Program Development Guide
Design Content and Approach
2. Design Content and Approach
Design Content and Approach
This section provides information on Step 2: Design training content and approach and Step 3: Develop plans for evaluating training outcomes and ongoing training of the key steps for training peer supporters as described in the previous section.
General Training Materials Outline
Figure 6 below outlines the key components for developing peer support training curriculum and approaches. Resources are broken into two parts:
- Knowledge and Competencies (5 units)
- Training Approaches
Materials for each unit are found below. As directors/ managers for peer support programs, you are welcome to adapt and incorporate these units into your peer support training curriculum as you see fit. Depending on your unique circumstances, it may not be necessary or feasible to develop a curriculum that addresses all of the topics given here.
Part 1: Knowledge and Competencies
UNIT 1: Disease Specific Information
1.1. General Background of Disease
Understanding the basic foundation of disease is an essential component of an effective peer supporter. A peer supporter’s knowledge base should cover what the disease is, how the disease can impact an individual, and key self-care behaviors linked to that disease. The depth of the information depends on the roles and the tasks for your peer supporters. In many cases, since peer supporters are not providers, the content in this area tends to focus on the basics. More importantly, it is good to provide both the resources (e.g., factsheet, handbooks) and back-up (e.g., phone number of their nurse manager). A general rule is to help peer supporters become resourceful and confident, but not to be a disease expert.
UNIT 2: Establishing Working Relationships
2.1. Individual Assessment
|FEATURED EXAMPLE: ESSENTIALS OF DIABETES
|General Diabetes Information and AADE Self-Care Behaviors can be helpful for structuring diabetes peer support program training. This document by Peers for Progress comprises a set of resources providing an overview of basic diabetes knowledge and self-care behaviors.|
|Peer for Progress’ Alivio project has a toolkit to help Compañero en Salud to lead diabetes education groups:
Individual assessment involves collecting, reviewing, interpreting, and using information for the purpose of setting goals and developing an action plan with an individual. Assessment helps health care providers, health educators, and peer supporters understand the self-management status of a person with chronic illness and set appropriate behavioral goals for improved self-management.
Here are a few example assessment instruments from Diabetes Initiative:
- Knowledge, Attitudes, and Beliefs Assessment Instruments: Attitudes Survey, Health Belief Questionnaire English/Spanish, Patient Diabetes Knowledge Questionnaire English, Patient Diabetes Knowledge Questionnaire Spanish, and Self Efficacy Assessment Tool
- Self-Management Behavior Questionnaires: Are You Ready? Brochure, Building Community Support Patient Questionnaire, Behavioral Health Assessment Tool, Behavioral Health Assessment Tool Spanish, and Case Management Assessment Form
You can find more instruments in the Resource section of this chapter.
2.2. Effective Communication Skills
|What and How to Train Communication Skills
|Communication skills are regarded as a core competency for peer supporters that engage patients in chronic disease management, setting the foundation for many peer support activities. In many aspects, successful peer support interventions rely on the Intuition of peer supporters. Therefore, many peer supporters are selected for their natural communication skills and then undergo intensive training to strengthen those skills.
Drawing from our collaborations with programs from around the world, this PfP brief, “Strengthening peer support communication skills”, highlighted that active listening and storytelling are two basic communication skills that are commonly taught. We also identified three keys to strengthening communications training are to 1) properly introduce and frame communication training, 2) introduce communication skills gradually over time, and 3) inspire confidence in trainees’ natural communication skills.
Being an effective communicator is critical in a strong peer support relationship as well as an effective patient-provider relationship.
Fundamental techniques of communication include active listening, sharing stories, and other skills like facilitation and coaching. These skills help build rapport, understanding, and trust between peers.
- Active listening involves strategic listening and responses to improve mutual understanding, openness, and honesty.
- Sharing stories allows individuals to discuss experiences and stories from their own lives. It is a good way to provide support in one-on-one settings, and is a particularly important part of some cultures.
- Facilitation skills are needed to effectively relay information, guide discussion, and encourage dialogue in both one-on-one and group support settings. Effective facilitation skills help peer supporters better serve people by influencing and guiding others toward lasting behavior change.
