HIV Education, Empathy, and Empowerment (HIVE3): A Peer Support Intervention for Reducing Intersectional Stigma as a Barrier to HIV Testing among Men Who Have Sex with Men in Ghana

Men who have sex with men (MSM) in Ghana remain at heightened risk of HIV infection, and face challenges in accessing HIV prevention and care services. Previous research in Ghana shows that MSM face intersectional stigma across ecological levels (family, peers, healthcare settings, and community level) and the criminalization of same-gender sexual behaviors in the country. To protect their wellbeing from exposure to stigma, many MSM avoid interactions with healthcare systems and services, which inadvertently inhibits their opportunities for early detection and treatment of HIV. Consequently, MSM in Ghana carry a disproportionate burden of HIV prevalence (18%) compared to the general population (2%), highlighting the need for culturally relevant processes in HIV/STI prevention, and care communication to optimize sexual health and wellness among MSM in Ghana. To this effect, we collaborated with community partners to use the Assessment, Decision, Adaptation, Production, Topical Experts, Training, Testing (ADAPT-ITT) model to modify a theory-driven smartphone-based peer support intervention to enhance its focus on intersectional stigma reduction, and improve HIV health-seeking behaviors among MSM, including HIV testing and linkage to care. We used the Dennis Peer Support Model to develop the peer support components (emotional, informational, and appraisal support) to increase peer social support, decrease social isolation, and minimize intersectional stigma effects on HIV-related healthcare-seeking behaviors. This paper shows the preliminary acceptability and effectiveness of employing culturally relevant techniques and communication strategies to provide secure peer support to improve HIV prevention and care among key populations in highly stigmatized environments.

Implementing a successful proactive telephone breastfeeding peer support intervention: volunteer recruitment, training, and intervention delivery in the RUBY randomised controlled trial

Background The RUBY randomised controlled trial demonstrated the benefit of proactive telephone peer support in promoting breastfeeding continuation in a setting with high breastfeeding initiation, where typically this is difficult to achieve. This paper describes the implementation and delivery of the peer support intervention with a focus on recruitment, training, and support of peer volunteers, and includes a description of the key components of the calls. Methods Data collection occurred between December 2012 and June 2016 in Melbourne, Australia. Volunteers completed enrolment forms at the training session and recorded data related to each call in a Call Log maintained for each mother supported. Data were summarised using descriptive statistics and responses to open-ended questions analysed using content analysis. Results A total of 693 women expressed interest in the peer support role, with 246 completing training, that is, 95% of whom supported at least one mother. Each supported a mean of two mothers (range 1 to 11). Training session topics included respecting individual values, using positive language, confidence building, active listening, empathetic support, and normal baby behaviour. There were 518 periods of support where at least one call was made between a volunteer and a mother to whom she was allocated. Of the 518 periods of support, 359 Call Logs (69%) were returned. The 359 call logs recorded a total of 2398 calls between peers and mothers. Call length median duration was 12 min (range 1 to 111 min). Volunteers perceived the most valued aspects of the calls were the provsion of ‘general emotional support’ (51%) and ‘general information/discussion about breastfeeding’ (44%). During the first call, mothers raised questions about ‘nipple pain/ damage’ (24%) and 'general breastfeeding information’ (23%). At ≥12 weeks postpartum, issues raised related to ‘normal infant behaviour’ (22%), ‘feed frequency’ (16%), and ‘general breastfeeding information’ (15%). Volunteers referred women to other resources during 28% of calls, most commonly to the Australian Breastfeeding Association. Conclusions Our findings demonstrate that the RUBY trial was feasible and sustainable in terms of recruiting volunteers who were willing to participate in training and who proceeded to provide peer support. Call content was responsive to the evolving breastfeeding information needs of mothers and the provision of emotional support was perceived by volunteers to be important. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN 12612001024831.

A Prospective Study Protocol for a Digital Peer Support Platform: A Randomized Controlled Trial to Translate Online Peer Support for Emerging Adult Mental Well-being (Preprint)

