Peer Health Research Articles

A key informant study of rural behavioral health agency providers assessing barriers to care and knowledge of peer health navigator interventions.

A key informant study of rural behavioral health agency providers assessing barriers to care and knowledge of peer health navigator interventions.

Characteristics and outcomes of community-based perinatal peer support: Protocol for a systematic review.

Mental health issues and parenting difficulties in the perinatal period are common, and have significant negative impacts on individuals, families, and broader society. Community-based peer support programs might be an effective adjunct to standard mental health interventions in perinatal mental health issues, specifically where low-cost interventions are required, or access to professional care is limited. A systematic review will be undertaken. Searches will be conducted on four electronic databases (Pubmed, Embase, Cinahl, and PsycINFO), using terms related to perinatal mental health and peer support. Literature will be screened by title and abstract and then by full text. Selected studies will be evaluated using the Quality Assessment with Diverse Studies (QuADS) tool. Data relevant to community-based perinatal peer support intervention characteristics and outcomes will be extracted, and synthesised narratively. This review will contribute to the existing evidence about perinatal mental health peer support, by synthesising information about community-based interventions specifically. The findings will be used to inform the design, implementation, and evaluation of a community-based perinatal mental health peer support program in urban and rural/remote hospital and health services in Australia. Systematic review registration: CRD42023451568.

LGBTQ Mental Health Peer Support: A Descriptive Survey

BackgroundGender and sexual minority adults have significant unmet mental health care needs and are often faced with barriers to accessing appropriate services. In this context, LGBTQ individuals often turn to each other for mental health support.MethodsIn a sample of 326 LGBTQ adults (M age = 37.64) who were providing mental health support to their LGBTQ peers, we examined the nature of LGBTQ peer support, including who provides peer support, to whom, and for what issues. We also examined the experiences of those providing LGBTQ peer support, and the role of mental health training. Data were collected in 2020.ResultsParticipants provided support to a range of individuals, including close friends, colleagues, and those who were previously strangers. The types of concerns they supported their peers with varied greatly, though depression, anxiety, suicidality, and coping with discrimination were common concerns. Participants were often managing multiple competing demands, and many appeared to be managing their own mental health concerns. Those who had received at least some mental health training appeared to fare better in their experiences of providing peer support compared to those without such training.Policy ImplicationsFindings illustrate the importance of increasing access to LGBTQ-affirmative mental health services. We also highlight the importance of developing and disseminating initiatives designed to support those providing LGBTQ peer support, both to increase the effectiveness of peer support and to help manage the impact of providing LGBTQ peer support.

Representing the experiences of charity peer leaders facilitating well-being interventions to their peers using a constructivist grounded theory methodology

PurposeThis study aims to generate theory that represented charity peer leader experiences, facilitating well-being interventions to two specific groups of people: new mothers and refugees.Design/methodology/approachPart 1 of this study used in-depth interviews (n = 8) and phone calls with experienced mothers (called “peer leaders”) who had facilitated well-being interventions to new mothers. These interviews were analysed using Constructivist Grounded Theory (CGT) (Charmaz, 2014) generating a theory. Following a systematic literature review using the theory categories as search terms, a training approach was devised: The Modelled Training Approach (MTA). Refugees (n = 16) were trained to facilitate another well-being intervention using the MTA followed by a further set of interviews (n = 6). These interviews were analysed using CGT.FindingsA theory was generated representing the “journey” the peer leaders took: their lived experience triggered empathic feelings towards their peers, which motivated them to build a rapport where they gave hope. As a result, the peer leaders felt rewarded.Originality/valueThe literature search did not find any studies looking at the experiences of peer leaders in the above settings. The theory generated could support mental health peer work offsetting statutory health costs.

Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis.

Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users' perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528.

Peer health coach experiences promoting a nondiet approach in a university health coaching program

