Receiving Peer Support Research Articles

Lessons from Peer Support Among Individuals with Mental Health Difficulties: A Review of the Literature

We conducted a comprehensive narrative review and used a systematic search strategy to identify studies related to peer support among adults with mental health difficulties. The purposes of this review were to describe the principles, effects and benefits of peer support documented in the published literature, to discuss challenging aspects of peer support and to investigate lessons from peer support. Fifty-one studies, including 8 review articles and 19 qualitative studies, met the inclusion criteria for this review. Most of the challenges for peer support were related to “role” and “relationship” issues; that is, how peer support providers relate to people who receive peer support and how peer support providers are treated in the system. The knowledge gained from peer support relationships, such as mutual responsibility and interdependence, might be a clue toward redefining the helper-helper relationship as well as the concepts of help and support.

Non-suicidal self-injury, youth, and the Internet: What mental health professionals need to know

Non-suicidal self-injury (NSSI) content and related e-communication have proliferated on the Internet in recent years. Research indicates that many youth who self-injure go online to connect with others who self-injure and view others’ NSSI experiences and share their own through text and videos platforms. Although there are benefits to this behaviour in terms of receiving peer support, these activities can introduce these young people to risks, such as NSSI reinforcement through the sharing of stories and strategies, as well as, risks for triggering of NSSI urges. Due to the nature of these risks mental health professionals need to know about these risks and how to effectively assess adolescents’ online activity in order to adequately monitor the effects of the purported benefits and risks associated with NSSI content. This article offers research informed clinical guidelines for the assessment, intervention, and monitoring of online NSSI activities. To help bridge the gap between youth culture and mental health culture, these essentials include descriptions of Community, Social Networking, and Video/Photo Sharing websites and the terms associated with these websites. Assessment of these behaviours can be facilitated by a basic Functional Assessment approach that is further informed using specific recommended online questions tailored to NSSI online and an assessment of the frequency, duration, and time of day of the online activities. Intervention in this area should initially assess readiness for change and use motivational interviewing to encourage substitution of healthier online activities for the activities that may currently foster harm.

Constant connections: piloting a mobile phone-based peer support program for Nuer (southern Sudanese) women

Refugee women have poor psychosocial health as a result of past trauma and difficulties associated with settlement. This study was a pilot to find out how to use mobile phone-based peer support to improve the psychosocial health of, and facilitate settlement in a group of nine Nuer refugee women in Melbourne, Australia. Nine participants recruited by a community leader received peer support training over two five-week periods. They were further provided with mobile phone recharge vouchers to call one another to practice peer support techniques. The fifth and final sessions were focus groups to evaluate the intervention. Notes from the focus groups were thematically analysed. The women reported greater confidence and empowerment as they received more support, had better connections within the group and better access to information. Relationships with friends, family and the community became richer as they adopted and experienced more functional communication patterns. Using mobile phones for peer support helped to re-create community by bridging the geographical distance that separates refugee women. It allowed the women, from similar backgrounds and with similar experiences, to provide mutual support and exchange information through a verbal channel, the form of communication they are most comfortable with. The program demonstrates the positive psychosocial effect of peer support in a refugee community, and provides a viable model for using mobile phones in health promotion interventions. The successful outcomes, as perceived by the participants, are indicative of the potential of using technology to bridge health inequities in a marginalised group.

Telephone peer support for women with gynaecological cancer: recipients' perspectives

Peer support is much valued by cancer patients. Previous research has focused on support groups, typically for women with breast cancer; little has addressed one-to-one support. This qualitative study examined a telephone-delivered one-to-one peer support intervention for women with gynaecological cancer, focusing on recipients' experiences of process and outcome. Semi-structured interviews were conducted with 24 women recently treated for gynaecological cancer who had received peer support for up to a 3-month period. Transcripts were analysed thematically using the 'Framework' approach. Six key components of the peer support process were identified: an emotional bond, empathy, talking openly, reciprocity, information and guidance, and humour. Their importance was highlighted by cases in which they were absent or problematic. Participants described several benefits, for example hope and confidence, making sense of the illness experience and rebuilding one's life. However, one-third reported limited or no benefits, although there was no evidence of adverse outcomes. One-to-one telephone peer support shares common features with support groups but is uniquely dependent on an effective working relationship between the support provider and recipient. Peer support can address the disease- and treatment-specific concerns of women with gynaecological cancer, as well as the adaptive tasks of recovery faced by cancer survivors. Further research needs to examine who is more or less likely to benefit from one-to-one peer support and which parameters of the intervention, such as duration and matching, influence its effectiveness. Patient-relevant outcomes should be included in future controlled trials.

