Perceptions and Utilization of Online Peer Support Among Informal Dementia Caregivers: Survey Study.

Background: Informal dementia caregivers are those who care for a person living with dementia and do not receive payment (eg, family members, friends, or other unpaid caregivers). These informal caregivers are subject to substantial mental, physical, and financial burdens. Online communities enable these caregivers to exchange caregiving strategies and communicate experiences with other caregivers whom they generally do not know in real life. Research has demonstrated the benefits of peer support in online communities, but this research is limited, focusing merely on caregivers who are already online community users. Objective: We aimed to investigate the perceptions and utilization of online peer support through a survey. Methods: Following the Andersen and Newman Framework of Health Services Utilization and using REDCap (Research Electronic Data Capture), we designed and administered a survey to investigate the perceptions and utilization of online peer support among informal dementia caregivers. Specifically, we collected types of information that influence whether an informal dementia caregiver accesses online peer support: predisposing factors, which refer to the sociocultural characteristics of caregivers, relationships between caregivers and people living with dementia, and belief in the value of online peer support; enabling factors, which refer to the logistic aspects of accessing online peer support (eg, eHealth literacy and access to high-speed internet); and need factors, which are the most immediate causes of seeking online peer support. We also collected data on caregivers' experiences with accessing online communities. We distributed the survey link on November 14, 2022, within two online locations: the Alzheimer's Association website (as an advertisement) and ALZConnected (an online community organized by the Alzheimer's Association). We collected all responses on February 23, 2023, and conducted a regression analysis to identifyn factors that were associated with accessing online peer support. Results: We collected responses from 172 dementia caregivers. Of these participants, 140 (81.4%) completed the entire survey. These caregivers were aged 19 to 87 (mean 54, SD 13.5) years, and a majority were female (123/140, 87.9%) and White (126/140, 90%). Our findings show that the behavior of accessing any online community was significantly associated with participants' belief in the value of online peer support (P=.006). Moreover, of the 40 non-online community caregivers, 33 (83%) had a belief score above 24-the score that was assigned when a neutral option was selected for each belief question. The most common reasons for not accessing any online community were having no time to do so (14/140, 10%) and having insufficient online information-searching skills (9/140, 6.4%). Conclusions: Our findings suggest that online peer support is valuable, but practical strategies are needed to assist informal dementia caregivers who have limited time or online information-searching skills.

A student-led clerkship primer: a near-peer orientation to clerkship.

The transition between pre-clerkship and clerkship can be difficult for medical students. Near-peer teaching may fill knowledge gaps within curricular clerkship orientation, leveraging recent, relatable, and up-to-date experiences from near-peers. These benefits have not been formally evaluated in the context of a clerkship orientation. We therefore created the Clerkship Primer, a near-peer teaching initiative that aimed to introduce incoming clerks to clerkship through a curricular session facilitated exclusively by senior clerkship students. Sessions had high satisfaction among students. This pilot project suggests that curricular near-peer teaching is a valuable component of clerkship orientation.

La transition entre le pré-externat et l'externat peut être difficile pour les étudiants en médecine. Un enseignement par les pairs a le potentiel de combler des lacunes dans les connaissances dans le cadre d'une orientation à l'externat, à partir d'expériences récentes et actualisées de pairs. Ces avantages n'ont pas été formellement évalués dans le contexte d'une orientation à l'externat. Nous avons donc créé le Clerkship Primer, une démarche d'enseignement par les pairs qui vise à présenter l'externat aux nouveaux externes dans le cadre d'une séance animée exclusivement par des externes séniors. Les séances ont été très appréciées par les étudiants. Ce projet pilote porte à croire qu'un enseignement par les pairs est une composante précieuse de l'orientation à l'externat.

Post-intervention perceptions on the antiretroviral therapy community group model in Trans Nzoia County, Kenya.

