The Power of Peers

As anyone living with, or involved in the care of someone with, a chronic condition will know - self-management is critical. We also know that knowledge, skills and confidence are core prerequisites for effective self-care management.

 

Peer support can help with the daily management of living with a chronic condition and help build the necessary knowledge, skills and confidence.  Peer supporters may have a role in helping with range of things including:

• Identifying local resources e.g. where to buy healthy foods, good locations for exercise
• Helping people cope with social or emotional barriers
• Helping to keep people motivated to reach their health goals.
• Identifying when it is necessary to seek medical assistance.

 Sounds a bit like the role of a Community Health Champion – right? (we are actually  piloting some work involving GPs, Health Trainers and Health Champions in supporting diabetes management in two areas of the Yorkshire region at the moment).

In Canada, there are a number of Community Health Centre’s delivering self-management programmes. Many of these use the Stanford Programme  as a model of delivery – and a number of them focus on diabetes management.

 Here are just a couple of examples for starters….

 

North Hamilton Community Health Centre runs the Stanford programme of peer support - a chronic disease self-management programme run by volunteers. The training is delivered over 6 weeks with a 2 ½ hour session each week with a focus is on diet, exercise, goal setting, and leadership training and takes a ‘train the trainers’ approach. There are around 15 people in each class and recruitment is usually from community groups. Expenses are paid.

 

The programme co-ordinator, Peter, explained that, as lay leaders, the volunteers are asked to ‘guide from the side’ and told there is no ‘sage on the stage’. This helps to put responsibility on client and to encourage small changes and develop confidence.

Evaluation uses the self-efficacy measures as set by the Stanford Programme (including confidence to perform self-management behaviors, confidence to manage condition in general, confidence to achieve outcomes). Participants are also asked to write a letter to Stanford at the end of the programme to say what they have learnt. Peter told me that these letters were often very powerful and told of the benefits people had gained in terms of taking control over their health and improving their ability to self-manage - and also the benefits of meeting others with the same issues and having increased social networks. More evidence of social capital building!

 

Black Creek CHC Diabetes Program: Live, Learn and Share

In Toronto, I had lunch with Michelle (Diabetes Manager), Spencer (Community Development Worker) and Sandra (Peer Educator), who are involved in a self-management programme around diabetes care in Black Creek.



Spencer, Michelle and Sandra from
Black Creek CHC



The programme is called. “Live, Learn and Share” and their materials on peer support sum up the value of peer support pretty well;

 “Peer relationships promotes respect, trust, warmth and helps empower the individual to make changes and decisions that enhance their lives”

Michelle explained how the programme was developed to meet an identified need. She told me how local people with diabetes, ”wanted to meet others with diabetes, to share experience, break isolation, learn about management strategies and form connections.” – so, as well as improving self management, it’s also about building social capital and connecting people. Community members have been heavily involved in the development of the programme and the training materials, so the training guide is based on, and informed by, individual lived experience and expertise.

Sandra, who has had diabetes for 6 years but only felt able to speak openly about her condition a year ago (as result of her involvement in the peer support programme) – now runs a peer support group for others. She told me how the Peer support programme and training she received gave her, “the knowledge to help other people…and I feel good about that.”

Spencer (who trains the trainers and supports the support groups) explained how the programme uses a strength based approach, “focusing on the wisdom, capacities and expertise of community members.” So - about identifying assets in communities to improve outcomes. Sounding familiar…?

Training for Peer Educators, delivered over 3 x 2.5 hour sessions, focuses on self-management, healthy eating and physical activity – very much like some of the training for Health Champions being delivered by some Altogether Better Projects.

The training for people wanting to set up peer support groups is delivered over 7 x 2 hour workshops and focuses on the role of peer support and the practical skills needed to set up, deliver and evaluate a peer support group.

Spencer shared how the effectiveness of peer support in improving self-management had been shown through research. An RCT (Heisler et al 2010) looked at the efficacy of two alternative approaches helping patients with diabetes develop self-care management efficacy:

• one-on-one telephone conversations between two patients (of similar age )with diabetes
• telephonic nurse care management

The findings show that a simple weekly phone call with a peer facing the same self-management challenges, helped diabetes patients manage their condition and improve their blood sugar levels better than those who used traditional nurse care management services alone. The study also showed that women with uncontrolled diabetes reduced their A1c levels after 6 months in the program.

It seems there is clear role (and financial incentive from a service point of view) for the use of Peer Support in terms of improving self-management and thereby empowering people to take more control of their condition (and their lives) and reducing demand on health services.

In the UK, Community Health Champions and Health Trainers are playing a partial role in some areas – but this is by no means any sort of universal provision and many people with chronic conditions continue to struggle with self management issues.  So – why aren’t peer support systems a more integral part of the wider health care system? Seems a no-brainer to me…

Sources:

The Black Creek Diabetes Programme Training Manual can be found here.  

The ‘Self-help Provincial Network’ has many materials for individuals interested in self-help / peer support www.selfhelp.on.ca

References:

Heisler, et al.  Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management – A Randomized Trial. Annals of Internal Medicine. 2010;153:507-515.

Dale, J. et al.  Peer support telephone calls for improving health. The Cochrane Library. 2009, Issue 3.