Postpartum depression peer support: Maternal perceptions from a randomized controlled trial

Background Peer support in the early postpartum period is effective in the prevention of postpartum depression among women identified as high-risk. Objectives To describe maternal perceptions of peer support received while participating in a trial. Design Cross-sectional survey of women participating in a randomized controlled trial to evaluate the effect of peer support in the prevention of postpartum depression. Setting Seven health regions across Ontario Canada. Participants 701 women were recruited between November 2004 and September 2006. Women eligible for the study were all mothers with an Edinburgh Postnatal Depression Scale score >9 who were within 2 weeks postpartum, at least 18 years of age, able to speak English, had a live birth, and had been discharged home from the hospital. Exclusion criteria included an infant not discharged home with the mother and current use of antidepressant or antipsychotic medication. Two hundred and twenty-one mothers completed the mailed questionnaire. Methods Women were randomly allocated to receive usual postpartum care (control group) or usual postpartum care plus telephone-based peer support (intervention group). Maternal perceptions of peer support were evaluated at 12 weeks postpartum using the validated Peer Support Evaluation Inventory. Results Interactions provided by the peer volunteer included the provision of emotional (92.7%), informational (72.4%), and appraisal (72.0%) support. Mothers reported high levels of positive relationship qualities such as trust (83.6%) and perceived acceptance (79.1%). Most (80.5%) mothers indicated they were very satisfied with their peer support experience. Maternal satisfaction was associated with the number and duration of peer volunteer contacts. Conclusions The majority of mothers perceived their peer volunteer experience positively lending further support to telephone-based peer support as a preventative strategy for postpartum depression. The following program modifications were suggested: (a) adapt training to enhance the provision of appraisal support; (b) improve matching of volunteers to participants based on age, number of children, and breastfeeding status; and (c) ensure participating mothers want to receive peer support in order to facilitate the development of relationships with their assigned peers.

Exploring kidney patients’ experiences of receiving individual peer support

Peer support schemes of various types are commonly offered to patients as an adjunct to health and social care services provided by professionals. For patients with chronic illness, peer support interventions have recently become associated with more directive attempts to increase self management and improve healthcare outcomes. There is little qualitative research on patients' experiences of one-to-one peer support. To explore kidney patients' experiences of receiving individual peer support. Two large teaching hospital renal units in South London, with peer support services for patients on the pre-dialysis care pathway. Qualitative telephone interviews with a purposive, maximum variation sample of 20 people who had received peer support. The majority of respondents were overwhelmingly positive about their experience of peer support and its benefits. They valued peer support because it had given them access to practical information about kidney disease, based on lived experience, which helped them reach decisions about treatment. Peer supporters offered patients empathy and understanding; confirmation that they were not alone in suffering; positive role models of coping with treatment for kidney disease; and hope for the future. Peer support helped patients adapt to chronic illness by normalizing adherence to demanding treatment regimes and increasing patients' sense of empowerment and agency. A brief meeting with a peer supporter delivered similar perceived benefits to those described by participants in support groups. Possible explanations for this include selection and training of peer supporters; careful matching of patients with peer supporters; and responsiveness to individual user-defined needs for information and psychosocial support.

