Telephone-based Peer Support Research Articles

Randomized controlled trial of a peer led multimodal intervention for men with prostate cancer to increase exercise participation.

Exercise may reduce morbidity, increase survival, and improve quality of life (QoL) in prostate cancer patients. However, effective ways to encourage exercise outside carefully controlled clinical trials remain uncertain. We evaluated the effectiveness of peer-led self-management for increasing exercise participation in men with localized prostate cancer. Four hundred and sixty-three prostate cancer patients from Queensland, Australia were randomized to a monthly telephone-based group peer support for 6months supported by self-management materials and exercise equipment (INT, n=232) or usual care (UC, n=231). Participants were assessed at baseline, 3, 6, and 12months. Primary outcomes were compliance with exercise guidelines; secondary outcomes were psychological distress and QoL. Patients in INT engaged in more resistance exercise than UC at 3months (19.4 [95% CI 6.52 to 32.28] min/wk, P=.003) and 6months (14.6 [95% CI 1.69 to 27.58] min/wk, P=.027); more men achieved sufficient physical activity levels at 3months (χ2 =8.89, P=0.003). There was no difference between groups for aerobic-based activity at any time point nor for resistance exercise time at 12-month follow-up. INT had higher QoL Relationships scores at 3months (.03 [95% CI .00 to .06], P=.038) compared with UC. Limitation included self-reported assessment of exercise. Peer-led intervention was effective in increasing patients' resistance exercise participation in the short-to-medium term and in the number of men achieving sufficient activity levels in the short-term; however, this was not accompanied by overall improvements in QoL or psychological distress. Methods to increase effectiveness and maintain long-term adherence require further investigation.

A Two-Tiered Strategy for Preventing Complications of Bereavement in the First Thirteen Months Post-Loss: A Pilot Study Using Peer Supports with Professional Therapist Back-up

This feasibility and acceptance pilot study for preventing complications of bereavement within the first year post loss recruited 20 adult grievers within 9 months of becoming bereft and assigned consenting subjects to peer supporters trained by a non-profit bereavement support organization for weekly or bi-weekly telephone-based peer support until month 13 post-loss. Subjects who met DSM-5 criteria for major depressive disorder or showed an Inventory of Complicated Grief (ICG) score exceeding 19, 6 months or more post loss, were assigned to 12 to 16 weeks of interpersonal psychotherapy (IPT) with an experienced therapist. Eight and six subjects completed the protocol assigned to peer support and IPT, respectively, with pre/post Patient Health Questionnaire-9 scores of 5.38 (2.45) versus 3.25 (4.13) (p = 0.266) and 16.67 (7.17) versus 8.40 (5.73) (p =0.063); and pre/post ICG scores of 12.50 (4.72) versus 5.00 (2.51) (p = 0.016) and 35.17 (5.12) versus 8.4 (5.73) (p = 0.063). Implications of this two-tiered model of early intervention for preventing complications of grief are discussed.

Development of a Telephone-Based Peer Support Program for New Mothers with Postpartum Depression

Development of a Telephone-Based Peer Support Program for New Mothers with Postpartum Depression

Weekly telephone-based peer support linked to reduced depression in mothers

Weekly telephone-based peer support linked to reduced depression in mothers

Implementing a telephone based peer support intervention for women with a BRCA1/2 mutation.

Women with a BRCA1/2 gene mutation face complex risk management decisions and communication issues that can lead to increased levels of distress and unmet needs. We describe the implementation of a peer-support program that aims to reduce distress among women with a BRCA1/2 mutation, including peer and support recipient satisfaction with the program, challenges and lessons learnt. Participants with a BRCA1/2 mutation were matched with a trained peer volunteer (also a mutation carrier) to have regular one-on-one phone calls, over 4 months. Details of the calls, including topics discussed, time spent and number, were collected. Peers and recipients completed surveys assessing how they felt the contact went, satisfaction with the program, and preferences for matching. Satisfaction with the program was high for both peers and recipients. 80% of pairs ended contact through mutual agreement. Peers and recipients differed in the importance placed on age and surgery experience to determine matches. The most challenging aspect of the program for peers was difficulty in contacting recipients. Peer support for women with a BRCA1/2 mutation is feasible. However, to encourage continued involvement by peers and recipients greater flexibility in the method and delivery of contact is needed. We advocate the use of text-messaging and/or email as mechanisms for pairs to arrange and maintain contact. These strategies should be in addition to, rather than replacing, calls. A mixed medium intervention, where recipients can tailor the method of communication to suit their needs, may be preferable and effective, though this would need to be tested.

