Healthcare professionals’ perspectives on peer support in post-rehabilitation care for individuals with acquired brain injury: a qualitative study

Abstract

Background

Acquired brain injury (ABI) can pose significant challenges, particularly during the transition from rehabilitation to independent living. Peer support, provided by individuals with similar experiences, may enhance self-management, emotional well-being, and coping strategies. Understanding healthcare professionals’ perspectives is essential for successful implementation in post-rehabilitation ABI care.

Methods

This qualitative study involved two focus groups with multidisciplinary healthcare professionals, including disciplines included rehabilitations specialists, physiotherapists, psychologists, social workers, speech therapists, and occupational therapists, from a Dutch rehabilitation unit. Discussions explored perceptions of integrating peer support. Data were analyzed thematically using Atlas.ti.

Results

Eleven professionals participated, acknowledging the value of peer support in providing emotional validation, role modeling, and practical guidance. Peer supporters were seen as crucial in addressing ABI's invisible consequences, such as cognitive and emotional challenges. Concerns included professional boundaries, quality assurance, and peer supporter well-being. Emotional stability, cognitive skills, and self-awareness were identified as essential to prevent burnout. Clear matching criteria and structured coordination were deemed necessary. Training, role clarity, and professional supervision were highlighted as key factors for successful implementation.

Conclusions

Healthcare professionals view peer support as a valuable addition to ABI care. Based on the findings of this qualitative study, a structured approach, including training, defined roles, intervision and supervision, is recommended to ensure safe and effective integration across the entire patient journey. Further research is needed to evaluate the effectiveness of peer-support interventions.

Supplementary information

The online version contains supplementary material available at 10.1186/s12913-025-13910-3.

Introduction

In the Netherlands, an estimated 650,000 people live with the consequences of acquired brain injury (ABI) [1]. One of the most common forms of ABI is stroke, with an incidence of approximately 45,000 people annually in the Netherlands [2]. ABI is an umbrella term used to describe a sudden brain injury that is not hereditary, congenital, or degenerative, and leads to irreversible disruptions in life trajectories [3]. The physical, cognitive, behavioral, social, and emotional problems following ABI can be severe and life-changing for affected individuals and their families. These issues often hinder daily activities and complicate social participation [4, 5].

Various rehabilitation programs have been developed to support patients in regaining participation in daily life, social activities, and work. Research indicates that, despite the knowledge and expertise of rehabilitation professionals, not all support needs are met [6, 7]. Especially the post-rehabilitation phase - whether in a hospital, nursing home, rehabilitation center, or at home there can be a lack of adequate support [6, 8]. This gap becomes particularly apparent as patients face increasing challenges in adapting to daily life [9]. Some patients may feel inadequately supported, even when support is available, because it may not align with their specific needs or expectations [10].

Despite participation-focused rehabilitation, individuals often struggle to apply what they have learned to their home environments post-rehabilitation. The transition from intensive care to independent functioning at home is a critical phase in the recovery process for individuals with ABI. During this transition, the intensity of (para)medical care and support decreases, while the difficulties associated with resuming daily life participation and self-management increase [8]. Peer support may play a significant role during this phase by helping individuals restore balance and quality of life. The inclusion of peer supporters is internationally recognized as a valuable component of rehabilitation, as highlighted in the UN Convention on the Rights of Persons with Disabilities and the World Report on Disability by the World Health Organization [11].

Peer supporters can complement conventional care effectively [12]. By sharing lived experiences and understanding the emotional impact of ABI, peer supporters can offer both practical and socio-emotional support. This complements the work of healthcare professionals, benefiting both individuals with ABI and their caregivers [13, 14]. Recent research has described and compared the characteristics of existing peer support interventions for adults with common neurological conditions [15]. Results showed improved health, self-confidence, and self-management skills among participants, and getting peer support was associated with enhanced participation in daily life [15].