Perceived Sources of Support of Adult Burn Survivors

The long-term effects of burn injuries can be devastating and last a lifetime. The aims of this study were to: (1) identify what factors adult burn survivors report as important during their burn recovery, (2) identify the frequency and reported benefits of peer support for burn survivors, (3) determine the difference in the level of reported hope among burn survivors who received peer support compared with survivors who did not receive peer support. A total of 117 adult burn survivors participated in this descriptive study and 87.8% reported family support as very important to their recovery, with 65% rating the burn team members as very important and 60.7% rated speaking to another burn survivor as very important to their recovery. Ninety-two percent found speaking to another burn survivor to be helpful and 96.6% would recommend that a newly injured burn patient speak with someone who has been through the recovery process of a burn injury. The t test scores for the two groups reflected the following: the group who received peer support (N=87) and the group who did not (N=28) showed a statistical significance for the Pathway Subscale [t=-2.197 (P=.030)] and the Total Hope Score [t=-1.971 and (P=<.050)]. The results of this survey suggest that there are perceived benefits of peer support and imply that peer support may have a positive impact on hope for burn survivors.

Powerful Choices: Peer Support and Individualized Medication Self-Determination

I am a certified peer specialist. I have helped homeless people and people with mental illnesses reclaim their lives by sharing my story of recovery from both homelessness and mental illness. I use many tools and creative talents each day at work: poetry, PowerPoint presentations, personal conversations, recovery research, and extensive social networking. I believe that the mental health system can change to provide recovery for every single person with mental illness. I think that 2 of the important science-to-service gaps in real-world schizophrenia treatment are the ability to inspire people to make changes in their own lives and to help people decide to take responsibility for important choices that will affect their recovery. As a peer specialist, I tackle both issues. I think that we need both more peer support and more medication self-determination and individualization of treatment. My message is a story of hope that all people with mental illness can take control of their lives on the other side of a diagnosis. We can regain a productive and fulfilling membership in the community. By combining my life passions, my recovery story, my dreams, and my joys, I am able to create novel presentations and workshops. I perform these for day programs, support groups, consumer-run organizations, and staff trainings at community mental health centers. These are active and participatory learning experiences that incorporate performance or spoken word poetry, PowerPoint slides, and cutting edge research that challenge how the current mental health system is being funded and operated. I am a storyteller, and I tell a tale of change: taking the power back to help oneself, taking risks, and finding new dreams. I create short or long workshops where people can become inspired by both giving and receiving peer support in order to learn the importance that mutual relationships can have. I believe that peer support is the future of the mental health system, and we will be some of the most powerful forces in transforming the mental health system to a “recovery-oriented community of hope.”1 My recovery involved finding a way to maximize my strengths and move beyond my weaknesses, and active transportation, including walking, running, and bicycling, is an important element in my daily routine. Patricia Deegan, PhD, a psychologist who has also recovered from schizophrenia, has come up with a term called “personal medicine,” which is what we do for ourselves. Pill medicine is what we take, and personal medicine is what we do, both how we stay well and the reasons we find for wanting to stay well.2 I have incorporated my art, my work, and my life, in a way where many of the things I do will enhance my recovery. I ride a bicycle everywhere I go and advocate for the 8.3% of Missouri households that have no access to an automobile.3 I use exercise as a positive coping tool for stress, I am out and involved in the community, and I have made a great group of friends and supporters who enjoy my personality with or without mental illness. My plan, my power, and my way is to do what I can to be a positive, inspirational person who has immense potential to make the world a better place.

Adults with Congenital Heart Disease: Psychological Needs and Treatment Preferences

Approximately one-third of adult congenital heart disease (ACHD) patients have mood or anxiety disorders, the majority of which go untreated. The extent to which this group of patients is interested in psychological services is, however, unknown. This study investigated the perceived psychological needs of patients and their mental health treatment preferences. Participants completed an anonymous survey with items regarding mental health treatment history, preferences for future treatment, Internet use, and interest in peer support. A total of 155 ACHD patients completed study questionnaires (mean age = 39 years; 50% female). Forty percent of patients reported previous mental health treatment. Some 51% of patients (73/142) indicated significant interest in at least 1 of 7 defined areas of psychological treatment (managing mood and/or anxiety, coping with a cardiac condition, stress management, anger management, relationship difficulties, substance use, and smoking cessation). Patients were most interested in stress management and coping with heart disease; one-third of patients (48/141 and 47/141, respectively) expressed high interest in these 2 topics. There was a consistent preference for psychological treatment to be provided over the Internet vs. in person or over the telephone; 94% of the patients had Internet access. In total, 35% of patients (51/145) were interested in receiving peer support. It is not only health providers who recognize the importance of psychological care for ACHD patients. As a group, patients are also interested in psychological treatment and peer support. Programs are encouraged to provide psychological services and maximize opportunities for interactions with other patients.

