How can talking about health problems help?
Is peer support the same as group therapy?
How is peer support different normal care?
What happens if I want to leave the process?
Will doctors, nurses, or other health professionals take part in peer support sessions?
Can I get information on medications at peer support sessions?
What do those who attend sessions typically talk about?
How formal are peer support sessions?
Does peer support work?
How does peer support work?
How long does each session last/how many sessions so I need to go to?
How can we introduce people into an established group – do you start afresh with a new group?
Can peer support be conducted over the telephone or e-mail instead?
Where will peer support sessions take place?
What happens if I cannot attend a session?
Will my GP know I am engaging in peer support?
Is peer support private and confidential? – as with therapy, are there some situations where confidentiality will be broken e.g. intention to harm?
Are peers allowed to bring friends/family along to session?
The facilitator role
How much support will be provided for me as a facilitator?
I don’t feel enough of an expert in my condition to be a facilitator – how much knowledge is needed?
What happens if I just don’t get on with those I am working with?
As a facilitator, do I have to complete paperwork as part of the role?
What are the benefits to me in volunteering to be a facilitator?
What training is required to be a facilitator?
What skills or personality do I need to be a facilitator?
I am not a very confident person. Can I still take part in peer support?
As a facilitator will I be working alone or will I have someone to help me?
How much of the organising will I do myself?
How much time commitment is required?
Will there be anyone to support me in my role?
What do I do if someone comes along to a session but won’t talk, or someone comes along who won’t be quiet?!
What happens if we run out of things to talk about in the group?
Who do I turn to if I get into real difficulty?
What if I or my peers have multiple illnesses or are in very bad health?
I might feel out of my depth if mental health issues come up in support – is that likely to happen?
Questions for organisers
I do not feel comfortable with the idea of referring patients to peer support programmes. What quality assurances are in place?
How much of a role will my practice play in supporting peer support?
As the GP of a patient engaging in peer support, how accountable am I for what happens during support sessions?
Will peer support not undermine the advice that health professionals give?
Is there enough evidence that peer support works?
Talking about problems is an innate human characteristic. Not only is it therapeutic in itself, but practically useful in the sense that others will have gone through similar issues, and will likely have suggestions on how to tackle them. Those who talk about their problems will feel more equipped and confident to solve them.
Peer support differs in two main ways. First, in diabetes at least, it has a focus on practical issues. Second, group therapy tends to be based on certain psychological techniques or frameworks e.g. psychodynamic theories or 12 steps programme as with Alcoholics Anonymous. Peer support is more of a general and natural support arrangement. That said, there are similarities between the two, particularly in terms of emotional issues related to the therapeutic process, and group dynamics.
Normal healthcare is provided by health professionals, who can provide expert advice, including advice on medications. However, health professionals have very little time available, and generally do not have the condition of their patients. They do not know what it is like to live with that condition, and do not have practical experience of it. Peer support is therefore different in that those who take part in it can support each other through the common experience of having the condition.
Anyone is free to leave the process at any time. If you are a peer, make sure you inform your peer supporter. They might have suggestions on where you can go next if you need further support. If you are a peer supporter, it would be good to try and ensure the group can continue without you. Maybe someone else would like to help take on the role. If you have a health professional supporting you in your role, by sure to discuss leaving the process with them.
The idea behind peer support is that it is by peers, for peers. Generally, health professionals are not supposed to be a main part of peer support. However, sometimes you may want to invite in health professionals and others as guest speakers.
This is a a difficult issue since peer support must not come to resemble clinical medical advice. On the other hand, we know that peers will naturally talk about medications during sessions. Nonetheless, peer supporters, or other peers, should not give advice on medications to take. However, participants will compare their experiences of being on medications. Whenever someone is unsure on medication, they should always consult a health professional.
People like to talk about the clinical care they are receiving, the foods they eat, exercise, their experiences with diabetes more generally,and many issues not related to diabetes! Besides these common topics, each group will talk about different topics because each group is somewhat unique.