Introduction: the increasing number of people receiving antiretroviral therapy (ART) in sub-Saharan Africa has stressed already overburdened health systems. A care model utilizing community-based peer-groups (ART Co-ops) facilitated by community health workers (CHW) was implemented (2016-2018) to address these challenges. In 2018, a post-intervention study assessed perceptions of the intervention. Methods: forty participants were engaged in focus group discussions consisting of ART Co-op clients, study staff, and health care providers from Kitale HIV clinic. Data were analyzed thematically for content on the intervention, challenges, and recommendations for improvement. Results: all participants liked the intervention. However, some reported traveling long distances to attend ART Co-op meetings and experiencing stigma with ART Co-ops participation. The ART Co-op inclusion criteria were considered appropriate; however, additional outreach to deliberately include spouses living with HIV, the disabled, the poor, and HIV pregnant women was recommended. Participants liked CHW-directed quarterly group meetings which included ART distribution, adherence review, and illness identification. The inability of the CHW to provide full clinical care, inconvenient meeting venues, poor timekeeping, and non-attendance behaviors were noted as issues. Participants indicated that program continuation, regular CHW training, rotating meetings at group members´ homes, training ART Co-ops leaders to assume CHW tasks, use of pill diaries to check adherence, nutritional support, and economically empowering members through income generation projects would be beneficial. Conclusion: the intervention was viewed positively by both clinic staff and clients. They identified specific challenges and generated actionable key considerations to improve access and acceptability of the community-based model of care.

Peer Facilitator Training for Diabetes Prevention in a Nigerian Drug Treatment Center.

INTRODUCTION AND BACKGROUND: Individuals with substance use disorders (SUDs) are at an increased risk of developing comorbid medical conditions, including Type 2 diabetes. Although the diabetes prevention program (DPP) is efficacious and cost-effective, there is no published evidence to support its implementation in Nigeria or within SUD treatment settings. In this first known DPP within an SUD treatment program, we implemented a multiphased, nurse-led DPP at a small outpatient drug treatment center in Nigeria. The aim of this article was to describe only the processes utilized for the initial peer facilitator (PF) training (Phase 1). METHODS: In Phase 1, a diabetes prevention master trainer delivered a virtual DPP training to the facility's lead nurse, who return-demonstrated the DPP workshop skills and competencies over four 4-hour sessions. The lead nurse then independently delivered four 8-hour training sessions to a small number of client volunteers (n = 4) who subsequently delivered the DPP lifestyle interventions to their peers in the outpatient treatment program. RESULTS: The client volunteers attended all PF workshop sessions and were observed to be proficient in all aspects of implementation. They indicated that the training objectives were easily achieved and expressed enthusiasm for delivering DPP content to their peers. The need to better contextualize the DPP curriculum specific to Nigerian food preferences was identified. CONCLUSION: The Phase 1 training process appears to be an appropriate and effective approach for preparing PFs to deliver health programs, like the DPP, in environments with limited resources for populations facing numerous challenges.

Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol.

INTRODUCTION: Young people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format interventions may be feasible and sustainable. The scoping review outlined in this protocol aims to map the literature on group-format, peer-facilitated, in-person interventions for mental health promotion for higher education students attending courses on campuses in high and low/middle-income countries. METHODS AND ANALYSIS: Relevant studies will be identified through conducting searches of electronic databases, including Medline, CINAHL, Scopus, ERIC and PsycINFO. Searches will be conducted using Boolean operators (AND, OR, NOT) and truncation functions appropriate for each database. We will include a grey literature search. We will include articles from student participants of any gender, and published in peer-reviewed journals between 2008 and 2023. We will include English-language studies and all study types including randomised controlled trials, pilot studies and descriptive studies of intervention development. A draft charting table has been developed, which includes the fields: author, publication date, country/countries, aims, population and sample size, demographics, methods, intervention type, comparisons, peer training, number of sessions/duration of intervention, outcomes and details of measures. ETHICS AND DISSEMINATION: No primary data will be collected from research participants to produce this review so ethics committee approval is not required. All data will be collated from published peer-reviewed studies already in the public domain. We will publish the review in an open-access, peer-reviewed journal accessible to researchers in low/middle-income countries. This protocol is registered on Open Science Framework (https://osf.io/agbfj/).

