A systematic review of influences on implementation of peer support work for adults with mental health problems

Abstract

Purpose The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work. Methods Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838). Results The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences. Conclusion The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.

Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic multicentre randomised controlled trial (UPSIDES-RCT)

“…Purposive sampling will be used to maximise diversity in terms of age, gender and years since qualifying. Data will be collected using an open focus group guide based on an implementation scale developed through a previous systematic review [16].This covers elements of organisational culture, training, role clarity, resourcing, access to a peer network and other factors essential for successful peer support implementation. In addition, at baseline and follow-up, focus group participants will be asked to complete a 16 item questionnaire (Mental Illness: Clinicians' Attitudes Scale, MICA [55]) to assess changes of stigmatising attitudes towards people with mental illness after working with PSWs.…”

“…CFIR covers five major domains that can influence effective implementation: (i) intervention, (ii-iii) outer and inner setting, (iv) individuals involved, and (v) process. Figure 2 about here ### Building on results of formative research described elsewhere [13,16,17], UPSIDES peer support will be implemented across recruiting sites in line with an implementation manual, taking into account differences across study sites. The development of the manuals as well as their implementation and the overall study design will take into consideration the five CFIR domains by, for example: incorporating adaptations to local contexts; planning for organizational readiness; paying attention to the selection and involvement of relevant stakeholders; and allowing for a staged approach to continuously modify implementation as needed.…”

Wie bewerten Führungskräfte den Einsatz von psychiatrieerfahrenen Genesungsbegleitern?

“…Als sehr wichtig wurde auch eine kooperative Unternehmenskultur eingeschätzt, die von gegenseitigem Respekt, dem Streben nach Augenhöhe in therapeutischen und kollegialen Beziehungen sowie einer konsequenten Nutzerzentrierung geprägt ist. Diese Bewertung entspricht internationalen Studien, in denen die zentrale Bedeutung der Organisationskultur für die Implementation von Peer-Support hervorgehoben wurde [14]. Allerdings schilderten die befragten Führungskräfte auch eine Reihe von Schwierigkeiten im Zuge der Einführung von Peer-Support, wie sie zum Teil bereits in der Fachliteratur beschrieben wurden [6,13,14,19].…”

“…Bei der Personalauswahl ist die Passung zwischen Person und Organisation besonders zu beachten. Die Erarbeitung von Stellenbeschreibungen ist wichtig, um Rollenunklarheiten und Orientierungsprobleme zu vermeiden [5,11,12,14]. Ebenso ist ein Coaching der Genesungsbegleiter als Hilfestellung bei ihrer Rollenfindung und der gleichberechtigten Integration im Team zu empfehlen [6].…”

“…Im Vergleich dazu wurde der Perspektive des Organisations-und Personalmanagements deutlich weniger Beachtung geschenkt. In den hierzu vorliegenden Publikationen wird darauf hingewiesen, dass für eine erfolgreiche Einbeziehung von Peers eine Reihe von Voraussetzungen erfüllt sein muss [14]. So sollten die Mitarbeiter einer Organisation adäquat auf die Einstellung von Genesungsbegleitern vorbereitet werden [6, 13 -16].…”