Peer Support Networks Research Articles

‘This is what is going to help me’: Developing a co-designed and theoretically informed harm reduction intervention for mobile youth in South Africa and Uganda

ABSTRACT Young migrants in sub-Saharan Africa are particularly vulnerable to HIV-acquisition. Despite this, they are consistently under-served by services, with low uptake and engagement. We adopted a community-based participatory research approach to conduct longitudinal qualitative research among 78 young migrants in South Africa and Uganda. Using repeat in-depth interviews and participatory workshops we sought to identify their specific support needs, and to collaboratively design an intervention appropriate for delivery in their local contexts. Applying a protection-risk conceptual framework, we developed a harm reduction intervention which aims to foster protective factors, and thereby nurture resilience, for youth ‘on the move’ within high-risk settings. Specifically, by establishing peer supporter networks, offering a ‘drop-in’ resource centre, and by identifying local adult champions to enable a supportive local environment. Creating this supportive edifice, through an accessible and cohesive peer support network underpinned by effective training, supervision and remuneration, was considered pivotal to nurture solidarity and potentially resilience. This practical example offers insights into how researchers may facilitate the co-design of acceptable, sustainable interventions.

Peer support networks: A local approach to the global issue of moral injury in surgical training and practice.

Peer support networks: A local approach to the global issue of moral injury in surgical training and practice.

“It’s Real, It’s Much More Real”: An Exploration of Values Based Reflective Practice ® as a Reflective Tool

Values Based Reflective Practice (VBRP®) is a group reflection framework widely utilized within healthcare settings across Scotland, where groups of colleagues meet and discuss their workplace-based experiences using the VBRP® structure. The VBRP® model has previously been noted within HSCC as assisting “courageous conversations” about working in a caring vocation (Bunniss, 2021a, 2021b). Despite its national platform, however, there has been limited evaluation of VBRP®. Aim: This study explores the impact of VBRP® as a reflective tool among undergraduate medical students. Method: A qualitative action research methodology was used. Results: Three themes were identified from the data: overcoming barriers to reflection during VBRP®; enhancing reflection through the social nature of VBRP®; participants’ perceptions of reflection through the lens of VBRP®. Conclusion: VBRP® enabled deeper, more authentic reflection and enhanced written reflection abilities due to its social nature. It promoted the formation of peer support networks and positive coping mechanisms among medical students. Teamworking and group relationships were also improved.

LGBTQ+ people living with dementia: an under-served population

Background: Lesbian, gay, bisexual, transgender and queer (LGBTQ+) people living with dementia are an under-served population. They are often at greater risk of vulnerability, discrimination, loneliness, health inequalities and poorer health outcomes. Aims: The aim of this applied practice paper was to produce an introductory summary of some of the challenges and considerations facing LGBTQ+ people living with dementia. This is the second in a series of clinical articles on dementia in underserved populations. Methods: A literature overview was undertaken comprising a number of literature searches. Salient academic articles, policy papers and third sector reports were analysed to identify themes. Findings: Three main themes emerged from the analysis regarding LGBTQ+ people living with dementia: an increasing awareness of needs; challenges and considerations; and recommendations for improving practice and care. Conclusions: Challenges and considerations facing LGBTQ+ people living with dementia include living with memory problems, remembering the past, reminiscence, personal relationships and receiving care. Recommendations include comprehensive training for health and care professionals, as well as strengthened peer support networks. Areas for future research to fully understand the needs of this under-served population are also suggested.

The Developmental Process of Peer Support Networks: The Role of Friendship.

This study investigated the characteristics and development of peer support networks in an effort to unravel the role of friendship in this developmental process. The relationships between friendship networks and peer support networks were explored, and the influence of dyadic and triadic friendships on the development of peer support relationships was examined. Two waves of data were collected among a sample of adolescents in six Chinese junior high schools (n = 913 students from 28 classrooms; mean age = 14.13 years; 50.49% boys), and classroom friendship networks and peer support networks were analyzed. The results showed that peer support networks were sparse, hierarchical, and sex-segregated. Furthermore, peer support networks and friendship networks partially overlapped. Friends tended to have similar support-seeking and support-providing ties. Longitudinal multiplex social network analysis revealed that peer support networks changed moderately over time, and friendships played various roles in the development of peer support networks. Dyadic friendships improved the formation of peer support ties. A mutual friend improved the formation of support relationships between two students when the mutual friend chose the two students as friends, but a mutual friend also hindered or had no effects on the formation of support relationships in other cases. The implications for educators to improve peer support networks are presented, and directions for future research are discussed.

