Peer support within a health care context: a concept analysis

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Abstract

Peer support, and the integration of peer relationships in the provision of health care, is a concept of substantial significance to health scientists and practitioners today, as the focus shifts from the treatment of disease to health promotion. If the nursing profession is to effectively incorporate peer relationships into support-enhancing interventions as a means to improve quality care and health outcomes, it is essential that this growing concept be clearly explicated. This paper explores the concept of peer support through the application of Walker and Avant's (Strategies for Theory Construction in Nursing, 3rd Edition, Prentice-Hall, Toronto, 1995) concept analysis methodology. This analysis will provide the nursing profession with the conceptual basis to effectively develop, implement, evaluate, and compare peer support interventions while also serving as a guide for further conceptual and empirical research.

Introduction

The importance of social relationships in the treatment of disease and the maintenance of health and well-being has drawn the attention of scientists and practitioners across a large number of behavioural science and health disciplines. Prospective population studies have established associations between measures of social relationships and mortality, psychiatric and physical morbidity, and adjustments to and recovery from chronic diseases. Furthermore, interventions designed to alter the social environment and the individual's transactions within it have been successful in facilitating psychological adjustment, aiding recovery from traumatic experiences, and even extending life for individuals with serious chronic disease (Cohen et al., 2000). Theoretically embedded within the social relationship construct (Fig. 1), peer support is a salient concept for the nursing profession.

Recognition of peer support's salutary impact on health outcomes (Lakey and Cohen, 2000) is reflected in recent trends where health care has become more health-promoting and disease-preventing (Stewart and Tilden, 1995). Acknowledging the greater benefits of preventing illness rather than treating it, health promotion not only encompasses nutrition, weight control, exercise, and stress management but also the enhancement of supportive relationships within an interpersonal network (Stewart and Tilden, 1995). To substantiate this view, the World Health Organization (1998) has identified strengthening social relationships as a health promotion strategy, while the augmentation of supportive resources, through health promotion mechanisms such as mutual aid and healthy environments, has been endorsed by the Ottawa Charter for Health Promotion (Epp, 1986).

While health-promoting strategies continue to underpin the contemporary health-care system, finances have led the delivery of health services in another direction. Rapidly expanding medical specialization and technology, while raising the quality of care for some individuals, has also led to less desirable effects including upwardly spiralling costs, shortened hospital stays, limited access to care, and reduced interpersonal communication between health professionals and their clients (Eng and Young, 1992). Consequently, during times of need individuals turn to social relationships for support in response to barriers or deficiencies encountered in the present health-care system. Accompanying financial limitations, changing population demographics, longer life expectancy, and an increase in chronic, long-term illness have resulted in the shift of responsibility for care to communities, again situating social relationships central to the delivery of health-care (Stewart and Tilden, 1995). Recognizing that health professionals alone are unable to address evolving health needs, consumers have brought the self-help movement centre stage in the health care arena (Stewart and Tilden, 1995). This movement specifically incorporates peer lay individuals with experiential knowledge who extend natural (embedded) social networks and complement professional health services. In recognition of the importance of social relationships, a proliferation of health-care services that incorporate peers in the delivery of support-enhancing interventions has been instituted in industrialized countries to meet consumer demand.

Within this dynamic environment, peer support has become a significant element in the delivery of quality health care (Cox, 1993; Eng and Young, 1992). As such, it is essential that the nursing profession have a clear and concise understanding of this concept. Unfortunately, peer support is a complex phenomenon whose application is vague and highly variable, although its benefits continue to be sought after as a means for improving health outcomes. The purpose of this paper is to provide an enhanced understanding of peer support using Walker and Avant's (1995) concept analysis methodology as a general guiding framework. In particular, defining attributes, antecedents, consequences, and related concepts will be discussed following a wide-ranging literature review. The goal of the analysis is to provide conceptual refinement in order to assist the nursing profession in the development, measurement, and evaluation of peer interventions. This analysis will also promote consistency in the implementation of these interventions, thereby aiding in the comparability of research findings and program evaluations.

Section snippets

Methods

Using the concept analysis methodology proposed by Wilson (1969) and described by Walker and Avant (1995), several steps are performed beginning with concept selection and purpose delineation. After all the uses of the concept are defined within an outlined context, diverse cases are constructed, antecedents and consequences are identified, and related concepts are described. However, according to Walker and Avant (1995), there are no rules for accomplishing this analysis and the steps above

Defining peer support

Etymological investigation of the noun ‘peer’ leads to ‘par,’ the Latin word for ‘equal.’ The New Lexicon Webster's Encyclopaedic Dictionary (Cayne and Lechner, 1988) defines the noun term as follows: “a member of one of the British degrees of nobility: a duke, marquis, earl, viscount, or baron; a nobleman of any country; someone having the same status in rank, age, ability, etc. as another.” The Oxford Dictionary of Current English (Allen, 1991) defines the noun ‘peer’ as “one who is equal to

Conclusion

This paper highlights one possible strategy towards an enhanced understanding of the peer support concept. However, some reflection on the results of this analysis should be presented. While determining the defining attributes of peer support was not overly difficult, as those proposed occurred frequently both explicitly and implicitly, regularity is no guarantee that a concept is more precise and less ambiguous. Several criticisms of Walker and Avant's (1995) methodology have been highlighted (

Acknowledgements

I gratefully acknowledge the Canadian Institutes for Health Research (CIHR) for the provision of a postdoctoral research fellowship (1999–2001) and Pamela Ratner, RN, Ph.D., Associate Professor, School of Nursing, University of British Columbia for her editorial suggestions.

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