Science Behind Peer Support

What does science say about the value of peer support?

Much evidence supports that peer support is a critical and effective strategy for ongoing health care and sustained behavior change for people with chronic diseases and other conditions, and its benefits can be extended to community, organizational and societal levels.

Overall, studies have found that social support:

  • decreases morbidity and mortality rates
  • increases life expectancy
  • increases knowledge of a disease
  • improves self-efficacy
  • improves self-reported health status and self-care skills, including medication adherence
  • reduces use of emergency services

Additionally, providers of social support report less depression, heightened self-esteem and self-efficacy, and improved quality of life.

 

The scientific evidence presented in this section is organized under the following categories:

Peer Support for Diabetes

Peer Support for Mental Health

Peer Support for a Multitude of Health Conditions

 

To view sample peer support review papers published between 2000-2010, click here.

To view sample peer support papers from 2011, click here.

 

Peer Support for Diabetes

Recent Research

 

Effectiveness of using group visit model to support diabetes patient self-management in rural communities of Shanghai: a randomized controlled trial

This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors, self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai. 208 patients with type 2 diabetes aged 35–80 years were randomly assigned to the intervention group (n=119) of 12 monthly group visit sessions or to a control group (n=89) of usual care. Compared with controls, the intervention patients, on average, increased their duration of aerobic exercise by more than 40 minutes per week (p=0.001); had significant increase of 0.71 in mean score on self-efficacy to manage diabetes (p=0.02); and had significant improvements in measures of illness intrusiveness and systolic blood pressure. (BMC Public Health; December 2012) [Full Abstract]

 

A Community-Based Participatory Diabetes Prevention and Management Intervention in Rural India Using Community Health Workers

This study tested the effectiveness of a 6-month community-based diabetes prevention and management program in rural Gujarat, India. A community-based participatory research method was used to plan and tailor the intervention by engaging trained community health workers as change agents to provide lifestyle education, serve as community advocates, and collect data from 1638 rural Indians (81.9% response rate). Ten culturally and linguistically appropriate health education messages were provided in face-to-face individual and group sessions (demonstrations of model meals and cooking techniques). The intervention significantly reduced blood glucose levels by 5.7 and 14.9 mg/dL for individuals with prediabetes and diabetes, respectively, and systolic and diastolic blood pressure by 8 mm Hg and 4 mm Hg, respectively, in the overall population. Knowledge of diabetes and cardiovascular disease improved by 50% in the high SES group and doubled in the low SES group; general and abdominal obesity also decreased by ≤ 1%. (Diabetes Education; November 2012) [Full Abstract]

 

Cost-effectiveness analysis of a community health worker intervention for low-income Hispanic adults with diabetes

This study estimated the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes. The incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters. The authors conclude that this study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels. (Prev Chronic Dis; August 2012) [Full Abstract]

 

Feasibility of Church-Based Peer Led Diabetes Prevention Program

A recent article by Tang and colleagues examined the feasibility of implementing a Peer Lifestyle Coach (PLC) based training program for a church based diabetes prevention program. PLCs attended one 8 hour training session with a certified diabetes educator and bi-weekly emails for 3 months prior to the start of the intervention.  The participants reported high levels of satisfaction with the length of training, balance between content and skills development, and preparation for leading group- and individual-based support activities. (Diabetes Educator; May 2012) [Full abstract]

Review Papers

 

What is the effect of peer support on diabetes outcomes in adults? A systematic review

A recent systematic review by Dale and colleagues examined the evidence for peer support programs in adults living with diabetes. Twenty five studies met the inclusion criteria for the review including 14 randomized control trials. Peer support was associated with statistically significant improvements in glycaemic control, blood pressure, cholesterol, BMI/weight, physical activity, self-efficacy, depression and perceived social support. The authors concluded that peer support appears to benefit some adults living with diabetes, but the evidence is too limited and inconsistent to support firm recommendations. (Diabetics Medicine; July 2012) [Full abstract]

Read our response to this review:

Looking at a Systematic Review: How Much Peer Support?