- Coaching skills are designed to help people understand and navigate their self-care plan to become a better health consumer. They can alleviate the problems of patients not understanding and/or not agreeing with clinicians’ advice and can help ensure people are receiving the highest quality of care possible.
2.3. Support Skills
Providing support is essential to anyone in a support role, including peer supporters, health educators, and health care professionals. There are two fundamental forms of support: non-directive and directive. The majority of the times, a peer supporter would need to use non-directive support. Other support skills that may be useful to peer supporters include motivation building, stage-based advising, and decision-making.
- Non-Directive Support allows a person to deal with what is important to them at their own pace, rather than leading or directing them to change. It helps people identify their own problem behaviors that need to be changed, which can help a person feel more in control of their self-management care routine. Non-directive support can both empower and encourage an individual.
- Empowerment is when an individual feels they have the power and self-confidence to make changes and take control of their illness. Empowered individuals are able to manage their illness better and often experience a better quality of life.
- Encouragement includes words and actions that may motivate people toward behavior change or overcome fears, challenges, and burnout related to self-management of an illness.
- Building Motivation is the ability to first recognize where a person may be in terms of behavioral change and then provide encouragement and guidance to individual decision-making in order to strengthen their motivation for change. Building motivation is often person-centered and collaborative and can help people with a chronic disease make lasting behavioral changes. This set of skills is often based on common counseling techniques such as Motivational Interviewing (MI) and stage-based advising derived from the Trans-theoretical Model.
UNIT 3: Assisting Self-Care Behaviors
|People Need More Than Just Goal Setting
|Goal setting can be an effective strategy when integrating into a process that also involves action planning and problem solving. For example, a person can set a goal of drinking one can of soda a day instead of two cans during the coming month. An action plan can help strategize how he can achieve this goal. Peer supporters can help him identify challenges, generate solutions to overcome them, and eventually assist him to come up with a revised goal and another action plan. In this way, a person can learn to change unhealthy behaviors by choosing a concrete, short-term goal, figuring out how to do so, and continually solving problems and revising their goals and plans.
Therefore, it is important to train your peer supporters this behavior modification process, not just how to set a goal.The five step goal setting and I-SMART template in the International Diabetes Federation’s Peer Leader Manual (pg.20 and pg.41) is a good example.
3.1. Setting SMART Goals
Setting SMART goals involves choosing something Specific, Measurable, Attainable, Realistic, and Timely (SMART) to change or achieve. For people with chronic illness, goals can be both short and long term. Goal setting is important for people to live longer and healthier lives with their condition.
3.2. Making an Action Plan
This refers to day-to-day plans, goals, and activities that help achieve long-term goals. Action planning can help people with chronic illness change unhealthy behaviors and better manage their condition. Action plans can be created based on information from the individual assessment and by using SMART goals.
3.3. Problem Solving
This is a crucial step to active self-management of chronic illness. Obstacles in chronic care management are encountered every day, so it is very important to know how to find solutions for unexpected problems. Solving problems, no matter how large or small they are, involves clear-headed thinking strong determination, and having the skills to solve problems as they arise.
3.4. Stress Coping and Emotional Management
- Stress Management: Stress is a normal part of life that can cause changes to both the emotions and bodies of people with chronic conditions. Too much negative stress can cause harmful changes in blood sugar and blood pressure, so effective coping with stress is very important to feel good and avoid health complications.
- Depression: Depression refers to persistent feelings of sadness and hopelessness. Depressive emotions can be a short-term response to stress or a chronic condition.
|Featured Tool: Healthy Coping in Diabetes
|Robert Wood Johnson Foundation’s Diabetes Initiative has a guide, Healthy Coping in Diabetes, which introduces the range of approaches that addresses negative emotions and may enhance.|
Peer supporters should be able to assist patients with stress coping and emotional management as they may encounter these issues in the field that are important aspects of self-care and disease management.
