Facilitating factors for the Community Health Support Centers (CHSC) |
A CHSC director indicated that peer leaders can help CHSC staff implement primary care more effectively, for example through group monitoring and care, with peer leaders helping to invite patients to attend. Instead of telephoning patients individually, peer leaders can contact them in groups and through their neighborhoods. |
CHSC staff suggested developing an ongoing network from the provincial level to community levels to facilitate program implementation, requiring that patients with diabetes receive diabetes self-management education, and improving PLSP outcomes through implementation over a longer time. |
Barriers for CHSCs |
Limited time and human resources, system coordination, and external locus; “We worry a little bit that the program may bring a large work burden for us.” (Community Health Center Station Staff Member) |
Although required to provide public health services, CHSCs tended to focus on fee-producing clinical services, while public health services depended largely on local government. |
Facilitating factors for peer leaders |
Instrumental support for peer leaders through collaboration with CHCS staff: “We contacted CHSC staff and professionals more frequently…. I have more close ties with CHSC staff. If we want them to help us, they always can do that.” |
Confidence: Training, discussions, and participation in the PLSP had increased diabetes knowledge, skills for diabetes self-management, and confidence in leading group meetings/activities. |
Sense of importance: PLSP meetings and activities were viewed as the best ways for those with diabetes to help each other. Peer leaders felt pride that they were able to meet needs, provide help, and be valuable to others and their communities. |
Barriers for peer leaders |
Need for modest financial support for materials (eg, table tennis balls), transportation, or refreshments. |
Limited ability to promote diabetes management; “I would like to have more time training.” (Peer Leader) |
“I would like to have a chance to learn from others. Could the CHSC organize us to visit another community to learn from them?” (Peer Leader) |
Facilitating factors for participants |
Most participants expressed positive views of group meetings and activities and valued the openness of their implementation, such as by being told in advance of topics to be discussed. |
Barriers for participants |
Reasons cited for not attending group meetings or activities included weather, family matters, inconvenient or non-preferred meeting times, and planned topics of little interest. |
Practical, specific support provided by peer leaders |
“…it is difficult to get up in the morning to do exercise. My peer leader had a phone call in the morning for weeks and waited for me under my building to get me doing morning exercise. Then I could get up every morning to do exercise with the group.” (Participant) |
“I often forgot the date to get my blood sugar checked free by the CHSC. My peer leader always gave me a call to mention that I needed to go to CHSC for a routine check the next day. If I still forgot, he would call me again to ask me to come to the CHSC for a check.” (Participant) |
Emergence of emotional support |
“The peer support group is like our ‘second home’ in which you can say what you want to say, without worry about misunderstanding and discrimination.” (Participant) |
“We could easily talk with peer leaders and peer group members when we felt unhappy, and we didn’t want to talk with our children because we didn’t want to burden them.” (Participant) |
Dissemination of the PLSP model |
CHSC leaders saw peer support as an innovative strategy for addressing needs other than diabetes management: “The peer support approach is a good method to help manage chronic disease, not only for diabetes…. I am preparing to set up peer groups to target hypertension patients.” (CHSC Director) |