PurposeResearch shows peer health education programs on university campuses can support students in pursuing sustainable health-related behavior changes. However, few programs deliver peer health education through a nondiet, weight-inclusive framework. Research shows that health educators who challenge the status quo of diet culture and weight-focused health interventions may face unique challenges when sharing this perspective with others. Thus, the purpose of this study was to examine the experiences of peer educators who provided critical health education by introducing a nondiet, weight-inclusive approach to health.Design/methodology/approachFive health coaches from a university health coaching program at a mid-sized southwestern university participated in a semi-structured interview. The data were analyzed through interpretative phenomenological analysis.FindingsPeer educators faced numerous challenges when introducing nondiet, weight-inclusive approaches such as lacking credibility as a peer to challenge weight-centric messages, feeling conflicted about honoring clients’ autonomy when clients are resistant to a weight-inclusive approach and feeling uncomfortable when discussing client vulnerabilities. Peer educators also identified several strategies that helped them navigate these challenges such as being intentional with social media, using motivational interviewing to unpack clients’ concerns about weight, and seeking group supervision.Originality/valueGiven the reality that health coaches will face challenges sharing weight-inclusive health approaches, educators and supervisors should explicitly incorporate strategies and training methods to help peer health coaches prepare for and cope with such challenges. More research is also needed to examine effective ways to introduce weight-inclusive approaches to college students.

Implementation of Educational Opportunities for Social Determinants of Health in Health Professions Education: A Scoping Review

Objective Health professions programs have recently increased their efforts to educate health care professionals about the social determinants of health (SDH); however, there seems to be a disconnect between graduate medical education and its applicability to other peer health professions. The current scoping review aims to map the literature that explores the implementation of educational opportunities focused on SDH in health professions education programs. Data Sources PubMed, CINAHL, ERIC, Education Source, and the Health Policy Reference Center were searched to identify relevant articles. Study Selection To be included in our review, articles had to have been published in the last 5 years and describe how material related to SDH was implemented into a graduate health professions education program. Outcomes were analyzed by thematic categories by type of curricular delivery (didactic, clinical education, service-learning experience, or reflection), timing of the implementation in the program, methods of implementation, and assessment after implementation. Data Extraction Our search identified 2006 articles that were reviewed by study authors; 36 were included in our full-text review. Information extracted included the study design, type of graduate education, aims of the studies, description of technique, timing of implementation, type of curricular delivery, and outcomes. Data Synthesis The majority (23, 63.9%) of studies used an observational design and used 2 or more (27, 75.0%) types of curricular delivery presented to medical students. Didactic (19, 52.8%) and small-group discussion (14, 38.9%) methods were used most often. Assessments were mostly student reflections or self-report items. Overall, students reported increased knowledge and satisfaction with activities. Conclusions Results of our scoping review indicated that various education opportunities related to SDH exist in graduate health professions education but are likely insufficient. More studies are necessary to investigate the purposeful implementation of SDH and the best methods to assess student knowledge of SDH. Future research should also investigate how to objectively assess student learning of SDH.

Exploring Sociopsychological Determinants and Interventions for Enhancing Health Literacy: A Multifaceted Approach

Health literacy, the ability to obtain, understand, and utilize health information to make informed decisions, is essential for promoting public health and reducing health disparities. This paper examines the sociopsychological determinants of health literacy, focusing on individual factors, interpersonal dynamics, and societal contexts. Specifically, it explores the influence of cognitive abilities, health beliefs, socioeconomic status, social support, family and peer influences, healthcare systems, health policy, and cultural competence on health literacy levels. Additionally, the paper discusses interventions to enhance health literacy, including education and health promotion programs, community-based initiatives, and digital health technologies. By synthesizing insights from social psychology and social work, the paper underscores the importance of addressing multifaceted factors shaping health literacy and promoting equitable access to health information and services.

Transcending technology boundaries and maintaining sense of community in virtual mental health peer support: a qualitative study with service providers and users

BackgroundThis qualitative study explores the experiences of peer support workers (PSWs) and service users (or peers) during transition from in-person to virtual mental health services. During and following the COVID-19 pandemic, the need for accessible and community-based mental health support has become increasingly important. This research aims to understand how technological factors act as bridges and boundaries to mental health peer support services. In addition, the study explores whether and how a sense of community can be built or maintained among PSWs and peers in a virtual space when connections are mediated by technology. This research fills a gap in the literature by incorporating the perspectives of service users and underscores the potential of virtual peer support beyond pandemic conditions.MethodsData collection was conducted from a community organization that offers mental health peer support services. Semi-structured interviews were conducted with 13 employees and 27 service users. Thematic analysis was employed to identify key themes and synthesize a comprehensive understanding.ResultsThe findings highlight the mental health peer support needs that were met through virtual services, the manifestation of technology-based boundaries and the steps taken to remove some of these boundaries, and the strategies employed by the organization and its members to establish and maintain a sense of community in a virtual environment marked by physical distancing and technology-mediated interrelations. The findings also reveal the importance of providing hybrid services consisting of a mixture of in person and virtual mental health support to reach a broad spectrum of service users.ConclusionsThe study contributes to the ongoing efforts to enhance community mental health services and support in the virtual realm. It shows the importance of virtual peer support in situations where in-person support is not accessible. A hybrid model combining virtual and in-person mental health support services is recommended for better accessibility to mental health support services. Moreover, the importance of organizational support and of equitable resource allocation to overcome service boundaries are discussed.

