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Mental health services are increasingly employing peer workers (PWs), individuals who have lived experiences with mental health problems, to support patients and be part of mental health care teams. While the employment of PWs continues to increase, little is known about how the function unfolds in practice. This paper explores the broader context in which the PWs navigate and the concrete outcomes and everyday issues that exist at the individual level. Methodologically, the paper draws on 22 interviews with PWs employed in the mental health services in Denmark. Theoretically, it combines Lipsky's (1980) theory on street-level bureaucrats with sociological discussions concerning the lay-expert divide. The analysis shows that PWs experience both role ambiguity and goal uncertainty and that they use substantial discretion in determining the nature, amount and quality of their peer practices. This – combined with the PWs' diverse lived experiences – calls for a heterogeneous understanding of peer work and therefore the analysis presents three categories of peer workers: PWs as (1) a representative of patients' lifeworld, (2) an interdisciplinary professional and (3) an 'expert by experience'. These categories display PWs different enactments of their lived experiences and reveal ambiguities tied to the lay-expert divide. [ABSTRACT FROM AUTHOR]

The shift towards recovery‐oriented mental health care has led to the extensive growth of peer support in contemporary service delivery. When enacting peer support, peer workers (PWs) use their lived experiences of mental illness to provide support to individuals experiencing mental health difficulties. While PWs are increasingly an integrated part of mental health services, the way in which peer support unfolds in everyday practices remains understudied. Drawing on ethnographic fieldwork from Danish mental health centres, this paper investigates how peer workers and users enact experiential knowledge and expertise to support one another. Theoretically, this paper draws on a micro‐sociological approach that comprehends expertise as an interactional accomplishment enacted within institutional arrangements. First, the analysis shows how PWs and users develop affective relations based on shared illness experiences that enable the enactment of expertise. Second, it demonstrates how PWs and users engage in these relations by exchanging sympathy and knowledge according to different situational demands. Third, it shows how experiences of relational limitations make service users contest the value of experiential knowledge and PWs' position as valid experts. Centrally, this paper contributes to a general discussion of expertise and the implications of bringing lived experiences into mental health services. [ABSTRACT FROM AUTHOR]

Background: It is currently unknown if school-based social norms interventions are effective in preventing harmful alcohol consumption and other drug use among adolescents in Denmark. This paper describes the social norms-based programme The GOOD life and the design of a cluster-randomized controlled trial to test its effectiveness.Methods/design: The intervention The GOOD life is composed of three social norms components representing three different communication channels, namely face-to-face communication (normative feedback session), print communication (posters) and interactive media (web application). The intervention period of 8 weeks is preceded and followed by data collection, with the follow-up taking place 3 months after baseline. Public schools in the Region of Southern Denmark with grades 8 and 9 are invited to participate in the study and participating schools are randomly allocated to either intervention or control schools. The aim is to recruit a total of 39 schools and a sample of 1.400 pupils for the trial. An online questionnaire is conducted to examine the use of alcohol, tobacco and marijuana as well as the perceived frequency of use among peers of their own grade, which is measured before and after the intervention. Baseline data is used to develop social norms messages which are included in the three intervention components. Primary outcomes are binge drinking (more than 5 units at one occasion) and perceived frequency of binge drinking among peers, while smoking, marijuana use and alcohol-related harm will be assessed as secondary outcomes.Discussion: The GOOD life study will provide necessary insights on descriptive and injunctive norms regarding alcohol and other drug use among Danish adolescents. In addition, it will provide new knowledge and insight on the feasibility, implementation context and effectiveness of a newly developed social norms intervention in the Danish school context.Trial Registration: Date of registration: 17 February 2016 (retrospectively registered) at Current Controlled Trials with study ID ISRCTN27491960. [ABSTRACT FROM AUTHOR]

