Health and social care workers perceptions of and experiences with virtual peer support: a qualitative study applying the Levesque Framework

Abstract

Background

During the initial years of the COVID-19 pandemic, there was a rapid growth in virtual peer support interventions for health and social care workers. While these were often positively evaluated initially, there has been little research on their ongoing utility in the post-COVID response context, characterized by healthcare worker shortages and rising healthcare demands. This paper applies the Levesque Framework on access to healthcare to explore health and social care workers perspectives and experiences of virtual peer support services.

Methods

Nine online focus groups were held with 52 health and social care workers in British Columbia, Canada. Transcripts were analyzed using a mixed inductive and deductive approach to reflexive thematic analysis.

Results

Most participants were unaware of existing services but favourable to the idea of virtual peer support initiatives, despite some skepticism that early interventions could meet current needs. Engaging in mental healthcare was viewed as acceptable, but participants wanted assurances of cultural safety and to be able to engage with peers from similar social locations. Health and social care workers noted that time and energy constraints restricted access and had concerns about confidentiality and data security.

Conclusions

Virtual peer support interventions must evolve to meet the current mental health needs of health and social care workers. This includes ensuring services are designed with a diverse workforce in mind and are proactive in assuring confidentiality and data security.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12913-026-15108-7.

Background

During the initial years of the COVID-19 pandemic, there was rapid development of virtual peer support interventions for health and social care workers [1]. These interventions aimed to help workers deal with the challenges of the pandemic, despite physical distancing requirements, and process experiences of trauma and moral distress (the conflict of being unable to provide the care one feels ethically obliged too) [2]. They were based on the evidence of the effectiveness of peer support interventions, an established intervention in mental healthcare [1, 3]. Within such programs, health and social care workers experiencing mental health challenges were provided support by peers who have experienced similar problems, and who draw on their own lived experiences to provide empathy, insight, encouragement, and assistance [4]. Programs were found to have a positive impact on psychosocial and recovery outcomes, promote feelings of empowerment and hope, and improve self-esteem, self-efficacy, and ability to manage challenges [5]. Virtual (including digital, tele-based and online) peer support interventions, in particular, increased the reach of mental health services when physical distancing policies inhibited in-person services [4]. Online services were also found to help overcome geographical barriers, reduce regional inequalities in access, offer convenience and increase accessibility for individuals who face obstacles to traditional, face-to-face mental health services, such as stigma, financial difficulties, time constraints, and location of services [3, 6]. While most evaluations were generally positive, findings from select studies also suggested that distress resulted primarily from external factors, such as staffing shortages, beyond the scope of the intervention [6–8].

These findings raise questions about the utility of such interventions in the current context, no longer characterized by a public health emergency, but rather by sustained systemic stressors. In Canada, where this research is conducted, the healthcare system has been described as in crisis due to a combination of labour shortages and increased demand driven by an aging population with complex needs, among other factors [9]. About a quarter of Canadians do not have a primary care provider and wait lists for admission to Long Term Care facilities are growing [10]. Consequently, burdens on emergency rooms and urgent care are increasing, and those who do enter Long Term Care are often doing so with acute healthcare needs. The stressors of exposure to trauma and grief, somewhat inherent in health and social care work, are being exacerbated in this context. For example, in a 2025 survey of physicians in Canada, 46% reported worse mental health outcomes compared to before the pandemic [11]. A 2024 survey by the Canadian Federation of Nurses Unions found that symptoms of burnout (sever physical, mental and emotional exhaustion caused by prolonged or repeat stress) had increased since the previous year, with 35% of nurses experiencing anxiety and 25% experiencing depression [12]. These trends are not unique to Canada but reflect similar challenges across countries with aging populations, staffing shortages and burnout related attrition [13]. Despite this apparent need for mental health supports, there is little research on virtual peer support interventions in the post-COVID response context.

In 2020, as part of its COVID-19 related mental health resources, the Ministry of Health in British Columbia, Canada – in partnership with the Canadian Mental Health Association and SaferCare BC - implemented Care to Speak, a virtual health and social care worker peer support intervention [14]. Care to Speak, which is ongoing at the time of writing, includes phone, text and webchat support to those working in primary care, long-term care, and community care/social services. Volunteers with experience in these sectors are available from nine am to nine pm from Monday to Friday to listen to concerns and direct callers to appropriate services and supports.