In 2019, Adelante Rehabilitation Center and Stichting Gehandicaptenzorg Limburg, in collaboration with Maastricht University, developed an adapted intervention based on the Stanford Chronic Disease Self-Management Program [16]. In this program, peer supporters conduct home visits during post-rehabilitation care [17]. These volunteers, who themselves live with ABI, are trained to provide support for socio-emotional self-management. At the end of the rehabilitation phase, the treatment team introduces the intervention to the patient and the peer supporter determines the best match, ensuring that the peer supporter aligns well with the patient’s specific needs and preferences. Participation in the program is optional for the patient. During the first home visit, the patient’s support needs are jointly addressed, following the principles of the Stanford Chronic Disease Self-Management Program, specifically tailored for individuals with ABI [16]. Unpublished implementation research conducted by Maastricht University showed that participants felt better equipped to reintegrate into society after receiving this support. Moreover, the role modeling provided by peer supporters enhances the patients’ perspectives and build trust.

To enable broader implementation of the intervention within specialized medical rehabilitation, a deeper understanding is needed of the perspectives, concerns, and needs of rehabilitation professionals who are unfamiliar with collaborating with peer supporters. Therefore, the aim of this study was to explore the views of healthcare professionals at a planned scaling-up site of Adelante, understand their concerns regarding the feasibility, added value, and potential challenges of the intervention, and identify specific needs for effective implementation of peer support during the specialized medical post-rehabilitation phase. The findings of this study provide insight into the factors that healthcare professionals consider important when facilitating peer support into care after specialized medical rehabilitation for patients with ABI. Additionally, the results contribute to sharing knowledge on the implementation process and increasing the utilization of peer support post-rehabilitation care.

Methods

Study design

A qualitative study was conducted using focus group interviews with healthcare professionals at Adelante Rehabilitation Center at location Venlo, in the south of the Netherlands. Adelante Rehabilitation Center, located in Venlo, in the southern Netherlands, is a specialized rehabilitation facility that caters to individuals with acquired brain injury (ABI) among other conditions. The center provides a range of rehabilitation services and serves a broad catchment area in the southern Netherlands, offering both inpatient and outpatient rehabilitation services. Healthcare professionals are involved in the outpatient rehabilitation of patients with acquired brain injury (ABI), where peer support have not yet been implemented in the specialized medical rehabilitation aftercare phase. All healthcare professionals involved in ABI rehabilitation were invited to participate, and interviews were conducted between July 5 and September 5, 2024. The Medical Research Ethics Committee of Maastricht UMC + decided that this study met the ethical policies and regulations of the Dutch government (non-WMO statement 2018–0930).

Population

Healthcare professionals from various disciplines were invited to participate in this study. These disciplines included rehabilitations physicians, physiotherapists, psychologists, social workers, speech therapists, and occupational therapists involved in the treatment of patients with ABI. Healthcare professionals were informed through team meetings, after which each discipline was asked to delegate two representatives. The researcher invited the delegated healthcare professionals by email to participate in the study. Prior to the interviews, participants received further explanation, were given the opportunity to ask questions, and provided written consent.

Data collection

Data was collected through focus group interviews facilitated by three researchers (Ruth Langeveld-Wobma (expert in rehabilitation and peer support), JV ( > 25 years as a physiotherapist, MSc), and MV (postdoctoral researcher, > 15 years as a physiotherapist, expertise in qualitative research). The researchers acknowledge that their professional backgrounds and experiences may have influenced the research process and interpretations. We maintain that our role as healthcare professionals might shape the data analysis process, but we aimed to minimize bias by adhering to established qualitative research practices, including independent coding and consensus discussion. The sample size was determined based on the principle of information saturation to ensure that sufficient data were collected to meet the study’s objectives (25). It was anticipated that approximately two focus groups, each consisting of six to ten healthcare professionals, would be required.

Content of the interviews

The interviews were conducted using a semi-structured interview guide developed by MV and JV, with open-ended questions designed to clearly define the topics to be explored. The topics aimed to investigate support for the use of peer supporters, explore perspectives, understand concerns, and identify specific needs. In developing the interview guide, we incorporated a conceptual framework for evaluating implementation outcomes, which includes eight distinct domains: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. Based on this framework, we structured the interview guide around four core domains; adoption, acceptability, suitability, and feasibility, tailoring the questions to address each of these aspects comprehensively [18]. The interview topics were structured around these four domains:

• Adoption: Focused on the willingness of healthcare professionals to embrace the involvement of peer supporters. Questions addressed prior experiences, perceived added value for patients, the impact on their own work, and the conditions necessary for successful collaboration.