UNIT 4: Linking to Health Care and Community Resources
4.1. Linking to Health Care Resources
Linking individuals to health care resources is a core role of peer supporters, particularly those who are assisting with chronic disease management. Regular visits with a health care provider can help monitor an individual’s condition, diagnose and treat problems based on assessments of their health. Furthermore, routine health care can help outline steps for achieving self-management goals. It is important to note that the role of peer supporters is distinct and does not replace the role of professional health care providers in care. Peer support complements and supplements primary care services to a person with chronic disease. By linking an individual to regular health care, a peer supporter can help a person with chronic illness work with a professional care provider to improve their health. Peer supporters can also assist participants with planning for their doctor visits and making the most of their doctor’s appointments.
4.2. Linking to Community Resources
Linking individuals to community resources, such as agencies, organizations, and other services that assist people with chronic illness, can help people manage their conditions and meet their goals. Peer supporters may fill information gaps if individuals with chronic diseases are unaware of resources available to them in the community and elsewhere.
Here are two examples from Alabama, U.S.:
- Chapter 11 “Knowing Your Limitations & Asset Mapping” from the training manual of ENCOURAGE (PfP grantee in Alabama)
- MyDiabetesConnect is a website launched by Cities for Life, which aims to connect people with diabetes to community resources in Birmingham, AL
UNIT 5: Program Protocols and Tools
|Featured Examples for Unit 5
|ENCOURAGE training manual (Chapter 10 & 12)
Australasian Peers for Progress Diabetes Project Training Manual (Session 8, 9 & 11)
5.1. Introduction of Roles, Tasks, and Organizational Policy
Providing written job descriptions and intervention/program protocols help peer supporters understand their roles and responsibilities and how to deliver those tasks. Training role plays can help to illustrate and practice specific scenarios. Creating written documents and/or flowcharts that describe work flow further elucidates the expectations and specific tasks of the peer supporters. These documents also serve as important references for peer supporters while in the field.
5.2 Ethical Considerations and Related Regulations
Ethical considerations refers to basic standards of right and wrong. For a peer supporter, ethical considerations include, but are not limited to, respecting others’ rights, confidentiality, doing no harm, and maintaining boundaries. Ethical considerations are important so that no one is harmed, physically or emotionally. Peer supporters should be trained in basic ethical principles so they understand the limits of their power, influence and care as well as how to deal with difficult people and situations.
The legal aspects of confidentiality are covered by national government regulations like the Health Insurance Portability and Accountability Act (a.k.a. HIPAA) in the U.S. for the use and disclosure of an individual’s health information. Peer supporters working in the health care setting will need to be trained to be in compliance with such regulations.
Provision of ongoing support for peer supporters is crucial in order for peer supporters to have a space to discuss any issues that may come up surrounding expectations, boundaries, and how to deal with difficult situations.
5.3. Introduction of Program Tools
In many cases, peer supporters need to use behavioral change tools, such as action plans, and data collection tools like contact forms and evaluation measures. Therefore, it is important to train peer supporters about organizational policy, data collection tools, and research protocol for missing or incomplete data.
Part 2: Training approach
In alignment with adult learning theory and information education, training approaches should emphasize interaction between peer supporters and participants by including role playing and simulation, skill building, as well as brain-storming and discussion on cases. Below is an introduction of role playing and simulation since it is essential to other interactive approaches.
Role Playing and Simulation
|Featured Examples for Role Playing & Simulation
|International Diabetes Federation’s Peer Leader Manual by Tang TS, Funnell MM, et al.Australasian Peers for Progress Diabetes Project Training ManualUCSF Health Coach Training in California|
Role playing is a training technique that allows peer supporters to act out hypothetical situations they may encounter in working with program participants. This approach is important because it allows participants to practice and become comfortable with dialogue, listening, and how to handle potentially difficult situations or conflict among people. To do so effectively, a trainer can facilitate the group to provide positive feedback and identify how a person can change his or her behavior. Remember to give enough time for multiple practices so the group can learn by doing and observing.
