City, University of London, London, UK.
St George's, University of London, London, UK.
BMC Health Serv Res. 2024 Sep 11;24(1):1050. doi: 10.1186/s12913-024-11447-5.
Peer workers are people with personal experience of mental distress, employed within mental health services to support others with similar experiences. Research has identified a range of factors that might facilitate or hinder the introduction of new peer worker roles into mental health services. While there is mixed evidence for the effectiveness of peer worker delivered interventions, there are no studies exploring how implementation might be associated with effect.
This was a qualitative comparative case study using data from interviews with 20 peer workers and their five supervisors. Peer workers delivered peer support for discharge from inpatient to community mental health care as part of a randomised controlled trial. In the trial, level of participant engagement with peer support was associated with better outcome (hospital readmission). Study sites with higher levels of engagement also had higher scores on a measure of fidelity to peer support principles. We compared data from sites with contrasting levels of engagement and fidelity using an analytical framework derived from implementation theory.
In high engagement-high fidelity sites, there was regular work with clinical teams preparing for working alongside peer workers, and a positive relationship between staff on inpatient wards and peer workers. The supervisor role was well resourced, and delivery of peer support was highly consistent with the intervention manual. In low engagement-low fidelity sites peer workers were employed in not-for-profit organisations to support people using public mental health services and in rural areas. Supervisors faced constrained resources and experienced barriers to joint working between organisations. In these sites, peer workers could experience challenging relationships with ward staff. Issues of geography and capacity limited opportunities for supervision and team-building, impacting consistency of delivery.
This study provides clear indication that implementation can impact delivery of peer support, with implications for engagement and, potentially, outcomes of peer worker interventions. Resourcing issues can have knock-on effects on consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where peer workers were employed in not-for-profit organisations. Attention needs to be paid to the impact of geography on implementation.
ISRCTN registry number ISRCTN10043328, registered 28 November 2016.
同伴工作者是指有过精神健康困扰个人经历的人，他们受雇于精神健康服务机构，为有类似经历的人提供支持。研究已经确定了一系列可能促进或阻碍新同伴工作者角色引入精神健康服务的因素。虽然同伴工作者提供的干预措施的有效性存在混合证据，但没有研究探讨实施情况如何与效果相关。
这是一项定性比较案例研究，使用了来自 20 名同伴工作者及其 5 名主管的访谈数据。同伴工作者作为一项随机对照试验的一部分，为从住院到社区精神卫生保健的出院患者提供同伴支持。在试验中，参与者与同伴支持的互动程度与更好的结果（住院再入院）相关。参与度较高的研究点在同伴支持原则的忠实度测量上也有更高的分数。我们使用来自实施理论的分析框架比较了具有不同参与度和忠实度的研究点的数据。
在高参与度-高忠实度的研究点，临床团队与同伴工作者一起做了定期准备工作，住院病房工作人员与同伴工作者之间建立了积极的关系。主管角色资源充足，同伴支持的提供与干预手册高度一致。在低参与度-低忠实度的研究点，同伴工作者受雇于非营利组织，为使用公共精神卫生服务的人和农村地区的人提供支持。主管面临资源有限的问题，并且在组织之间的合作方面存在障碍。在这些研究点，同伴工作者可能与病房工作人员之间存在具有挑战性的关系。地理和能力问题限制了监督和团队建设的机会，影响了提供服务的一致性。
本研究清楚地表明，实施情况会影响同伴支持的提供，这对参与度，可能对同伴工作者干预措施的效果有影响。资源问题会对交付的一致性产生连锁反应，同时还存在与临床团队的准入、权威和关系相关的挑战，特别是当同伴工作者受雇于非营利组织时。需要关注地理对实施的影响。
ISRCTN 注册号 ISRCTN82242362，于 2016 年 11 月 28 日注册。
