Table 2.
Description of peer leaders
| Author and year | Characteristics of peer leaders | Number of peer leaders | Recruitment process, training, supervision, support, remuneration, safe-guarding | Responsibilities and tasks |
|---|---|---|---|---|
| Psychotherapy and counselling | ||||
| Dow et al. 2020 | Young adults (23–30 years old) with background of either living with HIV and/ or having prior experience with mental health research. |
N = 6 | Recruitment: Not specified Training: On-site intensive two-week training with the principal investigator and a U.S. based clinical psychologist. Supervision, support, safeguarding: Group leaders continued to have weekly practice under supervision 1 day before the intervention group sessions. This is followed by a review of session notes and fidelity checklists.* 1 Remuneration: Not specified |
Group leaders were sex-concordant with participants in their group. Two group leaders led each session, and the third group leader would be responsible for keeping detailed notes of each youth and ensured protocol delivery using a fidelity checklist. |
| Ferris France et al. 2023 | Community Adolescent Treatment Supporters (CATS) are 18–24 year olds LHIV. | N = 15 | Recruitment:15 CATS were identified out of a group of 30 CATS initially recruited to receive the intervention delivered by adult coaches. Selection process not specified. Training: A residential face-to-face, 6-day immersive Training of Trainers, led by local adult coaches LHIV trained in IBSR. Supervision, support, safeguarding: CATS were supported by the local adult coaches at each intervention session. Each day that training and/or intervention were evaluated, feedback was used real-time to adapt the curriculum. Investigators assessed and graded group leader competence and intervention fidelity Remuneration: Not specified |
CATS peer coaches delivered the second round of the intervention to 30 CATS participants. |
| Osborn et al. 2020a | Group leaders 17–21 years old who are high school graduates and required to read in English. None were formally certified in counselling or related fields. |
N = 5 | Recruitment: Group leaders were recruited from local universities and high-school graduate forums with a written application and interview process assessing past experiences, interest in the project, familiarity with mental health issues, and interpersonal facilitation skills. Five out of 11 applicants were selected. Training: 20 h of training spanning 5 days and covering the content of both Shamiri and study skills group. Training was led by the first three authors involving general communication and leadership skills, handling conflicts and referring students to appropriate school officials. This is followed by didactic training in the specific content of the weekly intervention sessions. The group leaders were then asked to role-play delivering the intervention content, and they received feedback from trainers and fellow group leaders. Supervision, support, safeguarding: Not specified Remuneration: Not specified |
Group leaders were instructed to strictly follow the protocol manual and not use content from the other condition during sessions. All group leaders led their groups individually. Three were assigned to the Shamiri intervention, two to the study skills control. |
| Osborn et al. 2021 | Group leaders were high school graduates fluent in English and Kiswahili 18–26 years old. | N = 13 (61.54% female) | Recruitment: Selection via a semistructured interview that gauged past experiences and interpersonal skills Training: 10 h of training by the study team covering: Shamiri and study skills intervention content, counselling techniques, role play, control content, and safety protocols. Supervision, support, safe-guarding: Group leaders had weekly supervision phone calls with study staff to ask questions, receive feedback, and bring up any concerns. Study staff are present during data collection and intervention delivery for support. In the event of serious mental health concern, group leaders are trained to call their supervisor.* 2 Remuneration: Not specified |
All leaders led both Shamiri and study skills content |
| Osborn et al., 2023 | Youth facilitators 18–22 years old from the Nairobi area and have a high school diploma. | Not specified | Recruitment: Semi-structured interviews were conducted, and past experiences, interests, interpersonal skills were assessed, following a validated protocol for youth lay-providers widely used in Kenya (Venturo-Conerly et al. 2022a) Training: They received 20 h of training covering the Pre-Texts and study skills content, led by the first author. Topics covered include general communication and group facilitation, referring students in need to proper school resources. The recruitment and training followed validated protocol for youth lay providers widely used in Kenya. Supervision, support, safe-guarding: Weekly supervision meetings were provided to review sessions that would take place in the coming week, and address any concerns faced in the past week. A member of the study team was assigned as support to provide materials, give time warnings and available in the general area if any concerns should arise. WhatsApp was used for any important reminders.* 3 Remuneration: A stipend of $150, and full reimbursement for transportation.* 4 |
