Aligning programmes with broader national policy initiatives and advertising campaigns was suggested as one way to ensure organisational support. In other situations some form of training needs assessment was carried out at the preliminary stage of an existing training programme and the findings were used to enable those delivering the training to tailor or modify the programme to meet individual or group learning needs. Liaison midwives worked with colleagues to facilitate acceptance of the volunteers, reduce potential opposition from colleagues and provide access to new mothers.108, Alternatively other professionals may assume this recruitment role: ‘Home economists assumed the responsibility for identifying potential peer educators. PSs valued training when it gave them the opportunity to share their experiences and gain support from other PSs and to make and maintain friendships. As noted in the previous chapter mechanisms and outcomes were operating on two different levels: the level of organisational engagement with communities in designing the programme and the level of implementing peer support with participants in communities. This technique involves a researcher in examining data collected from multiple cases and not necessarily by the same investigators. Support for the proposition that involving stakeholders at an organisational level in the development of a peer-support intervention through regular updates and dialogue leads to the intervention being more easily embedded within existing service provision: Understanding the wider cultural context in which a programme would be delivered was discussed by several authors. some already had specific skills or activities in mind (such as walking, holistic therapies, writing, art, t’ai chi, yoga) others were just keen to try something new or get involved with an AB project’ (AB, Altogether Better).113. Cross-case synthesis is an analytic technique that applies to the analysis of multiple case studies. Cross-case analysis is used when the unit of analysis is a case, which is any bounded unit, such as an... Looks like you do not have access to this content. The approach of selecting on qualifications and interpersonal skills worked for this programme, but may have worked less well when qualifications led the PS to use their professional rather than lay knowledge. We describe a worked example of three such methods where three independent teams synthesized two studies that investigated critical factors of trust in outsourced projects through thematic synthesis and cross-case analysis, and compared these to each other and also to an already published narrative synthesis. The included studies covered a wide range of types of recruitment with variation in how PSs themselves were recruited and also in how they, themselves, might be further used to recruit more PSs or participants to the programmes. Propositional statement Potential recruits may see involvement in peer support as offering access to social networks. The Advisory Network emphasised the importance of clearly defining the community health champion role from the beginning, including both ‘what it is’ and ‘what it is not’. A typical example is to impress speechon various natural sounds, such as ``talking wind.'' For example: The health champion involved in this case study wanted some support in getting himself and his family taking part in more regular activity and to encourage other taxi driving friends to become more active.113, A key attraction of becoming involved in a nutrition-related peer-led project was that they expected it to involve active learning for themselves – whether that related to the substantive content on nutrition or to the development of the skills required to run a food club.134. Although the original recruitment model was followed initially: . Role play was one activity that was identified as something that PSs might find daunting. Programmes may have different underpinning rationales that determine appropriate recruitment, for example an initiative may seek to broaden the representation across all sectors of the community, it may identify a target community opportunistically or according to convenience or it may target those perceived to be at greatest risk (from the health problem) or seek to address perceived inequalities. CE therefore offered potential benefits during programme design. those receiving the peer-support intervention. Tailoring the individual training sessions to the needs and pace of individuals and to make the best use of the group dynamics was felt to be helpful. . Payment or other incentives may also influence decisions to become a PS. Logistical planning and project support included consideration of the help needed with child care, travel expenses, language barriers, setting and organisational factors (such as attitudes, funding, resources, etc.). This aligns with Nutbeam’s assets-based model for HL.15,16 For example, authors of the Diabetes Sharing Stories cluster explained how the intervention built on common cultural beliefs, attitudes and behaviours – rather than trying to ‘remedy deficiencies’,79 whereas authors of the Breastfeeding cluster stated: ‘Bottom up changes in the service model places emphasis upon understanding the local culture and implementing change in a creative, systemic and culturally sensitive way’.127. Authors from the nutritional programme for the Healthy Eating Aboriginal Australians cluster argued that the cultural targeting of the course was considered crucial to its success.122 The participants knew other students would be Aboriginal and cultural appropriateness was increased by using an Aboriginal teacher supported by Aboriginal health workers. PSs also valued training which they felt developed their knowledge, skills and attitudes to enable them to help others and fulfil