Effect of peer health education intervention on HIV/AIDS knowledge amongst in-school adolescents in secondary schools in Imo State, Nigeria

BackgroundPeer education is an approach to health promotion in which community members are supported to promote health-enhancing change among their peers. The study assessed the effect of peer health education on HIV/AIDS knowledge amongst in-school adolescents in secondary schools in Imo State.MethodsThis was an intervention study carried out among 296 and 287 in-school adolescents aged 15 to 19 years attending Akwakuma Girls Secondary School and Federal Government Girls College Owerri Imo State respectively. The study was in three stages: before intervention, intervention, and after intervention. The impact of peer education was evaluated twelve weeks after intervention. Data were collected using semi-structured questionnaires. The study utilized a quasi-experimental study design. The chi-square test and McNemar’s test were used to test the hypothesis with a significance level of p ≤ 0.05.ResultsThe result from the study revealed that the majority (73%) of the respondents at Akwakuma Girls Secondary School (test group) had poor knowledge of HIV/AIDS mode of transmission and prevention at baseline. The overall good knowledge of respondents in the test group improved from 27 to 81% after the intervention. 36% of the respondents in the control group had good knowledge at baseline, the knowledge of 64% of them with poor knowledge at baseline were compared post-test to those in the test group who also had poor knowledge at baseline. The knowledge of only 27.7% of those in the control group increased post-test while the remaining 72.3% still had poor knowledge. The result of the inter-school comparison using Chi-square revealed that the p-value was statistically significant. Intra-school comparison using McNemar’s test revealed a statistical significance for all questions in the test group, while none was positively significant in the control group.ConclusionsPeer health education improved the knowledge of the students at Akwakuma Girls Secondary School which was very low at the baseline. The knowledge of the students in the control group with poor knowledge at baseline didn’t increase post-study. Peer health education should be strengthened and expanded as one of the tools for behavior change among adolescents. There should be more focus on adolescents for HIV-targeted prevention.

Peer and land-based approaches for fostering empowering and healthy relationships with Indigenous and northern young people in the Northwest Territories.

Indigenous and Northern women in Canada experience high rates of intimate partner violence (IPV), and this is particularly true in the Northwest Territories (NWT). Adolescents are also at increased risk of IPV, which has far-reaching, lifelong effects. Indigenous youth are particularly vulnerable to IPV due to ongoing effects of intergenerational trauma caused by colonialism, racism and residential school legacies. We explored attitudes towards IPV and the healthy relationship knowledge, skills, and experiences among participants of Fostering Open eXpression among Youth (FOXY) and Strength, Masculinities, and Sexual Health (SMASH) Peer Leader Retreats in the NWT. Multi-method approaches included quantitative surveys youth completed before and immediately following retreats. Quantitative analysis from retreats (2018-2021) included 240 participants aged 12-19 (mean age 14.5) who reported ever having an intimate partner. Most were from the FOXY program (64.2%), Indigenous (69.6%) and heterosexual (66.4%). Qualitative methods included Focus Group Discussions (FGD) (n = 69) conducted with peer leaders and apprentices (n = 311) and youth and adult staff (n = 14 FGDs, n = 165 participants). We thematically analysed FGDs to explore healthy relationship knowledge and skills, alongside paired t-tests to examine pre/post retreat changes in attitudes towards IPV. Qualitative findings suggest that leadership and embodied learning were effective in equipping youth with violence prevention and healthy relationship skills. While young women were committed to sharing knowledge and skills about healthy relationships in their communities, young men resonated with values of respect and appreciated support to identify and express emotions. Participants across programmes demonstrated their belief that healthy intimate relationships have communal, relational and intergenerational benefits. Quantitatively, we found a statistically significant reduction in attitudes accepting of IPV among young women, but no changes were noted among young men. Findings contribute to emergent evidence on strengths-based, culturally-responsive IPV prevention programming. Components of effective IPV prevention programming with young men merit further exploration.

NIDILRR ARRT Fellows Symposium: Exploration of Workplace Stigma Resistance among Mental Health Peer Support Specialists

NIDILRR ARRT Fellows Symposium: Exploration of Workplace Stigma Resistance among Mental Health Peer Support Specialists

Using focus groups to inform a peer health navigator service for people who are transgender and gender diverse in Saskatchewan, Canada.

