Rebeccah L. Sokol|Edwin B. Fisher
Peer Support for the Hardly Reached: A Systematic Review
University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill
background health disparities aggravated prevention care initiatives fail reach intended help groups classified hardly reached according variety circumstances fall 3 domains individual eg psychological factors demographic eg socioeconomic status culturalenvironmental eg social network several reports indicated peer support effective means reaching hardly reached individuals however review explored peer support effectiveness relation circumstances associated hardly reached across diverse health problems objectives conduct systematic review assessing reach effectiveness peer support among hardly reached individuals well peer support strategies used search methods three systematic searches conducted pubmed identified studies evaluated peer support programs among hardly reached individuals aggregate searches covered articles published 2000 2015 selection criteria eligible interventions provided ongoing support complex health behaviors including prioritization hardly reached populations assistance applying behavior change plans socialemotional support directed toward disease management quality life studies excluded addressed temporally isolated behaviors limited protocol group classes included peer support dependent variable include statistical tests significance incorporated comparison conditions provided appreciable social support data collection analysis abstracted data regarding primary health topic categorizations hardly reached groups program reach outcomes strategies employed conducted 2sample test determine whether reported strategies related reach results fortyseven studies met inclusion criteria studies represented 3 domains circumstances assessed individual demographic culturalenvironmental interventions addressed 8 health areas commonly maternal child health 255 diabetes 170 chronic diseases 149 thirtysix studies 766 assessed program reach ranged 24 79 study population fortyfour studies 94 reported significant changes favoring peer support eleven strategies emerged engaging retaining hardly reached individuals among programs reported strategy trust respect higher participant retention 828 programs reporting strategy 481 p 003 5 6 studies examining moderators effects peer support peer support benefits greater among individuals characterized disadvantage eg low health literacy conclusions peer support broad robust strategy reaching groups health services often fail engage wide range audiences health concerns among peer support successful suggests basis success may flexible response different contexts including intended audience health problems setting public health implications general benefits peer support findings suggesting may effective among heightened disadvantage indicate peer support considered programs intended reach benefit often hardly reached engendering trust respect significantly associated participant retention programs emphasize strategy