their role as PSs. Peer-led interventions that recruited older PSs appeared to encounter fewer barriers to recruitment. Some church members were embarrassed by their smoking behaviour and others did not want to identify themselves as needing help.129. It was argued that the most successful models of drop-in centre associated with the breastfeeding peer-support schemes were located in a venue ‘that was both acceptable and accessible to the target group of women . . Propositional statement PSs value training when they perceive it to be of personal benefit to themselves. When PSs were recruited to the same programme over a period of time, it was important to design training that could be delivered on an ongoing basis. talked to the participants as group before and after the slide-tape show . Authors of the Diabetes Sharing Stories programme discussed how the project team engaged with the wider NHS organisation when developing and trialling the intervention. Cocreating training encourages ownership (artwork: Sarah Smizz). Most VOCALOIDs are not able to be registered for XSY and this is particularly true for single voicebanks that are not part of any XSY group, so releases such as Yanhe, Yohioloid and Flowercannot … . what we wanted to say locally was Fag Ends is here to help you if you want to give up smoking’.120. in becoming more informed or assuming a more influential position within a community). Some were held in more formal health settings, while others were social club venues: ‘Different advocate led user groups developed their own format and identity . .’.119, Once PSs have initially been recruited they may, in turn, be used to recommend or indeed actively recruit additional supporters: It is ‘exceedingly helpful’ to select peer counsellors from recommendations made by other peer counsellors or supervisors.136. When the drop-in venues and times linked with other activities, for example a baby clinic, they were particularly well attended’.123 Authors of other clusters suggested that programmes worked most effectively in non-health, non-institutional settings. The cross-case synthesis was one of the few viable options given the study’s lack of dependent and independent variables. There can also be community barriers such as discomfort with the proposed intervention or general distrust regarding the recruiting organisation. thematic synthesis in SE as a scientific inquiry consisting of five steps based on the extent literature (See also Table 2). They agreed that ‘being valued to be part of it and being trusted to be part of it’ was key to becoming a peer supporter (Advisory Network #11) (Figure 16). elderly persons who were used as teachers and as demonstrators in the colorectal cancer presentation . Based on the data reported, four stages were identified: programme design, recruitment of PSs, training of PSs, and implementation of peer support (see Appendix 5, Data extraction template for programme stages). . Synthesis of case studies is necessary to build a body of knowledge from individual cases. The type of interaction during recruitment appears to be important in terms of engaging in some sort of dialogue about roles and expectations, and establishing a connection with people. The stage of recruitment includes how PSs are initially contacted and informed about the initiative, their characteristics, the barriers and facilitators to recruitment, the mechanism by which they were recruited, and whether or not remuneration and other incentives influenced recruitment and retention. Some participants visualise benefits from their own involvement in terms of access to information or to health programmes. . . Propositional statement Training that is designed to build on the pre-existing abilities of PSs maintains PSs’ self-esteem and confidence to deliver the intervention effectively. Authors of other clusters highlighted that needs assessment helped them to develop culturally appropriate materials, for example in programme participants’ own language: The sharing stories model was developed specifically to address the needs of limited English speakers with diabetes living in deprived inner city areas.125, . Call it trying things out; imagine; what if? Information about the planning of training found in the literature relates to the cocreation of training and materials used during training, that is the involvement and participation of PSs in the development or tailoring of training materials for specific individuals or groups. Using gay bars to promote safer sex, for example, was not effective in the Glasgow Gay Men project, with the gay community in Glasgow ‘representing a relatively closed social environment . ♦ The displaced complementary DNA strand then anneals itself to the strand that was originally complementary to the invading strand. supporting data illustrating the evidence base for the propositional statements. It may be helpful to look at alternatives ways to improve the knowledge, skills and attitudes of PSs and thereby equip individuals to fulfil their peer-support role. Some form of recognition and pride in being asked to contribute appears to play a part in successful recruitment, as does a need to be engaged with others and involved in social networks. Any study design can have bia… When using cross-case synthesis, Yin (2014) suggests that it’s better to create a table about all the cases and categorize them. In some instances prospective PSs were limited in the extent to which they could participate in the training that was offered. PSs responded to their incentive and there was low attrition with most completing the trial.79, Alternatively payment may relate to the core activity of engagement with others in implementing health promoting interventions. In this situation there was no flexibility to modify the training that was delivered according