This study investigated healthcare access and quality for people who are transgender and gender-diverse (PTGD) in Saskatchewan (SK), Canada, to inform a larger project that was piloting two peer health navigators for PTGD. Two online focus groups were held. Nineteen participants were recruited to represent a broad range in age, gender and location in SK. Transcripts of the focus groups were analyzed using a thematic approach. The core theme that was identified was participants' desire for culturally safe healthcare. This core theme had two component themes: (1) systemic healthcare factors and (2) individual healthcare provider(HCP) factors. The healthcare system primarily acted as a barrier to culturally safe healthcare. HCPs could be either barriers or facilitators of culturally safe care; however, negative experiences outweighed positive ones. PTGD in SKface discrimination, with delays and barriers to care at all levels of the healthcare system. Peer health navigators can address some of these discrepancies; however, greater support is required for PTGD to be able to access culturally safe healthcare. People with lived experience/PTGD were involved in all stages of this project. They were included on the team as community researchers and co-developed the research project, conducted the focus groups, participated in the analyses and are co-authors. As well, both navigators and all the participants in the focus groups were also PTGD.

Level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia: an application of the data envelopment analysis

BackgroundBesides the scarcity of resources, inefficient utilization of available health service resources has been the bottleneck to deliver quality health services in Ethiopia. However, Information regarding the efficiency of health service providers is limited in the country. Health service managers and policy makers must be well informed about the efficiency of health service providers and ways of using limited resources efficiently to make evidence-based decisions. This study aimed to assess the level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted among 27 randomly selected health centers in East Gojjam zone, Northwest Ethiopia, from October 30, 2022, to April 30, 2023. Using an interviewer-administered questionnaire and document review checklist, health centers’ data was collected and entered to Epi-Data version 4.6. The data was exported to Microsoft office excel and Stata version 14 for analysis. A two-stage output-oriented data envelopment analysis with a variable return to scale assumption was employed to determine the level of technical efficiencies. Finally, the tobit regression model was applied to identify the associated factors at 5% level of significance.ResultsIn this study, 59.3% of the health centers were technically efficient. The mean technical efficiency score of the health centers was 0.899 ± 0.156. Inefficient health centers could provide more 22, 433 outpatient visits, 1,351 family planning visits, 155 referral services, 206 skilled deliveries and 385 fully vaccinations of children if they were technically efficient as their peer health centers for the same year. From the tobit regression, the catchment population and number of administrative staffs were statistically significant determinants of the technical efficiency of health centers.ConclusionsThe mean technical efficiency of the health centers in East Gojjam zone, Northwest Ethiopia was high. However, nearly half of the health centers were technically inefficient, which indicates the exitance of a space for further improvements in the productivity of these health centers. Employing excess number administrative staffs (above the optimal level) should be discouraged and selecting appropriate sites where the health centers to be constructed (to have large catchment population coverage) could improve the productivity of health centers.

Impact of a resilience-building energy management intervention for people with systemic sclerosis: a mixed methods study.

People with SSc often experience fatigue, which significantly affects daily life functioning and quality of life. We aimed to explore participants' experiences of a peer health-coached resilience-building energy management to enhance well-being (RENEW) intervention on symptoms and well-being and to use mixed methods to compare how SSc duration influenced the experiences of participants who had clinically significant fatigue improvement vs those who did not. Semi-structured interviews were conducted with 21 participants from the parent clinical trial randomized to the RENEW intervention. Data were analysed using the rigorous and accelerated data reduction technique combined with thematic content analysis. A mixed methods approach used a joint display to identify themes related to the impact of SSc duration on fatigue improvement status. Participants were categorized into short/improvement, short/limited improvement, long/improvement, and long/limited improvement. Our team generated four themes: participant and peer health-coach relationship, physical and psychological well-being improvement, need for a tailored approach and easy program access through technology. Mixed methods analysis revealed that, regardless of SSc duration, participants with improved fatigue reported increasing self-awareness of SSc-related symptoms and learning coping strategies to manage fatigue. Participants in the short/improvement group reported preferences for slower pacing of the program and pairing with a coach with similar symptom severity. Participants in the long/limited improvement group sought SSc-specific symptom management information. Incorporating peer health coaches and technology is beneficial for self-management interventions for people with SSc. Future tailoring of RENEW based on SSc duration and symptom severity is needed. clinicatrials.gov, NCT04908943.

