A Peer Intervention Facilitates Trust and Improves Psychosocial Well-Being in Diverse, Low-Income Older Adults

We evaluate a peer outreach intervention to improve the psychosocial well-being of diverse, low-income older adults. Participants (N=74, Age 58-96 years) were recruited from an urban senior center and matched with peers who were >55 years old, received mental health training, and connected participants with health or social activities. We conducted surveys at baseline and 6-month follow-up for 2 years with validated measures of loneliness, social interaction, barriers to socializing, and depression, and thematically analyzed qualitative, semi-structured interviews conducted among a subset of participants (n=15) and peers (n=6). Participants were 58% male, 18% African-American, 19% Latinx, and 8% Asian. Over 2 years, participants experienced sustained reductions in loneliness (p=0.015), depression (p<0.001), and barriers to socializing (p<0.001). Qualitative interviews detailed the role of longitudinal relationships, program flexibility, and the matching process in facilitating trust, motivation, and improved mood. Results can inform larger efficacy studies and implementation of peer-driven community programs.

Resident interactions when affirming and correcting peers in a therapeutic community for women

Purpose While recent years have seen a number of studies of social networks in therapeutic communities (TCs) and other residential settings, these have primarily focused on male residents. This paper aims to conduct a longitudinal social network analysis of interpersonal interactions in a TC for women. Design/methodology/approach The data consists of a longitudinal directed social network of instances of feedback between 56 residents of a 16 bed TC for women over a period of 611 days. Mean age of the participants was 33.1 years, mean length of stay was 133.9 days and 91% of the participants were female. Feedback consisted of written affirmations for prosocial behavior and written corrections for contravening TC norms. Data was analyzed using a latent factor longitudinal social network model. Findings Residents react to peer intervention in complex ways. Residents reciprocated affirmations (B = 0.14, 95% confidence interval = 0.10, 0.18) and corrections (B = 0.20, 95% CI = 0.13, 0.25). Controlling for reciprocity, participants who received affirmations were more likely to affirm and correct peers (B = 0.10, 95% CI = 0.06, 0.15; B = 0.17, 95% CI = 0.10, 0.23), suggesting that the encouragement offered by affirmations leads to increased activity. Homophily by admission time occurred in both affirmations and corrections (B = 0.23, 95% CI = 0.10, 0.37; B = 0.51, 95% CI = 0.29, 0.74). Originality/value While affirmations and corrections serve as vehicles for behavioral reinforcement and social learning, they also allow residents to interact in ways that strengthen social bonds.

Co-developing peer interventions in health-related contexts: A case study from exercise referral

Objective: Peer support interventions can be successful in enhancing physical activity (PA) in a variety of health-related contexts. However, the evidence base remains equivocal, and ways to integrate structured peer support within the context of exercise referral schemes (ERSs) remain unexplored. In this regard, few studies consider the prospective acceptability of peer support interventions. Prior qualitative exploration can elicit insight into factors likely to influence peer intervention success, thus maximising the likelihood of developing and implementing effective peer support interventions. This study assessed the prospective acceptability of a peer support intervention for exercise referral. Design/Setting: Individual semi-structured interviews were conducted with 14 ERS clients ( n = 10) and providers ( n = 4) across two ERS sites in the North West of England, UK. Method: Interviews covered preferred demographic and personal characteristics of ERS peers and prospective peer roles. Interviews were analysed using thematic analysis. Results: A desirable ERS peer was perceived as someone who was positive and empathetic, with good interpersonal skills. ERS peers were considered to present a promising opportunity to enhance the accessibility of emotional, motivational and informational support among ERS clients while alleviating burden on ERS providers. Conclusion: Study findings have relevance to the integration of peer support in comparable ERS contexts, highlighting the value of developmental research to refine peer recruitment criteria and to facilitate ownership and support among providers across a variety of health-related contexts.