to a preprepared training manual. In cases when the sense of community is more diffuse or less tangible – for example communities defined by demographics – recruitment becomes more complex as potential PSs within the community may not necessarily have relationships with the target group. This feature works with a selection of VOCALOID3 voicebanks when imported into the VOCALOID4 engine, however not all products are compatible. The nature of such compromises may well determine the extent of the success or failure of the programme. They may also relate to altruism (i.e. The propositions for recruitment (Table 10) both build upon and add to the propositions that were identified at the stage of programme design. study, cross-case analysis refers to analysis and findings that relate the situationality elements and instructional methods found in specific cases to those found in other cases. In some cases existing organisations or networks may become the mechanism for recruitment. Only a small number of the clusters reported active involvement of stakeholders in the design of programmes. We propose that this interaction and the perceived acceptability of the intervention are weighed against intrinsic motivators. The next chapter looks at if these activities, processes and mechanisms provided a firm foundation for implementation by exploring what actually happened when PSs tried to offer support to disadvantaged communities. The pilot intervention was not successful and the authors suggest that a contributory factor may have been a lack of time for training, in combination with the fact that those providing training had been unable to prioritise the salient points because this would have meant deviating from the prescribed number of training package.138. These VPEs took on the role of instructors for their peer group.121 In another model, community organisations/networks recruited PSs to act as Elderly Educators from a local Ageing Network and a high-rise apartment for the elderly.135 Local HPs may also be used to recruit PSs. . Peer supporters’ self-esteem was maintained when training was designed to recognise and build on their pre-existing attributes and to make use of their qualities and expertise (Advisory Network #8). The types of research studies at the top of the list have the highest validity while those at the bottom have lower validity. Payment of lay health workers for both training and subsequent leading of health promotion classes was considered a critical success factor in a study focused on the Latino community in Los Angeles.118. The danger is that ‘culturally sensitive’ might mean that individually tailored is lost. Peer supporters value training when it leads to an additional qualification or accreditation and enhances their employability. Training needs analyses were carried out prior to, or, in some instances, at the start of, training. The Diabetes Sharing Stories programme79 and a project within the Healthy Living Older People cluster119 reported using action research, whereas another project reported working with a stakeholder steering committee to guide the programme development process (Smoking in Ethnic Minorities). Training that gave this opportunity enabled PSs to build their social networks and reduced their sense of social isolation. Based on the types of bias that are inherent in some study designs we can rank different study designs based on their validity. They suggested that the use of the word ‘training’ might have negative connotations for some individuals. Many participants placed great importance on the value of ‘word of mouth’: People are often frightened of taking part in something that is new to them – they wonder what is expected of me? . When stakeholders are not involved, problems can be encountered in terms of embedding peer support into existing services. They provided regular updates within the governance and leadership structures of the Trust. Please choose from an option shown below. Propositional statement Recruitment (and hence the subsequent success of the programme) may be less effective when potential peer supporters feel uncomfortable about the issues, condition, the prescribed approach to peer support or the objective of improved HL. Role playing is off putting for many people – needs to be in safe space with feedback from a trusted person. One smoking cessation programme was located in secondary schools, where support activities can be integrated with daily routines.128 Conversely, settings that require activities to conform to existing routines – such as some of the breastfeeding programmes that were reviewed – can constrain the ability of PSs to gain access and implement support.127. . The Diabetes Sharing Stories cluster79 described development of their programme using action research processes, working with staff who would deliver the peer-support programme (in this case, bilingual health advocates). The cross-programme analysis of design, recruitment and training identified some patterns in terms of context, mechanisms and outcomes. When this happened it created an environment in which PSs felt that their experiential knowledge was recognised and valued. The nature of the proposed intervention, the degree of acceptance for it, and the sensitivity and acceptability of the proposed health messages could either align, or conflict, with community and personal values. In some cases a researcher recruited PSs, for example in one study121 a researcher encouraged members of the participant group who were willing to volunteer as peer educators (volunteer peer educator, VPE). Propositional statement Training is more effective when it takes into account the personal needs of peer supporters. 