Developing role models for health in the fire service: a pilot case study

OBJECTIVES

The objectives of this case study were to develop role models for health in the fire service through knowledge and behaviour change, to improve the role models' own health, and to facilitate behaviour change in other firefighters through their example.

DESIGN

Volunteers interested in improving their own health and serving as role models to others in the fire service were identified at a statewide Maryland fire service leadership meeting.

SETTING

Participants worked with the Johns Hopkins Weight Management Center to learn how to improve their own health and shared that knowledge with others in their fire departments.

PARTICIPANTS

Three Maryland fire service leaders were recruited at a leadership meeting with the goal of improving their own health and becoming role models. One participant dropped out shortly after beginning, while two male participants, aged 57 and 61, completed the study.

MAIN OUTCOME MEASURES

Quantitative measures were collected at baseline and 12 months, and included weight, blood pressure and fasting glucose and cholesterol. Semi-structured interviews were conducted approximately 14 months postintervention to determine the participants' perceptions of their own health and impact on others in the fire service.

RESULTS

Each participant had biweekly to monthly visits over a one-year period to learn the knowledge and skills that would assist him with improving dietary behaviours, increasing fitness and achieving a healthy weight. Case study participants experienced reductions in body weight (-13% and -11% of total body weight), glucose and blood pressure. Qualitative one-on-one interviews conducted postintervention with the participants revealed that they embraced their status as role models and felt their success inspired other firefighters. Their experiences suggest that role models can play an important role in helping firefighters increase self-efficacy, self-regulation and social support in the workplace environment.

CONCLUSIONS

These findings provide promising evidence for the use of role models to improve health, especially in the workplace.

Development and evaluation of a hospital-based peer support group for younger individuals with stroke

The incidence of stroke in younger individuals is rising, producing unique challenges due to loss of productive roles and long-term impact in the survivor's life. This paper reports the results of a hospital-based program based on occupational therapy principles that was designed to provide support and education for 13 younger individuals (<65) with stroke. Participants demonstrated improved socialization, healthy coping, and role attainment as measured by the Stroke Impact Scale (SIS), the Community Integration Questionnaire (CIQ), and a member satisfaction questionnaire. Key factors for successful implementation and considerations for future programs to meet the needs of younger adults with stroke are discussed.

Suicidal ideation in adolescents: A structural equation modeling approach

The purpose of this study is to test a model linking adolescents' experience of violence and peer support to their happiness and suicidal ideation. The participants were high school students in Seoul, and in Kyungi, and Chungnam Provinces in Korea. The Conflict Tactics Scale, School Violence Scale, Oxford Happiness Inventory, and Suicidal Ideation Questionnaire were administered to just over 1000 adolescents. The model was tested using a path analysis technique within structural equation modeling. The model fit indices suggest that the revised model is a better fit for the data than the original hypothesized model. The experience of violence had a significant negative direct effect and peer support had a significant positive direct effect on their happiness. Happiness had a significant negative effect and the experience of violence had a significant positive effect on suicidal ideation. These findings demonstrate the fundamental importance of reducing exposure of violence to adolescents, and that increasing peer support and their happiness may be the key to adolescent suicidal ideation prevention.

Key concepts in consumer and community engagement: a scoping meta-review

BACKGROUND

Although consumer and community engagement (CCE) in health care is receiving increasing attention, research and practice in this area are hampered by the variability of concepts and terminology commonly employed. This scoping meta-review aims to identify key CCE concepts and examine terminology used to describe them.

METHODS

In a scoping meta-review, an extensive list of 47 phrases and 11 Medical Subject Headings (MeSH) was used to undertake a comprehensive and systematic search in PubMed Central, Embase, EBM reviews, CINAHL, APAPsycNET, and Scopus.

RESULTS

59 systematic reviews met the selection criteria and were included in the final analysis. The analysis identified nine different concepts related to CCE: shared decision making, self-management, CCE in health care systems, community-based health promotion, providing access to health care, rehabilitation, participation in research, collaboration in research design and conduct, and peer support. The identified concepts differ from each other in many aspects including the aim of the activity, the role of consumers and the type of professionals' involvement. Each concept was described by a range of terms, with some terms shared by different concepts. In addition, two overlapping concepts of patient-centeredness and patient empowerment were recognised.

CONCLUSIONS

This study describes CCE-related key concepts and provides new insight into their relationship with different CCE-related terms. Identification of key CCE-related concepts and terms will be useful to focus future studies and initiatives and enhance production of CCE-related evidence.

I am no longer alone - How do university students perceive the possibilities of social media?

An increasing number of people have become users of social media, mostly looking for social contacts and networking. But what kind of social capital do social networking services (SNSs) provide? University students' (N = 90) experiences of and opinions on social media were studied through a semi-structured questionnaire. The following research questions were set for this study: (1) What kinds of benefits do university students perceive in the usage of social media? and (2) What kind of social capital does social media produce according to university students' opinions? Their answers were analysed with the qualitative content analysis method. The results revealed that SNSs can increase students' social capital in many ways, such as in the form of peer support groups and learning environments, and enhance bonding and communality in them. These possibilities should be better studied in educational contexts, as they can have a positive impact on students' well-being, engagement to studies and, thus, study success.

Ringing Up about Breastfeeding: a randomised controlled trial exploring early telephone peer support for breastfeeding (RUBY) - trial protocol

BACKGROUND

The risks of not breastfeeding for mother and infant are well established, yet in Australia, although most women initiate breastfeeding many discontinue breastfeeding altogether and few women exclusively breastfeed to six months as recommended by the World Health Organization and Australian health authorities. We aim to determine whether proactive telephone peer support during the postnatal period increases the proportion of infants who are breastfed at six months, replicating a trial previously found to be effective in Canada.

DESIGN/METHODS

A two arm randomised controlled trial will be conducted, recruiting primiparous women who have recently given birth to a live baby, are proficient in English and are breastfeeding or intending to breastfeed. Women will be recruited in the postnatal wards of three hospitals in Melbourne, Australia and will be randomised to peer support or to 'usual' care. All women recruited to the trial will receive usual hospital postnatal care and infant feeding support. For the intervention group, peers will make two telephone calls within the first ten days postpartum, then weekly telephone calls until week twelve, with continued contact until six months postpartum. Primary aim: to determine whether postnatal telephone peer support increases the proportion of infants who are breastfed for at least six months.

HYPOTHESIS

that telephone peer support in the postnatal period will increase the proportion of infants receiving any breast milk at six months by 10% compared with usual care (from 46% to 56%).Outcome data will be analysed by intention to treat. A supplementary multivariate analysis will be undertaken if there are any baseline differences in the characteristics of women in the two groups which might be associated with the primary outcomes.

DISCUSSION

The costs and health burdens of not breastfeeding fall disproportionately and increasingly on disadvantaged groups. We have therefore deliberately chosen trial sites which have a high proportion of women from disadvantaged backgrounds. This will be the first Australian randomised controlled trial to test the effectiveness and cost effectiveness of proactive peer telephone support for breastfeeding.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12612001024831.