Research on peer support programmes for people with type 2 diabetes has shown a positive effect on health-related behaviours, yet little is known about what causes this effect. This study researched the mechanisms generating immediate outcomes (changes in awareness) and intermediate outcomes (behavioural changes) among socially vulnerable people with type 2 diabetes in a Danish peer support intervention. Using a realist-informed evaluation approach, we investigated how nonprofessional volunteers perceived and performed as peer supporters, and how these activated mechanisms in the interaction between peers and peer supporters. Furthermore, we explored how contextual factors related to peers and peer supporters influenced how mechanisms worked. The study was based on a qualitative multimethod case-study design (n = 11). Data consisted of semistructured interviews with four key informants (peer, peer supporter, project manager, and a diabetes nurse) (n = 27), participation observation of two peer supporter training courses, one network meeting, two supervisions for peer supporters, and logbooks from peer supporters. Data were analysed using systematic text condensation. The findings revealed that the peer supporters used their lived experience to perceive and perform in the peer support meetings. Furthermore, being with a like-minded person with type 2 diabetes activated mechanisms, such as trust, respect, empathy, care, and honesty between peers and peer supporters, which led to increased self-care awareness among the peers (immediate outcome). Finally, the findings revealed that contextual factors, such as peer supporters' lived experiences and peers' and peer supporters' sociodemographic characteristics and health conditions, affected how the mechanisms were at stake. Thus, our study contributes on how to support socially vulnerable people with type 2 diabetes and where peer support programmes can supplement the established healthcare system by providing social and emotional support to this vulnerable group. This trial is registered with ClinicalTrials.gov, Retrospective Registration (20 Jan 2021), registration number NCT04722289. [ABSTRACT FROM AUTHOR]

Background:In Denmark group supervision for general practitioners is an established part of continuing professional development. Several different approaches are used, including Balint Groups and Bendix Groups. The aim of this paper is to describe the benefits and challenges of a peer group supervision model with the role of supervisor taken by group members in turn. The setting was a group of general practitioners using a patient-centred consultation model and video-recordings of consultations. Methods and material:As part of a larger study the first author studied this long-established group by observing three group sessions over a period of six months. She conducted two individual, semi-structured interviews with each general practitioner who presented consultations at the observed sessions, and held a group interview with the entire group at the end of the observation period. The interviews were recorded digitally and transcribed verbatim. The data were analysed using systematic text condensation. Results and conclusion:Participation seemed to improve communication skills and the ability to take a more patient-centred approach. It increased job satisfaction and prevented burnout. A non-judgemental environment, respect and acknowledgement of all participants were important for developing confidence and for supporting personal and professional development. [ABSTRACT FROM AUTHOR]

Day centres are increasingly being established, as many older persons are isolated and in need of meaningful activities and social interaction with others. Previous research has shown that day centres are still an important arena for older attendees to socialise and engage in meaningful activities, although day centres are increasingly introducing activities as part of rehabilitation programmes to enhance physical and mental enablement. However, little is known about what attendees and staff regard as meaningful activities. Based on a multi‐site ethnographic investigation at four day centres in Denmark and Norway in 2018 and 2019, this article examines how staff and attendees alike 'utilise' day care centres to pursue meaningful activities and what is considered meaningful for those attending and working there. Furthermore, this article discusses the potential for person‐centred care in communities like day centres. Our study shows that activities are first and foremost perceived as meaningful if they enhance an enjoyable social dimension with 'a touch of fresh news'. Hence, day centres function as a social space where elderly attendees can share stories and news based on personal experiences from the past and present. Consequently, person‐centred care in day care centres preferably facilitates communities to give attendees something new and refreshing to bring back home with them—and not only facilitate personal histories, preferences and wishes. [ABSTRACT FROM AUTHOR]

Peer-led interventions are highlighted as promising strategies to promote health among adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers in school-based health promotion, we combined participant observations, focus group interviews and video recordings to explore high school students' reception of a peer-led intervention component (Young & Active). Young & Active aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016–2017 in a larger school-based intervention study, the Healthy High School study in Denmark. The Healthy High School study was designed as a cluster-randomized controlled trial with 15 intervention schools and 15 control schools. At each intervention school, university students in Sports Science and Health (members of the research group) facilitated an innovation workshop aiming at inspiring all first-year students to initiate movement activities at schools. The findings illustrate potentials and challenges implied in the PM role. The peer mentors' profound commitment, as well as their response and sensibility to situational contingencies, were found to be significant for the students' reception and experience of the intervention. In conclusion, the specific job of PMs as implementers seems to consist of simultaneously following a manual and situationally adjusting in an emerging context balancing commitment and identification to the target group and the intervention project. [ABSTRACT FROM AUTHOR]