Each group will vary, with some being more relaxed and informal than others. Some groups might have a feel of having to get through the business of the day, following a set agenda. Others will be more like informal meeting groups. The thing that all groups should have in common is a focus on supporting others in managing their diabetes and the issues that go along with that.
Overall, there is some emerging evidence that peer support in diabetes can be effective in a number of contexts. Please see the ‘Evidence for peer support’ section here.
In diabetes, we understand that there are three main ways in which peer support works. First, peers can gain practical advice on how to manage their diabetes, particularly in terms of diet and exercise. Second, by linking to health services, peer support can help to ensure that peers are getting the most from them. Third, it is now well documented how positive social support is for health. Those who feel like others care for them, and who feel part of something, do better both physically and mentally.
Each session will last about an hour, though that will vary. If it session goes on for longer than an hour and a half, that is probably too long. It is entirely up to you on how many sessions you go to – it depends on your own needs. Our initial programme suggested six sessions to start with. However, if the group continues to run, there is no reason why you cannot keep attending if you feel you are getting something out of it.
It is up to the group to decide whether they want to be a closed or open group. In a closed group, new members are not allowed in once the group has started. In an open group, members can come and go as they please. If the group is open, new members should be made to feel as welcome as possible.
Yes, these are now popular ways to conduct peer support. Note that this toolkit is geared towards face-to-face support, but many of the lessons and principles are applicable to other forms. Telephone or e-mail support can be useful for those who are geographically isolated or who prefer not to meet face-to-face. On the other hand, some people do not like talking over the telephone or do not have internet access. It is important to keep in mind that one size does not fit all.
Sessions often take place in public locations especially places in the community such as churches, community centres or village halls. People also often meet in cafes. Others have taken to meeting around each other’s homes, but trust must be established first for this option. Lastly, sometimes people meet on the move, such as when they have a walking or exercise session.
If you are a peer, it would be good to inform your peer supporter. This way they will know you will return, which is important in terms of the future health of the group. As a peer supporter, it is even more important to let others know. Another fellow peer supporter might be able to run the group. If not, inform others that the group will not run. Sometimes not being able to attend is unavoidable, but clear communication is key.
If the peer support is arranged in your local surgery, then it is possible our GP will know about you taking part. However, generally there is no reason why your GP would be informed – remember that those who run and take part in groups are patients who will not necessarily have a direct link to healthcare professionals, and even if they do they should respect your privacy in taking part. On the other hand, we would encourage you to inform your GP you are taking part so that they are aware how the support may be benefiting your care.
In any situation, if people seem to be a threat to themselves or others, there is an obligation to inform authorities. Apart from this one exception, peer support should be a private and confidential arrangement. What happens within sessions should stay in sessions, and this should be made clear for all those who enter into the process.
This will be up to each group. In our study, some groups invited in friends and family, and found this useful. Generally, the group will need to agree that this is OK. Friends and family will need to be respectful of privacy and follow the ground rules set out as with other members. We would expect them to contribute to the group in their capacity as someone who supports another with diabetes.
The facilitator role
The point in peer support is that people who are at different stages of the condition all have something to add. A facilitator who has less knowledge than others might be able to relate more to others who are similar. Nonetheless, we would suggest that some basic knowledge of the condition is required, so that the facilitator is not misinforming peers. In our study, facilitators were required to have had diabetes for a year, and also to attend a structured education programme so they had a basic level of knowledge. However, this might not be practical for those setting up new groups. In these situations we would suggest that facilitators are at least a little comfortable with their knowledge of their condition.
This is bound to happen in some cases. It might be that the problem is something that can be resolved with good communication. Sometimes people can work together effectively without necessarily being the best of friends. It is important to have clear responsibilities so that it is agreed beforehand how you will share the work. If after this you feel that you will not be able to resolve your differences, then it might be a good idea to see if there are other local groups, or form a new group.