This paper draws on data gather during a Ministry of Health funded multi-method evaluation of Care to Speak. During the first phase of the evaluation, a survey of 377 health and social care workers found that most (91.3%) respondents had not accessed the services [15]. Consequently, the second phase of the study, which included focus group discussions, aimed to better understand accessibility barriers and facilitators related to virtual peer support services more generally. This paper reports on the findings from these focus groups, using the example of Care to Speak as a springboard to discuss accessibility of virtual peer support interventions more general with the intent to inform the continued evolution of such programs.

We use the Levesque Framework on access to healthcare to frame our analysis of how access to virtual peer support services is structured by both system-level and individual factors [16]. The Levesque Framework conceptualizes healthcare access as a dynamic process, defined by interaction between five dimensions of accessibility at the systems level (Approachability, Acceptability, Availability and Accommodation, Affordability, and Appropriateness) and five corresponding abilities of populations (Ability to Perceive, Ability to Seek, Ability to Reach, Ability to Pay, and Ability to Engage). It asks if and how accessibility of the healthcare system and the ability of the population fit together. Following an initial presentation of the mental health profile of participants, results are structured according to the categories of the Levesque Framework.

Methods

Ethical approval for this study was provided by the Research Ethics Board at Simon Fraser University (Protocol #30002992) and all research was conducted in accordance with the Declaration of Helsinki. All participants consented to participation. The study was conducted according to the Standards for Reporting Qualitative Research (SRQR) with the checklist attached as supplementary file 2.

This research was conducted in British Columbia (BC) Canada, a province of approximately 5.7 million people. The health system in BC, as in all of Canada, is publicly funded, with community and social care provided by a mix of private and public services. As is a trend across the country, health and social care workers in BC report high levels of stress, anxiety and burnout, as health systems struggle to meet shifting demands related to an aging population and more complex health needs among other factors [17].

As noted above, the first phase of the evaluation of Care to Speak included a cross-sectional, web-based survey conducted between June and September 2025. Recruitment was carried out through multiple channels including unions, professional associations, and healthcare organizations, circulated study invitations through newsletters, email distributions, institutional communication networks, social media platforms and digital advertisements. To be eligible, participants had to be 18 years of age or older, reside in BC, and currently work in health, social, or community care. The survey was designed to capture constructs informed by the Reasoned Action Approach and the Levesque Healthcare Access Model, and included validated measures of psychological distress. Detailed survey methodology and results are reported on elsewhere [15]. 218 participants completed the survey with demographic characteristics available in supplementary file 1.

Focus group participants were recruited through the survey, which included a question on whether respondents would be interested in participating in further research. After follow-up with all 98 volunteers, 47 responded and participated in focus groups. To address limitations of our survey sample, which was predominantly white (see supplementary file 1), we worked with a community partner representing racialized healthcare workers, who put out a call for volunteers. Five people responded and we held a focus group specifically with these participants. In total we engaged 52 participants in nine online focus groups (ranging in size from five to eight participants each) in October 2025 (see demographic details in Table 1 below). Two of the authors facilitated the focus groups using a semi-structured guide (supplementary file 2). All focus groups were sound-recorded, transcribed, deidentified and then uploaded to Nvivo software. While the majority of the discussion occurred verbally, any content entered into the chat was saved, deidentified, and added to the transcript files.

Due to the explorative orientation of the study, we employed reflexive thematic analysis using a collaborative deductive and inductive approach. Reflexive thematic analysis is a multistep process used to identify, analyze, and interpret patterns of meaning within qualitative data. The process emphasizes the researcher’s active interpretive role in data analysis and is flexible to the inclusion of conceptual frameworks (such as the Levesque Framework) while promoting accountability through reflexivity [18]. We employed reflexive thematic analysis through a multi-step process wherein the two authors who had conducted the focus groups first familiarized themselves with the data and developed codes inductively. These were then shared with the broader research team for discussion to generate initial themes. The two authors then refined the themes and organized them according to the Levesque Framework dimensions (Fig. 1). The resulting codebook was imported into NVivo to code the transcripts, with the two researchers first coding one transcript together to ensure consistency, then each coding four or five transcripts and sharing their analyses to ensure consistency and credibility. Throughout the process the researchers held reflexive discussion with each other and the rest of the team to discuss possible bias, differences of interpretation and conflicts. This process included self-reflexivity on our own role as researchers, social positions, perceptions of health care work, mental health support and other related topics. Through this process we sought to both reduce influence of bias and deepen our analysis.