Screening and referral is not enough: a qualitative exploration of barriers to access and uptake of mental health services in patients with cardiovascular diseases

BackgroundCardiovascular diseases (CVD) are commonly comorbid with mental health disorders, portending poorer cardiac prognosis. Despite the high prevalence of depression and anxiety, and guidelines recommending routine depression screening and referral, uptake of mental healthcare in CVD populations remains low. Reasons for the underutilisation of mental health and psychological services for this population remain largely unknown.MethodsThirteen CVD patients with clinically significant psychological symptoms (depression, anxiety and/or stress) participated in one-on-one in-depth semi-structured interviews. Data were analysed using inductive thematic analysis.ResultsBarriers to uptake included the timing of referral and screening, with patients reporting a need for longer term follow-up. A lack of information provision and understanding around mental health and services, especially following cardiac-events were further barriers. A reluctance to report mental health or engage in services was also identified, with patients indicating a preference for informal peer support networks. A range of practical barriers such as mobility, transport and cost were also reported.ConclusionsLonger term follow-up and routine mental health assessment may be beneficial to facilitate use of mental health services. Upskilling of practitioners around mental health may be a further avenue to promote information provision and enhance service use. Further focus on enhancing informal peer support may be a valuable initial approach for the CVD population. The implications for improving services and enhancing service use are discussed.

The emergence of a texas collaboration to improve well-being in learning health systems

ABSTRACT Prior models of well-being have focused on resolving issues at different levels within a single institution. Changes over time in medicine have resulted in massive turnover and reduced clinical hours that portray a deficit-oriented system. As developments to improve purpose and professional satisfaction emerge, the Texas Medical Association Committee on Physician Health and Wellness (PHW) is committed to providing the vehicle for a statewide collaboration and illuminating the path forward. To describe the existing health and wellness resources in Texas academic medical centers and understand the gaps in resources and strategies for addressing the health and wellness needs in the medical workforce, and in student and trainee populations. Various methods were utilized to gather information regarding health and wellness resources at Texas academic medical centers. A survey was administered to guide a Think Tank discussion during a PHW Exchange, and to assess resources at Texas academic medical centers. Institutional representatives from all Texas learning health systems were eligible to participate in a poster session to share promising practices regarding health and wellness resources, tools, and strategies. Survey responses indicated a need for enhancing wellness program components such as scheduled activities promoting health and wellness, peer support networks, and health and wellness facilities in academic medical centers. Answers collected during the Think Tank discussion identified steps needed to cultivate a culture of wellness and strategies to improve and encourage wellness. The Texas Medical Association Committee on Physician Health and Wellness and PHW Exchange provided a forum to share best practices and identify gaps therein, and has served as a nidus for the formation of a statewide collaboration for which institutional leaders of academic medical centers have affirmed the need to achieve the best result.

Relationship between Emotional Peer Support Networks and Subjective Recovery of People with Mental Illness Living in the Community

Relationship between Emotional Peer Support Networks and Subjective Recovery of People with Mental Illness Living in the Community

The impact of COVID-19 measures on children with disabilities and their families in Uganda

To understand the impact of the COVID-19 public health response on families of children with disabilities in Central Uganda we conducted phone interviews with parents and children during the first 5 months of the outbreak (March - July 2020). Most parents and children were well informed about COVID-19 and were keen to adhere to government prevention measures. The majority said lock-down measures had a negative effect on their mental and physical health, social life, finances, education and food security. Access to medical services and medication for chronic illness had been limited or absent due to restrictions in travel, some facilities restricting access, and limited financial resources. The majority of parents reported loss of work which resulted in difficulties in finding enough food and paying rent. Parents worried about children missing education and friends. We suggest greater attention to children with disabilities and their families when implementing mitigating and long-term responses. Points of interest This paper reports a study with families of children with disabilities in Uganda during the Coronavirus pandemic in 2020, known as COVID-19. Families of children with disabilities in Uganda are well informed about COVID-19 and try to follow prevention measures. Families of children with disabilities have difficulties meeting daily basic needs as they were unable to work and had no income during the COVID-19 related lock down. The COVID-19 response affects access to health and rehabilitation services for children with disabilities in Uganda. Parents of children with disabilities struggle with home education and learning due to lack of access to accessible learning materials and learning support in Uganda. The COVID-19 response affects the peer support networks and social support for parents of children with disabilities in Uganda. Children with disabilities and their families should be involved and considered in the development and implementation of the COVID-19 response.

“Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. To describe the treatment journeys of pregnant women with RR-TB-including how their care experiences shape their identities-and identify areas in which tailored interventions are needed. In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to "be brave"). Care experiences required them to negotiate seemingly contradictory identities as both new mothers-"givers of life"-and RR-TB patients facing a complicated and potentially deadly disease. In terms of their "pregnancy identity" and "RR-TB patient identity" that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the "mothering" and "patient" roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child's health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

Addressing Older Adult Social Isolation in Various Settings With Unique Conflating Trajectories of Care Models

No matter the age, social isolation is common among older adults due to a number of factors. In looking at social isolation through the framework of the International Classification of Functioning, Disability and Health (ICF) model, the biopsychosocial factors intersect. Care models will be explored that involve the ICF model multi-disciplinary concepts of body functions, activities, participation and environmental factors. Developing more programs to counter isolation is critical for the health of older persons. (1) The experience of vulnerability may be overcome by banding together through assisting others or building a peer support network. (2) A holistic perspective is needed in promoting interventions that support functionality. Regular programming with body awareness and cognitive reflection is enjoyed by institutionalized older adults. (3) The role of social action and social justice in reducing social isolation is part of training social work students about the importance of culture and advocacy. (4) Collected ethnographic data found that the practice of remembrance reduces social isolation regardless of the program. Gardening and storytelling were found to be opportunities to reduce social isolation. (5) With unexpected longevity in individuals with hemophilia due to scientific advances, researchers also found shame, fear, and coping through social isolation to avoid social assumptions of health status. Care models are being explored to support this cohort. To conclude, Dr. Sharon Bowland will summarize our abstracts and discuss how they revolve around the ICF model of care that can be applied to the important social determinant of health area of social isolation.

PPE for your mind: a peer support initiative for health care workers.

PPE for your mind: a peer support initiative for health care workers.

Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate.

Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents' experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. In-depth semistructured interviews. Pediatric tertiary care center. Parents of children younger than 7 years of age with cleft lip and/or palate. From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents' reactions to their child's pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child's school and peer groups. The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents' needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.

Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

BackgroundWith the global shortage of skilled health workers estimated at 7.2 million, outpatient tuberculosis (TB) care is commonly task-shifted to lay health workers (LHWs) in many low- and middle-income countries where the shortages are greatest. While shown to improve access to care and some health outcomes including TB treatment outcomes, lack of training and supervision limit the effectiveness of LHW programs. Our objective was to refine and evaluate an intervention designed to address common causes of non-adherence to TB treatment and LHW knowledge and skills training needs.MethodsWe employed a pragmatic cluster randomized controlled trial. Participants included 103 health centres (HCs) providing TB care in four districts in Malawi, randomized 1:1 stratified by district and HC funding (Ministry of Health, non-Ministry funded). At intervention HCs, a TB treatment adherence intervention was implemented using educational outreach, a point-of-care reminder tool, and a peer support network. Clusters in the control arm provided usual care. The primary outcome was the proportion of patients with successful TB treatment (i.e., cure or treatment completion). We used a generalized linear mixed model, with district as a fixed effect and HC as a random effect, to compare proportions of patients with treatment success, among the trial arms, with adjustment for baseline differences.ResultsWe randomized 51 HCs to the intervention group and 52 HCs to the control group. Four intervention and six control HCs accrued no eligible patients, and 371 of 1169 patients had missing outcome, HC, or demographic data, which left 74 HCs and 798 patients for analysis. Randomization group was not related to missing outcome, however, district, age, and TB type were significantly related and included in the primary analysis model. Among the 1153 patients with HC and demographic data, 297/605 (49%) and 348/548 (64%) in the intervention and control arms, respectively, had treatment success. The intervention had no significant effect on treatment success (adjusted odds ratio 1.35 [95% confidence interval 0.93–1.98]).ConclusionWe found no significant effect of the intervention on TB treatment outcomes with high variability in implementation quality, highlighting important challenges to both scale-up and sustainability.Trial registrationClinicalTrials.gov NCT02533089. Registered August 20, 2015.

Young Voices: Sexual Health and Transition Care Needs in Adolescents with Intersex/Differences of Sex Development-A Pilot Study.

To determine the sexual health and well-being needs of current generations of youth with intersex/Differences of Sex Development (DSD) during transition from pediatric to adult health care. Qualitative narrative analyses, quantitative descriptives, and questionnaires. Peer support networks and outpatient clinics. Eighteen adolescents aged 16-21years with intersex/DSD. Semi-structured interviews and/or survey. Youths learning about bodily differences, their sexual experiences and motives (eg, agency, pleasure), body image, sexual communication inside and outside of health care, and perceived gaps between current and ideal transitional care. Quantitative and qualitative content of the surveys and interviews were analyzed to identify key topics. We found that (1) there is a need for open-minded perceptions of health care providers about what it means to have a sex variation: (2) there is a need for continued support and information about lived realities relating to the diagnosis and treatments as well as experiential aspects of sexuality: and (3) there are communication obstacles with providers in a multidisciplinary team setting as well as with parents. A user-centered care perspective for adolescents with sex variations includes their stories and feedback toward service improvement. This pilot study shows that adolescents want to be more involved in their sexual health care in ways that connect to their specific questions. Their desire for information increases as they grow older, and underlines the most essential lesson that health care providers can bring their patients about their bodies: how to care for, respect, and enjoy them.