Adolescent relationship violence: help-seeking and help-giving behaviors among peers

Young people tend to disclose relationship violence experiences to their peers, if they disclose at all, yet little is known about the nature and frequency of adolescent help-seeking and help-giving behaviors. Conducted within a sample of 1,312 young people from four New York City high schools, this is the first paper to ask adolescent help-givers about the various forms of help they provide and among the first to examine how ethnicity and nativity impact help-seeking behaviors. Relationship violence victims who had ever disclosed (61%) were more likely to choose their friends for informal support. Ethnicity was predictive of adolescent disclosure outlets, whereas gender and nativity were not. Latinos were significantly less likely than non-Latinos to ever disclose to only friends, as compared to disclosing to at least one adult. The likelihood of a young person giving help to their friend in a violent relationship is associated with gender, ethnicity, and nativity, with males being significantly less likely than females to give all forms of help to their friends (talking to their friends about the violence, suggesting options, and taking action). Foreign-born adolescents are less likely to talk or suggest options to friends in violent relationships. This study also found that Latinos were significantly more likely than non-Latinos to report taking action with or on behalf of a friend in a violent relationship. This research shows that adolescents often rely on each other to address relationship violence, underlining the importance of adolescents' receipt of training and education on how to support their friends, including when to seek help from more formal services. To further understand the valuable role played by adolescent peers of victims, future research should explore both which forms of help are perceived by the victim to be most helpful and which are associated with more positive outcomes.

Peer support to decrease diabetes-related distress in patients with type 2 diabetes mellitus: design of a randomised controlled trial

BACKGROUND

Many type 2 diabetes mellitus patients face difficulties self-managing their illness, which can lead to high levels of diabetes-related distress. Diabetes distress may be decreased by peer support, as peers understand and have dealt with similar problems, and can help motivate each other. A recent systematic review concluded that evidence of benefits of peer support in patients with type 2 diabetes mellitus is too inconsistent due to weak theoretical foundation of the interventions. This study describes the design of a trial evaluating the effectiveness of a group-based, peer support programme with a strong theoretical foundation on diabetes-related distress in type 2 diabetes patients.

METHODS

This is a parallel group randomised controlled trial of a six session group-based peer support intervention, delivered by peer leaders and group psychotherapists, compared with one educational meeting on diabetes. At least 152 patients with a type 2 diabetes duration of three years or more and between 50 and 70 years of age, recruited via their general practitioner, will be randomised to receive the peer support intervention or one educational meeting. The intervention is developed in line with three key stages of research development of the Medical Research Council framework. The primary outcome measure for this study is diabetes-related distress. Secondary outcomes include self-management behaviour, well-being and health-related quality of life. Perceived social support is a process measure. Outcomes will be measured one month before, and 6, and 12 months after the intervention by means of self-reported questionnaires. Analysis will be on an intention-to-treat basis.

DISCUSSION

This article contains a description of the design of a study that will investigate the effect of a group-based, peer support intervention on diabetes-related distress in type 2 diabetes patients. The intervention was developed in recognition of the limited evidence, and the importance of a theoretical foundation and its implementation. Findings will contribute to knowledge in the field of peer support and patient-important outcomes in type 2 diabetes patients.

TRIAL REGISTRATION

Dutch Trial Registry: NTR3474.

Implementing a one-on-one peer support program for cancer survivors using a motivational interviewing approach: results and lessons learned

Peer Connect matches cancer survivors and caregivers (guides) with those currently experiencing cancer-related issues seeking support (partners). Motivational interviewing (MI)-based communication skills are taught to provide patient-centered support. There is little guidance about MI-based applications with cancer survivors who may have multiple coping needs. This paper addresses the results and lessons learned from implementing Peer Connect. Thirteen cancer survivors and two caregivers received a 2-day MI, DVD-based training along with six supplemental sessions. Nineteen partners were matched with guides and received telephone support. Evaluation included guide skill assessment (Motivational Interviewing Treatment Integrity Code) and 6-month follow-up surveys with guides and partners. Guides demonstrated MI proficiency and perceived their training as effective. Guides provided on average of five calls to each partner. Conversation topics included cancer fears, family support needs, coping and care issues, and cancer-related decisions. Partners reported that guides provided a listening ear, were supportive, and nonjudgmental. Limited time availability of some guides was a challenge. MI can provide support for cancer survivors and caregivers without specific behavioral concerns (e.g., weight and smoking). An MI support model was both feasible and effective and can provide additional support outside of the medical system.

Four-year retention and risk factors for attrition among members of community ART groups in Tete, Mozambique

OBJECTIVE

Community ART groups (CAG), peer support groups involved in community ART distribution and mutual psychosocial support, were piloted to respond to staggering antiretroviral treatment (ART) attrition in Mozambique. To understand the impact of CAG on long-term retention, we estimated mortality and lost-to-follow-up (LTFU) rates and assessed predictors for attrition.

METHODS

Retrospective cohort study. Kaplan-Meier techniques were used to estimate mortality and LTFU in CAG. Individual- and CAG-level predictors of attrition were assessed using a multivariable Cox proportional hazards model, adjusted for site-level clustering.

RESULTS

Mortality and LTFU rates among 5729 CAG members were, respectively, 2.1 and 0.1 per 100 person-years. Retention was 97.7% at 12 months, 96.0% at 24 months, 93.4% at 36 months and 91.8% at 48 months. At individual level, attrition in CAG was significantly associated with immunosuppression when joining a CAG, and being male. At CAG level, attrition was associated with lack of rotational representation at the clinic, lack of a regular CD4 count among fellow members and linkage to a rural or district clinic compared with linkage to a peri-urban clinic.

CONCLUSIONS

Long-term retention in this community-based ART model compares favourably with published data on stable ART patients. Nevertheless, to reduce attrition, further efforts need to be made to enroll patients earlier on ART, promote health-seeking behaviour, especially for men, promote a strong peer dynamic to assure rotational representation at the clinic and regular CD4 follow-up and reinforce referral of sick patients.

Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK

BACKGROUND

Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged.

METHODS

This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge.

RESULTS

A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support.

CONCLUSIONS

The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to support the cost effectiveness of providing peer support, but neither was it proven a costly intervention to deliver. The findings support an argument for a larger scale trial of peer support as an adjunct to existing services.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN74852771.

The impact of volunteer mentoring schemes on carers of people with dementia and volunteer mentors: a systematic review

This systematic review aims to examine the differences and similarities between the various types of volunteer mentoring (befriending, mentoring and peer support) and to identify the benefits for carers and volunteers. Literature searching was performed using 8 electronic databases, gray literature, and reference list searching of relevant systematic reviews. Searches were carried out in January 2013. Four studies fitted the inclusion criteria, with 3 investigating peer support and 1 befriending for carers. Quantitative findings highlighted a weak but statistically significant (P =.04) reduction in depression after 6 months of befriending. Qualitative findings highlighted the value carers placed on the volunteer mentors' experiential similarity. Matching was not essential for the development of successful volunteer mentoring relationships. In conclusion, the lack of need for matching and the importance of experiential similarity deserve further investigation. However, this review highlights a lack of demonstrated efficacy of volunteer mentoring for carers of people with dementia.

'Newcomer adaptation': a lens through which to understand how nursing students fit in with the real world of practice

Aims and objectives

To present a discussion on newcomer adaptation as a lens through which to understand how nursing students adapt to clinical practice and raise awareness of strategies that can be used to enhance their learning experiences.

Background

Socialisation is an important factor that facilitates students’ learning in the clinical setting. Therefore, it is beneficial to examine organisational socialisation literature, particularly that pertaining to newcomer adaptation.

Design

This is a critical review of organisational socialisation literature.

Methods

Seminal literature and more recent research in the field of organisational socialisation and newcomer adaptation were accessed. In addition, nursing and allied health literature examining students’ socialisation and the clinical learning environment was retrieved.