Randomized controlled trial of a telephone-based peer-support program for women carrying a BRCA1 or BRCA2 mutation: impact on psychological distress.

To assess the effectiveness of a telephone-based peer-delivered intervention in reducing distress among women with a BRCA1 or BRCA2 gene mutation. The intervention involved trained peer volunteers contacting women multiple times over a 4-month period to provide informational, emotional, and practical support. Three hundred thirty-seven participants completed the baseline questionnaire, and those reporting interest in talking to other mutation carriers were randomly assigned to either the usual care group (UCG; n = 102) or the intervention group (IG; n = 105). Participants and researchers were not blinded to group allocation. Two follow-up questionnaires were completed, one at the end of the intervention (4 months after random assignment, time 2) and one 2 months later (time 3). Outcomes included breast cancer distress (primary outcome), unmet information needs, cognitive appraisals about mutation testing, and feelings of isolation. There was a greater decrease in breast cancer distress scores in the IG than UCG at time 2 (mean difference, -5.96; 95% CI, -9.80 to -2.12; P = .002) and time 3 (mean difference, -3.94; 95% CI, -7.70 to -0.17; P = .04). There was a greater reduction in unmet information needs in the IG than UCG (P < .01), with unmet needs being lower in the IG than UCG at time 2. There was a greater reduction in Cognitive Appraisals About Genetic Testing stress subscale scores in the IG than UCG (P = .02), with significantly lower scores among the IG than UCG at time 2 (P < .01). The intervention is effective in reducing distress and unmet information needs for this group of women. Identifying strategies for prolonging intervention effects is warranted.

Effects of telephone-based peer support in patients with type 2 diabetes mellitus receiving integrated care: a randomized clinical trial.

In type 2 diabetes mellitus (T2DM), team management using protocols with regular feedback improves clinical outcomes, although suboptimal self-management and psychological distress remain significant challenges. To investigate if frequent contacts through a telephone-based peer support program (Peer Support, Empowerment, and Remote Communication Linked by Information Technology [PEARL]) would improve cardiometabolic risk and health outcomes by enhancing psychological well-being and self-care in patients receiving integrated care implemented through a web-based multicomponent quality improvement program (JADE [Joint Asia Diabetes Evaluation]). Between 2009 and 2010, 628 of 2766 Hong Kong Chinese patients with T2DM from 3 publicly funded hospital-based diabetes centers were randomized to the JADE + PEARL (n = 312) or JADE (n = 316) groups, with comprehensive assessment at 0 and 12 months. Thirty-three motivated patients with well-controlled T2DM received 32 hours of training (four 8-hour workshops) to become peer supporters, with 10 patients assigned to each. Peer supporters called their peers at least 12 times, guided by a checklist. Changes in hemoglobin A(1c) (HbA(1c)) level (primary), proportions of patients with attained treatment targets (HbA(1c) <7%; blood pressure <130/80 mm Hg; low-density lipoprotein cholesterol <2.6 mmol/L [to convert to milligrams per deciliter, divide by 0.0256]) (secondary), and other health outcomes at month 12. Both groups had similar baseline characteristics (mean [SD] age, 54.7 [9.3] years; 57% men; disease duration, 9.4 [7.7] years; HbA(1c) level, 8.2% [1.6%]; systolic blood pressure, 136 [19] mm Hg; low-density lipoprotein cholesterol level, 2.89 [0.82] mmol/L; 17.4% cardiovascular-renal complications; and 34.9% insulin treated). After a mean (SD) follow-up period of 414 (55) days, 5 patients had died, 144 had at least 1 hospitalization, and 586 had repeated comprehensive assessments. On intention-to-treat analysis, both groups had similar reductions in HbA(1c) (JADE + PEARL, 0.30% [95% CI, 0.12%-0.47%], vs JADE, 0.29% [95% CI, 0.12%-0.47%] [P = .97]) and improvements in treatment targets and psychological-behavioral measures. In the JADE + PEARL group, 90% of patients maintained contacts with their peer supporters, with a median of 20 calls per patient. Most of the discussion items were related to self-management. In patients with T2DM receiving integrated care, peer support did not improve cardiometabolic risks or psychological well-being. clinicaltrials.gov Identifier: NCT00950716.