• Suitability: Examined the relevance and practicality of involving peer supporters in current healthcare practice. Healthcare professionals were asked about the suitability for specific patient groups, the support required for peer supporters, and methods for informing patients about this form of support.

• Acceptability: Explored healthcare professionals’ attitudes toward the intervention, including concerns about potential role overlap, such as peer supporters performing similar tasks, alignment with departmental values, and perceptions of the success and qualifications of peer supporters.

• Feasibility: Investigated the practical feasibility of implementing peer support in both the short and long term. Questions focused on required resources, organizational support, and potential barriers or challenges.

The interview guide can be found in Appendix 1.

Data analysis

Data were collected according to the Standards for reporting qualitative research checklist [19]. All interviews were recorded and transcribed verbatim. These transcripts were then fragmented and coded openly using Atlas.ti software. The open codes were organized into subthemes and themes using thematic analysis [20]. The interviews were independently fragmented, coded, and categorized into themes by two researchers (JV and MV). Themes were discussed and refined until consensus was reached between the two researchers. In cases where consensus could not be achieved, a third researcher (SS) was designated to mediate. However, this was unnecessary, as consensus was ultimately reached without further consultation. Final themes were described and summarized in a code tree (Table 1).

Table 1.

Code tree

Code	Subtheme	Theme
ED must use its own experience	Opinions	Essential skills and attributes for ED suitability
ED has a listening ear
ED is seen as part of the treatment team
ED can speak from his own perspective
ED can give patients courage/future perspective
ED is also a fellow sufferer
ED must have had ABI a long time ago
ED may offer something different than therapist
Personal experience distinguishes ED from professional
EDs need a safety net
What training does ED receive?	Concerns
ED must know his limits
Condition: prior knowledge of rehabilitation patient problems	Needs
ED can estimate its own limits well
ED must be able to turn to someone with questions
ED must speak the same language as therapists
Team demarcation of which question will be addressed by ED
Inclusion: not too many criteria	Opinions	Frameworks and criteria for ED suitability
Inclusion: all rehabilitation patients have an intake interview
Inclusion: premorbid personality traits
ED is not instead of professional
Exclusion: severe cognitive problems	Concerns
Exclusion: if therapists already have difficulty with intercourse
Exclusion: no safe home situation
Exciting for therapists where the boundaries lie in inclusion
Not wanting to put ED in a difficult situation
Match: same help question	Needs
Match: same age group
Match: both aphasia
Condition: looking for a good match
ED can provide recognition	Opinions	Added value of ED
ED as a safety net and reassurance RDB
Peer contact is experienced as helpful
ED also for informal care
ED can be a support for invisible disabilities
ED as an interim solution before the start of RDB
ED can be a support for invisible disabilities
Obstruction: When ED starts projecting its own problems	Concerns
Obstacle to expectation management
Obstacle: Can EDs really provide help?
Obstruction: ED also cognitive problems
ED may limit restart of rehabilitation
Good feedback increases the chance of success	Opinions	Collaboration and communication
Annual report can be a feedback
ED must be able to enter with an open mind
Therapists difficult to let go of ED	Concerns
Who will reimburse this?
Whether or not the team should be involved in submitting questions to the ED	Needs
Need for collaboration time with ED
Case manager discussing ED option with rehabilitation patient
Team’s role in whether or not to submit question to ED
Conversation during specialized medical rehabilitation for a good transition
Need for feedback
Need for quarterly update
Chance of success: add to care pathway	Opinions	Influence of treatment team on success factors
Chances of success depend on ourselves
Chance of success: wanting less control as a therapist	Concerns
Chances of success: we will soon see obstacles
Obstruction: to what extent can ED analyze
Keeping the option open for patients who do not want to at first	Needs
Letting go of rehabilitation is hard
Abbreviations: ABI = Acquired brain injury, ED = peer supporter

Results

Two focus groups, comprising five and six healthcare professionals respectively, were conducted. Each group included a physical therapist, an occupational therapist, a speech therapist, a rehabilitation physicians, and a psychologist. Additionally, one group included a social worker. All healthcare professionals were directly involved in the treatment process through their roles within the interdisciplinary rehabilitation team and either had prior experience with peer support or expressed interest in its involvement. These 11 participants represented approximately one-third of the healthcare professionals working in the department. The interviews lasted between 90 and 120 minutes.