Individual Assessment – Survey Instruments
|Michigan Diabetes Research and Training Center (MDRTC) assessment instruments: Diabetes Care Profile (DCP); Diabetes History (DMH); Diabetes Knowledge Test (DKT); Diabetes Attitude Scale (DAS-3); and Diabetes Empowerment Scale (DES)||MDRTC developed several survey instruments for diabetes patients and health professionals. The website includes explanations and information about the surveys and downloadable versions of all instruments.|
|Diabetes Intiative’s Knowledge Attitudes and Beliefs Assessment Instruments: Attitudes Survey; Health Belief Questionnaire English/Spanish; Patient Diabetes Knowledge Questionnaire English; Patient Diabetes Knowledge Questionnaire Spanish; and Self Efficacy Assessment Tool||This set of instruments helps to assess knowledge, attitudes and beliefs of those with diabetes.|
|Diabetes Initiative’s Self-Management Behavior Questionnaires: Are You Ready? Brochure; Building Community Support Patient Questionnaire; Behavioral Health Assessment Tool; Behavioral Health Assessment Tool Spanish; and Case Management Assessment Form||This set of instruments helps patients, or health professionals to understand individual diabetes self-care behaviors.|
Communication Skills – Toolkits & Curricula
|The Art of Active Listening the National Aging Information and Referral Support Center||This is a tip sheet on active listening.|
|The University of Kansas Community Tool Box – 16.2: Developing Facilitation Skills; 16.4: Techniques for Leading Group Discussions||These sections introduce basic facilitation and group leading skills.|
|National Alliance on Mental Illness’ Training on Telling Your Story and Sharing Cultural Perspective: Six steps and Practice Sheet||This resource introduces how to craft a story in a succinct and powerful way. It also has examples and a practice sheet.|
|International Diabetes Federation’s Peer Leader Manual by Tang and Funnell: Active Listening (pg.18; pg.30–35)||This section of the manual focuses on building active listening skills.|
|Australasian Peers for Progress Diabetes Project Training Manual: Session 3 – Story Telling and Communication Skills; Session 7 – Group Facilitation Skill||These sections of the facilitator handbook concentrate on storytelling, and facilitation skills for peer supporters.|
|Health Coaching Training by the Center for Excellence in Primary Care at the University of California San Francisco||This is a comprehensive training curriculum for health coaching. It was developed by and have been used for the Peers for Progress grantee project in San Francisco.|
|Coached Care Project’s Coach Training Materials||This document includes training materials for community-based coaches with type 2 diabetes to help reduce racial disparities in diabetes. The training materials, most of which are also available in Spanish and Vietnamese, focus on communication with patients.|
|Peers for Progress’ Strengthening Peer Support Communication Skills||This article has identified several key issues around the training of peer supporters in communications. It also shares insight into keys to strengthening communication training.|
|Coaching Patients for Successful Self-Management from the California Health Care Foundation||In this 14-minute video, Dr. Tom Bodenheimer, at the University of California, San Francisco, presents how health professionals and peer supporters can help patients develop a realistic action plan, and which essential coaching techniques should be used to encourage healthy behavior change and medication adherence.|
|Diabetes Initiative’s Characteristics of an Effective Meeting/Group Visit||This presentation can be adapted for training how to promote an effective support group meeting.|
Support Skills – Toolkits & Curricula
|The Lay Health Educator Manual of the Move More Diabetes Project: Directive and Nondirective Support (pg.25-33)||These slides give an overview of directive and nondirective support.|
|Patient Empowerment Training Module by the National Partnership for Women and Families||This training module is designed to be an interactive presentation between a presenter and a single patient or group of patients, families and caregivers. It can be adapted for training peer supporters to understand and convey the importance of an empowered patient.|
|Helping Patients Make and Sustain Healthy Changes: A Brief Introduction to Motivational Interviewing in Clinical Diabetes Care by Heisler and Resnicow||This article introduces basic principles of motivational interviewing and primary care provider’s role in it. This can be revised for training peer supporters.|
|Diabetes Initiative’s Effective Strategies to Motivate and Encourage Healthy Lifestyle Changes (pg.15)||This resource provides information on using the Stages of Change.|
|Counseling for Behavior Change by the American College of Physicians||This presentation illustrates counseling skills based on the stages of change.|
