Abstract
Purpose: Despite increasing attention to the benefits of peer support for people with newly acquired spinal cord impairment, limited consideration is given to its theoretical basis. This research developed theory explaining how contextual factors and mechanisms of effect within peer support interventions impact on health outcomes within an inpatient rehabilitation setting.
Method: We used realist methods to explain in which situations, how, and why peer support improves health outcomes. We reviewed peer support service documentation, conducted focus groups and interviews with peer support providers to develop initial program theory, and refined programme theory in response to peer support provider feedback gathered from further focus groups.
Results: Peer support actively promotes the experience of belonging, competence, adaptive coping, optimism and autonomy. The degree to which key mechanisms are facilitated may depend on the physical and relational spaces in which peer support occurs, rather than solely relating to what is being discussed or the similarity of personal characteristics between the person with newly acquired spinal cord impairment and the peer support provider.
Conclusions: This model will inform the ongoing development and evaluation of peer support services for people with newly acquired spinal cord impairment.
Implications for rehabilitation
• We propose a theoretical model explaining in which situations, how, why peer support improves health outcomes in people with newly acquired spinal cord impairment (SCI)
• Peer support the experience of belonging, competence, adaptively coping, optimism and autonomy.
• Empathic peer support encounters contribute to belonging and the development of autonomy by ensuring that people feel listened to and able to question aspects of their care
• Shared experiences in real-world settings facilitate the development of competence and optimism through seeing what functioning and a ‘good life’ looks like.