The process of developing and implementing a telephone-based peer support program for postpartum depression: evidence from two randomized controlled trials.

BackgroundA randomized controlled trial evaluated the effect of telephone-based peer support on preventing postpartum depression (PPD) among high-risk mothers. The results indicated that support provided by peer volunteers may be an effective preventative strategy. The purpose of this paper is to outline the process of developing, implementing, maintaining, and evaluating the peer support program that we used in this PPD prevention trial.MethodsThe peer support program had been used successfully in a pilot trial and a previous breastfeeding peer support trial. Based on our experience and lessons learned, we developed a 4-phase, 12-step approach so that the peer support model could be copied and used by different health providers in various settings. We will use the PPD prevention trial to demonstrate the suggested steps.ResultsThe trial aim to prevent the onset of PPD was established. Peer volunteers who previously experienced and recovered from self-reported PPD were recruited and attended a four-hour training session. Volunteers were screened and those identified as appropriate to provide support to postpartum mothers were selected. Women who scored more than 9 on the Edinburgh Postnatal Depression Scale within the first two weeks after childbirth were recruited to participate in the trial and proactive, individualized, telephone-based peer support (mother-to-mother) was provided to those randomized to the intervention group. Peer volunteers maintained the intervention, supported other volunteers, and evaluated the telephone-based support program. Possible negative effects of the intervention were assessed. An in-depth assessment of maternal perspectives of the program at 12 weeks postpartum was performed.ConclusionsThe 4-phase, 12-step approach delineated in this paper provides clear and concise guidelines for health professionals to follow in creating and implementing community-based, peer-support interventions with the potential to prevent PPD.Trial registrationCurrent Controlled Trials ISRCTN68337727.

Effects of Telephone-Based Peer Support in Patients With Type 2 Diabetes Mellitus Receiving Integrated Care: A Randomized Clinical Trial

Effects of Telephone-Based Peer Support in Patients With Type 2 Diabetes Mellitus Receiving Integrated Care: A Randomized Clinical Trial

Randomised controlled trial of a telephone-based peer support intervention to reduce depressive symptoms and improve social support in women with CHD

Randomised controlled trial of a telephone-based peer support intervention to reduce depressive symptoms and improve social support in women with CHD

Psychosocial and psychological interventions for preventing postpartum depression

Epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables as postpartum depression risk factors. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression. Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of professionally-based versus lay-based interventions, (3) the effectiveness of individually-based versus group-based interventions, (4) the effects of intervention onset and duration, and (5) whether interventions are more effective in women selected with specific risk factors. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), scanned secondary references and contacted experts in the field. We updated the search on 31 December 2012 and added the results to the awaiting classification section of the review for assessment at the next update. All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care. Review authors and a research co-ordinator with Cochrane review experience participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data. Twenty-eight trials, involving almost 17,000 women, contributed data to the review. Overall, women who received a psychosocial or psychological intervention were significantly less likely to develop postpartum depression compared with those receiving standard care (average RR 0.78, 95% confidence interval (CI) 0.66 to 0.93; 20 trials, 14,727 women). Several promising interventions include: (1) the provision of intensive, individualised postpartum home visits provided by public health nurses or midwives (RR 0.56, 95% CI 0.43 to 0.73; two trials, 1262 women); (2) lay (peer)-based telephone support (RR 0.54, 95% CI 0.38 to 0.77; one trial, 612 women); and (3) interpersonal psychotherapy (standardised mean difference -0.27, 95% CI -0.52 to -0.01; five trials, 366 women). Professional- and lay-based interventions were both effective in reducing the risk to develop depressive symptomatology. Individually-based interventions reduced depressive symptomatology at final assessment (RR 0.75, 95% CI 0.61 to 0.92; 14 trials, 12,914 women) as did multiple-contact interventions (RR 0.78, 95% CI 0.66 to 0.93; 16 trials, 11,850 women). Interventions that were initiated in the postpartum period also significantly reduced the risk to develop depressive symptomatology (RR 0.73, 95% CI 0.59 to 0.90; 12 trials, 12,786 women). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.66, 95% CI 0.50 to 0.88; eight trials, 1853 women). Overall, psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Promising interventions include the provision of intensive, professionally-based postpartum home visits, telephone-based peer support, and interpersonal psychotherapy.