Conclusions

It is revealed in this article that to create an appropriate clinical learning environment, an understanding of socialisation tactics could be beneficial. Role modelling is deemed crucial to successful newcomer adaptation. Peer support is necessary but must be advocated with caution as it can have a negative impact when students form a ‘parallel community’. Students with some knowledge of the workplace tend to adapt more easily. Likewise, students’ disposition and, in particular, their confidence can also enhance the socialisation process.

Relevance to clinical practice

Both the organisation and the student can impact on how successfully the nursing student ‘fits in’. Understanding this through the lens of newcomer adaptation means that strategies can be put in place to facilitate this process.

Peer navigation in African American breast cancer survivors

PURPOSE

The purpose of this study was to explore the feasibility and acceptability of a peer navigation survivorship program for African American (AA) breast cancer survivors (BCS) and its potential effects on selected short-term outcomes according to the Quality of Life Model Applied to Cancer Survivors.

METHODS

An AA BCS who completed treatment over 1 year prior to the study was trained as a peer navigator (PN), and then paired with AA women completing primary breast cancer treatment (n=4) for 2 months. This mixed-methods, proof of concept study utilized a convergent parallel approach to explore feasibility and investigate whether changes in scores are favorable using interviews and self-administered questionnaires.

RESULTS

Results indicate that the PN intervention was acceptable by both PN and BCS, and was feasible in outcomes of recruitment, cost, and time requirements. Improvements in symptom distress, perceived support from God, and preparedness for recovery outcomes were observed over time. Qualitative analysis revealed six themes emerging from BCS interviews: "learning to ask the right questions", "start living life again", "shifting my perspective", "wanting to give back", "home visits are powerful", and "we both have a journey": support from someone who has been there.

CONCLUSION

Results support current literature indicating that AA women who have survived breast cancer can be an important source of support, knowledge, and motivation for those completing breast cancer treatment. Areas for future research include standardization of training and larger randomized trials of PN intervention.

IMPLICATIONS FOR CANCER SURVIVORS

The transition from breast cancer patient to survivor is a period when there can be a loss of safety net concurrent with persistent support needs. AA cancer survivors can benefit from culturally tailored support and services after treatment for breast cancer. With further testing, this PN intervention may aid in decreasing general symptom distress and increase readiness for recovery post-treatment.

Using second life to facilitate peer storytelling for grieving oncology nurses

BACKGROUND

Oncology nurses often experience intense emotional reactions to patient deaths but may be forced to ignore or hide their feelings because of work-related responsibilities. The complexity of nurses' work and personal lives creates obstacles for participating in traditional support groups where grieving nurses can bond and share. We hypothesized that using a web-based, three-dimensional (3-D) virtual world technology (Second Life) may provide a venue to facilitate peer storytelling to support nurses dealing with grief.

METHODS

We used a mixed-methods approach involving focus groups and surveys to explore the use of peer storytelling for grieving oncology nurses. Nine acute and ambulatory oncology nurses in groups of 3 participated using avatars in 5 group moderator-guided sessions lasting 1 hour each in a private 3-D outdoor virtual meeting space within Second Life. Baseline information was collected using a 12-item demographic and professional loss survey. At the end of the study, a 20-item survey was administered to measure professional losses during the study, exchange of support during sessions, and meaning-making and to evaluate peer storytelling using Second Life.

RESULTS

Overall, nurses reported peer storytelling sessions in Second Life were helpful in making sense of and in identifying a benefit of their grief experience. They felt supported by both the group moderator and group members and were able to personally support group members during storytelling. Although nurses reported Second Life was helpful in facilitating storytelling sessions and expressed overall satisfaction with using Second Life, open-ended comments registered difficulties encountered, mostly with technology. Three central themes emerged in sessions, representing a dynamic relationship between mental, spiritual, and emotional-behavioral responses to grief: cognitive readiness to learn about death, death really takes death experience, and emotional resilience.

CONCLUSION

This study suggests a potential benefit in using peer storytelling sessions in Second Life to facilitate oncology nurses' grief resolution. In particular, Second Life provides a nonthreatening venue for participating nurses to share their innermost feelings and accrue their own inventory of stories. Through these stories, each nurse's relational experience in expressing and coping with grief is realized.

A diabetes peer support intervention that improved glycemic control: mediators and moderators of intervention effectiveness

OBJECTIVE In a randomized trial, a guided diabetes peer support intervention improved glycemic control (A1c), with a difference in A1c change between groups of 0.58% (p = 0.004). The current study examined whether improvements in insulin uptake and perceived diabetes social support mediated the intervention's impact on A1c. We also examined potential moderation by patients' health literacy, diabetes social support, or diabetes distress. METHODS We conducted secondary analyses for 212 type 2 diabetes patients participating in the trial using accepted methods for testing mediation and moderation effects.

RESULTS

Roughly half (49%, 95% CI: 3-80%) of the A1c effect was mediated by increased insulin use, while changes in diabetes social support had a negligible impact. A1c impacts varied across subgroups defined by baseline diabetes social support and functional health literacy (both p < 0.01). The intervention was particularly beneficial among patients with low baseline diabetes support or literacy levels. The intervention had a greater impact on A1c among patients with more frequent engagement in peer support calls (p < 0.01). DISCUSSION Patients receiving increased peer support had improved glycemic control largely due to their greater likelihood of initiating insulin. Greater intervention engagement was associated with stronger effects. The intervention had its greatest benefits among patients with low support or poorer health literacy.

The relationships among perceived peer acceptance of sexual aggression, punishment certainty, and sexually aggressive behavior

Researching the correlates of men's sexually aggressive behavior (i.e., verbal coercion and rape) is critical to both understanding and preventing sexual aggression. This study examined 120 men who completed an anonymous online questionnaire. The study aimed to determine the relative importance of two potential correlates of men's self-reported use of sexual aggression: (a) perceptions that male peers use and support sexual aggression and (b) perceptions of punishment likelihood associated with sexual aggression. Results revealed that perceptions of male friends' acceptance of sexual aggression were strongly associated with individual men's reports of using verbal coercion and rape. Perceptions of punishment likelihood were negatively correlated with verbal coercion but not with rape through intoxication and force. Implications for sexual aggression prevention are discussed.

Addressing inequalities in health--what is the contribution of health trainers?

AIMS

The role that members of the public (non-professional lay people) can play in improving health is being increasingly recognised in research and policy. This paper explores what contribution lay people employed as health trainers are making to addressing health inequalities in England.

METHODS

Data from eight local evaluations of health trainer services were synthesised using a data-extraction framework to find out about client populations, any lifestyle changes made, health trainers' background and community engagement activities. These data were compared with national data to assess how findings relating to addressing inequalities compared with the national picture.

RESULTS

Local data largely matched national data and showed that health trainers are reaching people living with disadvantage and enabling them to make lifestyle changes. The data suggest that they do this by engaging with communities and taking a person-centred approach. Being non-clinical peers is also important. However, no evidence was found that health trainers were impacting on health inequalities at a population level.

CONCLUSION

Health trainers are contributing to addressing health inequalities but the services evaluated were small and had been operating for a limited time, so to expect reductions in inequalities at a population level within districts would be unrealistic. The findings of this synthesis present a challenge to primary care and public health to employ health trainers in order to engage marginalised communities as one element of plans to address health inequalities.

