Embrace peer support to encourage self-management

There is increasing consensus on the need to engage people more fully in their health and care. But the challenges for individuals, their families and carers are considerable and often complex.

They are trying to manage their conditions successfully; to keep their independence and wellbeing; to adopt healthier behaviour; and to use healthcare services in the best and most appropriate ways.

‘The challenges for individuals, their families and carers are considerable and often complex’

Various approaches have been tested and researched. They can be summarised as building “knowledge, skills and confidence”. Indeed, NHS England has an objective to address these as built into its mandate.

While interventions such as tailored information, education and support for self-management, and patient decision aids can help with the knowledge and skills, the “confidence factor” is all important.

None of us can take on challenges and change if we do not feel comfortable and supported to try. That confidence is hard to achieve for people who have poor health literacy, deprivation, frailty, multiple health conditions, stress and anxiety.

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Person centred care narratives

When producing five complementary “narratives” for person centred coordinated care, National Voices heard time and again a powerful plea from people using services for more readily available peer support to sustain their own efforts.

Likewise, innovation charity Nesta’s People Powered Health programme demonstrated how four models of peer support helped people improve their lives by shifting from an “illness” to an “asset” based approach.

‘Peer support can help people feel more knowledgeable, confident and less isolated’

National Voices and Nesta came together to conduct a research review with the Evidence Centre to explore what is known about the things that constitute good peer support and what is shown to work.

Surveying more than 1,000 published research studies, we found evidence that peer support can help people feel more knowledgeable, confident and happy, and less isolated and alone.

Peer support may also encourage people to take more care of their health which, in the longer term, is likely to lead to better health outcomes such as improved blood pressure or blood sugar control, and less anxiety.

These are important and encouraging findings in the context of the NHS Five Year Forward View which promotes greater patient engagement and cites peer support as one of the “slow burn, high impact” interventions essential to the future of the NHS.

Which is most effective?

However, one of the challenges is that the research base is inadequate in various ways.

Evaluating effectiveness and outcomes has often not been systematic, and it is particularly difficult to determine whether one form of support creates more benefits than another.

Nonetheless, the evidence shows the following kinds of peer support are likely to help improve outcomes:

• face to face groups run by trained peers which focus on emotional support, sharing experiences, practical activities and education;
• one to one support offered face to face or by telephone;
• online forums, particularly for improving knowledge and anxiety; and
• support offered regularly (such as weekly) for 3-6 months.

We also found that peer support:

• has the potential to improve experience, psycho-social outcomes, behaviour, health outcomes and service use among people with long term physical and mental health conditions;
• is most effective for improving health outcomes when facilitated by trained peers, lay people (not necessarily peers) or professionals;
• is  most effective for improving health outcomes when delivered one to one or in groups of more than 10 people;
• is most effective for improving health outcomes when it is based around specific activities (such as exercise or choirs) and focuses on education, social support and physical support;
• works well when delivered face to face, by telephone or online; and
• works well in a range of venues, including people’s own homes, community venues, hospitals and health services in the community.

Push the peer support

Peer support can be relatively inexpensive, but it does require organisation and incurs costs.

Currently, there is little research that adequately assesses cost effectiveness or that would help commissioners build business cases.

‘We will advocate an expansion of peer support provision based on tested models’

Commissioners also have to negotiate the subtle challenge of ensuring peer support is available, while not overdetermining its form and content. A recent systematic review found that “authoritarian design” of programmes limits the ability of the peer supporters to use their experience to tailor support to the target community.

Over the next few months we will be looking to build the policy agenda around peer support, tapping into examples of successful work in the voluntary and community sector.

It seems likely we will advocate an expansion of peer support provision based on tested models, with a clear single evaluation framework that further builds a robust evidence base.

Don Redding is policy director of National Voices