The results are presented below, organized into five emerging themes: essential skills of peer supporters, criteria for suitability, added value, collaboration and communication, and the role of the treatment team in success. The initial interview guide focused on four domains related to key influences on implementation. However, the results naturally expanded to include a wider range of factors that were important for understanding the success of the initiative.

Essential skills and characteristics of peer supporters

Healthcare professionals emphasized that peer supporters should primarily be equipped to provide emotional support and recognition, drawing from their personal experiences. These qualities, including empathy, active listening, and understanding, were described as essential for their effective integration into the support process. Healthcare professionals mentioned that peer supporters were valued for their ability to listen attentively and provide empathy, helping patients adjust to and cope with their new circumstances. Healthcare professionals noted that the presence of a peer supporter could significantly enhance a patient’s recovery and self-management, particularly in coping with emotional and psychological challenges. Additionally, healthcare professionals highlighted the importance of having a safety net for patients in the post-rehabilitation phase, particularly for those who may face challenges or have questions. Peer supporters were identified as adequate to fulfill this role.

There are always some patients you worry about … outside the formal care setting, I think it’s a welcome addition. We cannot provide that lived experience outside the rehabilitation treatment context. I think many obstacles arise once the rehabilitation ends.

Beyond emotional support, healthcare professionals considered it essential that peer supporters understand their own boundaries and can recognize when a situation requires the attention of a healthcare professional. Concerns were raised about whether peer supporters could effectively distinguish between their supportive role and the responsibilities of professional care. Healthcare professionals mentioned that it was deemed critical that peer supporters maintain objectivity despite personal experiences, and it was emphasized that peer supporters should avoid projecting their own situations onto patients. One key criterion mentioned was that peer supporters should have completed their own recovery journey some time ago to maintain sufficient emotional distance.

You want a peer supporter who not only has experience but has also built enough distance so that it doesn’t become a direct projection of their own story.

Healthcare professionals also stressed the importance of cognitive stability, such as reasoning ability, problem-solving skills, and effective communication. They suggested that peer supporters should receive support to develop self-awareness and improve social cognition, enhancing their ability to fulfill their role. There were concerns about whether peer supporters have sufficient coaching skills, highlighting the need for proper training and ongoing supervision. Options such as intervision (peer-led reflective meetings) sessions or coordinator-led reflective supervision were recommended.

What defines a peer supporter? When can you use that title? I don’t think you can just assume that role … You don’t want a patient to disengage because the peer supporter misjudges a situation, especially if they have a cognitive impairment themselves.

Healthcare professionals also proposed the development of exclusion criteria to ensure suitability, particularly for individuals with significant impairments in self-awareness and social cognition. They noted that such impairments could negatively impact the peer support relationship if not properly assessed.

I think there should be exclusion criteria, such as significant impairments in social cognition. That needs to be assessed because we see among our patients that some struggle with social skills, which can often be overlooked. So, what profile do we use to select peer supporters?

Frameworks and criteria for the deployment of peer supporters

Healthcare professionals discussed which rehabilitation patients should or should not be offered support from a peer. They noted that criteria for deployment should not be overly restrictive, advocating for all patients to have the opportunity to meet a peer supporter. However, the potential risk of overburdening peer supporters was a key concern when defining these frameworks. Healthcare professionals emphasized that careful consideration is required for patients with severe cognitive impairments or complex (social-)emotional issues, as such cases may place additional burden on peer supporters. This potentially jeopardizes their balance and well-being, highlighting the importance of monitoring the workload of peer supporters, many of whom face their own limitations. Healthcare professionals also noted that unsafe home environments, such as situations involving domestic violence or severe family tensions, could justify withholding peer support in those specific cases.

