Youth Peer Research Articles

"Adolescents do not only require ARVs and adherence counseling": A qualitative investigation of health care provider experiences with an HIV youth peer mentoring program in Ndola, Zambia.

IntroductionAdolescents and young adults (AYAs) living with HIV face unique challenges and have poorer health outcomes than adults with HIV. Project YES! was a youth-led initiative to promote HIV self-management and reduce stigma among AYAs in four Ndola, Zambia clinics. Clinic health care providers (HCPs) were involved in multiple intervention aspects, including serving as expert resources during AYA and caregiver group meetings, facilitating resistance test-based AYA antiretroviral drug changes, meeting with participants referred through a safety protocol, and guiding a subset of participants’ physical transition from pediatric to adult clinic settings. This study aimed to understand HCP insights on facilitators and barriers to implementing Project YES! and scaling up a clinic-based, youth-focused program.MethodsA trained interviewer conducted ten in-depth interviews with participating HCPs from November–December 2018 and analyzed data, identifying key themes. These themes were examined in terms of two implementation science outcomes–acceptability and feasibility–to inform scalability.ResultsHCPs found peer mentoring valuable for AYAs with HIV and the bimonthly caregiver meetings beneficial to AYA caregivers. HCPs voiced a desire for more involvement in specific processes related to patient clinical care, such as drug changes. HCPs’ experiences with the study safety protocol, including referrals for youth experiences of violence, shifted their views of AYAs and informed their understanding of key issues youth face. Considering this, many HCPs requested more resources to support AYAs’ varied needs. HCPs noted limited time and clinic space as implementation barriers but felt the program was valuable overall.ConclusionsHCPs concluded youth peer mentoring was highly acceptable and feasible, supporting scale-up of youth-led interventions addressing the multi-faceted needs of AYAs living with HIV. Continued provider involvement in resistance test-based antiretroviral drug changes, considered in the context of health system and clinic policy, would enhance long-term success of the program at scale.

Examining the Sustainability of the Youth Peer Health Education Network within Primary Schools in Njombe, Tanzania

Youth Peer Health Education (YPHE) is a health promotion technique that promotes sharing information, values, and behaviours among demographically matched peers. YPHE is increasingly being utilized in schools in sub-Saharan Africa to address the need for HIV prevention. Since September of 2010, a YPHE program has been ongoing within 50 primary schools in the Njombe region of Tanzania, where the prevalence of HIV is the highest in the country at 5.1% among youth aged 15-24. The program is managed by volunteers of the non-governmental organization Highlands Hope Umbrella (HHU), with no external source of funding since 2014. This qualitative research study examined the facilitators and barriers to the future sustainability of the program. Data was collected from individual interviews with key informants, participant observation during YPHE meetings, and focus group sessions with youth peer health educators and teacher-mentors. Facilitators for sustainability included an increase in leadership abilities among youth, a sense of moral responsibility to decrease the prevalence of HIV in the region, and ongoing support from adults in positions of authority. Barriers to sustainability included a lack of teaching materials, inadequate communication between involved members, scheduling issues, and no continuous source of funding. These findings will help inform sexual health programs for youth in low-recourse settings, and can be used to promote the integration of YPHE programs into school curriculums, leading to changesin health and education policies.

Paths Toward Sustainable State and County Systems of Care.

The Substance Abuse and Mental Health Services Administration's Children's Mental Health Initiative (CMHI) Cooperative Agreements support the development of children's systems of care (SOCs). The National Evaluation of CMHI interviewed representatives from Mental Health Authorities (MHA) and Medicaid agencies in 25 state, county, and municipal jurisdictions in the FY13 and FY14 grant cohorts in grant years 2 and 4. This paper analyzes funding for five services (wraparound planning; intensive care coordination; family peer support; youth peer support; and flexible funding) that are a core part of SOCs, and grantee descriptions of sustainability strategies and challenges. The analysis found that, of the five pathways described in the literature: securing Medicaid coverage; obtaining state MH system funding; braiding funding with other child-serving systems; modifying payment structures to support workforce development; and redeploying funds from higher cost to lower cost services, grantees most frequently used Medicaid coverage, often combined with MHA funding.