Fig. 1.

Thematic analysis based on Levesque Framework

This study engaged health and social care workers living in BC, Canada, including those working in primary care, long-term care, community care and community social services. Demographic data reported in this section is based on voluntary self-identification of participants. Some participants preferred not to respond to some of the posed questions, ranging from profession, gender, and age, among other social demographics.

Table 1.

Focus group participants

(%, n)	Social & community service workers (40%, 21)	Nursing & caregiving professions (21%,11)	Counselling professions (6%, 3)	Other (managers, pharmacists, paramedics, physicians) (10%, 5)	No Data (23%, 12)
Race/ Ethnicity (%, n)	White (46%, 24)	Asian (29%, 15)	Black/African descent (8%, 4)	Other (Arab, Latin American) (6%, 3)	No Data (12%, 6)
Gender (%, n)	Woman (63%, 33)	Man (23%, 12)	Other (Transmasculine) (2%, 1)	~	No Data (12%, 6)
Sexual Orientation (%, n)	Heterosexual (50%, 26)	Bisexual/ Heteroflexible/ Pansexual (21%, 11)	Gay/Lesbian (4%, 2)	Other (Queer, Asexual) (4%, 2)	No Data (21%, 11)
Age (%, n)	25–44 years (63%, 33)	45–64 years (15%, 8)	65 years or older (6%, 3)	18–24 years (4%, 2)	No Data (12%, 6)
Immigration Status (%, n)	Canadian-born (50%, 26)	Immigrant (37%, 19)	~	~	No Data (13%, 7)

Results

Mental health profiles and sources of stress

Focus group participants were asked to enter one word in the chat that reflected the relationship between their mental health and work. Many participants spoke about how their work positively contributed to mental wellbeing using terms like ‘fulfilling’ to describe the benefits of feeling like they were making a difference. For example, one participant noted, “as a therapist, it kind of provides fulfillment in making tangible, positive impact in people’s lives. You know, kind of seeing how people come having overcome the challenges, and becoming okay, it’s very satisfying to me” (FG03). Participants also noted that even positive experiences bore mental and physical health costs. One respondent explained:

And, you know, my job is beautiful, in a way, that the clients come to my office and they have many problems, right? And then when they leave my office, they have a smile on their face, right? But many times it requires lots of support from my end, like mentally and, of course, physically too (FG5).

Throughout the focus groups, participants highlighted experiences of burnout, often noting the lasting effects of the COVID-19 response. For example, one participated noted:

I was in patient-facing care for a long time, and then after COVID, I very much burnt out on certain things. So I got burnt out, and I’m in a different area in health, but I find that because of my focus and having to like respond to certain things that were happening, you can take it home, even when you might not have done so before. I think when we’re caring for other people, no matter what hat you wear, it can be difficult to cut that cord at whenever your day is done (FG2).

Participants further noted work stressors emanating from work conditions and heavy workloads. Moral distress was also linked to the current context of structural changes and resource scarcity. Participants observed that their work environments had become increasingly demanding and unpredictable:

When I started in this career a number of years ago I felt things were quite predictable, at least in the world I was working in, and I had a lot of mentors, a lot of older nurses at the time who had been nursing for long, long periods of time, and their routines were just down pat and I would come to work and know what was expected of me every day. But in the last five years, for sure, it’s kind of like every day is just like fires to put out, and there’s no predictability, so that’s hard on my mental health (FG8).

Ability to perceive - approachability

The ability to perceive a health service relates to clients’ willingness to engage with it due to the belief that it will be of benefit. Focus group participants had a high degree of health literacy, with many noting past experience providing or receiving mental health services, including peer support initiatives. Consequently, support for peer support interventions has a common theme across transcripts, with a participant commenting, “the best supports that I’ve found for myself have been almost always peer based supports, whether that’s peers within my own organization or peers in other kind of helping fields, professions.”(FG2).

