The Development of Social Capital in a Peer-Led HIV Adherence Intervention

Background: Behavioral health interventions conducted by peers – individuals who share common characteristics, circumstances, or experiences with research participants – have shown promising results. The Adherence Connection for Counseling, Education, and Support (ACCESS) I proof-of-concept study is a peer-led intervention to improve HIV medication adherence in youth living with HIV who are in treatment but have detectable viral loads. Participants received five online sessions with peer health coaches who followed a structured intervention manual. Although peer health coaches maintained intervention fidelity, they also engaged in dialogue not directly related to intervention content during the sessions. We believe that these casual interactions develop social capital, which can then be used to encourage positive health outcomes. Methods: Sessions were transcribed and coded for intervention content as well as content that was not directly covered in the intervention manual. Sections of session transcripts that included this non-intervention content, labeled peer-to-peer (P2P), were then sub-coded to document the focus of these interactions. Results: Ten P2P sub-codes were identified, and sessions were divided into beginning, middle, and end to allow for the “small talk” that was expected at the start of each session and the scheduling that occurred at the end of each session. “Activities” was the most common code in the beginning sections, commonly reflecting a review of participant activities since the prior session. “Personal Experiences” was the most common code during the middle of the sessions, as peers built social capital by sharing their own stories and providing additional support to participants. At the end of sessions, “Activities” was again the most common code, as peers and participants discussed upcoming plans and scheduled their next session. Conclusions: Narrative content not directly included in the intervention manual reflected interactions that strengthened the peer-participant relationship, building social capital for the peer educators who could then use this social capital to encourage positive behavior change. Although social capital was not directly measured, these analyses illustrate the value of attending to seemingly casual interactions in peer-led interventions. Future research can focus on the measurement of social capital and the ways in which it is deployed to encourage behavior change.