Condom use increased after a peer group intervention implemented by community volunteers in Malawi.

BACKGROUND: HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. METHODS: Three communities sequentially rolled out the program. Effectiveness was evaluated using a stepped wedge design. Repeated surveys 11-13 months apart were conducted between 2016 and 2019. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 771) and condom use at last sex (N = 880). The analytical sample included all sexually active persons answering that question at one or more time points. Mixed-effects cumulative logit and Generalized Estimating Equation (GEE) models were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. RESULTS: This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final adjusted models with non-significant factors removed, condom use in the last two months increased for the intervention group vs. control group [Time 2: Adjusted Odds Ratio (AOR) = 1.59 (1.15, 2.21); Time 3: AOR 2.01 (1.23, 3.30)]. Similarly, condom use at last sex increased for the intervention group vs. control group [Time 2: AOR = 1.48 (1.08, 2.03); Time 3: AOR 1.81 (1.13, 2.90)]. Other significant predictors of greater condom use were also described. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. CONCLUSIONS: In this community-engaged implementation study, an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Community ownership and program delivery by trained volunteers offer an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening healthcare systems in sub-Saharan Africa. TRIAL REGISTRATION: Clinical Trials.gov NCT02765659 Registered May 6, 2016.

The role of recovery peer navigators in retention in outpatient buprenorphine treatment: a retrospective cohort study.

BACKGROUND: Racial and ethnic disparities are evident in the accessibility of treatment for opioid use disorder (OUD). Even when medications for OUD (MOUD) are accessible, racially and ethnically minoritized groups have higher attrition rates from treatment. Existing literature has primarily identified the specific racial and ethnic groups affected by these disparities, but has not thoroughly examined interventions to address this gap. Recovery peer navigators (RPNs) have been shown to improve access and overall retention on MOUD. PATIENTS AND METHODS: In this retrospective cohort study, we evaluate the role of RPNs on patient retention in clinical care at an outpatient program in a racially and ethnically diverse urban community. Charts were reviewed of new patients seen from January 1, 2019 through December 31, 2019. Sociodemographic and clinical visit data, including which providers and services were utilized, were collected, and the primary outcome of interest was continuous retention in care. Bivariate analysis was done to test for statistically significant associations between variables by racial/ethnic group and continuous retention in care using Student's t-test or Pearson's chi-square test. Variables with p value ≤0.10 were included in a multivariable regression model. RESULTS: A total of 131 new patients were included in the study. RPNs improved continuous retention in all-group analysis (27.6% pre-RPN compared to 80.2% post-RPN). Improvements in continuous retention were observed in all racial/ethnic subgroups but were statistically significant in the non-Hispanic Black (NHB) group (p < 0.001). Among NHB, increases in continuous retention were observed post-RPN in patients with male sex (p < 0.001), public health insurance (p < 0.001), additional substance use (p < 0.001), medical comorbidities (p < 0.001), psychiatric comorbidities (p = 0.001), and unstable housing (p = 0.005). Multivariate logistic regression demonstrated that patients who lacked insurance had lower odds of continuous retention compared to patients with public insurance (aOR = 0.17, 95% CI 0.039-0.70, p = 0.015). CONCLUSIONS: RPNs can improve clinical retention for patients with OUD, particularly for individuals experiencing several sociodemographic and clinical factors that are typically correlated with discontinuation of care.

Recovery peer navigators improve continuous clinical retention following initiation of outpatient treatment for opioid use disorder.Recovery peer navigators may be especially beneficial for patients with factors and identifiers commonly associated with discontinuation of care.

[L'Atelier créa: a therapeutic mediation group for neonatal parents]. / L'Atelier créa : un groupe thérapeutique à médiation pour les parents en néonatalogie.

The parents of a baby hospitalized in a neonatal unit are confronted with the trauma of premature birth. L'Atelier créa, a creatively-mediated peer group, was designed to give them a space in which to meet and share their experiences. It's a time for talking, imagining and dreaming about the baby. This group is also a form of passage, taking the place of ritual, allowing access to the parent-baby triad, in this sometimes so inhospitable universe.