Facilitators were randomly assigned to groups in each school, with each facilitator leading both Pre-Texts and study skills groups. They were tasked with referring students in need to proper school resources. They also facilitated the use of challenging texts as raw material for artmaking. |
| Simms et al. 2022 | Community Adolescent Treatment Supporters (CATS) who are 18–24 years old living with HIV who are trained and mentored to provide peer counselling and support. | N = 60* 5 | Recruitment: CATS are selected based on readiness and capacity to provide peer counselling Training: A three-week programme utilising role play, pre- and post-tests, group sessions and one-on-one sessions for those with difficulty. They are trained on the use of PST with ALHIV and how to make referrals to mental health services.* 5 Supervision, support, safe-guarding: There was weekly nurse-led group supervision and monthly supervision from a mental health specialist.* 5 CATS in Zvandiri-PST arm met a Zvandiri mentor at least once every 2 weeks to review individual cases Remuneration: Not specified |
Tasks include helping participants choose a manageable, relevant problem, establish a goal, and brainstorm solutions. Afterwards, selecting a detailed solution and devising an action plan. |
| Venturo-Conerly et al., 2022b | Lay-providers that were recent Kenyan high school graduates. | N = 13 | Recruitment: Lay-providers were selected based on online applications and in-person interviews. They were assessed for interest, availability, conscientiousness, experience, personal characteristics, and experience indicating good leadership abilities. Training: Lay-providers were trained as part of Osborn et al., 2020a study (see above) in the four-session format of the Shamiri intervention, but also an additional hour-long training in how to deliver the single-session versions for this study. All lay-providers were trained in all conditions to allow for random assignment to conditions Supervision, support, safe-guarding: Weekly supervision meetings were provided to review sessions that would take place in the coming week, and address any concerns faced in the past week. A member of the study team was assigned as support to provide materials, give time warnings and available in the general area if any concerns should arise. WhatsApp was used for any important reminders.* 6 Remuneration: A stipend of $150, and full reimbursement for transportation.* 6 |
Different lay-providers were assigned to facilitate three intervention components: Growth Intervention, Gratitude Intervention, Value Affirmation Intervention, and Study-Skills Control. In the Growth Intervention, lay-providers explained that everyone can improve with effort, followed by participants engaging in planned activities. Finally, lay-providers presented a take-home activity where participants used skills and concepts from the session to address a personal challenge. In the Gratitude Intervention, lay-providers began the session by emphasising the importance of gratitude and discussing personal examples. Participants then engaged in planned activities. Finally, lay-providers assigned a take-home activity: writing three things for which participants felt grateful every day for 1 week. In the Value Affirmation Intervention, lay-providers described how personal values contribute to shaping our lives, including decision-making and academic outcomes. Participants then engaged in planned activities. Finally, lay-providers assigned a take-home activity involving a specific values-promoting exercise planned previously. |
| Venturo-Conerly et al., 2024 | Lay-providers that were recent Kenyan high school graduates aged 18–21. | N = 20 | Recruitment: Lay-providers were selected using semi-structured interview assessing experiences with youth, interpersonal skills, and attitudes toward mental health. Training: Four days of teachings on protocols, general counselling techniques, ethical guidelines for research, and risk procedures. Training included clinical risk assessment and response, sensitive to local resources, attitudes and customs, and were involved in the monitoring of adverse events that may require escalation to a higher-level doctoral psychologist. Supervision, support, safe-guarding: Each lay-provider was assigned a clinical supervisor with at least a bachelors-level of psychology and counselling experience, who trained them, supervised group sessions, and provided care in case of risk. Weekly supervision and daily onsite supervision were implemented. Remuneration: A stipend of $150, and full reimbursement for transportation.* 7 |
Each trained lay-provider facilitated a group of approximately 8–15 students. Lay-providers facilitated three interventions: (1) the Growth Intervention, which challenges the belief that personal characteristics are fixed, teaching participants that growth and improvement are possible, especially when facing challenges; (2) the Gratitude Intervention, designed to enhance feelings and expressions of gratitude to increase well-being and improve relationships; and (3) the Values Intervention, which encourages students to cultivate their personal values and intentionally plan and act in alignment with these values. |
