Accelerating Best Practices in Peer Support Around the World

What do we mean by “emotional support”?

Sarah Kowitt, MPH

Emotional support is a key component of peer support and health

Social support is a protective factor in health, the absence of which predicts mortality and morbidity. Looking at a nationally representative sample of adults, Strine et al. (2008) found that those who rarely or never received social and emotional support were:

  • 1.6 times more likely to report frequent physical distress
  • 4.1 times more likely to report frequent mental distress
  • 2.2 times more likely to report frequent activity limitations
  • 6.8 times more likely to report frequent depressive symptoms
  • 4.0 times more likely to report frequent anxiety symptoms
  • 2.7 times more likely to report insufficient sleep
  • 1.8 times more likely to report frequent pain

Social and emotional support can result from a wide variety of sources, such as family members, friends, close acquaintances or peers. Because peers are generally viewed to be members of one’s own community with lived experience of a condition, peer support can provide a flexible supplement to formal health system services and support from family friends. Accordingly, social and emotional support is one of the four key functions of peer support, in addition to assistance in daily management, linkages to clinical care and community resources, and ongoing support.

Along with practical support, social and emotional support is critical to achieving and sustaining complex behaviors for chronic disease management and healthy lifestyles. While they are often grouped together, social and emotional support can refer to different concepts. Social support is often viewed as the broad umbrella of supportive exchanges whereas emotional support is a specific subtype of social support.

Clearly, emotional support is an important component of peer support programs; yet emotional support has been understudied in the peer support literature—leading us to ask: what exactly is emotional support.

Emotional support is difficult to define

There is little consensus on how to define or operationalize emotional support. Some researchers have defined emotional support to include the provision of care, empathy, love and trust (Langford et al., 1996) while others have emphasized expressions of encouragement, active listening, reflection, and reassurance (Dale, Williams & Bowyer, 2012). Moreover, some researchers have characterized emotional support as reciprocal interactions of “mutual obligation” while others have characterized it as solely a subjective perception of feeling accepted loved and respected (Langford et al., 1996). We are thereby left wondering: does emotional support include care and love? Or is it based on encouragement and listening? Is it related to a sense of community? Or is it based on subjective perception?

Compounding the problem is the fact that research and interventions often use different scales to measure emotional support, leaving us with confusion over what the term means and how it can be compared across studies. Examples of scales can be viewed here (NIH Scale of Emotional Support) and here (Emotional Support-Uchida). While it may be clear that emotional support is important, it is less certain what emotional support means, how the meaning changes based on population or context, and how it is provided. For instance, research has suggested that males are more likely than females to not receive adequate emotional support, suggesting that how emotional support is perceived and defined may differ by sex. Similar patterns are seen by age where older adults over the age 75 years are the most likely to report not receiving social and emotional support compared to those who are younger.

Prelude to an investigation on emotional support

Not everyone is in touch with their feelings. Part of the problem with emotional support is that many individuals find it difficult to express their desire for emotional support or fail to recognize how they can benefit from it. For instance, many participants enter into peer support programs asking for informational support and concrete skills to help manage their disease, when in reality, they will benefit from the emotional support aspects of the program. Why this happens is still up for debate, but some research suggests that patients may feel ashamed to ask for emotional support, they may believe that they have all the support that they need, or they may not realize how they can benefit from emotional support.

Interestingly, one hypothesis in the social support literature is that the effectiveness of social support is “determined by whether or not the support provided matches the support desired by a distressed individual” (Kim, Sherman & Taylor, 2008). Accordingly, many peer support programs tailor the type of support offered based on patients’ requests. However, instead of asking, “what do patients want?” maybe we should take a step back and consider, “do patients know what they want?”

There is little research on how emotional support is provided, how it is perceived by patients, and the factors that influence its provision. One important area in which this research will be useful is for training. Because emotional support is difficult to define and context-dependent, it is hard to determine what training competencies are needed and whether or not they are already being provided. For instance, training often emphasizes that peer supporters should have:

  • Disease specific information
  • Communication and support skills
  • Problem solving skills
  • Goal-setting skills
  • Knowledge of community and health care resources

Within communication and support skills, peer supporters can learn how to provide encouragement and active listening, but arguably, some of the most important components of emotional support, such as empathy, understanding, and care, may not be provided within training modules.

More research needs to be conducted to understand emotional support. Doing so will provide insights on the definition of emotional support, factors that influence how patients view emotional support, training of peer supporters to deliver emotional support, and measurement of emotional support constructs.



Boothroyd, R.I. & Fisher, E.B. (2010). Peers for Progress: promoting peer support for health around the world. Family Practice, 27(suppl 1): i62-i68.

Dale, J. R., Williams, S. M., & Bowyer, V. (2012). What is the effect of peer support on diabetes outcomes in adults? A systematic review. Diabetic Medicine, 29(11), 1361-1377.

Kim, H. S., Sherman, D. K., & Taylor, S. E. (2008). Culture and social support. American Psychologist, 63(6), 518.

Langford, C. P. H., Bowsher, J., Maloney, J. P., & Lillis, P. P. (1997). Social support: a conceptual analysis. Journal of advanced nursing, 25(1), 95-100.

Strine, T. W. (2008). Health-related quality of life and health behaviors by social and emotional support. Social Psychiatry and Psychiatric Epidemiology, 43(2), 151-159.


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