There's no place like home: Exploring sexual and gender diverse youth's outcomes related to urban/nonurban settings, opted consent procedure, and social support

AbstractThis study uses the minority stress model to examine the relationship between sexual and gender diverse youth's (SGDY's) emotional and peer problem outcomes with their school setting (i.e., attending school in an urban or nonurban setting) and consent type (i.e., parental/guardian or waived consent). The study also explores how social support can alter these relationships as a protective factor. The instruments used to collect data were self‐report and included the Child and Adolescent Social Support Scale and the Strengths and Difficulties Questionnaire. Results indicated that more youth in nonurban settings experienced emotional and peer problems compared to those in urban settings, and youth who opted for waived consent endorsed fewer emotional and peer problems compared to youth who opted for parental/guardian consent. When controlling for social support, the consent procedure and school setting variables lost significance. Implications for school psychologists are reviewed.

Peripheral immune correlates of childhood and adolescent peer relationships: A systematic review.

The objective of this review was to comprehensively evaluate the literature investigating associations between peripheral immune correlates and youth peer relationship dimensions. We aimed to identify potential aspects of peer relationships in childhood and adolescence that may be associated with immune profiles and to identify gaps in the field to provide suggestions for future research in this area. We conducted a systematic electronic search in health-related databases from the earliest records to December 2020. Search terms included domains related to youth, immune correlates, and peers. We summarized studies by the time between the peer measurement and the immune outcome. In the 17 included studies, associations between peer dimensions and immune outcomes varied substantially. Peer victimization in youth demonstrated the most consistent negative associations with immune health across development, including within 1week of measurement, 1-3years later, and 10 or more years later. This review indicated that that peer relationships during youth may have important associations with immune processes; however, there are several gaps in the literature regarding the operationalization of peer relationships, the timing of the immune measurement, and the type of immune outcome to be addressed by future research.

Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala, Uganda: qualitative findings.

IntroductionHIV‐related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self‐testing, with urban refugee youth in Kampala, Uganda.MethodsWe implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala's informal settlements from February‐April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non‐government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations.ResultsParticipants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a “Ugandan disease”; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same‐sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self‐testing. They recommended HIV self‐testing implementation strategies to be peer supported and expressed concerns regarding sexual‐ and gender‐based violence with partner testing.ConclusionsIntersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi‐level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.

Lessons learned from the implementation of the Young Deadly Free peer education programme in remote and very remote Australian Aboriginal communities

ABSTRACT Past efforts to address endemic rates of sexually transmissible infections amongst young Aboriginal people living in remote/very remote Australian communities have had limited success. Peer education has been used in youth sexual health promotion but has received limited evaluation and has not been tested in remote Aboriginal settings. The Young Deadly Free youth peer education programme trained Aboriginal young people in 15 remote/very remote communities as peer educators to deliver sexual health education to other young people. Semi-structured interviews were conducted with the project team and regional coordinators to understand the barriers and enablers to implementing peer education in remote communities. Programme credibility, the offer of financial gratuities, and the recruitment of peer educators with prior sexual health knowledge and/or group facilitation experience were identified as programme enablers. Implementation challenges included programme rigidity, cultural sensitivities, and retention and expectations of peer educators. Seven implications for policy and practice are identified to increase the efficacy and long term-impacts of youth peer education. Peer education for youth sexual health promotion in remote communities can be effective if young peer educators are supported appropriately and the peer education programme is part of a comprehensive sexual health promotion strategy.

Vulnerability to interrogative suggestibility from negative life events. A comparison of separated asylum-seeking youth and age-matched peers.

The consistency of young asylum-seeker's verbal testimony is often critical in determining the outcome of their claims. It is well established that an interviewee may change their answers to appease an interviewer or in response to suggestions. Experiencing adversity during childhood may increase vulnerability in such interview situations. Here, the vulnerability to interview pressure of asylum-seeking youth separated from their caregivers as minors was compared with age-matched peers. Thirty participants (16–23 years) completed the Gudjonsson Suggestibility Scale (GSS2, measures of negative life events (NLEs) and non-verbal cognitive functioning measures. Vulnerability to interrogative suggestibility, non-verbal cognitive functioning and number of NLEs was compared between two groups. This preliminary data showed asylum-seeking youth as significantly more vulnerable to Shift; changes in response to interviewer feedback. NLEs and lower non-verbal cognitive functioning were significantly more common among the separated youth increasing vulnerability to Shift. The implications are discussed.

Exploring Peer Support Services for Youth Experiencing Multiple Health and Social Challenges in Canada: A Hybrid Realist-Participatory Evaluation Model

The Canadian youth services system is fragmented with less than one third of youth accessing the mental health services they need. Experts have called for systems transformation that will increase the integration of youth services and take advantage of complementary services, such as peer supports. Further, researchers have suggested that there is a need to identify the unique contribution and underlying mechanisms that support client recovery within youth peer support interventions. This paper describes the steps taken to implement a hybrid realist and participatory evaluation examining peer support services for youth (14–26 years old) with mental health, physical health and/or substance use challenges. We describe the procedures followed to engage peers in the design of the study and how this was integrated with a realist approach. We also provide a detailed description of the related adaptations to the methods applied within the second stage of the study. Lessons learned through the integration of the two methods are provided as well as potential implications for the findings and related research.