Aim: To explore how hospital nurses experienced their work situation during the COVID‐19 pandemic and how this affected the conduct of their professional and their everyday life. Methods: Interviews using critical psychology. A total of 24 nurses participated, representing departments of both medicine and surgical specialties. All nurses worked either in the department where they are usually stationed or were recruited from other departments to the COVID‐19 department. Results: Five themes were identified: (1) COVID‐19 had importance to nurses' sense of self as a nurse; (2) a new solidarity developed; (3) professional reflections—caring for patients; (4) the importance of recognition and humiliation and (5) COVID‐19 had consequences for the nurses' conduct of everyday life. Conclusion: The findings showed that some nurses caring for patients with COVID‐19 experienced a new solidarity with their colleagues. Other nurses found it to have a negative impact on their conduct of their professional life. [ABSTRACT FROM AUTHOR]

The study reports the results of a qualitative study on the views and experiences of non-peer mental health providers on working together with peer colleagues in mental health. Semi-structured interviews were conducted with 20 providers in different mental health settings. Data were systematic analyzed using thematic analysis and resulted in three overall themes: (1) The relationship and collaboration between the mental health providers and their peer colleagues, (2) The benefits of working with peers, and (3) The challenges of working with peers. In analyzing the data material, the theme of the relationship and collaboration between the non-peer mental health providers and their peer colleagues could be organized into two subthemes on the differences that the providers perceived between themselves and their peer colleagues. One subtheme was on differences when the providers perceived the differences as positive and meaningful. The other subtheme was on differences between themselves and their peer colleagues when the providers perceived the differences as concerning. This study's findings show that the attitudes and experiences of peer support in mental health providers are in general positive, but also that mental health providers in the early phases of peer support implementation could have many concerns and may find the perceived and mainly valued differences between themselves and their peer support colleagues also distressing. The implications for practice include a need to address possible barriers to peer support, including frustration or feelings of injustice among mental health providers, especially as such issues are not easy to pinpoint or address by formal guidelines on peer support. [ABSTRACT FROM AUTHOR]

In this study, we explored specific mechanisms of a board game developed to facilitate peer support among people with Type 2 diabetes attending group-based diabetes education. The game was tested with 76 people with Type 2 diabetes who participated in focus groups after the game. Data from observations of audio-recorded games and focus groups were analyzed using Interpretive Description. Six mechanisms facilitating peer support among people with Type 2 diabetes were identified: (a) entering a safe space of normality created by emotional in-game mirroring; (b) mutual in-game acknowledgment of out-of-game efforts; (c) forming relationships through in-game humor; (d) health care professionals using game rules to support group dialogues of interest to people with Type 2 diabetes; (e) being inspired by in-game exchange of tips and tricks; and (f) co-players guiding each other during the game. Peer support was inhibited by the mechanism of game rules obstructing group dialogues. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to gain insight into experiences and reflections of persons with amyotrophic lateral sclerosis and relatives concerning the peer group rehabilitation programme "More Life – Less Illness". Methods: This qualitative study used the Interpretive Description methodology with Symbolic Interactionism as the analytical framework. Eighteen programme participants representing persons with amyotrophic lateral sclerosis (n = 8) and relatives (n = 10) were included. Data consisted of individual interviews and participant observation. Results: The analysis revealed two categorical themes, "Sense of Community Building" and "Understanding my ALS", which represented the participants' experiences and reflections on peer group rehabilitation. Through the analysis, it became apparent that "Sense of Community Building" gave rise to an increased and personalised understanding of amyotrophic lateral sclerosis among the participants. As a part of the continuous processing of the knowledge gained, "Facing Facts" and "Retaining Normality" appeared as subthemes regarding the participants' ability to live a less dependent and more meaningful life. Conclusions: This study of peer group rehabilitation for persons with amyotrophic lateral sclerosis and relatives indicates that programme participation leads to positive experiences in terms of living a shared meaningful life despite severe disability. The findings may guide practice to develop longitudinal peer group rehabilitation programmes with joint inclusion of persons with amyotrophic lateral sclerosis and relatives. Peer group rehabilitation may facilitate an increased and personalised understanding of what it means to live with amyotrophic lateral sclerosis. A programme design with six months of sequential sessions enables a continuous processing of shared experiences and gained knowledge. Joint participation of persons with amyotrophic lateral sclerosis and their relatives supports both their internal relationship and social networking. Peer group rehabilitation in amyotrophic lateral sclerosis should help overcome obstacles concerning the needs of participants, accessibility, and geographical distance. [ABSTRACT FROM AUTHOR]