A Mobile Peer Intervention for Preventing Mental Health and Substance Use Problems in Adolescents: Protocol for a Randomized Controlled Trial (The Mind Your Mate Study)

Background Anxiety, mood, and substance use disorders have significant social and economic impacts, which are largely attributable to their early age of onset and chronic disabling course. Therefore, it is critical to intervene early to prevent chronic and debilitating trajectories. Objective This paper describes the study protocol of a CONSORT (Consolidated Standards of Reporting Trials)-compliant randomized controlled trial for evaluating the effectiveness of the Mind your Mate program, a mobile health (mHealth) peer intervention that aims to prevent mental health (focusing on anxiety and depression) and substance use problems in adolescents. Methods Participants will consist of approximately 840 year 9 or year 10 students (60 students per grade per school) from 14 New South Wales high schools in Sydney, Australia. Schools will be recruited from a random selection of independent and public schools across the New South Wales Greater Sydney Area by using publicly available contact details. The intervention will consist of 1 introductory classroom lesson and a downloadable mobile app that will be available for use for 12 months. Schools will be randomly allocated to receive either the mHealth peer intervention or a waitlist control (health education as usual). All students will be given web-based self-assessments at baseline and at 6- and 12-month follow-ups. The primary outcomes of the trial will be the self-reported use of alcohol and drugs, anxiety and depression symptoms, knowledge about mental health and substance use, motives for not drinking, and willingness to seek help. Secondary outcomes will include positive well-being, the quality of life, and the impact of the COVID-19 pandemic. Analyses will be conducted using mixed-effects linear regression analyses for normally distributed data and mixed-effects logistic regression analyses for categorical data. Results The Mind your Mate study was funded by an Australian Rotary Health Bruce Edwards Postdoctoral Research Fellowship from 2019 to 2022. Some of the development costs for the Mind your Mate intervention came from a seed funding grant from the Brain and Mind Centre of the University of Sydney. The enrollment of schools began in July 2020; 12 of 14 schools were enrolled at the time of submission. Baseline assessments are currently underway, and the first results are expected to be submitted for publication in 2022. Conclusions The Mind your Mate study will generate vital new knowledge about the effectiveness of a peer support prevention strategy in real-world settings for the most common mental disorders in youth. If effective, this intervention will constitute a scalable, low-cost prevention strategy that has significant potential to reduce the impact of mental and substance use disorders. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000753954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379738&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/26796

Drug Story Theater: A Mixed-Methods Study of a Peer-to-Peer Approach to Substance Abuse Education

Objective: Drug Story Theater (DST) is a peer-to-peer intervention that engages teenagers in the early stages of their recovery to develop shows about the seduction of, addiction to, and recovery from drugs and alcohol. Methods: We analyzed anonymous surveys completed by students before and after attending a DST performance, and transcripts of focus group interviews conducted with (1) program developers, (2) stakeholders, (3) performers, and (4) audience members. Results: Students (N = 871) from 5 schools attended one of 2 DST performances. Participants demonstrated increased knowledge on 5 fact-based questions (mean improvement range, 19%- 35%; p < .001 for all), and favorable changes on 10 items addressing perceptions regarding substance use risk (paired t test range, 3.9-9.4; p < .001 for all). Through iterative thematic analysis we developed an alliterative “7P” model spanning 2 domains: (1) Participants (Performers and Peers); and (2) Program (Partnerships, Practicalities, and Prevention). Conclusions: Exposure to a DST performance improved knowledge and risk perceptions about addiction among middle and high school students. It remains to be seen if those changes can have an effect on the prevention of substance use and dependence among vulnerable youth, and whether the active components of DST can be replicated in other school environments.

Dating Violence and the Impact of Technology: Examining the Lived Experiences of Sorority Members

Dating violence (DV) is pervasive on college campuses with far-reaching health implications. We examined 70 sorority members’ lived experiences with DV and explored the role of technology. Experience, perpetration, exposure, support systems, and conceptualization of DV were assessed, and sorority members engaged in small focus groups to examine their lived experiences. Emerging themes included (a) normalization of unhealthy behaviors, (b) technology and the experience of violence, and (c) sources of support and coping. Findings included significant correlations between the experience and perpetration of DV. Results highlight the need for peer intervention and prevention programming and infusing technology in constructive ways.

A Mobile Peer Intervention for Preventing Mental Health and Substance Use Problems in Adolescents: Protocol for a Randomized Controlled Trial (The Mind Your Mate Study) (Preprint)