BACKGROUND Background: The burgeoning mental health issues among emerging adults (ages 19 to 25) worldwide has fueled concerns about their widespread experiences of anxiety and depression. With the onset of the COVID-19 pandemic, emerging studies are being directed towards the development and deployment of digital peer emotional disclosure and support for the psychological well-being of emerging adults. However, much remains to be explored regarding implementation and clinical effectiveness, how best to conduct digital peer support intervention for emerging adults’ psychological well-being, and the associated mechanism of change. OBJECTIVE Objective: This protocol delineates a randomized controlled trial for evaluating the implementation and clinical effectiveness of Acceset, a digital peer support intervention for emerging adult mental well-being with two components. First, the digital peer support training equips befrienders (i.e., peers who provide support) in harnessing four active ingredients—Mattering, selfhood, compassion, and mindfulness—to provide effective peer support for seekers (peers who seek support). Second, the Acceset platform incorporates digital markers of psychological well-being, hinges on peer emotional disclosure process and entails community engagement. METHODS Methods: 100 participants (aged 19 to 25) from the National University of Singapore (NUS) will be recruited and randomly allocated into two arms. Arm 1 (n = 50) seekers will engage with the Acceset platform for a period of 3 weeks, together with befrienders (n = 30) and moderators (n = 30). Arm 2 (n = 50) a control group will be placed on a waitlist for Acceset intervention. Both seekers and befrienders will be monitored using a questionnaire battery at 4 time points: baseline (before the intervention), 3 weeks (the end of the intervention), 6 weeks and 9 weeks (to measure carry over effects). The implementation outcomes on the two components of the intervention will be adoption and fidelity evaluation of the digital peer support training curriculum and the feasibility and acceptability of the Acceset platform. The clinical outcomes will include Mattering, self-hood, compassion, mindfulness, perceived social support and psychological well-being scores. RESULTS Results: This protocol has received approval by the Institutional Ethics Review Board of NUS in October 2021. Recruitment will commence in January 2022. We expect data collection and analyses to be completed in June 2022. The aim is to publish the preliminary results in December 2022. The size effect will be estimated using the Cohen d index with a significance level of .05 (95% reliability) and a conventional 80% power statistic. CONCLUSIONS Conclusions: This protocol considers a novel digital peer support intervention—Acceset—that incorporates active ingredients and digital markers of emerging adult mental well-being. Through the validation of Acceset intervention, this study defines the parameters and conditions for digital peer support intervention for emerging adults. CLINICALTRIAL Trial Registration: ClinicalTrials.gov NCT05083676

The feasibility of a peer support intervention to encourage adoption and maintenance of a Mediterranean diet in established community groups at increased Cardiovascular Disease risk - the TEAM-MED EXTEND study: a pilot Cluster Randomised Controlled Trial

This study aimed to evaluate the feasibility of a peer support intervention to encourage adoption and maintenance of a Mediterranean Diet (MD) in established community groups where existing social support may assist the behaviour change process. Four established community groups with members at increased cardiovascular disease risk and homogenous in gender, were recruited and randomised to receive either a 12-month Peer Support (PS) intervention (PSG) (n=2) or a Minimal Support intervention (educational materials only) (MSG) (n=2). The feasibility of the intervention was assessed using recruitment and retention rates, assessing the variability of outcome measures (primary outcome: adoption of a MD at 6 months (using a Mediterranean Diet Score (MDS)), and process evaluation measures including qualitative interviews. Recruitment rates for community groups (n=4/8), participants (n=31/51) and peer supporters (n=6/14) were 50%, 61% and 43% respectively. The recruitment strategy faced several challenges with recruitment and retention of participants, leading to a smaller sample than intended. At 12-months, a 65% and 76.5% retention rate for PSG and MSG participants was observed respectively. A >2-point increase in MDS was observed in both the PSG and the MSG at 6-months, maintained at 12-months. An increase in MD adherence was evident in both groups during follow-up, however, the challenges faced in recruitment and retention suggest a definitive study of the peer support intervention using current methods is not feasible and refinement based on the current feasibility study should be incorporated. Lessons learned during the implementation of this intervention will help inform future interventions in this area.

Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED): a randomised pilot trial of a peer support intervention for dietary behaviour change in adults from a Northern European population at high cardiovascular disease risk

Adhering to a Mediterranean Diet (MD) is associated with reduced cardiovascular disease (CVD) risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED) was a 12-month pilot parallel group RCT involving individuals aged ≥40 y, with low MD adherence, who were overweight, and had an estimated CVD risk ≥20% over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64%) were eligible. After 12 months there was a retention rate of 69% (PSG 59%; DSG 88%; MSG 63%). For all participants, increases in MDS were observed over 12 months (p<0.001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards a MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial.

Understanding the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes: a realist evaluation

Background Despite an increasing use and positive effects of peer support interventions, little is known about how the outcomes are produced. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating the participating peers’ interactions, we furthermore examined how their individual contextual factors either facilitated or hindered the mechanisms in operation. Methods We used a multi-method case-study design (n = 9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager, and a diabetes nurse) for each case (n = 25). Furthermore, we collected survey data from peers both before and after participation (n = 9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis. Results We identified 2 groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes. Trial registration ClinicalTrials.gov, Retrospective Registration (20 Jan 2021), registration number NCT04722289.