Peer-to-Peer Chain Recruitment for Enrolling Young South African Women into an HIV Pre-exposure Prophylaxis (PrEP) Intervention Study: How Did It Perform?

Peer-to-peer chain recruitment has been used for descriptive studies, but few intervention studies have employed it. We used this method to enroll sexually active women ages 18 to 25 into an online Pre-Exposure Prophylaxis (PrEP) information and motivation intervention pilot in eThekwini (Durban), South Africa. Seeds (N = 16) were recruited by study staff and randomized to Masibambane, Ladies Chat, a Gender-Enhanced group-based WhatsApp Workshop (GE), or Individual-Access (IA), a control condition that provided participants with online information/motivation materials only. Each seed could recruit up to three women to participate in the same study condition, with an incentive for each enrolled woman; participants in subsequent waves could choose to recruit or not. We evaluated if peer-to-peer recruitment was self-sustaining and resulted in enrolling women who, in subsequent waves, had less contact with the health care system and less knowledge about PrEP than the initial seeds. Over three recruitment waves beyond the seeds, 84 women were recruited. Almost 90% of women became recruiters, with each recruiting on average 1.90 women and 1.26 eligible enrolled women. The approach was successful at reaching women with less education but not women with less health system contact and PrEP knowledge across waves. IA participants had a slightly higher, though non-significantly different, percentage of individuals who became Peer Health Advocates (PHAs) than GE participants and, on average, they recruited slightly more women who enrolled. Our findings demonstrated that peer-to-peer recruitment is a feasible and self-sustaining way to recruit SA young women into a PrEP intervention study.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries.

Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

Chat windows and zoom bombers: virtual boundaries in mental health peer support

Mental health peer support is a form of care in which people with mental health conditions provide emotional support and education to fellow individuals in recovery, and it is often offered online. Yet little research has considered the social and ethical consequences of providing peer support virtually. Drawing on qualitative data on peer support at mental health agencies across Ohio, this paper argues that the move to online platforms like Zoom led to concerns around boundaries: the rules within personal relationships between people giving and receiving support. In particular, the shift to virtual delivery of peer support posed new questions around privacy and communication. I assert that understanding boundaries in virtual settings is critically important to the field of disability studies, as scholars, activists, and practitioners document and analyze the nature of interdependent care relationships that unfold across a variety of social contexts.

183. Advancing the Health of Juvenile Justice Involved Youth: The Efficacy of a Peer Health Education Curriculum at a Juvenile Detention Facility

183. Advancing the Health of Juvenile Justice Involved Youth: The Efficacy of a Peer Health Education Curriculum at a Juvenile Detention Facility

Peer effects and health impacts of different body cognitive biases in children: micro evidence from China.

In China, children commonly display body cognitive biases, which constitute a significant yet hidden public health issue. These biases potentially jeopardize children's well-being, hinder the cultivation of human capital, and impede societal progress. However, limited research employs theoretical analysis and econometric testing to investigate the formation of different body cognitive biases among Chinese children and their health impacts. Based on a local average network model for theoretical analysis, this study utilizes a sample of 4,289 children from four phases of the China Health and Nutrition Survey (CHNS) conducted from 2004 to 2011. Utilizing Logit and IV Probit models, systematically evaluate the peer effect, heterogeneity of effects, and health impacts of children's different body cognitive biases. (1) The peer effect contributes to the development of light- and heavy-body cognitive biases in Chinese children. (2) The heterogeneity analysis shows that the peer effect of body cognitive biases is more significant in rural and female children. (3) The influence of heavy-body cognitive bias is more pronounced in adolescent children. (4) The "eating-activity balance" is disrupted by the two body cognitive biases in children, leading to deviations from normal body type. (5) Specifically, the light-body cognitive bias leads children to intake more and burn fewer calories, increasing their risk of obesity. (6) Conversely, the heavy-body cognitive bias prompts children to intake less and expend more calories, resulting in a higher prevalence of thinness. This study innovates by exploring peer effects on body cognitive biases in Chinese children, elucidating their direction and health implications. While overweight and obesity are recognized as overt health issues, the spread and impact of implicit issues like body cognitive biases should not be overlooked. Nevertheless, the issue is largely neglected in developing countries, such as China, where existing children's health policies are inadequate in addressing it. Promoting accurate body image perception and understanding of health prevention strategies among children requires adequate attention to peer effects.