What is the potential for social networks and support to enhance future telehealth interventions for people with a diagnosis of schizophrenia: a critical interpretive synthesis

BACKGROUND

Digital technologies are increasingly directed at improved monitoring, management and treatment of mental health. However, their potential contribution to social networks and self-management support for people diagnosed with a serious mental illness has rarely been considered. This review and meta-synthesis aimed to examine the processes of engagement and perceived relevance and appropriateness of telehealth interventions for people with a diagnosis of schizophrenia. The review addresses three key questions. How is the use of digital communications technologies framed in the professional psychiatric literature? How might the recognised benefits of telehealth translate to people with a diagnosis of schizophrenia? What is the user perspective concerning Internet information and communication technologies?

METHODS

A critical interpretive synthesis (CIS) of published findings from quantitative and qualitative studies of telehealth interventions for people with a diagnosis of schizophrenia.

RESULTS

Most studies were of an exploratory nature. The professional discourse about the use of different technologies was overlain by concerns with surveillance and control, focusing on the Internet as a potential site of risk and danger. The critical synthesis of findings showed that the key focus of the available studies was on the delivery of existing traditional approaches (e.g. improving medications adherence, provision of medical information about the condition, symptom monitoring and cognitive behavioural therapy). Even though it was clear that the Internet has considerable potential in terms of accessing and utilising lay support, the potential of communication technologies in mobilising of resources for personal self-management or peer support was a relatively absent or hidden a focus of the available studies.

CONCLUSIONS

Based on an interpretive synthesis of available studies, people with a diagnosis of schizophrenia or psychosis use the Internet primarily for the purposes of disclosure and information gathering. Empowerment, regulation and surveillance emerged as the key dimensions of engagement (or not) with telehealth interventions. The findings suggest that telehealth interventions are disproportionately used by particular patient groups (e.g.women, people who are employed). Further research needs to ascertain the mechanisms by which telehealth interventions may be potentially beneficial or harmful for engagement and management to people with a diagnosis of schizophrenia.

Peer support for carers: a qualitative investigation of the experiences of carers and peer volunteers

Being a carer of someone with dementia can be rewarding and also challenging. Volunteer peer support schemes for carers are being introduced, little is known about either their impact on carers and volunteers or about volunteers' and carers' experiences. This study investigated peer volunteer and carer recipient experiences of a peer support service. Thematic analysis of 13 in-depth interviews with 9 carers and 4 peer volunteers revealed that peer support helped both carers and peer volunteers through the realization that they were "not alone" in their experiences and emotions. Additional carer benefits included opportunities to talk freely about difficult experiences and learning how others cope. Volunteers found their role rewarding, describing satisfaction from putting their own experiences to good use. These findings highlight the isolation and exclusion experienced by current and former carers of people with dementia and draw attention to the benefits of peer support for both the groups.

Australian consumer perceptions of peer support

INTRODUCTION

Peer support in mental health service delivery is a relatively new development in Western Australia, occurring only in the last decade. Consequently, what is known about peer support in mental health has been largely drawn from the overseas literature. The purpose of the present study was to identify how consumers of mental health services in Western Australia viewed the impact that peer support workers had on their life.

METHODS

The nominal group technique was the method used to collect and analyze the data from nine participants living in the community who were supported by a peer support worker; the role of the peer support worker was to encourage healthy lifestyle behaviors.

RESULTS

The results indicate that the main influences of a peer worker for consumers were motivation, increased social interaction, living a healthier lifestyle, positive mental attitude and building confidence.

DISCUSSION

It was concluded that participants viewed the support they received as a positive experience, which contributed to building confidence and enabled participants to make lifestyle changes. However, the results need to be viewed with caution, not only because of the small sample size, but also because the peer workers and the participants were all male. Results may well be different where the role and gender of the support worker and consumer are different.

Supported employment for young people with intellectual disabilities facilitated through peer support: a pilot study

The article reports the evaluation of a small-scale-supported employment project in a local authority in England. The study examined whether or not the peer support model could be used to deliver supported employment to a group of young people with intellectual disabilities. We utilised a mixed-method approach involving activity data, family interviews and a postal survey with participating employers. Five families took part in the study. Our findings show that families viewed the project positively, although it was insufficiently embedded in the wider transition planning. The study indicates that the peer support model may represent a useful addition to the conventional supported employment efforts for this population. However, more research is needed to demonstrate the benefits of peer support over and above the benefits of conventional supported employment for young people in post-school transition. In particular, producing a better evidence base on the exact impact of peer support on service users' experiences is recommended.

The effect of peer support groups on self-care for haemophilic patients with HIV in Japan

Experienced peer support groups (EPSG) are expected to improve self-care and complement professional health care for haemophilic patients, even those living in inconvenient clinical setting. However, these benefits have not been verified quantitatively. The structural equation modelling (SEM) was used to evaluate the effects of contact with EPSG on self-care for haemophilic patients in the Japanese clinical settings. Factors affecting self-care were compared between groups with and without EPSG contact. Self-reported questionnaires were mailed to 652 haemophilic patients with HIV in Japan (September 2005-January 2006). SEM demonstrated significant associations between EPSG contact, self-care scores and other social and individual factors. The total effect of EPSG contact on self-care was calculated. The structural differences between models were analysed in a multi-group analysis. Of the 257 respondents (response rate, 39.4%), 109 reported having contact with an EPSG (EPSG+ group) and 139 reported no contact (EPSG- group). EPSG contact was significantly associated with better self-care. In the multi-group analysis, the total effect of inconvenient access to medical services on self-care in the EPSG+ group was 10% of that in the EPSG- group and was significantly associated with poor illness-related knowledge and high anxiety level only in the EPSG- group. In the EPSG+ group, patient age was strongly associated with self-care than in the EPSG- group. These findings suggest that EPSG contact may alleviate inconvenience in medical services. Factors associated with self-care differed between groups. Health care professionals must carefully assess self-care behaviours and service accessibility based on these results.

Social support strategies in adult patients with diabetes: a review of strategies in the USA and Europe

Improvement of adherence in patients with a chronic disease state such as diabetes can be facilitated through well-crafted social support strategies. Family and friends are support options for many individuals living with diabetes. A systematic search of three databases was conducted to evaluate literature published from 2006 to April 2013 regarding social support in adults with diabetes conducted in the USA and Europe. While various studies had different findings, the overall trend shows that social support can result in a positive influence on both the ability of the patient to initiate and sustain diabetes management that can potentially result in positive health outcomes. This appears true even when the patient has low psychosocial skills and a small social support network. Healthcare professional involvement also correlates with patient improvement in specific outcomes not overlapped by the patient's social network. Support facilitated by peers can be a viable option along with the multitude of electronic options to help with social support.

Talking About Cancer and Meeting Peer Survivors: Social Information Needs of Adolescents and Young Adults Diagnosed with Cancer

PURPOSE

Limited research exists on the social information needs of adolescents and young adults (AYAs, aged 15-39 at diagnosis) with cancer.

METHODS

The Adolescent and Young Adult Health Outcomes and Patient Experiences (AYA HOPE) Study recruited 523 patients to complete surveys 6-14 months after cancer diagnosis. Participants reported information needs for talking about their cancer experience with family and friends (TAC) and meeting peer survivors (MPS). Multiple logistic regression was used to examine factors associated with each need.

