Assessment of a Peer Support Group Intervention for Undocumented Latinx Immigrants With Kidney Failure

Abstract

ImportanceMost undocumented immigrants with kidney failure rely on emergency dialysis (defined as dialysis after a patient presents as critically ill) and experience significant depression and anxiety and high mortality. Culturally and language-concordant peer support group interventions may be associated with reduced depression and anxiety and may provide emotional support.ObjectiveTo investigate the feasibility and acceptability of a single-group peer support group intervention.Design, setting, and participantsThis qualitative and single-group prospective study for undocumented immigrants with kidney failure receiving emergency dialysis was conducted in Denver, Colorado, from December 2017 to July 2018. The 6-month intervention included peer support group meetings in the hospital while participants were hospitalized for emergency dialysis. Data were analyzed from March to June 2022.Main outcomes and measuresTo assess feasibility, the recruitment, retention, implementation, and delivery for the intervention were tracked. To measure acceptability, interviews were conducted with participants using a structured format. To assess the value of the peer support group intervention, themes and subthemes were identified from interviews with participants and group meetings.ResultsOf 27 undocumented immigrants with kidney failure receiving emergency dialysis, 23 participants (9 females [39.1%] and 14 males [60.9%]; mean [SD] age, 47 [8] years) agreed to participate (recruitment rate, 85.2%). Among them, 5 individuals withdrew and did not attend meetings and 18 participants (retention rate, 78.3%) attended a mean of 6 of 12 meetings (50.0%). From interviews and meetings, 3 themes, with associated subthemes, were identified: camaraderie and emotional support from peers (subthemes: peer support is vital for people newly diagnosed with kidney failure, safe space to build relationships and share hardship with peers, hospital setting for peer support is ideal, solidarity to survive and change policy, and sustainability of the peer support group), solutions to improve care and resilience (subthemes: self-advocacy, self-motivation and optimism, kidney disease education, emotional support from peers caregivers, and faith), and emotional and physical aspects of receiving emergency dialysis (subthemes: psychosocial and physical distress, mixed experiences with language-concordant care, emotional exhaustion from end-of-life conversations, and gratitude for clinicians).Conclusions and relevanceThis study found that peer support group intervention achieved feasibility and acceptability. The findings suggest that a peer support group may be a patient-centered strategy to build camaraderie and provide emotional support in kidney failure, especially for socially marginalized uninsured populations who report limited English proficiency.

The Transplant Experience for Undocumented Immigrant Patients Formerly Receiving Emergency Dialysis and Caregivers

“…A key area for education, information, and support for the undocumented community with kidney failure in our study was their community. Indeed, most participants first heard about options for private health insurance through a community peer support group . Peer support groups for patients with kidney disease have demonstrated improvements in self-efficacy, emotional well-being, decision-making, and development of coping strategies; in a peer group for individuals of undocumented immigration status receiving emergency dialysis, the peer support allowed patients support to improve care and resilience, including self-advocacy, self-motivation and optimism, and kidney disease education .…”

“…Indeed, most participants first heard about options for private health insurance through a community peer support group . Peer support groups for patients with kidney disease have demonstrated improvements in self-efficacy, emotional well-being, decision-making, and development of coping strategies; in a peer group for individuals of undocumented immigration status receiving emergency dialysis, the peer support allowed patients support to improve care and resilience, including self-advocacy, self-motivation and optimism, and kidney disease education . The participants in our study reported that self-efficacy was a key component in their pursuit of transplant, a skill that may have been augmented by seeing others like themselves succeed with transplant.…”