Implementing youth peer support in an early psychosis program

Purpose The purpose of this study was to identify and understand the barriers and enablers to the implementation of youth peer support in a clinical mental health service. The development of a lived experience workforce in mental health is a key component of policy at both the state and the federal level in Australia. Implementing a peer workforce within existing clinical services, however, can be a challenging task. Furthermore, implementing peer support in a youth mental health setting involves a further degree of complexity, involving a degree of care for young people being invited to provide peer support when they may be still early in their own recovery journey. Design/methodology/approach This paper reports on a formative evaluation of the beginning stages of implementation of a youth peer workforce within an existing clinical mental health service in Melbourne. Findings The project found that it was feasible and beneficial to implement youth peer support; however, significant challenges remain, including lack of appropriate training for young people, uncertainty amongst clinical staff about the boundaries of the peer role and the potential for “tokenism” in the face of slow cultural change across the whole service. Originality/value Very little evaluation has yet been undertaken into the effectiveness of implementing peer support in youth mental health services. This paper offers an opportunity to investigate where services may need to identify strengths and address difficulties when undertaking future implementation efforts.

Indigenous Youth Mentorship Program: key implementation characteristics of a school peer mentorship program in Canada.

The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program developed for elementary school students in Indigenous school communities in Canada. A local young adult health leader (YAHL) and high school mentors offer students healthy snacks, physical activity games, relationship building activities and cultural teachings. IYMP aims to improve children's health and wellbeing and empower Indigenous youth and communities. The purpose of this focused ethnography was to describe the key characteristics of successful IYMP delivery. Two focus groups were conducted with 16 participants (8 YAHLS and 8 youth mentors) from 7 schools followed by 4 individual interviews (3 YAHLs, 1 youth peer mentor). Transcripts were analyzed using content analysis. Findings were triangulated with IYMP program field observations and notes from IYMP national team meetings. The five characteristics identified as important for IYMP delivery were a sense of ownership by those delivering the program, inclusion of Indigenous Elders/knowledge keepers, establishing trusting relationships, open communication among all stakeholder groups, including community and academic partners, and adequate program supports in the form of program funding, manuals that described program activities, and local and national gatherings between academic and community partners for sharing ideas about the program and its components. This study indicates the importance of respectful partnerships between community and academic leads for program success and sustainability. As IYMP is implemented in more communities and becomes community autonomous, program sustainability may be ensured and implementation challenges mitigated by embedding the identified five essential characteristics within the fabric of IYMP.

Family, Community and Long-Term Socio-Economic Inequality: Evidence from Siblings and Youth Peers

AbstractUsing administrative data for the population of Danish men and women, we develop an empirical model which accounts for the joint earnings dynamics of siblings and youth community peers. We provide the first decomposition of the sibling correlation of permanent earnings into family and community effects allowing for life-cycle dynamics and extending the analysis to consider other outcomes. We find that family is the most important factor influencing sibling correlations of earnings, education and unemployment. Community background matters for shaping the sibling correlation of earnings and unemployment early in the working life, but its importance quickly diminishes.

Voluntary HIV Counseling and Testing Among Commercial Motorcyclist Youths: An Exploration of Ethical Challenges and Coping Mechanisms in Dar es Salaam.

BackgroundRegardless, the known benefits of voluntary testing and counseling (VCT) in the fight against HIV/AIDS, its uptake is still low among youth. This study explored ethical challenges facing voluntary counseling and testing for HIV/AIDS among youth engaged in commercial motorcycling in Kinondoni municipality, Dar es Salaam city.MethodsQualitative exploratory study was carried out to 35 people using key informants’ interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). Key informants were purposefully selected based on their roles in VCT services, while the FGD participants and in-depth interview respondents were purposefully selected among youth commercial motorcyclists. Qualitative content data analysis was used to analyze the gathered information.FindingsResults of this study show that lack of privacy during counseling and treatment, fear of HIV status disclosure to others by counselors and difficulties in counseling are the main ethical challenges facing VCT services among youth in Kinondoni municipality. Shortage of counselors to match the number of VCT services’ clients and lack of on-job training on HIV/AIDS testing and counseling among counselors partly contributed to the revealed ethical challenges. In an attempt to address the ethical challenges, youth peer educators and routine supervision were the available initiatives on improving VCT services among youth.ConclusionVCT services face ethical challenges which are either health facility-based, community-based or are at the national level. Addressing the ethical challenges is necessary in order to improve the uptake of VCT services and thus strengthen the fight against HIV/AIDS. Deployment of enough counselors, refresher training to counselors, and raising community awareness on HIV/AIDS and the negative impacts of stigma are among the initial strategies for remedying the situation.