Peer support relationships: an unexplored interpersonal process in mental health

Consumer-survivors (C/Ss) identify peer support as a resource that facilitates their recovery. However, little is known about the factors that influence or how the peer support relationship (PSR) develops/deteriorates. The purpose of the study was to explore and describe the PSR within the subculture of mental health. Using an ethnonursing method, the study focused on informants from two C/S organizations who received peer support (n = 14). Findings revealed that the PSRs may develop or deteriorate through three, overlapping phases. Contextual factors that influenced the development/deterioration of the PSR are discussed. Understanding the processes and factors that contribute to the development/deterioration of PSRs will enable clinicians and C/Ss to assess and promote the development of healthy, supportive PSRs in mental health.

Commentary on “The Benefit of Support Group Participation to Lung Cancer Survivors”

McCarthy et al have undertaken the first- ever survey of support groups for lung cancer patients in the United States. Under the auspices of the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE), they identified and collected survey information on 11 lung cancer– specific support groups. They also conducted telephone interviews with the facilitators of nine of the groups. It is remarkable, given the high incidence of lung cancer in the United States and the increasing prevalence of cancer support groups, that there were only 11 support groups identified by their survey efforts. The reasons for this are not difficult to speculate upon. Lung cancer victims, who tend to be in an older age bracket, do not expect or rely upon external supports. lncreasingly, lung cancer patients are current or former smokers from lower socioeconomic circumstances who recognize that their illness was self-induced for the most part. Those caring for these patients acknowledge that they are an undemanding group of patients. Their expectations of help from the medical profession and support from other care providers are generally limited. The low 5-year survival rate (<15%) also means that few patients survive long enough to consistently participate in a support group. Those most in need of psychosocial support with advanced disease have particularly poor survival. Patients with stage IV disease on chemotherapy can expect, at best, a median survival of about 40 weeks and a prospect of being alive at 1 year of 35%-40%. Patients with stage III disease have on average a 9-month survival. 1 Although the number of support groups surveyed is small, some facts are clear. Successful groups have strong leadership shared between patient and health care professional, usually an oncologist or an individual with expertise in psychosocial support. They most commonly focus on discussions of treatment and its side effects and how to deal with the symptoms of the disease. Not surprisingly, palliative care and death and dying were topics that were avoided either by the group leaders or by the patients themselves. Maintaining continuity in such groups was made difficult by frequent dropouts, and groups had difficulty coping with the loss of members. Curiously, according to the survey, complementary and alternative therapies were an infrequently discussed topic. Given the fact that it is estimated that over 50% of all cancer patients take alternative medicine in the United States, it is surprising that this wasn't a more frequently discussed topic. 2 Given the fact that it is hard to maintain a viable lung cancer–specific group because of patient dropout, one wonders whether the needs of lung cancer patients might be adequately met by participation in general cancer support groups. The actual needs of lung cancer patients have not been specifically assessed in a formal fashion. The facilitators of the groups believe that lung cancer–specific support groups are needed because of the stigma associated with lung cancer, and the fact that patients and their families feel anger and isolation and have a poor prognosis and symptoms that distress non–lung cancer patients. This may be true, but it would be highly desirable to have information from the patients themselves. ALCASE recognizes this need and plans a needs assessment of lung cancer patients followed by a survey of the benefits of support groups. Many implicitly believe that support groups are beneficial to cancer patients. This study suggests, through a survey of the facilitators, that patients receiving peer support benefit from companionship, learn coping skills, and gain access to diseasespecific educational resources. In addition, there has been one trial of group support versus usual medical support that demonstrated a survival benefit in breast cancer patients from participation in a group. 3 This study has not been reproduced and it is highly unlikely that a support group would actually confer survival benefit on lung cancer patients. Nonetheless, there likely are benefits. These benefits need to be quantified, and the information needs to be derived from patients rather than the facilitators of support groups. If health care institutions or other agencies are to provide support for such activities, they need to know that value is being derived by the clients of the services. In an increasingly fiscally-constrained health care environment, few would invest where there is, as yet, no evidence of benefit or no effort to quantify and document perceived benefits.