At the Heart of the Pandemic:: Nursing Peer Support

The COVID-19 pandemic has presented extraordinary demands, uncertainty, and stress among nurses, which take a toll on individual resilience and well-being. Leadership actions are necessary to protect and promote the psychological well-being of the nursing workforce. Nurse leaders have a responsibility to help reduce the harmful effects of our battle against this unprecedented pandemic. An essential element of a response plan to sustain well-being should be a formalized peer support network. This article outlines nurses’ experiences during the pandemic, describes peer support basics, offers best practices for peer support programs, and presents lessons learned from 2 mature peer support programs.

Supporting the survivors: Experiences and perceptions of peer support offered to UK terrorist survivors

Recent terror incidents in the UK, including the targeting of concert attendees in Manchester, to individuals socialising and working in central London, highlight the public’s vulnerability and that attacks can be indiscriminate, resulting in any individual becoming a victim to this fearful crime. As a consequence of these and other attacks, including those overseas, media reporting within the UK has increasingly focused on the inadequate levels of support offered to survivors from official agencies. However, little evaluation has been conducted regarding the benefits of support networks and online support groups created directly by those individuals affected by terror attacks. Quantitative research findings obtained through a self-administered online questionnaire, completed by 81 survivors of terrorist attacks who are members of different peer support networks in the UK, endorsed that while victims feel that adequate professional support is lacking, significant positive experiences have been achieved through peer support, particularly through the internet. This first independent academic study found that it was these methods of support that had the most resonance with individuals and offers several recommendations, based on findings, which could enhance and improve support for survivors of terrorism in the future.

LGBTQ+ people living with dementia: an under-served population

Background Lesbian, gay, bisexual, transgender and queer (LGBTQ+) people living with dementia are an under-served population. They are often at greater risk of vulnerability, discrimination, loneliness, health inequalities and poorer health outcomes. Aims The aim of this applied practice paper was to produce an introductory summary of some of the challenges and considerations facing LGBTQ+ people living with dementia. This is the second in a series of clinical articles on dementia in underserved populations. Methods A literature overview was undertaken comprising a number of literature searches. Salient academic articles, policy papers and third sector reports were analysed to identify themes. Findings Three main themes emerged from the analysis regarding LGBTQ+ people living with dementia: an increasing awareness of needs; challenges and considerations; and recommendations for improving practice and care. Conclusions Challenges and considerations facing LGBTQ+ people living with dementia include living with memory problems, remembering the past, reminiscence, personal relationships and receiving care. Recommendations include comprehensive training for health and care professionals, as well as strengthened peer support networks. Areas for future research to fully understand the needs of this under-served population are also suggested.

Mental Health and Fieldwork

ABSTRACTResearchers discuss the logistics of successful fieldwork but not the mental health considerations that fieldwork and the research process introduce. Successful fieldwork and fruitful academic careers hinge on acknowledging and managing our mental health. We discuss peer-support networks, secondary trauma, coping skills, therapy, and researchers’ mental health options before, during, and after fieldwork.

A health care professionals training needs assessment for oncology in Uganda

BackgroundCancer incidence and mortality in sub-Saharan Africa are increasing and do account for significant premature death. The expertise of health care providers is critical to downstaging cancer at diagnosis and improving survival in low- and middle-income countries. We set out to determine the training needs of health care providers for a comprehensive oncology services package in selected hospitals in Uganda, in order to inform capacity development intervention to improve cancer outcomes in the East African region.MethodsThis was a cross-sectional survey using the WHO Hennessey-Hicks questionnaire to identify the training needs of health workers involved in cancer care, across 22 hospitals in Uganda. Data were captured in real time using the Open Data Kit platform from which the data was exported to Stata version 15 for analysis using the Wilcoxon signed-rank test and Somers-Delta.ResultsThere were 199 respondent health professionals who were predominately female (146/199, 73.37%), with an average age of 38.97 years. There were 158/199 (79.40%) nurses, 24/199 (12.06%) medical doctors and 17/199 (8.54%) allied health professionals. Overall, the research and audit domain had the highest ranking for all the health workers (Somers-D = 0.60). The respondent’s level of education had a significant effect on the observed ranking (P value = 0.03). Most of the continuing medical education (CME) topics suggested by the participants were in the clinical task-related category.ConclusionThe “research and audit” domain was identified as the priority area for training interventions to improve oncology services in Uganda. There are opportunities for addressing the identified training needs with an expanded cancer CME programme content, peer support networks and tailored training for the individual health care provider.