The Relationship between Mother's Attachment and female youth's Peer Rejection: Focusing on Mediating effects of mother’s Sociality, female youth’s attachment, female youth’s sociality.

The Relationship between Mother's Attachment and female youth's Peer Rejection: Focusing on Mediating effects of mother’s Sociality, female youth’s attachment, female youth’s sociality.

Social network determinants of alcohol and tobacco use: A qualitative study among out of school youth in South Africa.

An important determinant of alcohol and tobacco use is the adolescent's social network, which has not been explored among out of school youth (OSY). OSY are adolescents not currently enrolled in school and have not completed their schooling. This study aims to qualitatively understand how OSY's social networks support or constrain alcohol and tobacco use. Respondent-driven sampling was used to select 41 OSY (aged 13-20 years) for individual in-depth interviews in a South African urban area. The data were analysed using content analysis. Smoking and drinking friends, family close in age to OSY that drank and smoked, and lack of parental support were associated with alcohol and tobacco use among OSY. Household norms, romantic partners and non-smoking or non-drinking friends were suggested to mitigate alcohol and tobacco use. Understanding how the social network of OSY plays a role in alcohol and tobacco use is useful for gaining an insight into the profile of OSY at risk for alcohol and tobacco use. Registration of OSY youth and community-based peer led programmes that include influential OSY family and friends could be beneficial.

Youth Peer Led Lifestyle Modification Interventions: A Narrative Literature Review

The prevalence of obesity remains high among school age children and continues to rise among adolescents in the United States. One strategy to address this challenge is to use peer rather than professional leaders to run weight management programs. Youth peer-led lifestyle interventions have become increasingly common over the last few decades, but there is a lack of review and synthesis of these programs. The purpose of this manuscript was to critically review and synthesize results and lessons learned from evaluated youth peer-led lifestyle modification and weight management programs. We searched the PubMed/MEDLINE database to identify articles published between March 2002 and December 2015. We identified 29 interventions including children from kindergarten to 12th grade from different settings and racial/ethnic and economic backgrounds. We first summarized descriptive information about the interventions and then compared outcomes based on intervention type, peer leader characteristics and training, and other related factors. Our review indicated that youth peer-led interventions of varying structure and content can result in positive changes in behavioral influences, diet, physical activity, body measures and other clinical outcomes. We used information from our analysis to formulate recommendations for design of future youth peer-led lifestyle interventions.

Engaging Youth in the Bipolar Youth Action Project: Community-Based Participatory Research.

BackgroundWe describe the methodological dimensions of community-based participatory research through a description of study design, youth engagement, and methods/processes in the cocreation of knowledge within a Canadian study, the Bipolar Youth Action Project. This collaborative partnership—carried out by a team composed of academic, community, and youth partners—was designed to investigate self-management and wellness strategies for young adults living with bipolar disorder.ObjectiveThe aim is to describe the opportunities and challenges of this collaboration and to reflect upon the process of involving youth with bipolar disorder in health research that concerns them, and share lessons learned.MethodsThe project was conducted in multiple phases over 2 years: (1) grant-writing, with youth contributing to the process; (2) recruitment, in which 12 youth were selected and trained to help shape and conduct two research forums; (3) the first research forum, where more youth were consulted about the strategies they apply to stay well (self-management strategies); (4) data analysis of Forum I findings; (5) research Forum II, which consulted youth with bipolar disorder about knowledge translation of Forum I findings; and (6) data analysis of Forum II findings. Youth peer researchers with bipolar disorder were involved in a significant capacity at every stage in the process.ResultsOf the initial 12 youth peer researchers, 7 remained on the project from the recruitment phase until the project ended. They collaborated in the creation of two youth research forums that consulted youth with bipolar disorder on their self-management strategies.ConclusionsThis article shares what was learned from the process of partnering with youth with bipolar disorder in a community-based participatory research study.

Roles of peer specialists and use of mental health services among youth with serious mental illness.