Matching peer supporters and patients based on life stage and shared experiences was deemed important. For example, there was a preference for pairing peer supporters with aphasia to patients experiencing similar challenges, as well as aligning matches based on age or life circumstances. This approach was viewed as fostering stronger connections and enhancing the support experience, as it ensures that patients feel understood and supported by someone who truly relates to their situation, increasing the likelihood of meaningful and impactful interactions.

I think you need to find a good match, someone in a similar phase of life or with a similar impairment, like aphasia. That can be very valuable.

Added value of peer supporters

Healthcare professionals expected that peer supporters would strengthen the rehabilitation team. They believed that peer supporters’ ability to share experiences and empathize from a relatable and encouraging perspective would be particularly beneficial for patients. This relatability was viewed as especially relevant for addressing the often invisible consequences of ABI, which can complicate reintegration into society or when feelings of shame play a role. Healthcare professionals pointed out that peer supporters could serve as role models, demonstrating that meaningful participation in daily life is possible after rehabilitation. By sharing their own experiences, they offer hope and practical guidance, which could enhance patients’ motivation and emotional resilience in navigating life beyond the rehabilitation phase. Additionally, the contributions of peer supporters were seen as valuable for caregivers and family members, who often face their own challenges and could gain recognition and emotional support. Peer support was considered by the healthcare professionals as particularly helpful during prolonged rehabilitation trajectories and key transitional moments, such as the conclusion of formal rehabilitation. Their presence was seen as offering emotional support and recognition that extends beyond conventional therapy. This complementary role enhances the overall rehabilitation experience by addressing emotional and social needs that are often difficult to meet through standard therapeutic interventions.

A peer supporter can offer emotional support and recognition that extend beyond therapy; their mere presence can help with processing and self-management.

Collaboration and communication with peer supporters

Healthcare professionals considered collaboration with peer supporters to be highly promising. They voiced concerns about assigning responsibilities to peer supporters, especially in the post-rehabilitation phase, due to uncertainties regarding the quality and consistency of the support. Barriers, such as the risk of overburdening peer supporters and challenges in their deployment, were identified. To address these concerns, healthcare professionals stressed the importance of aligning mutual expectations and maintaining regular feedback and coordination to enhance collaboration.

If we occasionally get feedback on what was discussed with the peer supporter, we can align our work accordingly. That would really strengthen collaboration.

Healthcare professionals recommended the structured integration of peer supporters into the workflow, suggesting that roles like rehabilitation physician or social workers could allocate specific time to coordinate with peer supporters. Establishing a central point of contact, such as a coordinator, was considered essential for evaluating and planning the deployment of peer supporters in post-rehabilitation care.

Influence of the treatment team on success factors

Healthcare professionals noted that the success of integrating peer support depends on their own attitudes and approaches as professionals. While relinquishing control and trusting peer supporters to operate more or less independently was seen as challenging, it was also recognized as necessary for the effective implementation of peer support.

I sometimes find myself wanting to maintain control, even though our goal is to learn and to let go and trust peer supporters to follow their own approach.

A systematic approach to discussing peer support options with patients during the rehabilitation phase was identified as a practical step to enhance the likelihood of successful implementation.

Healthcare professionals believed that offering an introductory meeting with a peer supporter during or immediately after rehabilitation could ease the transition and bridge the gap between care phases. Healthcare professionals indicated that it is important to keep the option of peer support open, even for patients who may initially decline it. The availability of peer supporters post-rehabilitation was highlighted as a critical factor, particularly given the “black hole” many patients experience when transitioning from intensive rehabilitation to independent living.

Healthcare professionals noted that the need for support sometimes arises only when patients encounter challenges in their daily lives. To address this, they proposed maintaining access to peer support through outpatient follow-up visits or in response to specific situations, which they believed could be valuable for addressing emerging needs and preventing relapse. They also expected that peer supporters could play a role in relapse prevention, reducing the likelihood of patients needing to restart rehabilitation programs. Flexible deployment of peer support was seen as contributing to a smoother transition from the rehabilitation phase to independent, participatory functioning for individuals living with ABI.

