A Relational Approach to the Design for Peer Support

Relational practice in health, education, criminal justice, and social care: a scoping review

BACKGROUND

Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice.

METHOD

This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects.

RESULTS

A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers (n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors.

CONCLUSION

Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021295958.

"They have their security, we have our community": Mutual support among people experiencing homelessness in encampments in Toronto during the COVID-19 pandemic

Unaffordable housing is a growing crisis in Canada, exacerbated by the COVID-19 pandemic, yet perspectives of people living outdoors in encampments have primarily gone unheard. We conducted qualitative interviews with encampment residents to explore how mutual support occurred within the social context of encampments. We found that mutually supportive interactions helped residents meet basic survival needs, as well as health and social needs, and reduced common health and safety risks related to homelessness. The homelessness sector should acknowledge that encampment residents form their own positive communities, and ensure policies and services do not isolate people from these beneficial social connections.

Relational Agents for the Homeless with Tuberculosis Experience

In human–computer interaction (HCI) research, relational agents (RAs) are increasingly used to improve social support for vulnerable groups including people exposed to stigmas, alienation, and isolation. However, technical support for tuberculosis (TB) patients, one such vulnerable group, remains insufficient due to the nature of the infectious disease and difficulties in accessing the homeless community. To derive design considerations for developing RAs targeting homeless TB patients, we conducted an empirical study on the patients. Data were collected through participatory observations and interviews and were processed using deductive thematic analysis. The patients’ environmental and behavioral characteristics were classified, which showed that understanding these factors in the design of an RA is important because the patients’ perception, attitudes, and expectations towards the agent are shaped by (and also shape) their environmental and behavioral characteristics, which consequently affect the nature of relationships formed between them. Therefore, we drew the following design considerations: (1) protection of privacy is a prerequisite to the use of an RA for homeless TB patients and can be addressed from both short-term (technical) and long-term (sociotechnical) perspectives; (2) the homeless group emphasized affective support from the agent, suggesting that relationships per se are already valuable to people who have been socially isolated and stigmatized; (3) consideration of the past memories in selecting social cues can facilitate the exchange of affective expressions in user–agent interaction; and (4) an RA should clarify to its interlocuters its identity as a machine to avoid confusing people with low technological literacy.