|NIDA-SAMHSA’s Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency||This resource is a collection of tools for mentoring counselors and other clinicians in the use of motivational interviewing skills during clinical assessments. It can be adapted for training peer supporters.|
|Public Health – Seattle and King County’s Motivational Interviewing Techniques Workshop for Community Health Workers||This set of slides shares how to conduct motivational interviewing.|
|International Diabetes Federation’s Peer Leader Manual by Tang and Funnell: Building Motivation (pg.19)||This section of the manual focuses on building skills related to building motivation.|
|The North Carolina Breast Cancer Screening Program: Stage-based advising training||This is part of a training manual for lay health advisors helping people with breast cancer. The session is to teach stage-based advising techniques.|
|ENCOURAGE’s training manual||Developed by the Peers for Progress grantee project in rural Alabama, this diabetes peer support training manual is based on motivational interviewing and SMART goal setting.|
|Introduction to Motivational Interviewing for Community Health Workers by Dr. Keri Bolton Oetzel from the University of New Mexico||This video introduces the basic principles of MI and also discusses the integration of motivational interviewing into community health work practice.|
|Peers for SafeTalk: Can a Motivational Interviewing-based Safer Sex Program for Persons Living with HIV be adapted for Peer Delivery? – Webinar by Golin and Allicock||This webinar discussed how “SafeTalk”, a program utilizing motivational interviewing with trained counselors, could be adapted for peer delivery|
Setting SMART Goals
|International Diabetes Federation’s Peer Leader Manual by Tang and Funnell: Five step goal setting and I-SMART (pg.20 and pg.41)||This section of the manual focuses on utilizing goal setting and I-SMART to facilitate behavior changes.|
|Australasian Peers for Progress Diabetes Project Training Manual: Session 4 – Goal Setting||This section of the facilitator handbook illustrates how to train peer supporters to set goals.|
|ENCOURAGE’s training manual||Developed by the Peers for Progress grantee project in rural Alabama, this diabetes peer support training manual is based on motivational interviewing and SMART goal setting.|
|Diabetes Initiative’s goal setting resources: Goal Follow Up Form; Goal Setting Assessment Tool; Goal Setting Form and Tips English/Spanish; Goal Setting Support Tool; Nutrition Goal Setting Form; Ready for Change Worksheet; Self-Management Goal Follow Up Form; Self-Management Goal Form; Self-Management Goal Form English; and Self-Management Goal Form Spanish||This set of resources can be used to assist in goal setting with people with diabetes.|
Making an Action Plan – Training Curricula
|International Diabetes Federation’s Peer Leader Manual by Tang and Funnell: I-SMART (pg.20; pg.44–49)||These sections of the IDF’s manual focus on utilizing I-SMART to make a diabetes action plan.|
|Australasian Peers for Progress Diabetes Project Training Manual: Session 4 – Goal Setting (pg.36)||The section of the facilitator handbook illustrates how to make an action plan.|
|Health Coaching Training by the Center for Excellence in Primary Care at the University of California San Francisco: Action Plans (pg.77)||This section of the training manual explains how to make an action plan.|
|The California Health Care Foundation’s My Diabetes Plan in English and Spanish||These handouts can be useful for peer supporters in assisting their participants in creating an action plan.|
|The Center for Excellence in Primary Care at the University of California San Francisco’s Action Planning forms in English||These multi-language handouts can be a useful resource for peer supporters in assisting their participants in creating an action plan.|
|Diabetes Initiative’s Action Plan Card English; Action Plan Card Spanish; Action Plan Form English; Action Plan Form Spanish; Weekly Action Plan Form||This set of resources can be used to assist diabetes with action planning.|
|Primary Care Resources and Supports for Chronic Disease Self-Management: Problem Solving||This online section offers resources and tools regarding problem solving as part of patient support strategies.|
|Solving the Problems of a Chronic Illness from the University of Michigan||This resource introduces a 6-step approach to problem solving.|
|International Diabetes Federation’s Peer Leader Manual by Tang and Funnell: Problem Solving (pg.20 and pg.50)||These manual sections concentrate on utilizing problem solving skills to facilitate behavior change.|
|Australasian Peers for Progress Diabetes Project Training Manual: Session 5 – Reviewing Goals and Problem-Solving||The section of the facilitator handbook illustrates how to train peer supporters to facilitate problem solving.|