 

Applying the community health worker model to diabetes management: using mixed methods to assess implementation and effectiveness

Four databases were searched to identify diabetes programs implementing the CHW model. Corresponding articles were reviewed and semi-structured interviews were conducted with directors of each program. Eight studies met inclusion criteria for review and their program managers were interviewed. Five CHW roles were identified: educator, case manager, role model, program facilitator, and advocate. Roles, responsibilities and training varied greatly across programs. Selected outcomes also varied, ranging from physiologic measures, to health behaviors, to measures of health care utilization and cost. The authors conclude that research regarding application of the community health worker model in diabetes management is limited and consensus regarding the scope of the CHW’s role is lacking. (J Health Care Poor Underserved; November 2008) [Full Abstract]

Featured Reports

 

World Health Organization Peer Support Programs in Diabetes (2007)

Meeting participants reviewed peer support as an approach for diabetes self-management and made suggestions for best practices. [Full Document]

 

 

Peer Support for Mental Health

Recent Research

 

Outcome of a randomized study of a mental health peer education and support group in the VA

This study used a randomized design with three groups: a recovery-oriented peer-led group (Vet-to-Vet), a clinician-led recovery group, and usual treatment. The sample included 240 veterans. Recovery and mental health assessments were obtained at enrollment and three months later. Across groups, depression and functioning, psychotic symptoms, and overall mental health improved significantly. Better group attendance was associated with more improvement. (Journal of Affective Disorders; December 2012) [Full Abstract]

 

Peer Support for Persons with Co-Occurring Disorders and Community Tenure: A Survival Analysis

This longitudinal, comparison group study examines the effect of participation in The Friends Connection, a peer support program for individuals with co-occurring disorders, on 3-year rehospitalization patterns. Results from a survival analysis suggest that program participants have longer community tenure than a comparison group. Chi-square tests also indicate that significantly more people in the comparison group (73%) are rehospitalized in a 3-year period versus those in the Friends Connection group (62%). (Psychiatr Rehabil Journal; Winter 2007) [Full Abstract]

 

Sustained Outcomes of a Peer-Taught Family Education Program on Mental Illness

This study examines 6-month follow-up data from participants in a randomized trial of a peer-driven 12-session family support and education program, called family-to-family (FTF) and offered by the US National Alliance on Mental Illness. All significant benefits that FTF participants gained between baseline and immediately post-FTF were sustained at 9 months including reduced anxiety, improved family problem-solving, increased positive coping, and increased knowledge. Greater class attendance was associated with larger increases in empowerment and reductions in depression and displeasure with ill relative. (Acta Psychiatr Scand.; July 2012) [Full Abstract]

Review Papers

 

Efficacy of Peer Support Interventions for Depression: A Meta-Analysis

Pfeiffer, Heisler, and colleagues conducted a meta-analysis of clinical trials conducted as of April 2010 related to depression and peer support. Seven RCTs comparing peer support with usual care for depression involving 869 participants were identified. Peer support interventions were superior to usual care in reducing depression symptoms. Another seven RCTs comparing peer support with group cognitive behavioral therapy (CBT) involving 301 participants were identified. No statistical difference was found between peer support interventions and group CBT. (General Hospital Psychiatry; January-February 2011) [Full Abstract]

 

Promotoras in Mental Health: A Review of English, Spanish, and Portuguese Literature

This article reviews the literature in 3 different cultures/languages (English, Spanish, and Portuguese) and aims to describe promotoras’ roles, training, and interventions and their outcomes related to mental health activities. Results demonstrate that in different cultures/languages, promotoras empower community members to promote mental health and prevent exacerbation of individuals’ mental illness. (Fam Community Health; April-June 2012) [Full Abstract]

 

Peer Support Among Persons with Severe Mental Illnesses: A Review of Evidence and Experience

Davidson and colleagues discuss the origins of peer support for mental health and the evolution of scientific research in this field. Based on their experience, they present the most commonly asked questions by staff and administrators in mental health settings, followed by brief answers and their recommendations for program implementation. (World Psychiatry; June 2012) [Full Abstract]

 

A Review of the Literature on Peer Support in Mental Health Services

Repper and Carter conducted a literature review of peer support services in professionally led settings in order to guide the implementation of such services in the United Kingdom. The authors examined 38 articles that met their inclusion criteria. The authors discuss some of the themes that emerged from the literature, including major challenges in program implementation. (Journal of Mental Health; August 2011) [Full Abstract]

Featured Reports

 

Best Practices for Peer Support Programs: White Paper

The Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury identified best practices to effectively apply peer support in the military environment. The authors review the key components of a variety of peer support programs for active military personnel and veterans. [Full Document]

 

Pillars of Peer Support I: Transforming Mental Health Systems of Care Through Peer Support Services (2009)

This comprehensive report is based on the findings of the first Pillars of Peer Support Services Summit in 2009, which brought together states that were then currently providing formal training and certification for peer providers working in mental health systems to examine the multiple levels of state support necessary for a strong and vital peer workforce able to engage in states’ efforts at system transformation.  The report begins with a literature review on the evolving policy for mental health peer support services, followed by a review of existing state level data of peer support services. During the Summit, a set of 25 pillars of peer support were developed as well as six recommendations to promote the promulgation of peer support services at the state and federal level. [Full Document]

 

Pillars of Peer Support II: Expanding the Role of Peer Support Services in Mental Health Systems of Care and Recovery (2010)