RESULTS

Approximately 25% (118/477) and 43% (199/462) of participants reported a TAC or MPS need respectively. Participants in their 20s (vs. teenagers) were more likely to report a MPS need (p=0.03). Hispanics (vs. non-Hispanic whites) were more likely to report a TAC need (p=0.01). Individuals who did not receive but reported needing support groups were about 4 and 13 times as likely to report TAC and MPS needs respectively (p<0.05). Participants reporting high symptom burden were more likely to report TAC and MPS needs (p<0.01), and those reporting fair/poor quality of care were more likely to report a TAC need (p<0.01). Those reporting that cancer had an impact on several key relationships with family and friends were more likely to report social information needs.

CONCLUSION

Social information needs are higher in AYAs diagnosed in their 20s, in Hispanics, among those reporting high symptom burden and/or lower quality of care, and in individuals not in support groups. Efforts should be made to develop interventions for AYAs in most need of social information and support.

Supporting recovery by improving patient engagement in a forensic mental health hospital: results from a demonstration project

BACKGROUND

Mental health services are shifting toward approaches that promote patients' choices and acknowledge the value of their lived experiences.

OBJECTIVE

To support patients' recovery and improve their experiences of care in a Canadian forensic mental health hospital, an intervention was launched to increase patient engagement by establishing a peer support program, strengthening a patient advisory committee, and creating a patient-led research team.

DESIGN

The effect of the intervention on patient- and system-level outcomes was studied using a naturalistic, prospective, longitudinal approach. Quantitative and qualitative data were gathered from inpatients and service providers twice during the 19-month intervention.

RESULTS

Despite succeeding in supporting patients' participation, the intervention had minimal impacts on internalized stigma, personal recovery, personal empowerment, service engagement, therapeutic milieu, and the recovery orientation of services. Peer support demonstrated positive effects on internalized stigma and personal recovery.

CONCLUSIONS

Strengthening patient engagement contributes toward improving experiences of care in a forensic hospital, but it may have limited effects on outcomes.

Callers' attitudes and experiences of UK breastfeeding helpline support

BACKGROUND

Breastfeeding peer support, is considered to be a key intervention for increasing breastfeeding duration rates. Whilst a number of national organisations provide telephone based breastfeeding peer support, to date there have been no published evaluations into callers' experiences and attitudes of this support. In this study we report on the descriptive and qualitative insights provided by 908 callers as part of an evaluation of UK-based breastfeeding helpline(s).

METHODS

A structured telephone interview, incorporating Likert scale responses and open-ended questions was undertaken with 908 callers over May to August, 2011 to explore callers' experiences of the help and support received via the breastfeeding helpline(s).

RESULTS

Overall satisfaction with the helpline was high, with the vast majority of callers' recalling positive experiences of the help and support received. Thematic analysis was undertaken on all qualitative and descriptive data recorded during the evaluation, contextualised within the main areas addressed within the interview schedule in terms of 'contact with the helplines'; 'experiences of the helpline service', 'perceived effectiveness of support provision' and 'impact on caller wellbeing'.

CONCLUSION

Callers valued the opportunity for accessible, targeted, non-judgmental and convenient support. Whilst the telephone support did not necessarily influence women's breastfeeding decisions, the support they received left them feeling reassured, confident and more determined to continue breastfeeding. We recommend extending the helpline service to ensure support can be accessed when needed, and ongoing training and support for volunteers. Further advertising and promotion of the service within wider demographic groups is warranted.

The E Sibling Project - exploratory randomised controlled trial of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis

BACKGROUND

Siblings of individuals with first episode psychosis are natural partners to promote service users' recovery and are themselves vulnerable to mental ill health due to the negative impact of psychosis within the family. This study aims to develop and undertake a preliminary evaluation of the efficacy of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis. The impetus for the intervention arose from siblings' expressed needs for peer support and information on psychosis, coping and management strategies for common symptoms and ways to promote recovery.

METHODS/DESIGN

The project design draws on the Medical Research Council framework for the design and evaluation of complex interventions. Mixed methods comprising collection of qualitative focus group data, systematic review and expert advisory group consultation are used to develop the theoretical basis for and design of the intervention. This protocol focuses on the modelling and piloting phase which uses a randomised controlled trial with factorial design to test the efficacy of the intervention. Outcome data on participants' mental wellbeing, knowledge, perceived self-efficacy and experiences of caregiving will be assessed at baseline, at end of the intervention (10 weeks later) and at 10 week follow-up. In addition, a post-intervention semi-structured interview with 20% of the participants will explore their experiences and acceptability of the intervention.

DISCUSSION

This multi-component online psychoeducational intervention aims to enhance siblings' knowledge about psychosis and their coping capacity, thus potentially improving their own mental wellbeing and promoting their contribution to service users' recovery. The factorial design randomised controlled trial with a supplementary process evaluation using semi-structured interviews and usage-monitoring will collect preliminary evidence of efficacy, feasibility and acceptability, as well as feedback about the barriers and strategies to using such an innovative resource. The RCT will provide data for estimating the likely effect size of the intervention on outcomes for siblings and inform the development of a definitive future trial.

TRIAL REGISTRATION

Trial registration: ISRCTN01416694.

Does neighborhood belonging matter? Examining school and neighborhood belonging as protective factors for Latino adolescents

Across many investigations, school belonging has been linked to several positive outcomes among adolescents, including academic success and psychological well-being. Based on an ecological framework of child development, this study expands on existing research to explore factors that contribute to adolescents' sense of neighborhood as well as school belonging and investigates how belonging in both contexts is related to Latino adolescents' academic and psychological functioning. Participants consisted of 202 Latino adolescents residing in low-income, urban neighborhoods. Structural equation modeling demonstrated that neighborhood peer support was significantly associated with adolescents' sense of neighborhood belonging, whereas teacher support and school peer support were related to school belonging. Although school belonging was positively associated with higher scores on all academic indicators, neighborhood belonging was negatively related to academic aspirations and expectations, grades, and educational values. Yet, both school and neighborhood belonging were associated with better psychological functioning as manifested by lower reported levels of depression. The importance of investigating Latino adolescents' development within multiple contexts is discussed.

Testing a peer support intervention for people with type 2 diabetes: a pilot for a randomised controlled trial

BACKGROUND

People with Type 2 diabetes face various psycho-social, self-management and clinical care issues and evidence is mixed whether support from others with diabetes, 'peer support', can help. We now describe a 2 month pilot study of different peer support interventions.

METHODS

The intervention was informed by formative evaluation using semi-structured interviews with health professionals, community support groups and observation of diabetes education and support groups. Invitations to participate were mailed from 4 general practices and included a survey of barriers to care. Participants were randomized by practice to receive individual, group, combined (both individual and group) or no peer support. Evaluation included ethnographic observation, semi-structured interviews and questionnaires at baseline and post-intervention.

RESULTS

Of 1,101 invited, 15% expressed an interest in participating in the pilot. Sufficient numbers volunteered to become peer supporters, although 50% of these (8/16) withdrew. Those in the pilot were similar to other patients, but were less likely to feel they knew enough about diabetes (60.8% vs 44.6% p = 0.035) and less likely to be happy with the diabetes education/care to date (75.4% vs 55.4% p = 0.013). Key issues identified were the need to recruit peer supporters directly rather than through clinicians, to address participant diabetes educational needs early and the potential for group sessions to have lower participation rates than 1:1 sessions.

CONCLUSIONS

Recruitment to a full trial of peer support within the existing study design is feasible with some amendments. Attendance emerged as a key issue needing close monitoring and additional intervention during the trial.

Use of participant focus groups to identify barriers and facilitators to worksite exercise therapy adherence in randomized controlled trials involving firefighters

BACKGROUND

Firefighters are at increased risk for back injuries, which may be mitigated through exercise therapy to increase trunk muscle endurance. However, long-term adherence to exercise therapy is generally poor, limiting its potential benefits. Focus groups can be used to identify key barriers and facilitators to exercise adherence among study participants.