Peer support for postpartum depression: volunteers' perceptions, recruitment strategies and training from a randomized controlled trial

A randomized controlled trial evaluated the effect of telephone-based peer support (mother-to-mother) on preventing postpartum depression among high-risk mothers. This paper reports volunteers' perceptions, which showed that peer support is an effective preventative intervention. Two-hundred and five (205) volunteers were recruited and trained to provide peer support to 349 mothers randomized to the intervention group. Volunteers' perceptions were measured at 12 weeks using the Peer Volunteer Experience Questionnaire, completed by 69% (121) of the 175 volunteers who provided support to at least one mother. Large majorities felt that the training session had prepared them for their role (94.2%), that volunteering did not interfere with their lives (81.8%) and that providing support helped them grow as individuals (87.8%). Over 90% stated that they would become a peer volunteer again, given the opportunity. Recruitment and retention of effective volunteers is essential to the success of any peer-support intervention. Results from this study can assist clinicians and program planners to provide effective training, sufficient on-going support and evaluation and appropriate matching of volunteers to mothers who desire peer support and are at high risk of postpartum depression.

What are the unmet support needs of women with a known BRCA1/2 mutation?

Background Women known to carry a BRCA1/2 mutation have to make complex decisions regarding the management of their increased cancer risk, such as whether or not to undergo risk-reducing surgery and how to communicate this risk information to family members. These women may face a unique set of supportive care needs, although unlike the situation for breast and other cancer patients, few supportive care services for mutation carriers exist outside the Familial Cancer Centres. The aim of this presentation is to describe the unmet support needs of women with a known BRCA 1/2 mutation volunteering for a randomised control trial (RCT) testing the effectiveness of a telephone based peer support program.

A Review of Volunteer-Based Peer Support Interventions in Diabetes

Given the complexity of diabetes self-management activities and patients' resultant need for lifelong diabetes self-management support (DSMS), peer support has been increasingly examined as a potential model for diabetes self-management education (DSME) and ongoing DSMS.1 Dennis2 defines peer support as “the provision of emotional, appraisal, and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, to address a health-related issue of a potentially or actually stressed focal person.” During the past decade, there has been a proliferation of research examining the feasibility, acceptability, and health-related impact of peer support interventions in the context of diabetes care.3–14 Based on a review of peer support interventions for patients with diabetes, Heisler15,16 identified five models of peer support, including 1 ) face-to-face group self-management programs, 2 ) peer coaches or mentors, 3 ) community health workers (CHWs), 4 ) telephone-based peer support, and 5 ) Internet or e-mail–based peer support. Face-to-face group support typically involves a peer supporter or a team of peer supporters delivering DSME or DSMS in a group-based setting such as the diabetes-specific version of the chronic disease self-management program of Lorig and Gonzales.17 Peer coaching or mentoring usually involves individuals working with patients on a less structured basis providing emotional support and serving as a role model.18 CHWs are individuals who live in the same community and share the same cultural background, values, and customs as the target patient population.19,20 CHWs provide informational, instrumental, and emotional support and often function as a bridge between community members and the health care system.19,20 In fact, some studies in a 2007 systematic review of diabetes interventions21 involving CHWs reported improvements in clinical (glycemic control, …

P02-509 - Systematic literature review of the use of lay support models in postnatal depression

