Gillard S, Gibson S L, Holley J, Lucock M
Institute of Population Health Research,St George's,University of London,London,UK.
Epidemiol Psychiatr Sci. 2015 Oct;24(5):435-45. doi: 10.1017/S2045796014000407. Epub 2014 Jul 3.
A range of peer worker roles are being introduced into mental health services internationally. There is some evidence that attests to the benefits of peer workers for the people they support but formal trial evidence in inconclusive, in part because the change model underpinning peer support-based interventions is underdeveloped. Complex intervention evaluation guidance suggests that understandings of how an intervention is associated with change in outcomes should be modelled, theoretically and empirically, before the intervention can be robustly evaluated. This paper aims to model the change mechanisms underlying peer worker interventions.
In a qualitative, comparative case study of ten peer worker initiatives in statutory and voluntary sector mental health services in England in-depth interviews were carried out with 71 peer workers, service users, staff and managers, exploring their experiences of peer working. Using a Grounded Theory approach we identified core processes within the peer worker role that were productive of change for service users supported by peer workers.
Key change mechanisms were: (i) building trusting relationships based on shared lived experience; (ii) role-modelling individual recovery and living well with mental health problems; (iii) engaging service users with mental health services and the community. Mechanisms could be further explained by theoretical literature on role-modelling and relationship in mental health services. We were able to model process and downstream outcomes potentially associated with peer worker interventions.
An empirically and theoretically grounded change model can be articulated that usefully informs the development, evaluation and planning of peer worker interventions.
一系列同伴工作者角色正在国际范围内被引入心理健康服务领域。有一些证据证明同伴工作者对他们所支持的人有益，但正式的试验证据尚无定论，部分原因是基于同伴支持的干预措施的变革模式尚不完善。复杂干预评估指南表明，在对干预措施进行有力评估之前，应从理论和实证角度对干预措施与结果变化之间的关联理解进行建模。本文旨在对同伴工作者干预措施背后的变革机制进行建模。
在一项针对英格兰法定和志愿部门心理健康服务中十个同伴工作者项目的定性比较案例研究中，对71名同伴工作者、服务使用者、工作人员和管理人员进行了深入访谈，探讨他们的同伴工作经历。我们采用扎根理论方法，确定了同伴工作者角色中对同伴工作者所支持的服务使用者产生变革作用的核心过程。
关键变革机制包括：（i）基于共同生活经历建立信任关系；（ii）为个人康复及与心理健康问题和谐共处树立榜样；（iii）促使服务使用者参与心理健康服务和社区活动。这些机制可以通过心理健康服务中关于榜样作用和关系的理论文献得到进一步解释。我们能够对可能与同伴工作者干预措施相关的过程和下游结果进行建模。
可以构建一个基于实证和理论的变革模型，为同伴工作者干预措施的开发、评估和规划提供有益参考。