The Supplemental Nutrition Program for Women, Infants and Children (WIC) and Cooperative Extension Partner with In-Home Breastfeeding Support

LEARNING OUTCOME: To describe how in-home support by trained paraprofessionals increases breastfeeding rates and duration among low-income WIC participants. Low breastfeeding incidence and duration among low-income women are of concern. In-home support was provided by Extension paraprofessionals who were trained as breastfeeding counselors. Breastfeeding duration was tracked for babies born to WIC mothers during a three year period. The intervention resulted in significant increases in numbers and percent still breastfeeding at two weeks and eight weeks postpartum. In thirteen counties with the lowest breastfeeding rates, WIC Coordinators and Extension Home Economists collaborated to hire paraprofessionals to be trained as Breastfeeding Peer Counselors by the state WIC Lactation Consultant. Wearing pagers, the counselors are available to provide support to low-income WIC participants prenatally, postpartum hi the hospital, and after discharge when breastfeeding concerns typically surface. The state WIC Lactation Consultant provides technical support to breastfeeding counselors by phone and site visits. Among the 2,250+ participants seen since 1993, both breastfeeding initiation and duration rates are more than double that of statewide WIC rates. The greatest effect is seen at two weeks, when only 16% of those receiving peer support quit breastfeeding, compared with 58% of those without support. Fifty-four percent are still breastfeeding at two months postpartum compared with 18% of women in the general WIC population. One unexpected finding was that African American mothers breastfed the longest compared to all racial groups. Participants cite the home visit as the most helpful aspect of the program.

Planning and Implementing Collaborative Strategy Instruction for Delayed Readers in Grades 6-10

This article describes the evolution of an innovative research project with in-service special education teachers engaged in collaborative strategy instruction with small groups of severely reading-delayed adolescents (ages 12-16). Although most strategy instruction has a common goal, we point out subtle differences among approaches that may cause confusion for teachers using strategy instruction. Our project stressed working with teachers to resolve problems of application, and in this article we emphasize how teachers' contributions resulted in a unique approach to reading strategy instruction. The characteristics of our teacher education model are described and related to findings from research on the model. 9 experimental and 7 control teachers and their students took part in the study. Experimental teachers received peer support from previously trained teachers and took part in self-evaluative workshops as they applied collaborative reading instruction with their students. An analysis of videotaped p...

A teacher development project in transactional strategy instruction for teachers of severely reading-disabled adolescents

This study investigates effects of an intervention for providing teachers with strategies for helping adolescent delayed readers take an active approach to reading informational texts. Nine experimental and seven control teachers and their students took part. Experimental teachers received peer support from previously trained teachers and took part in self-evaluative workshops as they applied strategic reading techniques with their students. An analysis of videotaped pre- and posttest reading sessions showed significant gains in favour of experimental teachers on many dimensions related to fostering strategic reading, which were mirrored by related gains in students. A standardized comprehension test also favoured experimental students.

The response to injustice: Effects of varying levels of social support and position of advantage or disadvantage

This study investigated the effects of varying levels of social support as well as position of advantage or disadvantage on subjects' response to injustice. Conditions of advantage and disadvantage were established by randomly assigning one member of each experimental dyad to a method of working which prevented him/her from earning points for prizes. Three levels of social support (“none,” “peer,” “authoritative”) were created. Advantaged and disadvantaged subjects receiving authoritative support for the possibility of change and disadvantaged subjects receiving peer support in the form of divided opinion statements rated the system as less fair than either group in the absence of support or the advantaged receiving only peer support. Disadvantaged subjects evidenced a tendency to assume personal responsibility for their lower outcomes. Social support reduced this tendency but did not eliminate it.