OBJECTIVE

To explore barriers and facilitators to worksite exercise therapy adherence among firefighters to inform future randomized controlled trials (RCTs).

METHODS

Participants enrolled in a previous RCT requiring twice-weekly worksite exercise therapy for 24 weeks were asked to take part in moderated focus group discussions centered on eight open-ended questions related to exercise adherence. Responses were analyzed qualitatively using a social ecological framework to identify key intrapersonal, interpersonal, and institutional barriers and potential facilitators to exercise adherence.

RESULTS

A total of 27 participants were included in the four focus group discussions, representing 50% of those assigned to a worksite exercise therapy group in the previous RCT, in which only 67% of scheduled exercise therapy sessions were completed. Lack of self-motivation was cited as the key intrapersonal barrier to adherence, while lack of peer support was the key interpersonal barrier reported, and lack of time to exercise during work shifts was the key institutional barrier identified.

CONCLUSION

Focus group discussions identified both key barriers and potential facilitators to increase worksite exercise therapy adherence among firefighters. Future studies should consider educating and reminding participants about the benefits of exercise, providing individual and group incentives based on exercise adherence and performance, providing outside monitoring of exercise adherence, varying the exercise routine, encouraging group exercise and competition, and scheduling exercise during each work shift.

National Survey on Implementation of Peer Specialists in the VA: Implications for Training and Facilitation

OBJECTIVES

Peer support is fundamental to the promotion of recovery as indicated in the President's New Freedom Commission Report. Five years into the Department of Veterans Affairs' (VA) initiative to hire Peer Specialists (PSs)-individuals with serious mental illnesses assigned to clinical teams to support others with serious mental illnesses-this study explored challenges, facilitators, and progress of PS implementation from a stakeholder group involved in their management.

METHODS

Ninety-two VA Local Recovery Coordinators (LRCs) from across the nationwide VA mental health system were surveyed about their perceptions about PS hiring, status of implementation, impact, barriers and facilitators to successful employment of PSs, and willingness to support implementation.

RESULTS

The data suggest that PS implementation is going well overall, but challenges remain such as hiring delays, lack of understanding about the PS role, and lack of funding.

CONCLUSIONS AND IMPLICATIONS

Implementation challenges can undermine the employment of PSs. The VA and other organizations using PSs could improve implementation by monitoring the challenges and proactively facilitating the process on an ongoing basis.

Mechanisms underpinning effective peer support: a qualitative analysis of interactions between expert peers and patients newly-diagnosed with bipolar disorder

BACKGROUND

The increasing burden on mental health services has led to the growing use of peer support in psychological interventions. Four theoretical mechanisms have been proposed to underpin effective peer support: advice grounded in experiential knowledge, social support, social comparison and the helper therapy principle. However, there has been a lack of studies examining whether these mechanisms are also evident in clinical populations in which interpersonal dysfunction is common, such as bipolar disorder.

METHOD

This qualitative study, conducted alongside a randomized controlled trial, examined whether the four mechanisms proposed to underpin effective peer support were expressed in the email exchange between 44 individuals newly-diagnosed with bipolar disorder and their Informed Supporters (n = 4), over the course of a supported online psychoeducation program for bipolar disorder. A total of 104 text segments were extracted and coded. The data were complemented by face-to-face interviews with three of the four Informed Supporters who participated in the study.

RESULTS

Qualitative analyses of the email interchange and interview transcripts revealed rich examples of all four mechanisms. The data illustrated how the involvement of Informed Supporters resulted in numerous benefits for the newly-diagnosed individuals, including the provision of practical strategies for illness management as well as emotional support throughout the intervention. The Informed Supporters encouraged the development of positive relationships with mental health services, and acted as role models for treatment adherence. The Informed Supporters themselves reported gaining a number of benefits from helping, including a greater sense of connectedness with the mental health system, as well as a broader knowledge of illness management strategies.

CONCLUSIONS

Examples of the mechanisms underpinning effective peer support were found in the sample of emails from individuals with newly-diagnosed bipolar disorder and their Informed Supporters. Experiential knowledge, social support, social comparison and helper therapy were apparent, even within a clinical population for whom relationship difficulties are common. Trial registration number ACTRN12608000411347.

A randomized trial of peer coach and office staff support to reduce coronary heart disease risk in African-Americans with uncontrolled hypertension

OBJECTIVE

Adopting features of the Chronic Care Model may reduce coronary heart disease risk and blood pressure in vulnerable populations. We evaluated a peer and practice team intervention on reduction in 4-year coronary heart disease risk and systolic blood pressure.

DESIGN AND SUBJECTS

A single blind, randomized, controlled trial in two adjacent urban university-affiliated primary care practices. Two hundred eighty African-American subjects aged 40 to 75 with uncontrolled hypertension.

INTERVENTION

Three monthly calls from trained peer patients with well-controlled hypertension and, on alternate months, two practice staff visits to review a personalized 4-year heart disease risk calculator and slide shows about heart disease risks. All subjects received usual physician care and brochures about healthy cooking and heart disease.

MAIN MEASURES

Change in 4-year coronary heart disease risk (primary) and change in systolic blood pressure, both assessed at 6 months.

KEY RESULTS

At baseline, the 136 intervention and 144 control subjects' mean 4-year coronary heart disease risk did not differ (intervention=5.8 % and control=6.4 %, P=0.39), and their mean systolic blood pressure was the same (140.5 mmHg, p=0.83). Endpoint data for coronary heart disease were obtained for 69 % of intervention and 82 % of control subjects. After multiple imputation for missing endpoint data, the reduction in risk among all 280 subjects favored the intervention, but was not statistically significant (difference -0.73 %, 95 % confidence interval: -1.54 % to 0.09 %, p=0.08). Among the 247 subjects with a systolic blood pressure endpoint (85 % of intervention and 91 % of control subjects), more intervention than control subjects achieved a >5 mmHg reduction (61 % versus 45 %, respectively, p=0.01). After multiple imputation, the absolute reduction in systolic blood pressure was also greater for the intervention group (difference -6.47 mmHg, 95 % confidence interval: -10.69 to -2.25, P=0.003). One patient died in each study arm.

CONCLUSIONS

Peer patient and office-based behavioral support for African-American patients with uncontrolled hypertension did not result in a significantly greater reduction in coronary heart disease risk but did significantly reduce systolic blood pressure.

The use of rites of passage in strengthening the psychosocial wellbeing of orphaned children in Botswana

Children who have been bereaved in the context of AIDS may experience many challenges to their psychosocial wellbeing. Programmes to help orphaned children are usually anchored in child rights. As the individual focus of rights-based approaches is inept in African collectivist culture, NGOs tend to make use of group approaches in psychosocial support programmes. One orphan-strengthening programme in Botswana, called the Ark for Children, uses rites of passage and rites of affirmation as part of a therapeutic retreat. This study explored how rites of passage and rites of affirmation contribute to psychosocial strengthening of orphaned children in Botswana. Ten orphaned children were involved in five rounds of data collection during a 16-day therapeutic retreat; and eight social workers answered questions on the effectiveness of the therapy. A supplementary document analysis was also completed, which included retreat reports since 2001 and correspondence from community-based support workers and graduates of the programme. Participants reported that the rites used during the retreat helped them to commit to therapeutic transformation. During a retreat, all the participants witness and support each individual going through each rite - a process reported to foster and strengthen group formation. It was documented that the symbols used as part of the themed rites of affirmation are used by participants for years afterwards as reminders of their transformation and commitment to the group. We conclude that rites of passage can provide a powerful tool to help children commit to therapeutic transformation, build the supportive group, and enable the community to recognise and affirm that the children return as changed individuals and members of the group.