To examine whether roles of peer specialists affect service use among Black, Latinx and White youth ages 16-24 with serious mental illness (SMI) in Los Angeles and San Diego Counties. Administrative data from 2015 to 2018 was used to summarize service use among 6329 transition age youth age 16-24 with SMI who received services from 76 outpatient public mental health programs with peer specialists on staff. Roles of peer specialists were assessed via a program survey. Generalized linear models were used to assess the relationship between peer specialist characteristics and service use outcomes (ie, outpatient and inpatient). Having a transition age youth peer specialist on staff (vs older peer specialists) and having peer specialists that provide four or more services (vs fewer services) was associated with an increase in annual outpatient visits in both counties (P=<.001 each). In Los Angeles County, having three or more peer specialist trainings (vs fewer trainings) was associated with lower use of inpatient services (P < .001). In San Diego County, having a transition age youth peer specialist and peer specialists that provide four or more services was associated with lower use of inpatient services (P < .001 each). Types of peer support and number of types of peer services were associated with mental health service utilization. Detailed examination of the roles of peer specialists is merited to identify the specific pathways that improve outcomes.

Youth leadership in peer-to-peer community sport: comparing programme rationales and peer delivery

Abstract Background Peer-to-peer approaches are widely used in health promotion. Peer leaders are suggested to increase credibility and identification through role modelling. We suggest that to meet the rationales of peer education, peer leaders should be able to interpret and rework their delivery, based on programme rationales. This entails a need for implementation studies to compare programme theory with the realities of implementation. The purpose of this study was therefore to conceptualise a youth-led programme and to explore how peer leaders engage with the peer leader education and subsequently implement activities. Methods The case of study was the Danish street sport organisation, GAME. GAME educates and supports youth peer leaders (age 16-25) in providing life skills-based community sports activities for younger peers (age 8-15) in less advantaged neighbourhoods. A theory of change was developed in partnership with professionals from GAME to conceptualise their programme and its rationales. To study implementation, we observed three two-day peer leader education camps and 49 peer-led GAME activities focusing on specific elements of the theory of change. Results We present a theory of change to illustrate the content, rationale, expected outcomes and key assumptions of a peer-led community sport programme. We compare this conceptualisation to the implementation of peer-led activities; i.e., GAME's operationalisation of the peer leader education and peer leaders' enactment of the programme in practice, focusing on role modelling, pedagogical approaches and interactions with participating children. As expected, implementation style varied considerably across settings and thereby the ways in which delivery corresponded with the intentions described in the theory of change. Conclusions The study provided insight into how youth peer leaders in community sport interpret their role and interact with peers of relevance to peer leadership research and practice. Key messages The rationales behind peer education call for programmes that allow youth peer leaders to interpret and adjust activity implementation with an ensuing need for implementation studies. Initiatives to educate and support peer leaders should be modified based on insights into peer leaders’ interpretation and implementation of peer-led activities.

Scaling up peer-led community-based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success.

IntroductionLow rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale. The provision of peer support has generated considerable enthusiasm because it has the potential to ameliorate the complex social and relational challenges which underpin suboptimal adherence. Little is known about the impact on young peer supporters themselves, which is the focus of this paper.MethodsWe present qualitative findings from the Zvandiri trial investigating the impact of a peer support intervention on the viral load for beneficiaries (ALHIV, aged 13 to 19 years) in Zimbabwe. The Zvandiri peer supporters aged 18 to 24 years, known as community adolescent treatment supporters (CATS), are themselves living with HIV. Individual in‐depth interviews were conducted in late 2018 with 17 CATS exploring their experiences of delivering peer support and their own support needs. Interviews were analysed iteratively using thematic analysis.ResultsThe CATS reported that being peer supporters improved their own adherence behaviour and contributed to an improved sense of self‐worth. The social connections between the CATS were a source of comfort and enabled them to develop skills to manage the challenging aspects of their work. Two substantial challenges were identified. First, their work may reveal their HIV status. Second, managing the emotional labour of this caring work; given how commonly the complexity of the beneficiaries’ needs mirrored the circumstances of their own difficult lives. Both challenges were ameliorated by the support the CATS provided to each other and ongoing supervision from the adult mentor. There was variation in whether they felt their roles were appropriately valued through the remuneration they received and within the health system. There was a consensus that their experience meant that they would graduate from being a CATS with transferable skills that could enhance their employability.ConclusionsTheir experiences illustrate the advantages and opportunities of being a CATS. To minimize potential harms, it is vital to ensure that they feel valued in their role, which can be demonstrated by the provision of appropriate remuneration, recognition and respect, and that there is continued investment in ongoing support through ongoing training and mentoring.