| Peer education and psychoeducation | ||||
| Balaji et al. 2011 | Not specified | Rural communities: N = 28 trained, 20 attended more than 75%. Educational institution-based components: N = 4 even though 98 peer leaders trained, 75 attended more than 75% |
Recruitment: Selected based on a pre-determine non-specified criteria Training: Training was led by psychologists and social workers experienced in adolescent health. Training materials were from standardised manuals. Resources guide was given for delivering the intervention. Supervision, support, safe-guarding: Support was provided in the form of a Community Advisory Board consisting of village council leaders and trained teachers. There were on-site supervision and weekly review meetings. Remuneration: moderate monetary and other incentives (certificates) |
Peer leaders were given a resource guide for delivering the intervention. They conducted group sessions and performed street plays. |
| Im et al. 2018 | Community youth leaders in the Somali community. |
N = 10 (initially 25 trained) |
Recruitment: Not specified Training: A weeklong TIPE training of trainer (TOT) by the project team, followed by training on facilitation and program monitoring and evaluation. Supervision, support, safe-guarding:: Not specified Remuneration: Not specified |
10 trained youth leaders were paired with five community health counsellors to perform the intervention. |
| Kermode et al. 2021 | Peer facilitators were individuals affected by mental illness, with at least Class 12 education, ability to travel to intervention sites and communication skills. | N = 8 | Recruitment: From local communities (Details not specified) Training: Training was led by the Burans Community Mental Health Project Team. (Details not specified) Supervision, support, safe-guarding: Support was offered by the Burans team. (Details not specified) Remuneration: Not specified |
Two peer facilitators led each group (11 groups of ~13 participants) |
| Mathias et al. 2018 | Group facilitators were locally recruited young women 20–30 years old expressing enthusiasm to work in youth resilience and have completed 12th Class. |
Not specified | Recruitment: Not specified Training: 5 days of training and 2 days of refresher training after the completion of eight modules. Supervision, support, safe-guarding: They were supported by a research team leader on tasks including planning, reporting, and who stepped in if a peer facilitator was unable to attend. The Nae Disha field coordinator supported all aspects of the intervention delivery and performed monitoring and support. Remuneration: Not specified |
Facilitators led in pairs with eight groups of 12–15 participants for 15 consecutive weeks. |
| Mathias et al., 2019 | Peer facilitators were selected from the four target communities, who were young people aged under 30 years, with personal experience of mental ill-health and who had completed 12th class in high school. | N = 8 | Recruitment: Facilitators were selected through a process of community meetings and interviews with community leaders. Training: Peer facilitators were trained for five days in group facilitation, how to support young people with PSD, and in the Nae Disha curriculum. Refresher training was conducted across the five-month intervention period. Supervision, support, safe-guarding: There was ongoing supervision by project staff. Remuneration: Peer facilitators were paid. (Amount not specified) |
Facilitators conducted 17 interactive sessions. It included modules such as accepting differences, managing emotions, communicating confidently, protecting ourselves etc. Facilitators also encouraged participants to participate in collective activities, direct participants to additional mental health services, and visit a de-addiction centre. |
| Merrill et al., 2023 | Youth Peer Mentors (YPM), aged 21–26 years old selected by healthcare providers as successfully managing their HIV were hired to work in the clinics. | Not specified | Recruitment: Process not specified. Training: Completed an intensive two-week training and underwent 1 month of practice meetings with youth before the intervention launch. Supervision, support, safe-guarding: Healthcare providers (HCPs) led the orientation and caregiver meetings and were available to answer questions if outside the scope of the YPM’s knowledge. Remuneration: YPM were paid for their work. (Amount not specified) |
YPM were introduced to their youth in the orientation meeting where they discuss action plans for subsequent meetings again. They have monthly individual and group meetings with youth following the Project YES! curriculum. |
| Mohamadi et al. 2021 | Peer educators were active volunteers who scored higher on the puberty health questionnaire prior to the start of the study. | Not specified | Recruitment: Based on scores on the puberty health questionnaire. Training: Educational content was taught to peer educators in one session. Supervision, support, safe-guarding: Peer-to-peer educators’ relationship with researcher continued so that educators could ask questions. Remuneration: Not specified. |
Each peer educator was responsible for transmitting information to 5–6 other students in one formal session, followed by informal sessions in small groups within 1 month. |
