Using peer advocates to improve access to services among hard-to-reach populations with hepatitis C: a qualitative study of client and provider relationships

Abstract

BackgroundPeer support programmes use individuals with specific experiences to improve engagement and outcomes among new clients. However, the skills and techniques used to achieve this engagement have not been mapped. This potentially restricts the development and replication of successful peer advocate models of care. This study explored how a group of peer advocates with experience of homelessness, alcohol and drug misuse made and sustained relationships with their client group. For the purposes of this project, the client group were located among a hepatitis C-positive cohort of people who have a history of injecting drug use and homelessness.MethodsFive self-selecting advocates gave a narrative interview lasting 40–90 min. These interviews were double transcribed using both thematic analysis and narrative analysis in order to triangulate the data and provide a robust set of findings about the unique skills of peer advocates in creating and sustaining relationships with clients from hard-to-reach populations.ResultsPeer advocates build rapport with clients through disclosing personal details about their lives. While this runs counter to assumptions about the need to maintain distance in client-patient relationships, the therapeutic benefits appear to outweigh the potential costs of this engagement.ConclusionWe conclude the therapeutic benefits of self-disclosure between peer advocates and their clients offer a moral grounding for self-disclosure as a means of building relationships with key hard-to-reach populations.

Provision of peer support at the intersection of homelessness and problem substance use services: a systematic ‘state of the art’ review

“…This theme was apparent in three papers ( [59,89,90]). Tookey et al [89] noted that peers discussed experiencing shifts in relationships with community members and friends and needing to establish boundaries between themselves and their clients.…”

“…[66]), and small, self-selected sample sizes (e.g. [65] with 10 participants and [59] with 5 participants).…”

“…MacLellan and colleagues [59] explored how peer advocates with experience of homelessness and problem alcohol and drug use made and sustained relationships with their Hepatitis C positive clients with experience of homelessness and injecting drug use. The authors reported three main 'techniques' used by the peers to achieve 'connectedness' through establishing a positive therapeutic alliance with clients: rapport; self-disclosure; and shared group membership with health services.…”

“…Eleven of the included papers looked at the challenges that those in peer support roles can face ( [34,43,47,55,57,59,65,70,[88][89][90]). Five key themes emerged: vulnerability; authenticity; boundaries; stigma; and a lack of recognition of value of peers and these are now discussed.…”

“…In some cases they discussed transitions between themselves and their former communities, which also involved making personal changes outside of work, such as someone deciding to move to a 'better' area/housing. MacLellan et al [59] noted that despite peers uniformly commenting on the need to maintain rapport and build friendships with their clients, they also countered this via a narrative of maintaining boundaries, and of selective self-disclosure: 'so you've got to share a bit but not too much' (p.4). Similarly, Chapman et al [90] commented on the challenges peer workers, who are themselves in recovery and may experience relapse, faced in setting up and addressing boundaries.…”