Patient-patient interaction--caring and sharing

AIM

The aim of this study is to provide an understanding of the significance of hospitalized patients' interpersonal interaction with fellow patients in an infectious disease ward in a large Danish hospital.

METHOD

A qualitative approach was selected using participant observation and semi-structured qualitative interviews. Six female participants at the age of 32-81 years with different types of infectious diseases accepted to participate in interviews. The analysis was carried out using Kvales' three levels of qualitative data analysis. Data were catalogued into two main categories with several subcategories representing significance of patients' interaction with fellow patients.

RESULTS

The qualitative analysis resulted in two main categories: (i) Caring for fellow patients and (ii) Sharing illness information with fellow patients. Each of the main categories was elucidated through several subcategories. Our findings clearly showed that interpersonal interaction with fellow patients was of utmost importance when it came to care and support and when they needed information about their illness. Typically, the interpersonal interaction was experienced as giving and referred to in positive terms, but occasionally, the opposite was experienced too. Less typically, the patients experienced interaction with fellow patients as a burden and referred to it in negative terms.

CONCLUSIONS

Patients' interaction resembled care as well as self-care. Patient-patient interaction was an important part of the social support system during hospitalization.

Informing the development of services supporting self-care for severe, long term mental health conditions: a mixed method study of community based mental health initiatives in England

BACKGROUND

Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems.

METHODS

A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together.

RESULTS

Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health.

CONCLUSIONS

Service delivery components - e.g. peer support groups, personal planning - advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.

Incentives as connectors: insights into a breastfeeding incentive intervention in a disadvantaged area of North-West England

BACKGROUND

Incentive or reward schemes are becoming increasingly popular to motivate healthy lifestyle behaviours. In this paper, insights from a qualitative and descriptive study to investigate the uptake, impact and meanings of a breastfeeding incentive intervention integrated into an existing peer support programme (Star Buddies) are reported. The Star Buddies service employs breastfeeding peer supporters to support women across the ante-natal, intra-partum and post-partum period.

METHODS

In a disadvantaged area of North West England, women initiating breastfeeding were recruited by peer supporters on the postnatal ward or soon after hospital discharge to participate in an 8 week incentive (gifts and vouchers) and breastfeeding peer supporter intervention. In-depth interviews were conducted with 26 women participants who engaged with the incentive intervention, and a focus group was held with the 4 community peer supporters who delivered the intervention. Descriptive analysis of routinely collected data for peer supporter contacts and breastfeeding outcomes before and after the incentive intervention triangulated and retrospectively provided the context for the qualitative thematic analysis.

RESULTS

A global theme emerged of 'incentives as connectors', with two sub-themes of 'facilitating connections' and 'facilitating relationships and wellbeing'. The incentives were linked to discussion themes and gift giving facilitated peer supporter access for proactive weekly home visits to support women. Regular face to face contacts enabled meaningful relationships and new connections within and between the women, families, peer supporters and care providers to be formed and sustained. Participants in the incentive scheme received more home visits and total contact time with peer supporters compared to women before the incentive intervention. Full participation levels and breastfeeding rates at 6-8 weeks were similar for women before and after the incentive intervention.

CONCLUSION

The findings suggest that whilst the provision of incentives might not influence women's intentions or motivations to breastfeed, the connections forged provided psycho-social benefits for both programme users and peer supporters.

Training peers to provide ongoing diabetes self-management support (DSMS): results from a pilot study

OBJECTIVE

This study determined the feasibility of training adults with diabetes to lead diabetes self-management support (DSMS) interventions, examined whether participants can achieve the criteria required for successful graduation, and assessed perceived efficacy of and satisfaction with the peer leader training (PLT) program.

METHODS

We recruited nine African-American adults with diabetes for a 46-h PLT pilot program conducted over 12 weeks. The program utilized multiple instructional methods, reviewed key diabetes education content areas, and provided communication, facilitation, and behavior change skills training. Participants were given three attempts to achieve the pre-established competency criteria for diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy.

RESULTS

On the first attempt 75%, 75%, 63%, and 75% passed diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy, respectively. Those participants who did not pass on first attempt passed on the second attempt. Participants were highly satisfied with the program length, balance between content and skills development, and preparation for leading support activities.

CONCLUSION

Findings suggest that it is feasible to train and graduate peer leaders with the necessary knowledge and skills to facilitate DSMS interventions.

PRACTICAL IMPLICATIONS

With proper training, peer support may be a viable model for translating and sustaining DSMS interventions into community-based settings.

Strategies to improve access to and utilization of health care services and adherence to antiretroviral therapy among HIV-infected drug users

We review five innovative strategies to improve access, utilization, and adherence for HIV-infected drug users and suggest areas that need further attention. In addition, we highlight two innovative programs. The first increases access and utilization through integrated HIV and opioid addiction treatment with buprenorphine in a community health center, and the second incorporates adherence counseling for antiretroviral therapy in methadone programs. Preliminary evaluations demonstrated that these strategies may improve both HIV and opioid addiction outcomes and may be appropriate for wider dissemination. Further refinement and expansion of strategies to improve outcomes of HIV-infected drug users is warranted.

The development of a pilot training program for peer leaders in diabetes: process and content

PURPOSE

The goal of this study is to describe the process of developing a program that trains peers to facilitate an empowerment-based diabetes self-management support intervention.

METHODS

To guide and advise the development process, the authors formed a peer leader training action committee. The committee was an interdisciplinary group (principal investigator, nurse-certified diabetes educators, dietitian-certified diabetes educators, nutritionist, physician, and 3 community members) that met every 3 months over a 1-year period for continuous quality improvement meetings. During meetings, the committee reviewed and supervised the curriculum development, provided feedback, and informed modifications and improvements.

RESULTS

The resulting peer leader training program is a 46-hour program with 2 training sessions conducted per week over a 12-week period. The competency-based training program is based on the theory of experiential learning, and it consists of 3 major components--namely, building a diabetes-related knowledge base, developing skills (communication, facilitation, and behavior change), and applying skills in experiential settings. All components are integrated within each training session using a range of instructional methods, including group brainstorming, group sharing, role-play, peer leader simulations, and group facilitation simulations.

CONCLUSION

Through the process described above, the authors developed a training program that equips peer leaders with the knowledge and skills to facilitate empowerment-based diabetes self-management support interventions. Future directions include conducting and evaluating the peer training program.

Diabetes control with reciprocal peer support versus nurse care management: a randomized trial

BACKGROUND

Resource barriers complicate diabetes care management. Support from peers may help patients manage their diabetes.

OBJECTIVE

To compare a reciprocal peer-support (RPS) program with nurse care management (NCM).

DESIGN

Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00320112)

SETTING

2 U.S. Department of Veterans Affairs health care facilities.

PATIENTS

244 men with hemoglobin A(1c) (HbA(1c)) levels greater than 7.5% during the previous 6 months.

MEASUREMENTS

The primary outcome was 6-month change in HbA(1c) level. Secondary outcomes were changes in insulin therapy; blood pressure; and patient reports of medication adherence, diabetes-related support, and emotional distress.