| Yuksel et al. 2019 | Mentors were fourth year nursing students with high academic achievement and effective communication skills, be loved among friends and volunteered to participate in the studies. | N = 10 | Recruitment: Among students who volunteered, those with an academic grade point of 2.50 or higher were ranked from high to low. Faculty members were then interviewed to determine the students who had effective communication skills and who were loved by their friends. Training: Mentors received 10 h of training over five days, including the features of peer counselling, communication, assistive communication techniques, and coping with stress. Supervision, support, safe-guarding: Researchers continued to provide guidance to the mentors throughout the eight weeks. Remuneration: Not specified |
Two mentors were assigned to each group of eight to 10 mentees. The mentors applied eight weekly sessions of peer mentoring to the mentees. |
| Peer support | ||||
| Duby et al. 2021 | Trained peer-educators of similar age | Not specified | Not specified | Not specified |
| Harrison et al., 2023 | Peer mentors who also live with a chronic condition | Not specified | Recruitment: Process not specified. Training: Peer mentors are trained to adjust their topics to age and cognitive maturity of the group. Supervision, support, safe-guarding: Peer mentors are overseen by a supervisor (either a psychologist or social worker) at each session to provide additional support. Remuneration: Not specified. |
Volunteer peer mentors are tasked with approaching patients in the Groote Schuur Hospital (GSH) waiting room and inviting them to participate in the Better Together group sessions. These group sessions are designed to help adolescents with chronic conditions (including HIV, renal disease and psychiatric conditions) to (1) build social networks that enhance psychosocial support; (2) develop a sense of belonging with peers; (3) create a space where adolescents can share their experience(s) living with and managing chronic illness; and (4) build empathy among Adolescents Living with HIV (ALHIV) and other conditions. |
| Tinago et al., 2023 | Peer educators are women who had given birth during adolescence, between the ages 19 and 25, with at least seventh grade education. | N = 12 | Recruitment: Peer educators were recruited by project coordinator and community health workers through snowball sampling and in-person recruitment. Training: They were trained by the project coordinator and local subject matter experts with a 3-day training session. Supervision, support, safe-guarding: WhatsApp was used as additional support for training and implementation and a platform to communicate and plan sessions. Monthly meetings were conducted to review session plans and project progress. Remuneration: Not specified. |
Along with Community Health Workers (CHWs), peer educators co-facilitated peer support groups which discussed 12 participant identified topics: (1) introduction to the peer support groups, (2) adolescent motherhood, (3) gossip, (4) healthy relationships, (5) depression, (6) substance abuse, (7) family planning, (8) sexual health, (9) healthy parenting, (10) income generation, (11) hygiene, and (12) moving forward as an adolescent mother. |
*
Information extracted from protocol paper:
1
Dow DE, Mmbaga BT, Turner EL, Gallis JA, Tabb ZJ, Cunningham CK, et al. Building resilience: a mental health intervention for Tanzanian youth living with HIV. AIDS Care. 2018;30(sup4):12–20.
2
T.L. Osborn, K.E. Venturo-Conerly, G.S. Arango, E. Roe, M. Rodriguez, R.G. Alemu, J. Gan, A.R. Wasil, B.H. Otieno, T. Rusch, D.M. Ndetei, C. Wasanga, J.L. Schleider, and J.R. Weisz, Effect of Shamiri Layperson-provided intervention vs. study skills control intervention for depression and anxiety symptoms in adolescents in Kenya: A randomised clinical trial. JAMA Psychiatry 78 (2021) 829–837. (Supplementary Materials).
3
T.L. Osborn, D.M. Ndetei, P.L. Sacco, V. Mutiso, and D. Sommer, An arts-literacy intervention for adolescent depression and anxiety symptoms: outcomes of a randomised controlled trial of Pre-Texts with Kenyan adolescents. EClinicalMedicine 66 (2023) 102288.
4
K. Venturo-Conerly, E. Roe, A. Wasil, T. Osborn, D. Ndetei, C. Musyimi, V. Mutiso, C. Wasanga, and J.R. Weisz, Training and supervising lay providers in Kenya: Strategies and mixed-methods outcomes. Cognitive and Behavioural Practice 29 (2022a) 666–681.
5
S. Chinoda, A. Mutsinze, V. Simms, R. Beji-Chauke, R. Verhey, J. Robinson, T. Barker, O. Mugurungi, T. Apollo, and E. Munetsi, Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: protocol of a cluster-randomised trial. Global Mental Health 7 (2020) e23.
6
K.E. Venturo-Conerly, T.L. Osborn, R. Alemu, E. Roe, M. Rodriguez, J. Gan, S. Arango, A. Wasil, C. Wasanga, and J.R. Weisz, Single-session interventions for adolescent anxiety and depression symptoms in Kenya: A cluster-randomised controlled trial. Behaviour Research and Therapy 151 (2022b) 104040.
7
K.E. Venturo-Conerly, A.R. Wasil, T.L. Osborn, E.S. Puffer, J.R. Weisz, and C.M. Wasanga, Designing culturally and contextually sensitive protocols for suicide risk in global mental health: Lessons from research with adolescents in Kenya. J Am Acad Child Adolesc Psychiatry 61 (2022c) 1074–1,077.