Population Health Research Institute, St George's, University of London, London, UK.
School of Health Sciences, City, University of London, London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2021 Oct;56(10):1903-1911. doi: 10.1007/s00127-021-02038-4. Epub 2021 Feb 19.
Evidence suggests that the distinctive relational qualities of peer support-compared to clinical-patient relationships-can be eroded in regulated healthcare environments. Measurement of fidelity in trials of peer support is lacking. This paper reports the development and testing of a fidelity index for one-to-one peer support in mental health services, designed to assess fidelity to principles that characterise the distinctiveness of peer support.
A draft index was developed using expert panels of service user researchers and people doing peer support, informed by an evidence-based, peer support principles framework. Two rounds of testing took place in 24 mental health services providing peer support in a range of settings. Fidelity was assessed through interviews with peer workers, their supervisors and people receiving peer support. Responses were tested for spread and internal consistency, independently double rated for inter-rater reliability, with feedback from interviewees and service user researchers used to refine the index.
A fidelity index for one-to-one peer support in mental health services was produced with good psychometric properties. Fidelity is assessed in four principle-based domains; building trusting relationships based on shared lived experience; reciprocity and mutuality; leadership, choice and control; building strengths and making connections to community.
The index offers potential to improve the evidence base for peer support in mental health services, enabling future trials to assess fidelity of interventions to peer support principles, and service providers a means of ensuring that peer support retains its distinctive qualities as it is introduced into mental health services.
有证据表明，同伴支持与临床-患者关系的独特关系质量可能会在受监管的医疗环境中受到侵蚀。对同伴支持试验的保真度的测量还存在不足。本文报告了一种用于心理健康服务中一对一同伴支持的保真度指数的开发和测试，旨在评估对构成同伴支持独特性的原则的保真度。
使用服务用户研究人员和从事同伴支持工作的人员的专家小组，利用基于证据的同伴支持原则框架，制定了一份草案指数。在 24 个提供各种环境下同伴支持的心理健康服务机构中进行了两轮测试。通过与同伴工作者、他们的主管和接受同伴支持的人进行访谈来评估保真度。对受访者的回答进行了分散度和内部一致性测试，对评分者间可靠性进行了独立的双重评分，并从受访者和服务用户研究人员那里获得反馈，以完善该指数。
制定了一个针对心理健康服务中一对一同伴支持的保真度指数，具有良好的心理测量学特性。保真度在四个基于原则的领域进行评估：基于共同生活经验建立信任关系；互惠和相互性；领导力、选择和控制；建立优势并与社区建立联系。
该指数有可能为心理健康服务中的同伴支持提供更好的证据基础，使未来的试验能够评估干预措施对同伴支持原则的保真度，并且为服务提供者提供一种确保同伴支持在引入心理健康服务时保持其独特品质的手段。
