Table 4.

The mechanisms that make peer-led interventions effective and their implementation challenges

Author and year	Benefits	Challenges
Balaji et al. 2011	Peer leaders report increase in self-confidence and leadership ability. There was also report of greater anger control, communication skills, reduced smoking and greater comfort in discussing sexual health issues.	Non-adherence of peer leaders due to school, house-work, other commitments, inconvenient timings, duration and locations. Integration of peer education into existing structures to ensure long term sustainability – peer education is expensive, logistical barriers.
Duby et al. 2021	The provision of emotional support and counselling Comfort and ability to relate on a peer-to-peer level Preference for receiving SRH from a similar age peer rather than an older adult
Ferris France et al. 2023	CATS felt a transformative effect of delivering the intervention themselves and learnt new skills	Covid–19 and delivering intervention online. Lack of face-to-face context and poor network connection, erratic power supply, exorbitant data charges.
Harrison et al., 2023	Vital importance of social support provided by peer mentor and peer support program “It teaches me a lot about other illnesses and how to approach or interact with others” Peer mentors themselves get to learn from the participants and new experiences.	An emotional toll when interacting with other young people with chronic illness, including sharing one’s story and working to understand and provide support to others
Im et al. 2018	TIPE intervention helped build a support system and enhanced the sense of community among participants. It promoted perceived social support, particularly among those with high PTSD symptoms.
Kermode et al. 2021		The peer facilitators required a lot of support from the project team, which was essential for the success of the intervention
Mathias et al., 2019	Young people were willing to participate and continue the intervention as they were assured of respect and kindness from peer facilitators “You never belittled our talk but always built it up. We came because we understood what you said, otherwise we wouldn’t have come. Who cares for drug addicts these days? But you showed that you did.”
Merrill et al., 2023	Individual meetings with youth peer mentor (YPM) gave opportunity to open up about personal issues or sensitive topics like condom use and sexual behaviour. YPM unique abilities to connect with youth given a similar age and shared experience of living with HIV
Simms et al. 2022	Peer-led intervention created a rare forum for adolescents to legitimately discuss their problems and be listened to with empathy by a trusted peer	Limits to how youth can solve their problems themselves as they have limited influence over their situations if they do not have adult support.
Tinago et al., 2024	Peer groups provided new forum to address primary sources of stigma, sharing challenges and seeking advice, alleviating social isolation as a source of stress Sole source of sexual and reproductive health information Consistent community engagement and trust-building efforts lead to increasingly positive and supportive attitudes toward participants and the intervention concept