Ideally, peer supporters should be integrated as a standard component of the care pathway, ensuring that patients are not left to fend for themselves at the end of their rehabilitation treatment.

Discussion

This study provides insights into the perceptions, concerns, and needs of healthcare professionals regarding the implementation of peer support in the post-rehabilitation care of specialized medical rehabilitation for individuals with ABI. Healthcare professionals indicated that they perceive the support provided by peers as a valuable addition to the patients’ rehabilitation process. They emphasized the importance of offering a safety net for patients, particularly in the post-rehabilitation phase treatment, in case they face challenges or have questions. To maximize its effectiveness, peer support should be structurally embedded within the healthcare system, ensuring continuity of care beyond the formal rehabilitation period. A well-integrated peer support system can help bridge the gap between medical treatment and long-term self-management, ultimately improving patients’ quality of life. The healthcare professionals recognized the unique contributions of peer supporters, particularly in providing emotional support, recognition, and a model of acceptance to patients and their loved ones. This type of support was seen as especially beneficial for addressing the emotional and social complexities that arise after rehabilitation, helping patients navigate their transition to independent living. Despite these benefits, concerns were raised regarding potential challenges associated with the deployment of peer supporters, including the risk of overburdening peer supporters, ensuring clear boundaries between their role and professional responsibilities, and appropriately addressing situations that necessitate professional care. These concerns underscore the need for careful planning, training, and supervision to ensure the successful implementation of peer support.

Healthcare professionals emphasized that peers must not only be competent in sharing their experiences and providing emotional support but also demonstrate suitability for the role by maintaining objectivity, respecting boundaries, and recognizing situations where professional care is needed. These concerns align with previous literature highlighting the importance of balancing personal involvement with professional boundaries, where adequate training, structural support, and supervision have proven to be effective strategies to mitigate projection, role ambiguity, and boundary violations [21, 22]. While numerous studies report positive outcomes of peer support, such as improvements in quality of life and mental well-being [14, 23–25], there are also studies pointing to potential risks, such as harmful interactions, overwhelming information, and interpersonal conflicts [10, 26, 27]. Additionally, interaction with a peer who is still experiencing difficulties may distress patients and exacerbate depressive symptoms [13, 26]. In the context of ABI, where many patients particularly need support during the transition from specialized medical rehabilitation treatment trajectory to home, the success of peer support is strongly dependent on effective collaboration with healthcare professionals [28]. Previous studies on peer support, particularly in populations with chronic diseases such as stroke or spinal cord injury, have similarly highlighted the importance of clear role boundaries for peer [29, 30]. The current study adds to this body of knowledge by focusing specifically on the ABI population and emphasizing the need for careful matching of peers and patients based on shared experiences, which has been found to enhance support and empathy in similar settings [29]. Therefore, for successful implementation, it is crucial to train both peers and healthcare professionals in forming partnerships and developing skills such as self-awareness, supportive communication skills, and coping strategies. Peer supervision and a long-term plan for continuing education play a crucial role in ensuring the quality and effectiveness and develop an integrated treatment with peer supporters.

Healthcare professionals identified clear frameworks and criteria as essential for the involvement of peers. Key criteria mentioned include a completed personal recovery journey and the presence of a solid cognitive foundation, encompassing self-awareness, reflective capacity, and the ability to process and communicate complex information. These criteria align with recommendations in the literature on peer support, which emphasize that peers should be in a stable life phase before supporting others [31]. The risk of peer overload was seen as a major concern, particularly in contexts involving intensive interactions, complex situations, and emotionally demanding cases. To address this, careful workload management and ongoing support are necessary to ensure the well-being and effectiveness of peer supporters. Additionally, while some previous studies indicate that peer support can sometimes exacerbate mental health challenges, our study found that with proper training and supervision, peer support can still play a crucial role in promoting recovery and quality of life [32].