The second Pillars of Peer Support Summit was designed to examine opportunities for expansion of Medicaid-billable peer-support services in states that were not currently billing Medicaid for Peer Support Services, and to identify the assistance each participating state might need to accomplish that goal. This report includes summaries of the presentations that were made at the Summit. [Full Document]

 

Pillars of Peer Support Services III: Whole Health Peer Support Services (2011)

The third Pillars of Peer Support Summit brought leaders together to examine the best practices in Medicaid and Peer Support Services for integrating healthcare across the full spectrum of behavioral and physical health. Leaders from the field presented keynote, plenary, and panel sessions aimed at addressing the rapidly evolving and transforming health systems, the roles of peers in Whole Health, innovative and exemplary programs, the role of Medicaid in funding Whole Health services, and the role of peers in the workforce. [Full Document]

 

The Pillars of Peer Support Services IV: Establishing Standards for Excellence (2012)

The fourth Pillars of Peer Support Summit focused on two issues: Establishing National Standards/Credentials for Peer Support Services and Creating Recovery Cultures that Support Peer Specialists. This report includes overviews of the keynote presentations, panel discussions, and workgroup reports. [Full Document]

 

 

Peer Support for a Multitude of Health Conditions

Recent Research

 

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in Southern Bangladesh

Puett and colleagues assessed the cost-effectiveness of adding the community-based management of severe acute malnutrition (CMAM) to a community-based health and nutrition program delivered by community health workers (CHWs) in southern Bangladesh. The community-based strategy cost US$26 per disability-adjusted life year (DALY) averted, compared with US$1344 per DALY averted for inpatient treatment. The average cost to participant households for their child to recover from SAM in community treatment was one-sixth that of inpatient treatment. These results suggest that this model of treatment for SAM is highly cost-effective and that CHWs, given adequate supervision and training, can be employed effectively to expand access to treatment for SAM in Bangladesh. [Full Abstract]

 

Peer Education for Secondary Stroke Prevention in Inner-City Minorities

Goldfinger and colleagues describe a New York based stoke prevention program based on peer-led community based support. The program is called Prevent Recurrence of All Inner-city Strokes through Education (PRAISE) and has enrolled 582 stroke survivors to receive the program. Curriculum was developed through focus groups of stroke survivors and using the Stanford Patient Education Research Center Chronic Disease Self-Management Program.  Participants randomized to the PRAISE intervention are scheduled to attend weekly peer-led workshops for six consecutive weeks, in ninety minute sessions. (Contemporary Clinical Trials; June 2012) [Full abstract]

 

Pedometry and Peer Support in Older Chinese Adults

A recent article by Thomas and colleagues looked at the role pedometers and having a motivational buddy may have on fitness levels of an older (> 60 years old) Chinese population. As part of a 2 × 2 factorial design 399 participants were assigned to have a pedometer, a buddy, a pedometer and a buddy or neither. While both a pedometer and a buddy increased physical activities levels, having a buddy also increased physical fitness including reduced body fat. (Medicine and Science in Sports and Exercise; June 2012) [Full abstract]

 

Systematic Review of Peer Support and Breastfeeding

Kaunonen and colleagues completed a systematic review to describe peer support interventions in Europe, North America, Australia or New Zealand supporting breastfeeding during pregnancy and the postnatal period. Individual support and education were most frequently used during pregnancy, hospitalization and the postnatal period.  The authors concluded that only continuous breastfeeding support produces effective results and the role of peer support is most important during the postnatal period. (Journal of Clinical Nursing; July 2012) [Full abstract]

Global Systematic Review

 

A systematic review for peer support being conducted through the Peers for Progress Development Center (PDC) has found appreciable evidence for peer support. Click here for a complete summary of these articles and the authors of this review. Also, click here for citation only.

To see the abstract of this review that was presented at the 2010 International Congress of Behavioral Medicine, click here.

Highlights

  • 01/01/2000 – 5/31/2011 : “peer support,” “coach,” “promotora” etc.
  • 80 separate studies met criteria of:
    • Support provided by nonprofessional
    • Support for multiple health behaviors over time (i.e., not isolated or single behaviors)
    • Not peer-led education in class settings
  • Preliminary outcomes:
    • Diseases/Health problems: asthma, blood pressure, breast feeding, cancer, cardiovascular disease, depression (post-partum), diabetes, & smoking cessation
    • 83.6% of papers report using controlled designs
    • 82% among the subset of paper report randomized controlled trials

Featured Reports

 

Heisler (2006) Building Peer Support Programs to Manage Chronic Disease: Seven Models for Success

This report introduces the theoretical and empirical work on the benefits of peer support for chronic disease self-management and discusses seven models that have been used and tested by health systems and clinics.