Concurrently, participants mentioned a desire for increased access to professional counseling services. While they recognized the benefits of peer support interventions many also felt their own needs were beyond what early intervention services could meet. Participants in every focus group noted they had limited access to professional counseling services due to the costs and restrictions on employee benefit programs.

Some participants mentioned that they felt discouraged from accessing mental health services because they recognized that such interventions could not address the underlying causes of their stress. One respondent asked, “We kind of brush over the problems, if we had adequate staffing, like, would I even have mental health issues? I probably honestly wouldn’t” (FG9). Another noted, “I haven’t really accessed these services, but mostly because I’m so focused on trying to figure out what the solution is to the stress, and then I feel like just talking about with somebody who can’t really affect the change in the workplace doesn’t feel very effective” (FG01).

The approachability dimension of healthcare access denotes clients` awareness of a specific service. Most focus group participants had not heard of Care to Speak (an intervention available to them in BC) prior to the focus groups, indicating that approachability was a key barrier. Those who had heard of Care to Speak learnt about it from their professional associations, colleges, or employers. Participants noted that information on services was often shared through emails, including long lists of mental health resources, which they often ignored due to time constraints and feelings of overwhelm.

When asked for recommendations on how to improve approachability, participants suggested creating greater awareness through multiple channels, including posters in high-traffic areas such as bathrooms and workplace text chats. Some participants recommended using more relational approaches, including having workplace-based in-person sessions to raise awareness about the existence and benefits of such services, which would provide an opportunity to ask questions about the program and build trusting relationships.

Ability to seek and acceptability

In the Levesque framework, acceptability relates to professional values, norms and culture; overall participants felt their workplaces valued mental health supports and self-care initiatives, often hosting speakers or promoting specific programs. The ability to seek relates to personal and social values, social positions and autonomy in accessing health services. Focus group participants spoke about how their social location influenced their perception of safety accessing virtual peer support services. One participant shared,

Queer and trans folks experience a ton of violence at work, not only from the people that they care for, but also from their colleagues and co-workers, and in counseling spaces… what has been the approach in other programs is just having a set of standards or expectations that you have for the folks providing that peer service like that are trauma informed, harm reduction approach (FG08).

Participants wanted to be able to select peers they would feel safe and be able to connect with. Women participants expressed a desire to be able to be sure they had the option to speak with women peer supporters, particularly when their wellbeing was influenced by gendered or sex-specific experiences, such as sexual harassment and menopause. Participants from marginalized ethnic, racialized and religious populations noted the benefits of being able to speak to someone from a similar background: “It’s beyond performative competency. It’s beyond like, having a script and like, kind of using it… so if someone refers to something, like, ‘I’m Muslim’, or like saying like, ‘I did a prayer today’. So, the actual peer understanding what the significance means for this person, it goes such a long way” (FG8). Participants wanted more than peers trained in cross-cultural communication; they sought authentic cultural connections. Participants also noted the importance of being able to speak their first language with a peer, in order to be able to fully express themselves and understand the other person, and a preference for speaking with someone of the same profession as them. Every focus group recommended that those accessing the service should be able to read bios about the peer support providers and select someone they felt would be safe and best able to relate to as opposed to engaging with a virtual stranger.

Ability to reach and availability

Ability to reach refers to clients’ ability to access health services, while availability examines whether a healthcare service can be reached by a client in a timely manner. Health and social care workers described time and energy limitations as key barriers to accessing virtual peer support interventions. During work hours, they had little time to access supports, noting, “it’s the unsolvable problem, if you just had less people who needed help, then we could take care of ourselves better”(FG02). Participants felt that they were expected to seek mental health support on their own time, but other demands, such as family caregiving, limited their ability to do so. Participants also often felt depleted at the end of the day, lacking the energy to seek support.

I think availability is a big one after work, especially if you’ve had a distressing shift, you’re often so burnt out, that it just kind of feels like extra work to then be texting or to take the time to call, and so that’s sort of a problem, because obviously in order to get support, you need to be in communication with someone. But if it feels like additional labor, then that’s a big barrier (FG09).

