School of Public Health, Universit� de Montr�al, 7101, Parc avenue C.P. 6128 Succ. Centre-Ville, Montreal, Quebec H3C 3J7, Canada.
Centre de recherche, Institut universitaire de g�riatrie de Montr�al, 4545, Queen Mary road, Montreal, Quebec H3W 1W4, Canada.
Health Educ Res. 2019 Dec 1;34(6):578-591. doi: 10.1093/her/cyz028.
Peer education is widely used as a health promotion strategy. However, few efforts have been undertaken to understand the implementation of peer-led health promotion programs (HPPs). This multiple-case study identifies factors facilitating the implementation of a peer-led HPP for older adults presenting with fear of falling (Vivre en �quilibre) and their mechanisms of action. It used a conceptual framework postulating factors that may influence peer-led HPPs implementation and mechanisms through which such factors may generate implementation outcomes. Six independent-living residences for older adults in Quebec (Canada) implemented Vivre en �quilibre as part of a quasi-experimental study. Implementation factors and outcomes were documented through observation diaries, attendance sheets, peers' logbooks, questionnaires administered to participants and semi-structured interviews conducted among peers, activity coordinators of residences and a subgroup of participants. The analysis revealed three categories of factors facilitating program implementation, related to individuals, to the program and to the organizational context. Three action mechanisms identified in the framework (interaction, self-organization and adaptation) were facilitated by some of these factors. These findings support the application of the peer-led program implementation conceptual framework used in this study and provide insights for practitioners and researchers interested in implementing peer-led HPPs.
同伴教育被广泛用作促进健康的策略。然而，很少有人努力了解同伴主导的健康促进计划（HPP）的实施情况。本多案例研究确定了促进针对有跌倒恐惧的老年人实施同伴主导的 HPP（Vivre en équilibre）的因素及其作用机制。它使用了一个概念框架，假设可能影响同伴主导的 HPP 实施的因素，以及这些因素可能产生实施结果的机制。加拿大魁北克省的六家独立生活的老年人住所参与了 Vivre en équilibre，作为一项准实验研究的一部分。通过观察日记、出席表、同伴的日志、向参与者发放的问卷和对同伴、住所的活动协调员以及参与者小组进行的半结构化访谈，记录了实施因素和结果。分析揭示了促进计划实施的三个类别的因素，涉及个人、计划和组织背景。框架中确定的三个行动机制（互动、自我组织和适应）被其中一些因素所促进。这些发现支持了在本研究中使用的同伴主导的计划实施概念框架的应用，并为有兴趣实施同伴主导的 HPP 的实践者和研究人员提供了见解。