Healthcare professionals’ protective stance both towards peers and patients highlights the crucial need for structural guidance from the treatment team. The prevailing belief is that having a coordinator, a clear framework, and regular communication between peers and healthcare professionals can help to build mutual trust. These frameworks outline the agreed-upon boundaries and guidelines that define the responsibilities of peers including s their roles, scope of involvement, and conditions under which they are deployed. This clarity helps to provide reassurance for both healthcare professionals and peers. Over time, this could lead to a more flexible and open integration of peer support, with less emphasis on strict frameworks and more on collaboration and trust. However, these findings also suggest that the need for clear frameworks may stem from unfamiliarity and a lack of trust in the collaboration with peers. Healthcare professionals seek certainty through strict criteria and boundaries, which may indicate a need for greater confidence in the process and the content of the support. As trust develops and healthcare professionals gain more experience working with peers, the perceived need for strict frameworks may decrease, paving the way for a more dynamic and trusting partnership.

Peers can play a crucial role in supporting patients and their loved ones, often beyond the direct oversight of healthcare professionals. This raises several ethical and legal issues for professionals, which may heighten the potential for tensions. A key issue is determining how far the involvement of peers should go, and identifying when a healthcare professional can trust a patient to continue their recovery journey independently. This challenge is further amplified by the current dynamics in healthcare, where rehabilitation periods are becoming shorter and more intensive. Patients are transitioning out of care sooner, which increases the likelihood of them becoming ‘out of sight’ for healthcare professionals. Furthermore, questions arise about the type of information that can be shared with peers and whether this complies with the General Data Protection Regulation. These questions highlight the delicate balance between maintaining control and fostering trust.

Collaboration with peers requires trust in their complementary role and autonomy, without unnecessary interference or violation of privacy rules. It is important to strike a balance to allow peers to perform their role independently while ensuring adequate coordination to facilitate a smooth transition from professional rehabilitation care to informal, peer-led support.

Healthcare professionals described peer support as a vital part of the rehabilitation (post-care) process, particularly in addressing invisible consequences that become apparent in societal participation, as well as in offering support to the loved ones of affected individuals. This collaboration between rehabilitation treatment and guidance by peer supporters reflects an integrated care approach, extending beyond the traditional scope of rehabilitation. The peer support intervention, while complementary to the rehabilitation phase, is positioned as part of the entire care pathway, bridging the transition from rehabilitation to post-care. This integration aims to support optimal participation and quality of life, highlighting the continuous nature of care, from rehabilitation through to post-rehabilitation support, which is key to successful reintegration into society. Matching peers with patients based on shared experiences, such as similar limitations (e.g. aphasia), or comparable life stages, was deemed important to achieve maximum recognition, support, and empathy. The findings suggest that a careful matching process, ensuring sufficient variation within the pool of peer volunteers and setting clear expectations from healthcare professionals are important for providing optimal support. These conclusions align with previous research where the involvement of peers was more effective in increasing patient satisfaction and improving social participation when peers and patients shared relevant experiences [8, 21, 33].

This underscores that matching must also take into account practical considerations, such as travel distance, logistical possibilities, and equitable caseload distribution for peers, making it challenging to achieve a perfect balance.

Limitations of the study

Although this study offers valuable insights, it is important to note that the results reflect the perceptions of healthcare professionals from a single institution, which may limit their transferability. Additionally, this study focused specifically on the use of peer support, but in practice, peer support often involves two elements: sharing experiential knowledge and assisting with self-management. Some concerns raised by the healthcare professionals, such as role ambiguity or projection, may not be entirely separable from the peer’s broader role in supporting self-management. Furthermore, the first focus group revealed that limited knowledge and experience in working with peers may have influenced the perceptions of participating healthcare professionals. While member checking was conducted through written and oral feedback in a multidisciplinary review meeting, triangulation was not utilized in this study. Additionally, the study did not explicitly address research reflexivity, which may have influenced the interpretation of the data. These methodological limitations should be considered in future research to enhance the trustworthiness and depth of the findings. Although the purposive sampling approach targeted healthcare professional roles, additional factors such as years of experience or familiarity with peer support were not considered. This should be noted as a limitation, as these factors may influence perspectives and experiences regarding peer support. Future research should also include the perspectives of peers and patients to provide a more complete picture of the dynamics and impact of peer support in the post-rehabilitation ABI care. By involving peers, patients, and healthcare professionals in research, collaborative efforts can help optimize the implementation of peer support in rehabilitation of ABI and develop practical solutions to address challenges. The use of established implementation frameworks, such as the Consolidated Framework for Implementation Research (CFIR), can provide insight into the factors that facilitate or hinder implementation. This framework is widely applied and offers structured insights to guide the development of implementation strategies and increase the likelihood of successful adoption.