Stress Coping & Emotional Management
|Diabetes Initiative’s Healthy Coping in Diabetes||This guides introduce the range of approaches that addresses negative emotions and may enhance healthy coping in adults with diabetes.|
|Diabetes Depression and Stress by the Northern County Psychiatric Associates||This article provides an overview of diabetes, depression and stress.|
|SONRISA||This is a curriculum toolbox for Promotores/peer supporters to address mental health and diabetes.|
|IN CHARGE: Stress Management||This is a course training manual focused on stress management strategies and problem solving.|
|Diabetes Initiative’s Take Action Program: Stress lesson plans and student materials by the Galveston County Health District in Texas City||This section on stress contains a lesson plan for health professionals to use while providing diabetes education and skill building. It also includes accompanying student material and worksheets for patients.|
|Michigan Diabetes Research and Training Center’s Coping with Stress||This is a handout on stress management.|
|Diabetes Initiative’s Diabetes and Stress Management||This is an informational handout on diabetes and stress management from the Take Action Diabetes Self-Management Program.|
|Depression and Steps for Healthy Living by the Migrant Clinicians Network||This is a handout with tips for general stress management. It is developed in both English and Spanish.|
|Diabetes Initiative’s Posters in Managing Depression in both English and Spanish||These are example posters on managing depression.|
Linking to Health Care Resources
|The Partnership for Clear Health Communication’s Askme3||This online education program introduces the three most important questions a patient should ask his/her health provider at every visit. It can be useful for peer supporters and their participants to understand effective patient-provider communication.|
|Australasian Peers for Progress Diabetes Project Training Manual: Session 6 – Linking to Clinical Care||The section of the facilitator training manual provides guidance to peer supporters on how to work with their health care providers and what Medicare entitlements exist for people with diabetes.|
|Puentes hacia una mejor vida/Bridges to a better life: How to conduct a visit to the clinic||This training section guides peer supporters on how to conduct a clinic tour that helps participants quickly familiarize with clinic setting.|
|Diabetes Initiative’s Living with Diabetes Guide to Doctor Visits||This handout can be a useful reference for peer supporters when helping their participants with diabetes to benefit most from a doctor’s visit.|
|Migrant Clinicians Network’s Importance of Doctor Visits in both English and Spanish||This handout provides tips on how to help participants with diabetes to best benefit from a doctor’s visit.|
Linking to Community Resources
|ENCOURAGE: Tapping into your community resources and asset mapping and community empowerment||This section of the training curriculum guides peer supporters how to link their participants to community resources needed for managing diabetes.|
|MyDiabetesConnect||Launched by Cities for Life, this website aims to connect people with diabetes to community resources in Birmingham, AL. This is a good example of community resources that can be used by peer supporters, patients/participants, as well as providers.|
Roles and Tasks
|Australasian Peers for Progress Diabetes Project Training Manual: Session 1 – Setting the Scene; Session 2 – PfP Support Group; and Session 9 – Peer Leader Roles and Responsibilities||These sections help peer supporters understand their roles and responsibilities, as well as how to put together the skills they learn.|
|Public Health – Seattle and King County’s Guidelines for when to ask for help||This document outlines situations and guidelines for CHWs describing when to ask for help from their clinical team addressing asthma-management concerns.|
|Code of Ethics for Community Health Workers (CHW)||This document is based on and supported by the core values adopted by the American Association of Community Health Workers. The Code of Ethics outlined in this document provides a framework for CHWs, supervisors, and employers of CHWs to discuss ethical issues facing the profession.|
|Arizona Department of Health Services’ Ethics and Boundaries Workbook||This workbook can be adapted as part of the training to guide peer supporters on following ethics codes and respecting boundaries.|
|Australasian Peers for Progress Diabetes Project Training Manual: Chapter 8 Ethics and Self Care||The section of the facilitator handbook illustrates how to train peer supporters to maintain confidentiality and recognize inappropriate relationships with their participants.|
© 2015 | Peers for Progress