2019 Jun 4;21(6):e13574. Addressing cultural needs helped to ensure that peer-support programmes worked with community values rather than against them. Examining Cost Measurements in Production and Delivery of Three Case Studies Using E-Learning for Applied Health Sciences: Cross-Case Synthesis. For example, in schools the incentives for completion were a £10 voucher and certificate of achievement for PSs who completed the trial. Such communication skills need to be augmented by interpersonal skills involving the positive building of connections: You need to establish some sort of connection to people who might be interested in becoming peer supporters . As noted in the previous chapter mechanisms and outcomes were operating on two different levels: the level of organisational engagement with communities in designing the programme and the level of implementing peer support with participants … Some individuals did not wish to participate in programs that were developed and delivered by fellow church members’.129. Stakeholder involvement is defined as the active involvement of key people in the peer-support design process. At the same time, the study contributes to theory development by integrating two competing theories. . The chapter concludes with a discussion of the emerging patterns in terms of how organisational context influenced design of the programmes. They are characterized by their flexible nature, multiple forms of data collection, and are mostly informed by qualitative data. The first two by Grybovych (2012) and Slocum, Backman, and Baldwin (2012) respectively report research processes related to specific projects, while the last seeks to provide an analysis associated with cross-case study research. This has implications for ‘diffusion of innovation’ because, although these people were certainly peers in that most were recruited in the bars, and were often recognizable to bar clientele, the ‘popular people’ model was not replicated exactly.81, The Healthy Eating ‘Body and Soul’ cluster revealed very prescriptive characteristics for recruitment, suggesting that educational and work experience ‘qualifications’ were being weighted more heavily than role in the community: ‘Churches were asked to identify individuals, preferably with a college degree or a graduate-level education and a background in a “helping profession” ’.137. Methods and levels of stakeholder involvement varied. In the Healthy Living Older People programme, PSs were quite anxious about the training workshops and their roles.119 Roles were clarified in the initial session, where the programme emphasised that ‘peer educators were not expected to become nutritionists nor try to learn enough about the subject to answer all the nutrition questions that could arise . . In this situation, training was required for the entire cohort as a preparatory stage prior to the start of the intervention: ‘Professional health education experts led teams of trainers who trained these peer supporters for two days, at a venue off the school premises, to intervene in informal situations and encourage their peers not to smoke’.128. This refers to situations for which training was designed or adapted to acknowledge and build on the current abilities of PSs. . One of the breastfeeding projects noted that ‘In the initial training, volunteers were taught to recognise limitations in their role and refer issues to HPs that they were not equipped to manage’.108 Our Advisory Network agreed that role clarification was important to prevent PSs from overstepping boundaries, particularly in terms of providing technical information: It’s important to recognise the parameters of the role and check things out . Propositional statement Recruitment is successful when a connection is established with potential PSs. . The ‘stage documents’ were then read through by the team and subjected to multiple iterative comparisons with programme CMOs to arrive at the main propositional statements for CBPS and HL. Building relationships, valuing the potential in others can be an asset that aids recruitment. Propositional statement Appropriate methods for recruitment of PSs are determined by the cohesiveness of the community that is being targeted. . The recruitment process can influence the likelihood of a community engaging with a particular initiative, both in terms of the coverage of the initiative and in the subsequent quality of interactions. In one pilot study, training was not tailored to groups in the study because of concerns about intervention fidelity. Moreover, it is an aggregative synthesis, integrating knowledge in one domain, and relies on analysis techniques like content analysis and cross-case analysis. Many barriers to recruitment of PSs are mirrored more widely in difficulties in recruiting participants more generally: The negative perception concerning smoking may have been a barrier for recruitment and participation. The mural ‘Les Trois Ages’ by Gonzalo Borondo, pictured above, loomed over us as we ate. It is important to note that multiple lines illustrating different pathways can be drawn between organisational context – for example, the organisation’s willingness to engage – and the mechanisms of increased understanding of the community that is being targeted. Although building on existing knowledge appears to be a new theme, it accords with the idea of building upon existing knowledge in the community when conducting needs assessments and developing appropriate recruitment strategies. The people who participated in training came from many walks of life. The authors of the Diabetes Sharing Stories programme argued that action research led to ‘progressively changing the focus of activity in response to participants’ needs and priorities . . . This suggests, in the context of the breastfeeding cluster, cultural needs assessments are an important initial aspect of the design process. 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