Implications for practice

The results of this study emphasize the need of a thoughtful and careful approach to integrating peer support into rehabilitation care pathways, in collaboration with healthcare professionals. It is essential that the treatment team has a clear understanding of the principles and goals of peer support. Establishing mutual trust and nurturing relationships between healthcare professionals and peers is essential in this process. Additionally, it remains important to define clear frameworks and criteria to ensure quality and prevent overburdening. This is particularly important when working with peers with ABI as cognitive impairments may influence their ability to provide effective support. A stable cognitive foundation and targeted support are essential, emphasizing the need for careful selection and tailored guiding measures. These insights highlight the potential of peer support to not only improve outcomes for patients but foster a more inclusive approach to care.

Another key recommendation is providing structural support of the peers and guidance through a coordinator. A coordinator can streamline the collaboration between healthcare professionals and peers and facilitate the integration of peer support into established care pathways. Training and continuing education for peers should focus on developing self-awareness, social cognition, boundary setting skills, and the ability to engage in case discussions. Regular supervision or coaching sessions can further enhance their capabilities and confidence.

Additionally, conducting regular evaluations of the collaboration and effectiveness of peer involvement are essential for sustaining quality, motivation, and mutual appreciation. These evaluations provide opportunities for adjustments to the approach based on feedback and ensure that peer support continues to meet the needs of patients and treatment teams. Such monitoring and reflection can not only improve the quality of care and normalize peer support as a standard offering but also provide more personalized and empathetic support for individuals with ABI, especially during the critical phase of regaining confidence in their independence.

Finally, this study can contribute to the development of targeted implementation strategies. Aspects such as team adoption willingness, the practical integration, feasibility, and sustainability of the approach can inform refinements and improve long-term success. By monitoring both process and outcome indicators, peer support can become more effective and better aligned with the needs of all involved.

Conclusion

Healthcare professionals emphasized that good collaboration and accessible communication with peers are essential for a successful implementation of peer support. Facilitating factors such as regular feedback, clear role definition, and structured meetings were mentioned as important elements for optimizing collaboration and integration. These factors are perceived as helpful in enhancing the quality of the intervention and are linked to better collaboration and integration. To mitigate barriers such as role ambiguity or lack of structural guidance, it is essential to engage the treatment team early in the process. A coordinator within the treatment team was reported to help reduce these obstacles. The safety net provided by this approach can help prevent the potential overload of peers while reinforcing their long-term effectiveness. By prioritizing a person-centered approach, peer support was perceived to enhance rehabilitation care. Providing interventions that encourage self-management and offer continuous support extends the impact of specialized medical rehabilitation into the critical post-care phase, ultimately being believed to contribute to better outcomes for individuals with ABI. A careful approach strengthens long-term usability and supports person-centered, effective rehabilitation care, focusing on enhancing self-management and support in post-rehabilitation care.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

ABI

acquired brain injury

WHO

World Health Organization

Authors’ contributions

The responsibility for the content of the manuscript is taken by MV and JV. Both MV and JV have made substantial contributions to the acquisition of data, analysis and interpretation. All authors contributed to the interpretation and critical revision of the contents of the manuscript, provided approval for the current manuscript version, and agreed to be accountable for all aspects of the work and remaining questions.

Funding

This research has not received any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Declarations

Ethics approval and consent to participate

The Medical Research Ethics Committee of Maastricht UMC+ reviewed the study and concluded that it does not fall under the scope of the Dutch Medical Research Involving Human Subjects Act (non-WMO declaration 2018–0930). The study was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided written informed consent prior to their participation in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.