AimsGrowing interest has been shown in the use of peers as lay health workers in maternal healthcare. This review aimed to examine published evidence on the effectiveness of lay support models for the management of postnatal depression (PND).MethodsMEDLINE, EMBASE, PsycINFO and the Cochrane Library were searched for randomised controlled trials (RCTs) of interventions conducted by lay health workers in postnatal women, published between 1980 and August 2010. The search revealed seven studies, totaling 16,095 participants, which reported outcomes in PND and mothers’ mental health/self-esteem.ResultsThe value of lay support models depends on the intervention type and the population targeted. Telephone based peer support, for women identified as high-risk for PND, showed a statistically significant reduction in Edinburgh Postnatal Depression Scale (EPDS) scores at 12 weeks. Universal provision of peer mentoring has been shown to significantly improve self-esteem at one year postpartum, but no studies have shown statistical significance on PND or mental health outcomes (measured by EPDS/SF-36). In poor populations, women's groups led by peer facilitators have been shown to reduce moderate depression by 57%, compared to controls. However, another study, which evaluated community group support showed a low uptake (19%) resulting in no statistical significance. Similarly there was no significant improvement in PND with self-help manuals, despite one study reporting favorable feedback.ConclusionsThere is some evidence from RCTs that high-risk groups and specific demographics can benefit from targeted peer support. However, no particular model can be strongly recommended, and further research is required.

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.

Telephone based peer support can reduce postnatal depression in women at high risk

Telephone based peer support can reduce postnatal depression in women at high risk

Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial

Objective To evaluate the effectiveness of telephone based peer support in the prevention of postnatal depression.Design Multisite randomised controlled trial.Setting Seven health regions across Ontario, Canada.Participants 701 women in the...

Psychosocial and psychological interventions for treating postpartum depression

Postpartum depression is a major health issue for many women from diverse cultures. While pharmacological interventions are an effective treatment for depression, mothers are often reluctant to take antidepressant medication due to concerns about breast milk transmission or potential side-effects. It is important that non-pharmacologic interventions be evaluated for use with postpartum women experiencing depressive symptomatology. Primary: to assess the effects of all psychosocial and psychological interventions compared with usual postpartum care in the reduction of depressive symptomatology.Secondary: to examine (1) the effectiveness of specific types of psychosocial interventions; (2) the effectiveness of specific types of psychological interventions; (3) the effectiveness of specific types of psychosocial interventions versus psychological interventions; (4) the effects of intervention mode (e.g., individual versus group-based interventions); and (5) the effects of sample selection criteria (e.g., targeting women with clinically diagnosed depression versus self-reported depressive symptomatology). CCDANCTR-Studies and CCDANCTR-References were searched on 1/8/2007, the Cochrane Pregnancy and Childbirth Review Group trials register, CENTRAL, MEDLINE (1966 to 2006), EMBASE (1980 to 2006) and CINAHL (1982 to 2006) using various combinations of the terms 'postpartum/postnatal depression.' Secondary references and experts in the field were used to identify other published or unpublished trials. All published, unpublished, and ongoing randomised controlled trials and quasi-randomised trials of psychosocial or psychological interventions where the primary or secondary aim was a reduction in depressive symptomatology. Both review authors participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. Ten trials met the inclusion criteria, of which nine trials reported outcomes for 956 women. Any psychosocial or psychological intervention, compared to usual postpartum care, was associated with a reduction in the likelihood of continued depression, however measured, at the final assessment within the first year postpartum. Both psychosocial and psychological interventions were effective in reducing depressive symptomatology. Trials selecting participants based on a clinical diagnosis of depression were just as effective in decreasing depressive symptomatology as those that enrolled women who met inclusion criteria based on self-reported depressive symptomatology. Although the methodological quality of the majority of trials was, in general, not strong, the meta-analysis results suggest that psychosocial and psychological interventions are an effective treatment option for women suffering from postpartum depression. The long-term effectiveness remains unclear.

Telephone-based peer support increased the duration of breast-feeding in primiparous mothers

Telephone-based peer support increased the duration of breast-feeding in primiparous mothers