Why and how do peer models work? Findings from ‘Peer models in hepatitis c healthcare service delivery: underlying mechanisms and implementation (PEERs)’

Background: The impact of peer-led work among marginalised populations with very limited access to healthcare is a key recommendation within the WHO Global Health Sector Strategies on blood borne viruses including viral hepatitis (WHO, 2022). While benefits of peer models are increasingly accepted, an in-depth understanding of how these models work, what influences their effectiveness, and how they are best integrated into existing healthcare settings for hepatitis C (HCV) and beyond is lacking. This study systematically describes and evaluates a national peer service embedded in UK community HCV healthcare.
Methods: We conducted a qualitative study with 45 participants (peer workers, service users and healthcare professionals) in diverse community healthcare settings in three research sites. We conducted semi-structured focus groups and interviews, in person and remotely. All data were pooled and analysed thematically.
Results: Key elements of the peer model surrounded definitions of peers (what makes a peer a peer), and identified initial implementation barriers in terms of trust, hierarchy of professionalism, undefined roles and responsibilities as well as an evolving peer pathway in diverse settings. Facilitators highlighted the importance of lived experience for service users, the perseverance of peer workers in engaging, testing and treating marginalised individuals, and the incremental benefit of a peer organisation co-ordinating the peer model. Underlying mechanisms include social influence, professional roles and transitional identities, and beliefs about capabilities and consequences.
Conclusion: Peer-enhanced healthcare service delivery is valuable alongside as well as embedded within the NHS. Lessons learned from this study provide recommendations for other services intending to implement peer models in HCV and beyond to optimise engagement and healthcare provision for marginalised populations.