INTERVENTION

Patients in the RPS group attended an initial group session to set diabetes-related behavioral goals, receive peer communication skills training, and be paired with another age-matched peer patient. Peers were encouraged to talk weekly using a telephone platform that recorded call occurrence and provided reminders to promote peer contact. These patients could also participate in optional group sessions at 1, 3, and 6 months. Patients in the NCM group attended a 1.5-hour educational session and were assigned to a nurse care manager.

RESULTS

Of the 244 patients enrolled, 216 (89%) completed the HbA(1c) assessments and 231 (95%) completed the survey assessments at 6 months. Mean HbA(1c) level decreased from 8.02% to 7.73% (change, -0.29%) in the RPS group and increased from 7.93% to 8.22% (change, 0.29%) in the NCM group. The difference in HbA(1c) change between groups was 0.58% (P = 0.004). Among patients with a baseline HbA(1c) level greater than 8.0%, those in the RPS group had a mean decrease of 0.88%, compared with a 0.07% decrease among those in the NCM group (between-group difference, 0.81%; P < 0.001). Eight patients in the RPS group started insulin therapy, compared with 1 patient in the NCM group (P = 0.020). Groups did not differ in blood pressure, self-reported medication adherence, or diabetes-specific distress, but the RPS group reported improvement in diabetes social support.

LIMITATION

The study included only male veterans and lasted only 6 months.

CONCLUSION

Reciprocal peer support holds promise as a method for diabetes care management.

Enabling or Engaging? The Role of Recovery Support Services in Addiction Recovery

Recovery capital-the quantity and quality of internal and external resources to initiate and maintain recovery-is explored with suggestions for how recovery support services (RSS) (nontraditional, and often nonprofessional support) can be utilized within a context of comprehensive addiction services. This article includes a brief history of RSS, conceptual and operational definitions of RSS, a framework for evaluating RSS, along with a review of recent empirical evidence that suggests that rather than enabling continued addiction, recovery supports are effective at engaging people into care, especially those who have little recovery capital, and/or who otherwise would likely have little to no "access to recovery."

Different models to mobilize peer support to improve diabetes self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research

Much of diabetes care needs to be carried out by patients between office visits with their health care providers. Yet, many patients face difficulties carrying out these tasks. In addition, many adults with diabetes cannot count on effective support from their families and friends to help them with their self-management. Peer support programmes are a promising approach to enhance social and emotional support, assist patients in daily management and living with diabetes and promote linkages to clinical care. This background paper provides a brief overview of different approaches to mobilize peer support for diabetes self-management support, discusses evidence to date on the effectiveness of each of these models, highlights logistical and evaluation issues for each model and concludes with a discussion of directions for future research in this area.

Using organizational change strategies to guide peer support technician implementation in the Veterans Administration

OBJECTIVE

The Veterans Administration (VA) mental health system is in the process of hiring "Peer Support Technicians" or PSTs-individuals in recovery from serious mental illnesses hired as clinical team members. The purpose of this article is to demonstrate an implementation process that has potential to improve the deployment of the Peer Support Technicians to existing clinical teams within the VA.

METHODS

As part of a larger randomized trial called PEers Enhancing Recovery (PEER), research staff collaboratively planned the deployment of PSTs with three case management teams serving those with serious mental illnesses. Clinical staff received significant opportunity to participate in defining the PST role. PEER staff took extensive notes during planning meetings about the discussions held and decisions made about the PST role.

RESULTS

PEER and clinical staff discussed and came to a consensus on several elements that comprise the PST job including goals for employing PSTs, desired characteristics of PSTs, job duties, training to be provided to PSTs, PST access to medical records, supervision, boundaries, confidentiality, how PSTs are to discuss their mental illness with veterans, and a sick leave policy.

CONCLUSIONS

It is critical to solicit and use input from team providers and leaders when establishing PST services. This approach using input and solicitation can be a model to implement a wide range of clinical interventions in which existing providers and teams will be asked to do something new.

Overcoming poor attendance to first scheduled colonoscopy: a randomized trial of peer coach or brochure support

OBJECTIVES

Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure support and compared these with concurrent patients who did not receive support.

METHODS

From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visits to 4 primary care practices and scheduled for a first colonoscopy from February 1, 2005 to August 31, 2006. Using block randomization, we assigned consenting patients to a phone call by a peer coach trained to address barriers to attendance or to a mailed colonoscopy brochure. Study data came from electronic medical records. Odds ratios of colonoscopy attendance were adjusted for demographic, clinical, and health care factors.

RESULTS

Colonoscopy attendance by the peer coach group (N = 70) and brochure group (N = 66) differed by 11% (68.6% vs 57.6%, respectively). Compared with the brochure group, the peer coach group had over twofold greater adjusted odds ratio (AOR) of attendance (2.14, 95% confidence interval [CI] = 0.99-4.63) as did 49 patients who met the prespecified criteria for needing no support (2.68, 95% CI = 1.05-6.82) but the AORs did not differ significantly for 41 patients who declined support (0.61, 95% CI = 0.25-1.45) and 49 patients who could not be contacted (0.85, 95% CI = 0.36-2.02). Attendance was less likely for black versus white race (AOR = 0.37, 95% CI = 0.19-0.72) but more likely for patients with high versus low primary care visit adherence (AOR = 2.30, 95% CI = 1.04-5.07).

CONCLUSION

For patients who often fail to keep appointments, peer coach support appears to promote colonoscopy attendance more than an educational brochure.

Predictors of successful relationships in a peer support program for Alzheimer's caregivers

This study explores the role of similarity in the success of peer support relationships in an intervention program for dementia caregivers. Hypothesized predictors of successful matches included structural similarity between partners (e.g., in age, education), appraisal similarity (e.g., in satisfaction with support for caregiving), and psychological similarity (e.g., in psychological well-being). Contrary to expectations, no relationship between these types of similarity and the success of the match were found, but effects were found for dissimilar pairs on several characteristics. The findings suggest: 1) that what really makes a difference for successful peer support is sharing the stressful but also rewarding experience of caregiving; and 2) that program planners do not need to develop extensive matching criteria.

Hear How I Feel

In an effort to heighten the awareness of the high school population, a support group program for young people whose parents were diagnosed with cancer received funding to produce an educational video titled Hear How I Feel. This article reports on the evaluation of the video by 146 high school teachers, guidance counselors, and students; elementary school teachers; university undergraduate social work students; and health care and social service providers. A qualitative analysis of the evaluations indicated that high school teachers and guidance counselors were reluctant to use the video in the high school setting because they could not respond expertly to emotions that might be elicited. The findings suggest that youths desire a forum in which difficult issues can be addressed, teachers and guidance counselors need training that would enhance their skill in responding to students' emotional responses, and cancer patients and their families have psychosocial needs that must be met.

The Use of Peer Support for Parents and Youth Living with the Trauma of Child Sexual Abuse: An Innovative Approach

This article describes and reports on an innovative intervention program for parents of sexually abused children and youth. Peer support provided by non-professional staff and volunteers, who have been personally affected by the trauma of child sexual abuse, is an approach with unique advantages. Many of these consumers have not been able to benefit from traditional service delivery approaches. Goals and objectives of the Peer Support Program (PSP) have been developed through inter-agency collaboration initiatives comprised of a coalition of existing social service agencies. This report examines characteristics of service delivery and level of consumer satisfaction of parents and youth who have participated in the peer support program. Implications for interventions with sexually abused youth and parents of sexually abused children are discussed.