Accelerating Best Practices in Peer Support Around the World

Program Development Guide

Reaching the Hardly Reached

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1. Engaging Your Program Participants

2. Reaching the Hardly Reached


Reaching the Hardly Reached

When working with hardly reached populations, Flanagan and Hancock (2010) suggest utilizing interventions that focus on trust and respect, flexibility, partnership working, and user involvement. Peer support is one mechanism that incorporates all of these factors.


Trust and Respect

Peer support should come from “people like me.” This similarity in disease experience and/or culture fosters trust and mutual respect within the peer/participant relationship. Continual follow-up and support enable the participant to trust her or his peer.

Peer supporters can “sell” themselves better than descriptions or professional referral through:

  • Telephone calls with participants
  • Group activities
  • Classes (e.g., Nurse educator leads patient education class in which peer supporters assist in discussions, then pick up participants for ongoing support)
  • Individual contact in clinical setting



Peer support models are flexible to regional, local, and individual variance. For example, peer support sessions in a South African community began and ended with song and prayer because women often attributed their disease to sin or witchcraft. Peer support is also tailored to individual schedules, which enables peers and participants to meet when it works best for both parties.

Peer support should be non-directive, flexible but persistent. Recommendations for communication with participants include:

Peer Support: An Innovative Strategy for Reaching “Special Audiences”
Peer supporters are particularly effective in reaching “special audiences,” such as racial, ethnic, rural, immigrant and other disadvantaged populations, and engaging them in health promotion services and programs. This brief by Peers for Progress highlights three special audiences – older adults, rural populations and racial/ethnic minority groups – that may benefit from peer support. This brief also proposes a set of considerations for those interested in using peer support-based interventions with special audiences.

After introducing services…

  • Peer supporter: “I’m wondering if there is anything I can do to be helpful”
  • Participant: “Well, as a matter of fact, I saw the other day about people saying butter is OK?”

Accepting basis for refusals…

  • Mother of child with asthma, “He’s fine now”
  • Peer supporter: “That’s terrific, I’ll call back”
  • Mother: “I’m too busy”
  • Peer supporter: “I surely understand, no problem”

Proactive Contact…

  • Peer supporter: “I’ll call back in a few weeks [titrate by peer supporter’s judgment] to check in with you, see if there’s anything I can do to be helpful”


Partnership Working

A key function of peer support is linking partners to clinical care and community resources. Peer supporters encourage participants to obtain clinical care and connect them to health care professionals and appropriate community resources.



Goal setting is collaborative. Peer supporter/participant co-involvement in setting self-management goals enhances the participant’s commitment to improved behavior change.


Examples from the Field

Low-income, single mothers of Medicaid-covered children hospitalized for asthma were provided asthma home management coaching, received outpatient asthma monitoring visits, and developed a collaborative relationship with a primary care provider. This intervention increased outpatient asthma monitoring visits among these women who were previously “hardly reached” by health care systems.


Flanagan SM & Hancock B: Reaching the hard to reach – lessons learned from the voluntary and community sector Qualitatively describes hardly reached populations and establishes characteristics for quality interventions with these groups.
Fisher EB Strunk RC et al (2009) A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach By evaluating usual care with 2-year asthma coach intervention, the randomized controlled study tested whether community health workers are able to reach low-income parents of African American children hospitalized for asthma and to reduce re-hospitalization among them.


© 2015 | Peers for Progress

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