No. If you have taken part in a study, you will have had to complete paperwork as part of that, but if you are taking part in ‘real world’ peer support, there is no need to document aspects of the programme. It might however be useful to have some documentation to help you in your sessions, such as goal setting documents or action plans. It is probably also a good idea to keep a record of attendance. Some facilitators find keeping a diary useful.
There is a well-documented effect in the literature referred to as the ‘helper-therapy principle’. This states that those who help others benefit themselves. Helping others makes you feel good about yourself and in turn improves how you look after and care for yourself. Volunteering in general is a positive way to spend time and make a contribution to society.
The most important thing is that you are genuinely interested in other people’s problems, and as an extension the most important skill is being able to listen properly. Few people really concentrate and listen completely and attentively to others. If you do this, the person speaking to you will feel appreciated and understood. Apart from this, we have also found that having some confidence in groups, being good at communicating with others and being organised also help.
The first thing to say is that taking part in peer support will likely increase your confidence as you spend time interacting with others. Everyone feels a bit nervous in new social situations – it is entirely natural and normal. Often the best course of action is to feel the fear and do it anyway. However, if you are extremely nervous, perhaps it is better to be a peer rather than facilitator. There is an opposite problem to this, which is that facilitators can be too confident, thinking they know all the answers and listening little to others. This goes against the principle of peer support.
This will vary by group. In some cases, more than one person may be interested in the facilitator role. In these cases, people can share the responsibilities, if that works well for the group. Other facilitators prefer to work alone.
As a peer supporter, you will generally be responsible for organising sessions. If you are sharing the work with another peer supporter, it may be that one of you does more of the organising, and another takes more of a lead in running sessions. You might want to ask some of the peers who regularly attend sessions to help out with certain aspects e.g. bringing along refreshments or booking venues, if they are happy to do so.
In terms of actual contact time, one meeting a months works well, which will last about an hour – perhaps slightly longer in some cases. The organisational aspects may take a little longer – anything up to a few hours. Sharing the work means less time will be required.
In both cases, it is a good idea to have a quiet word with the person afterwards. Explain the situation to them, and how it is making things difficult. During a session, you can encourage a quiet person to speak by doing ’rounds’, which is where you say you will ask each person in turn about their opinion or experience. If a person is dominant, then you can directly ask other members what they think about the issue or topic. In all situations, the best option is to be honest. You might say to the person you’re concerned they don’t feel comfortable to contribute, or that they are contributing so much others are not getting a chance. Of course it is best to approach this conversation in a calm, considered way.
There are plenty of ways to keep discussion flowing. Remember that you can also engage in practical activities as part of peer support, such as having an recipe session or exercising together, or even having a BBQ in the summer months. You could ask group members to bring in materials to discuss. If you have not planned these things in advance and the situation arises during a session then you could do ’rounds’, asking each person in turn their opinion or experience. You could even break larger groups up into small subgroups, which may help some members feel more confident to talk.
If a person has a certain condition such as diabetes, they are likely to have other conditions at the same time (this is known as co-morbidity). This may make peer support, which tends to focus on one condition, quite difficult. The important thing is that those who are experiencing multiple illnesses are getting the professional healthcare they need. Peer support is only intended to be a supplement and not substitute for this care. It is important for peer supporters to be sensitive to the group members’ needs. Perhaps starting sessions by establishing the kind of difficulties that people face can help peer supporters to be sensitive to these issues. For example, this will allow peer supporters to know that recommending exercise for someone with arthritis is inappropriate. Remember to respect privacy and confidentiality, however.
Since depression and anxiety are fairly common, and generally even more so amongst people with diabetes, you are likely to encounter people who are depressed or anxious. To some extent, this is a normal part of life. Some people may however be chronically depressed or anxious. It is likely that you can help such people with friendly support and listening. If anyone seems particularly distressed it is important to refer them to a health professional. Similarly, if you encounter anyone with serious mental health issues then you should refer them.
Questions for organisers