Peers for Progress

Summary

Peers for Progress is an organization that promotes peer support as a “key part of health, health care, and prevention”^[1] globally. Founded in 2006, Peers for Progress enhances the health and wellbeing of patients through research, publications, quality improvement, and program development for peer support to help manage chronic diseases. Dr. Edwin Fisher, Global Director of Peers for Progress, says, “We have lots of good medications, but helping people to manage chronic diseases such as diabetes is where the real gap lies in care and health outcomes.”^[2] Peer supporters can play an integral role in filling that gap.

What is Peer Support?

As Dr. Fisher says, “Support from other people is a powerful, fundamental characteristic of human behavior” that people need to live happier, healthier lives. Through non-hierarchical, reciprocal relationships, support from laypersons with shared lived experiences has a profound ability to impact the lives of people with chronic diseases. Peers are trained to deliver care in different capacities depending on the unique environments in which they work.

Peers for Progress promotes four core functions as a framework for developing, improving, and evaluating peer support programs. The four core functions of peer support are:

Assistance in daily management

Social and emotional support

Linkages to clinical care and community resources

Ongoing support

First, peers who provide support to patients with diabetes often have diabetes themselves or are close with someone who has diabetes. Therefore, they have unique knowledge and skills about the care practices necessary to manage chronic conditions. Furthermore, peers also come from the same communities as the people they serve, enabling them to develop relationships of trust. Peers can provide social and emotional support to patients simply by “being there” for them. On top of that, peers who are trained in empathetic listening and motivational strategies help patients cope with social, emotional, and medical stressors. The third core function of peers is to link patients to clinical care and community resources. Peers are not medical professionals, but they can provide key resources and help patients overcome personal and socioeconomic obstacles that prevent them from accessing care. Finally, peers provide ongoing support to meet the changing needs of patients over time. Diabetes is “for the rest of your life,” so peer support should be readily available and should adopt proactive strategies for continued patient engagement. Timely peer support helps patients feel secure and prevents them from falling through the cracks of fragmented medical systems.

Keys to Success

A major strength of Peers for Progress is its flexible framework that can be applied to a variety of cultures for patients with a wide range of chronic diseases. Its approach of “standardization by function, not content” transcends societal factors while promoting quality assurance. In its Program Development Guide,^[3] Peers for Progress specifies the ways that communities can develop, implement, and evaluate peer support programs. Within each of these categories, the guide outlines specific ways to recruit and train peer supporters, provide supervision and backup, and evaluate program efficacy. It also outlines ways to make sure there is infrastructure within a community to allow peer supporters to thrive, and to figure out the best ways to reach those who are most underserved and may need the most help. The framework provides specific ways to ensure success while still maintaining flexibility so communities can implement the recommendations that best fit their patients’ specific needs.

Ability to Inspire

Peers for Progress strives to humanize care within healthcare systems that can often feel impersonal. Peers make patients feel “secure, respected, and empowered” when seeking medical care. They fill the gap between healthcare providers and patients; they can provide practical advice and care while also advocating for them within the larger health community. Dr. Fisher says, “Peers end up helping patients in areas where healthcare providers have trouble. Having a good peer support program makes the healthcare provider able to do a better job in their profession and be more effective with patients.”

Efficacy in Improving Health Outcomes

Through a variety of methods, including randomized control trials, qualitative studies, and expert convening, Peers for Progress has found that peer support is both humanizing and cost-effective for patients with chronic diseases. In 2014, the organization hosted a conference to advance the field of peer support in diabetes care, and some of their key findings are explained here.

Peers for Progress found that peer support is feasible. It can be successfully implemented across the globe, regardless of socioeconomic limitations and cultural differences. There are natural helpers in every community that have the ability to serve as peer supporters, and healthcare organizations have found creative ways to integrate peers into their practice. Furthermore, patients desire peer support and see it as a valuable complement to conventional health care.

Next, Peers for Progress found that peer support is effective in improving health outcomes. Several studies have documented improved health outcomes for patients with diabetes who were involved in peer-support led diabetes education and management interventions, including improvements in glycemic control, reduction in HbA1c, fewer foot ulcers, and reductions in foot amputations.^[4] The Global Evidence for Peer Support report describes that, among “14 projects funded by Peers for Progress, HbA1c declined from an average of 8.5% to 7.7%, systolic blood pressure from 137 mmHg to 134 mmHg, and BMI from 32.0 to 30.9 kg/m2.”^[5] These successes represent just a few of the many projects from the Peers for Progress network that have shown remarkable results.

Drawbacks & Limitations

While Peers for Progress has had amazing success, there are areas in which it hopes to improve. Dr. Fisher wishes that the organization focused more on group mentoring that occurs organically, instead of solely on individual peer-patient relationships, which are more convenient to study with randomized trials.

Mr. Patrick Tang, a program manager at Peers for Progress, feels that more advocacy efforts are needed to bring peer support into the mainstream. Mr. Tang says,  “In order to make systemic or policy changes, we have to have a strong advocacy arm in addition to building a strong evidence base.”^[6] In an era of ongoing debates about healthcare reform, the time is ripe for expansion of peer support.