Participants further noted that the service’s hours (9 am to 9 pm Monday to Friday for Care to Speak) affect their ability to access virtual peer support. They noted that later in the evening (after 9 pm) was often the only time they had for self-care and that it would be beneficial to be able to access the service during night shifts when feelings of isolation were common.

Ability to pay and affordability

Participants noted that it was essential for virtual peer support interventions to be free of charge and noted that virtual modalities also reduced time and travel costs. A few participants did mention indirect costs associated with the use of calling minutes, text messages, and the internet. This is likely to affect care providers earning low wages with limited financial capacity to enroll in comprehensive phone and data plans.

Participants highlighted the opportunity cost of accessing peer support, including taking time off from work, family responsibilities, rest and other forms of self-care. For casual workers paid on an hourly basis, speaking with a peer support worker meant losing paid work. As noted above, others hesitated to give up precious rest time to access the service. As a result, their approach to seeking support involved assessing personal costs and benefits. Affordability was linked to perceived quality, effectiveness, and appropriateness of care in answering the question: is it worth it?

Ability to engage and appropriateness

Ability to engage refers to clients’ ability to participate in the health service in terms of their agency, adherence and broader supports; appropriateness relates to the technical and interpersonal quality of the service. Participants repeatedly noted they needed to feel they could trust the service and peer workers they were speaking with, acknowledging the challenges of doing so through virtual modalities. One participant explained,

I think that the peer element is really effective because people, it’s essentially people who get it, who’ve been there, but in terms of actually accessing it, like, why I haven’t accessed it. . . Is, I find virtual really difficult to try to actually connect with somebody, if you’re trying to be maybe like vulnerable, or try to explore something that’s a bit difficult to have that be done through a screen with somebody you don’t know. I find really difficult, and so I I’ve never reached out for that, but I have accessed some in-person, peer support stuff in the past (FG01).

Related to questions of trust and appropriateness, focus group participants expressed skepticism about the confidentiality of virtual peer support initiatives. One participant noted confusing messaging where they were informed that anonymity was assured unless there is risk of harm, which made them question how privacy could be assured (FG09). Others had questions about where and how data is stored:

If we’re talking about providing services digitally, we need to talk about where our things are saved and specifically now with the US threat to Canadian data, this is very, very real. . it’s really dangerous to equity, to specific equity groups with a lot of whistleblowing happening. And so, if there’s a client sharing information about being trans or being, you know, subject to trauma from immigration or whatever, all this data is directly going to be pulled when they decide they want to pull it (FG06).

Participants recommended proactive transparency on data security and confidentiality policies including informing potential users where their data would be stored and using Canada-based servers.

Discussion

Focus group discussions with health and social care workers in BC, Canada, indicate widespread support for virtual peer support interventions at individual and organizational levels, and appreciation for the accessibility of free virtual services. However, they also indicated that work and time demands not only contribute to mental health needs but also inhibit health and social care workers from accessing services. Lack of awareness of initiatives was largely attributed to not having time to sift through or seek out information. Once aware of the service, participants weighed whether it would be worth the investment of their scarce time and energy, and wanted to be assured of their safety and security.

The Levesque Framework demonstrates how the above accessibility elements influence health outcomes. The findings presented here are similar to those on COVID-specific interventions that found psychosocial peer support programs for health and social care workers were feasible and impactful, but systemic changes were required to address underlying sources of stress [19]. Participants in the focus group described their mental health needs within a context of long term and sustained stressors, reflecting on the staffing shortages, unpredictability and high work demands. While participants continued to get fulfillment from their work, they noted a layering of wellbeing costs. These experiences were similar to those described elsewhere, which document how staffing shortages and increased demands limited the ability of healthcare workers to process moral injuries, further compounding harm [20]. In this context of high needs, participants recognized the limits of virtual peer support programs, noting that such interventions are primarily designed as early interventions offering short-term coping strategies and service connections. Many participants found such coping strategies insufficient and noted that service connections were only helpful if barriers to such services, such as costs for clinical counselling, were removed. This mismatch – between respondents’ demands and what virtual peer support interventions provide – raises questions about how such programs might adapt to meet demands and how workplaces might adapt to enhance the effectiveness of peer support.