BACKGROUND Anxiety, mood, and substance use disorders have significant social and economic impacts, which are largely attributable to their early age of onset and chronic disabling course. Therefore, it is critical to intervene early to prevent chronic and debilitating trajectories. OBJECTIVE This paper describes the study protocol of a CONSORT (Consolidated Standards of Reporting Trials)-compliant randomized controlled trial for evaluating the effectiveness of the Mind your Mate program, a mobile health (mHealth) peer intervention that aims to prevent mental health (focusing on anxiety and depression) and substance use problems in adolescents. METHODS Participants will consist of approximately 840 year 9 or year 10 students (60 students per grade per school) from 14 New South Wales high schools in Sydney, Australia. Schools will be recruited from a random selection of independent and public schools across the New South Wales Greater Sydney Area by using publicly available contact details. The intervention will consist of 1 introductory classroom lesson and a downloadable mobile app that will be available for use for 12 months. Schools will be randomly allocated to receive either the mHealth peer intervention or a waitlist control (health education as usual). All students will be given web-based self-assessments at baseline and at 6- and 12-month follow-ups. The primary outcomes of the trial will be the self-reported use of alcohol and drugs, anxiety and depression symptoms, knowledge about mental health and substance use, motives for not drinking, and willingness to seek help. Secondary outcomes will include positive well-being, the quality of life, and the impact of the COVID-19 pandemic. Analyses will be conducted using mixed-effects linear regression analyses for normally distributed data and mixed-effects logistic regression analyses for categorical data. RESULTS The Mind your Mate study was funded by an Australian Rotary Health Bruce Edwards Postdoctoral Research Fellowship from 2019 to 2022. Some of the development costs for the Mind your Mate intervention came from a seed funding grant from the Brain and Mind Centre of the University of Sydney. The enrollment of schools began in July 2020; 12 of 14 schools were enrolled at the time of submission. Baseline assessments are currently underway, and the first results are expected to be submitted for publication in 2022. CONCLUSIONS The Mind your Mate study will generate vital new knowledge about the effectiveness of a peer support prevention strategy in real-world settings for the most common mental disorders in youth. If effective, this intervention will constitute a scalable, low-cost prevention strategy that has significant potential to reduce the impact of mental and substance use disorders. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12620000753954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379738&amp;isReview=true INTERNATIONAL REGISTERED REPORT DERR1-10.2196/26796

Physio-fEedback and Exercise pRogram (PEER) for Shifting Maladaptive Fall Risk Appraisal

We aimed to examine the effectiveness of Physio-feEdback and Exercise pRogram (PEER) for shifting maladaptive to adaptive fall risk appraisal and determine the feedback and acceptability of the program. Forty-one older adults were assigned to either PEER intervention or attention control (AC) group. The 8-week PEER intervention consists of a visual physio-feedback, cognitive reframing, and combined group and home-based exercise led by a trained peer coach. The AC group read fall prevention brochures and continued their normal activities. BTrackS Balance Test and Fall Efficacy Scale were measured from pre- to post-intervention. About 11% of participants in the PEER group had positive shifting but none in AC group. Up to 32% of the participants in AC had negative shifting while 5.3% in the PEER group. PEER intervention facilitates a shift from maladaptive to adaptive fall risk appraisal. PEER group reported significant decreases in fall risk and high acceptability of the program.

Expert Opinions on Web-Based Peer Education Interventions for Youth Sexual Health Promotion: Qualitative Study

Background Participatory education, in the form of peer education, may be an effective way to promote youth sexual health. With the advent of the internet, web-based interventions have potential as an attractive new tool for sexual health promotion by peers. Objective The aim of this study was to evaluate professional experts’ opinions on the perspectives for web-based participatory interventions to promote sexual health by peers and among young people. Methods Semistructured interviews were carried out with 20 experts (stakeholders in direct contact with young people, researchers, and institutional actors) specializing in sexual health, health promotion, peer education, youth, internet, and social media. After coding with N’Vivo, data were subjected to qualitative thematic analysis. Results The majority of experts (18/20, 90%) found this kind of intervention to be attractive, but highlighted the necessary conditions, risks, and limitations attached to developing an acceptable peer intervention on the internet for sexual health promotion among young people. Five main themes were identified: (1) an internet intervention; (2) sexual health; (3) internet skills, and uses and the need for moderation; (4) multifaceted peers; and (5) minority peers. In the absence of youth interest for institutional messages, the experts highlighted the attractive participatory features of web-based interventions and the need for geolocalized resources. However, they also warned of the limitations associated with the possibility of integrating peers into education: peers should not be mere messengers, and should remain peers so as not to be outsiders to the target group. Experts highlighted concrete proposals to design an online participatory peer intervention, including the process of peer implication, online features in the intervention, and key points for conception and evaluation. Conclusions The experts agreed that web-based participatory interventions for youth sexual health promotion must be tailored to needs, uses, and preferences. This type of action requires youth involvement framed in an inclusive and holistic sexual health approach. Peer education can be implemented via the internet, but the design of the intervention also requires not being overly institutional in nature. Involving young people in their own education in an interactive, safe online space has the potential to develop their empowerment and to foster long-term positive behaviors, especially in the area of sexual health.