The research team for this study included CESAR Director Dr. Jessica Magidson and several members of the UM Department of Psychology Global Mental Health and Addiction Program research team. More information about GMAP is available here: https://www.gmhaddictionlab.org/.
Researchers in the United States, South Africa, and Western Australia, led by Dr. Helen Jack at the University of Washington, collaborated to identify common lessons learned about peer-delivered programs in different settings: Baltimore, Maryland and Cape Town, South Africa. The goal of the study was to provide an opportunity for mutual capacity building, a bidirectional exchange of ideas between distinct settings, in this case a setting in a high-income country and another in a middle-income country. Their findings were published in the International Journal of Drug Policy. Researchers conducted qualitative interviews with participants who had participated in a pilot trial of a peer-delivered intervention for substance use disorder (n=21 from Baltimore, n=16 from Cape Town) and combined these interviews for joint analysis. The interviews focused on exploring the participants’ perspectives and to better understand the acceptability and feasibility of peer programs.
Baltimore and Cape Town differ in many ways, but both are large multi-cultural cities with significant racial disparities in income and health. The researchers found many commonalities in the participants’ experiences. They identified five themes reflecting what the participants valued about their peer-delivered intervention: “1) Skills learned, 2) Meaningful interpersonal relationship with the peer, 3) Ability to help others based on what they learned in the intervention, 4) Improved adherence to medications for both HIV or substance use, and 5) Changes in substance use behaviors attributed to the peer-led intervention.”(Jack et al. 2023) Participants in both Baltimore and Cape Town mentioned acquiring skills, discussing that the peer-delivered program gave them the skills or support they needed to make changes in their substance use behaviors. The Cape Town participants emphasized the value of learning about specific skills, such as mindfulness and gaining knowledge about their health condition more than the Baltimore participants. Conversely, many Baltimore participants emphasized how much they appreciated companionship and support from the peer, which they felt they lacked from other people in their lives, as many were socially disconnected from family and friends.
Jack et al. concluded that participants across cultures, programs, and sites valued the peer intervention. The participants cared about more types of outcomes than substance use disorder recovery and medication adherence. “Nearly all participants valued a combination of their relationship with the peer and the skills and techniques they learned, such as activity scheduling. Cutting across all themes was the idea that participants cared about outcomes beyond their substance use recovery, such as interpersonal relationships, and overall health, and they were able to address these areas of their lives through the peer-delivered intervention…while many participants in Baltimore emphasized the importance of their relationship with the peer, participants in [Cape Town] were more focused on skills and knowledge.”(Jack et al. 2023)
Reasons for these differences could be related to what is missing for participants at each site and/or differences in the peer intervention itself. Program administrators and peers should consider tailoring their programs to meet the specific needs and gaps in the community they serve.