Research Assistant, School of Health Sciences, Institute of Mental Health, University of Nottingham, UK.
Research Fellow, Institute of Applied Health Research, University of Birmingham, UK.
Br J Psychiatry. 2020 Jun;216(6):301-307. doi: 10.1192/bjp.2019.264.
Peer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects.
To conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems.
We systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications.
A total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues.
Peer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings.
同伴支持工作角色正在国际上实施，并且在资源较少的环境中越来越多地实施。然而，目前没有一个框架可以告知需要进行哪些类型的修改，以解决当地的背景和文化方面的问题。
进行系统评价，确定针对有心理健康问题的成年人的同伴支持工作进行修改的类型。
我们按照 PRISMA 系统评价指南（于 2018 年 7 月 24 日在 PROSPERO（国际前瞻性系统评价注册库）上注册：CRD42018094832）系统地审查了同伴支持文献。所有研究设计都符合条件，根据规定的入选标准选择研究，并使用标准化的批判性评估工具进行分析。进行叙述性综合，以确定修改的类型和理由。
共确定了 15300 个独特的研究，其中有 39 项研究符合入选标准，只有一项来自资源较少的环境。确定了六种类型的修改：角色期望；初始培训；接触类型；角色扩展；同伴支持工作者的工作场所支持；和招聘。确定了五种修改理由：提供最好的同伴支持；最好地满足服务使用者的需求；满足组织需求，最大限度地明确角色；并解决社会经济问题。
当实施同伴支持工作时，会以预先计划和非计划的方式进行修改。考虑到每一种已确定的修改都是一个候选的变化，这将导致更系统地考虑是否以及如何在不同的环境中修改同伴支持。需要对可修改与不可修改的同伴支持工作组件进行未来的评估性研究，以了解在不同的心理健康系统和文化环境中实施所需的修改。
