condition (adjusted mean difference -1.98, 95 % CI -3.93, -0.02, p = 0.048, d = 0.26). In this study in an urban setting in Türkiye, gPM+ did not alleviate symptoms of depression and anxiety among Syrian refugees experiencing psychological distress and daily living difficulties. However, participants with higher distress at baseline seemed to benefit from gPM+, but treatment gains disappeared in the long term. Current findings highlight the potential benefit of tailored psychosocial interventions for highly distressed refugees in volatile low-resource settings.

Self-directed versus peer-supported digital self-management programmes for mental and sexual wellbeing after acquired brain injury (HOPE4ABI): protocol for a feasibility randomised controlled trial

BackgroundAcquired brain injury (ABI) can lead to biopsychosocial changes such as depression, low self-esteem and fatigue. These changes can cause, and be caused by, sexual issues affecting relationships and wellbeing. Given the relationship between sexual wellbeing and mental health, it is feasible that supporting sexual wellbeing will benefit psychological wellbeing. However, neurorehabilitation is inconsistent and often fragmented across the UK, and psychological, sexual and social support are lacking. Research shows that self-management and peer-support programmes can improve quality of life, self-efficacy and psychological wellbeing after brain injury. This protocol describes a feasibility randomised controlled trial (RCT) of a digital self-management programme to support mental and sexual wellbeing (known as HOPE4ABI), co-designed with and for people with ABI.MethodsThis mixed-methods feasibility RCT has two parallel trial arms of the 8-week digital HOPE4ABI self-management programme. Eligibility criteria include age > 18 years, diagnosed or suspected ABI > 3 months prior to trial entry, access to an Internet-enabled device and ability to engage with the intervention. Referrals to the study website will be made via the National Health Service (NHS), social media and partnering organisations. Sixty eligible participants will be randomised at a ratio of 1:1 to peer-supported (n = 30) or self-directed (n = 30) HOPE4ABI programmes. Primary feasibility outcomes include recruitment and retention rates, engagement, adherence and usage. Secondary outcomes related to standardised measures of quality of life, sexual wellbeing and mental wellbeing. Participants and peer facilitators will be interviewed after the course to assess acceptability across both trial arms.DiscussionThis feasibility trial data is not sufficiently powered for inferential statistical analyses but will provide evidence of the feasibility of a full RCT. Quantitative trial data will be analysed descriptively, and participant screening data representing age, ethnicity and gender will be presented as proportions at the group level. These data may indicate trends in reach to particular demographic groups that can inform future recruitment strategies to widen participation. Progression to a definitive trial will be justified if predetermined criteria are met, relating to recruitment, retention, engagement and acceptability.Trial registrationISRCTN46988394 registered on March 1, 2023.

Outcomes of an interprofessional peer facilitators program: Building a confident, competent, and collaboration ready healthcare workforce

Peer facilitation during interprofessional simulation-based learning enables students from diverse professions and backgrounds to enrich each other's learning in small groups. Peer facilitators are interprofessional role models and serve to maintain neutrality, listen actively, and respond to group dynamics supporting interprofessional education (IPE). This paper will report the outcomes of an interprofessional peer facilitation program as part of a larger IPE curriculum in a graduate program in the health professions. The authors conducted a mixed methods evaluation of peer facilitators' development measured through a peer facilitator knowledge and self-efficacy tool. Results of qualitative and quantitative data from four years of the program are discussed, documenting the outcomes serving as a peer facilitator has on entry-level health professions learners.

INNV-34. A NOVEL APPROACH TO ADDRESSING THE UNIQUE NEEDS OF ADOLESCENT AND YOUNG ADULT (AYA) BRAIN TUMOR PATIENTS: A FRAMEWORK FOR A VIRTUAL PEER-LED YOUNG ADULT SUPPORT GROUP

Abstract INTRODUCTION Adolescent and young adult (AYA) patients (age 15-39) constitute 14.3% of new brain tumor diagnoses annually. While navigating cognitive and physical challenges from their tumor, these patients are also pursuing social independence, education, careers, relationships, and family planning. These patients have unique, and often unmet, psychosocial needs compared to older patients, requiring a new approach for comprehensive care. METHODS Three YA neuro-oncology patients from UCSF volunteered to facilitate a monthly virtual support group. Facilitators were trained in peer support mentorship and support group facilitation by a licensed psychologist. A program planning committee consisted of: a social worker, nurse practitioner, program manager, communications specialist, two neuro-oncologists, and the peer facilitators. Promotion was done through flyers, the UCSF and ABTA websites, and word-of-mouth. Feedback was collected via anonymous survey and informal discussions, and the planning committee met monthly to adapt to evolving group needs. Participants used a video chat app to stay connected between meetings. RESULTS Over one year, 73 patients registered, and 40 total participated (average 15/session). Participant age range was 19–44, and age at diagnosis was 10–43. From 19 survey responses, 84% preferred a mix of open and topic-driven discussions. Key topics desired for peer discussion included meditation/mindfulness (68%), cognitive changes (58%), symptom management (58%), relationships/sexual health (58%), exercise (58%), and anxiety (58%). By contrast, participants wanted healthcare providers to address tumor treatment (37%), cognitive challenges (37%), symptom management (32%), seizures (26%), nutrition (26%), and integrative health (21%). Qualitative feedback highlighted community and social support from similarly-aged peers facing similar challenges amongst the most valuable aspects. CONCLUSIONS AYA patients have different information and support needs from peers versus providers. Peer-led support groups effectively provide social support for AYA brain tumor patients. Successful implementation involves volunteer facilitators, training, regular planning committee meetings, and participant feedback.

Fidelity Assessment of Peer-Delivered Cognitive-Behavioral Therapy for Postpartum Depression.

Fidelity assessment of peer-administered interventions (PAIs) by expert therapists can be costly and limit scalability. This study's objective was to determine whether peer facilitators could assess the fidelity of peer-delivered group cognitive-behavioral therapy (CBT) for postpartum depression as effectively as an expert psychiatrist or a trained graduate student. Intervention adherence and competence were assessed by three peers (N=9 sessions) and by one expert psychiatrist and one graduate student (N=18 sessions). Interrater reliability was assessed with intraclass correlation coefficients (ICCs). ICCs were good to excellent (0.88-0.98) for adherence and competence ratings among the three types of raters (psychiatrist vs. peers, psychiatrist vs. student, and student vs. peers). Trained peers may be able to reliably rate the fidelity of a PAI for postpartum depression. This preliminary study represents the first step toward peer-led feedback as an alternative to expert-led supervision of peer-delivered group CBT for postpartum depression.