Psoriasis is a long-term condition with a possibly cumulative life course impairment. Young people struggle to minimize its effects on appearance and functioning. To date, the self-management needs of adolescents suffering from psoriasis have been underinvestigated. Using focus groups and individual interviews, we present an interpretive description of young people’s experiences of living with psoriasis, the challenges they face, and the support they need to relieve suffering and come to terms with their condition. This process is characterized by loneliness, the self-imposition of limitations, and the lack of personalized knowledge and communication skills to manage the impact of disease and society’s reactions. Our study provides insight into needs of early interventions tailored to address condition, role, and emotional management, involving parent education, peer support, storytelling, and roles for professionals. We argue that further research should involve young people, their parents, and professionals in the development and evaluation of interventions. [ABSTRACT FROM AUTHOR]

Photo-elicited interviews indicate that children hardly ever mention educators when asked about elements in preschool that make them feel happy. Happiness is found to occur in activities in the ‘under-life’ of the ECEC institution. Children challenge adult rules and norms in order to create status in the peer-group, while at the same time, they seek to construct social identity and maintain a positive relationship with their educators. A child that manages to balance both adult expectations and what is needed to participate in the underlife among peers, experiences happiness and thus, is in a good state of well-being. [ABSTRACT FROM AUTHOR]

Aims: To present and discuss implementation experiences regarding the involvement of community pharmacists with ethnic minority backgrounds in a medication review intervention for ethnic minority poly-pharmacy patients in Denmark. Methods: Data sources include 1) reflection notes from an introductory seminar with pharmacists and the cross-disciplinary research team and 2) five individual interviews and one focus group interview with pharmacists. Data were thematically coded and synthesised to identify underlying rationales and challenges encountered when involving professionals with ethnic minority backgrounds in interventions for ethnic minorities. Results: Informants perceived the need for interventions targeted at ethnic minority poly-pharmacy patients, and highlighted the potential of involving professionals with diverse ethnic backgrounds in such interventions. However, implementation created challenges, because the professional identity of the pharmacists reduced their options for serving as peers with the same ethnic background. Furthermore, issues related to organisational difficulties and overcoming language barriers in the intervention impacted on the potential of involving professionals with ethnic minority backgrounds. Conclusions: Involving healthcare professionals with ethnic minority backgrounds in encounters with ethnic minorities holds potential for the adaptation of services to ethnically diverse populations, thus improving access to and quality of care. However, it is important to ensure sufficient personal and organisational support and to acknowledge the delicate balance between simultaneously serving as a peer and as a professional. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to investigate whether the depressive symptoms of the bullied respondents differed according to who the perpetrator was.Methods: We used cross-sectional questionnaire data from two representative cohorts: the Danish Working Environment Cohort Study (DWECS 2010) and the Work and Health Study (WH 2012). After excluding respondents not having a leader, or being self-employed, assisting spouses, and those reporting multiple perpetrators in WH 2012, the statistical analysis included 2478 bullied individuals. We compared respondents reporting being bullied by their (1) leader, (2) subordinates, (3) clients / customers / patients / students, or (4) colleagues, respectively. The occurrence of depressive symptoms was measured by the Major Depression Inventory (MDI).Results: The most frequent perpetrator of bullying was clients (41.5 %) in DWECS 2010 and colleagues (60.3 %) in WH 2012. In DWECS 2010, the MDI score of those being bullied by clients were significantly lower than the MDI scores of the other groups. In WH 2012, respondents who reported bullying from leaders had a significantly higher mean MDI score than participants being bullied by colleagues. Also in WH 2012, our results indicated that those who were bullied by leaders had a higher MDI score than those bullied by clients, although this difference was not statistically significant at conventional levels.Conclusion: Our findings indicated a similar pattern in the two cohorts, with a tendency of more severe depressive symptoms among employees who are exposed to bullying by their leaders, and the least severe symptoms among those who are bullied by clients. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate patients' lived experiences of exercise-based cardiac rehabilitation. Background Exercise-based cardiac rehabilitation is used to enable patients with cardiac problems to move forward to lead satisfying lives. However, knowledge of patients' concerns while they follow the current programmes is sparse. Design This study, which included nine men and two women with unstable angina pectoris and non-ST-elevation myocardial infarction, used a phenomenological-hermeneutic approach. Methods The patients were followed by field observations during exercise-based cardiac rehabilitation. Focus group interviews were conducted at the programme end, and individual interviews were performed one to two months later. The interpretation comprised three methodological steps: naïve reading, structural analysis, and comprehensive interpretation and discussion. Findings Although both physically and psychologically challenged, the patients were encouraged to maintain an active lifestyle. Three themes were identified: anxiety regarding exercise, whereby the patients are initially insecure about how to behave with their diseased hearts; encouragement from training together, whereby the patients support each other in exercising; and growing confidence in the heart, whereby the patients enjoy being physically active. Conclusions In exercise-based cardiac rehabilitation, patients' insecurity with respect to their heart disease is revealed as an existential anxiety. Through peer support and a positive physical perception, the patients gain renewed self-efficacy, helping them to continue their lives in an active and satisfying way. Relevance to clinical practice Knowing that patients are confronted with an existential anxiety during exercise-based cardiac rehabilitation is important because it requires specific care. Recognising this anxiety also highlights how participating in the programme can be very demanding, which can help us understand aspects of adherence problems. Of greatest importance is that exercise-based cardiac rehabilitation enables patients to find a new foothold, which comprises enjoying being physically active. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Understanding peer effect is potentially important for finding ways to combat the obesity epidemic. Nevertheless, it is not clear whether a peer effect exists because of the composition of the peer group, because the group members have similar, unobserved individual characteristics, or because of an endogenous effect. METHODS This issue is addressed here by using a unique longitudinal data set of 573 schoolchildren attending state schools in the Municipality of Aalborg, Denmark, during 2008-2010. To identify the spillover effect of a targeted intervention on peers, we use a difference-in-differences approach. RESULTS A targeted health intervention reduced body mass index (BMI) among overweight, inactive individuals and, more interestingly, that BMI among the nontreated peers was reduced by 1.04%. CONCLUSIONS The analysis suggests that individually targeted health intervention has a health benefit beyond the treated individual, which needs to be included when evaluating targeted policies aiming to combat childhood overweight and inactivity. [ABSTRACT FROM AUTHOR]

Research has shown how cochlear implants (CIs), in children with hearing impairments, have improved speech perception and production, but very little is known about the children's pragmatic language development. During a 4-year longitudinal study of three children with CIs, certain aspects of pragmatic language development were observed in free social peer interaction. Observations were analysed both quantitatively and qualitatively. Some of the analysed aspects were speech intelligibility, auditory performance, turn-taking, response, repair, and gaze behaviour. The three children improved their speech intelligibility and auditory performance during the 4 years, but they continued to have difficulties with pragmatic language usage. Included in this study are explanations of pragmatic language difficulties among some children with CIs and other related issues as peer interaction, theory of mind, psychosocial wellbeing, and self-efficacy. Some children with CIs may face pragmatic language difficulties; therefore, supporting a child's pragmatic language development could be conducive to their social and linguistic development. [ABSTRACT FROM AUTHOR]