Participants had multiple suggestions to guide such developments, including using diverse information channels and investing in in-person trusting building activities. While improving information provided about the services was seen as likely to increase use, it was noted that being able to access such services during paid work hours would increase ability to engage. Participants further noted that such services should be accompanied by further investments in clinical counseling benefits, and by commitments to address the underlying systemic and workplace drivers of poor mental health. While recognizing change takes time, health and social care workers wanted to know that the burden of care was not solely on them, and that decision-makers were also taking responsibility.

The sample of the focus group reflected the diversity of the health and social care sector in Canada. Women make up more than 75% of many healthcare professionals in Canada [21]. Racialized workers represent 58% of all health professionals and 55% of all social and community service professionals, and are overrepresented in professions, such as nurse aides, orderlies and patient service associate occupations at 63% [22]. While virtual peer support has been found to increase accessibility for those who face stigma and discrimination [6], participants expressed concerns around cultural safety and language accessibility. They wanted to be able to connect with those they felt safe with and with whom they were most likely to have shared experiences. These requests can be contextualized within a heightened awareness of discrimination in the health system, as well as within online spaces. If virtual peer support interventions are to be safe and supportive, they must take in to account the diverse makeup, and therefore needs, of the healthcare workforce. Allowing participants to connect with those who have shared experiences and social locations has the potential to increase the quality of peer interaction and foster feelings of safety.

Relatedly, participants expressed a demand for transparent details on confidentiality and data security. As health and social care workers, respondents were highly aware of the limits of protections within current systems, as well as of potential professional consequences if their personal needs became known. These concerns should be situated in a context of increased awareness of data security lapses and misuse of personal data by online actors. They also raises questions about the rapid scale-up of artificial intelligence (AI), including providing alternatives to human-based peer support [23]. Results from these focus groups suggest that hesitancy to engage with virtual services due to concerns about privacy and security would likely increase if services included the use of AI.

This study reports on a focus group discussions with health and social care workers in a specific location, British Columbia, Canada, using the example of a specific intervention (Care to Speak) to understand accessibility of virtual peer support interventions more broadly. As such, any generalizability should be treated with caution. There is a need for more representative research on health and social workers` experiences and preferences with virtual peer support programs. The findings here might inform exploration of similar questions about how to support health and social care workers in other contexts that are experiencing post-pandemic challenges related to labour shortages and system stressors.

Conclusion

As multiple contexts face healthcare worker shortages and strains on health systems, there is an acute need to develop supports for healthcare workers. Here we explore the accessibility of virtual peer support interventions to improve health and social care workers` mental health. We found widespread recognition of the benefits of peer support and appreciation for the accessibility created by virtual delivery. However, focus group participants also noted the need to clearly communicate about service offerings, tailor services to meet the needs of an increasingly diverse workforce, and for proactive measures to assure confidentiality and data security. These recommendations point to how virtual peer support interventions might adapt to meet needs within the current crisis, as well as to the need for broader systemic changes.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

BC

British Columbia

Author contributions

JS contributed to conceptualization, formal analysis, methodology, supervision, and writing of the original draft. AM contributed to conceptualization, data curation, formal analysis, methodology, project administration, reviewing and editing. AS contributed to conceptualization, data curation, formal analysis, methodology, project administration, reviewing and editing. KC contributed to conceptualization, funding acquisition, methodology, supervision, reviewing and editing.

Funding

This research was funded by a seed grant from the Ministry of Health, Province of British Columbia. The views expressed herein do not necessarily represent those of the Government of British Columbia. JS and KC are supported by Micheal Smith Scholar salary awards from Health Research BC.

Data availability

The qualitative data collected (focus group transcripts) are not publicly available due to participant confidentiality and informed consent agreements. Data are available upon reasonable request from the corresponding author, subject to ethical review.

Declarations

Ethics approval

Ethical approval for this research was provided by the Simon Fraser University Research Ethics Board (Protocol #30002992). All participants provided informed consent.

Consent for publication

All participants provided informed consent for publication.

Competing interests

The authors declare no competing interests.