Assessing the perceived value of a user-led educational intervention to support recovery in a Swedish psychiatric organization: A qualitative case study.

INTRODUCTION: Many people with mental health issues recover and re-establish their identity and find hope and meaning in life, irrespective of symptom burden. Recovery can be supported through learning and education, aiming at strengthening self-management and coping skills. Such education offered by peers with lived experience is rare and scarcely reported. The aim was to assess the perceived value of an educational intervention, called the Patient School (PS), organized within a psychiatry organization by employed patient peers with lived experience. METHODS: A qualitative case study based on interviews with people with mental health issues (n = 8), peer-organizers (n = 4) and healthcare professionals (n = 4), and documents such as schedules and educational materials were used. First, the interviews were transcribed and analyzed using inductive conventional content analysis. Second, the findings were synthesized into a programme theory, illustrated in a logic model. RESULTS: The perceived value of the PS was related to the willingness of peer-organizers to share their own experiences, a sense of belonging, sharing with like-minded and new knowledge, practical skills, roles and attitudes acquired. These experiences were empowering, decreased stigma and reassured user participants that one's identity is not defined by mental health issues. This increased self-confidence paves the way for increased self-management and creates a potential for a more efficient use of healthcare services. CONCLUSION: We conclude that this PS, organized within a psychiatry organization by salaried peers, achieved the same positive results as those reported in the literature and showed the value of having peer-organizers being part of the staff. PATIENT OR PUBLIC CONTRIBUTION: This research was performed in a partnership between academic researchers and persons with user experience of psychiatric services, engaged in the educational intervention in the focus of the study. The research plan was co-designed, and the analysis of the data collected was performed in collaboration. The participation of the co-researchers with user experience gave the project team access to the study site, provided the team with insights into to study context and contributed with an understanding promoting the interpretation of the findings.

The effectiveness of interprofessional peer-led teaching and learning for therapeutic radiography students and Speech and Language Therapy students.

BACKGROUND: Therapeutic Radiographers (RT) and Speech and Language Therapists (SLT) work closely together in caring for people with head and neck cancer and need a strong understanding of each others' roles. Peer teaching has been shown to be one of the most effective methods of teaching; however, no studies to date, have involved RT and SLT students. This research aims to establish the effectiveness and perceptions of peer-led teaching between undergraduate RT and SLT students in Ulster University. METHODS: Twenty SLT students and 14 RT students participated. Knowledge tests were taken online before the peer-led teaching session (T1), after the session (T2) and 3 months later (T3). Students' perceptions of the experience were collected at the end of the session. Wilcoxon signed-rank tests were used to analyse the impact of the intervention on knowledge scores. Qualitative content analysis was used for open text response data. RESULTS: RT students' own professional knowledge score at T2 was statistically significantly higher than the score at T1; the score at T3 was not deemed to be statistically significantly higher. RT students' SLT knowledge score at T2 and T3 was found to be statistically significantly higher than the score at T1. SLT students' own professional knowledge score was not statistically significantly higher at T2 or T3 than T1. They did have a statistically significantly higher score at T2 on the RT test, but score at T3 was not deemed to be statistically significantly higher. The majority of students across both professions agreed or strongly agreed that the peer-led teaching experience had a positive impact on their learning. CONCLUSION: This investigation highlights the benefits of an interprofessional peer-led teaching intervention for RT and SLT students and the findings add to the evidence of more objective study of knowledge gain as a result of interprofessional peer teaching.

"A shoulder to lean on during your first year"-An exploration into a Canadian post-secondary institution's peer mentor program for varsity student athletes.

The transition period from high school to post-secondary can be particularly challenging for many, including varsity student-athletes (SAs). To better support SAs through this transitional experience, some institutions have created peer mentor programs. What is unclear, however, is the perceived value of these mentorship programs from the perspectives of multiple stakeholder positions. This paper contributes to the Scholarship of Teaching and Learning by presenting findings of a program evaluation that investigated the perceived value of a peer mentor program to its stakeholders. To accomplish this, semi-structured interviews were conducted with 30 participants to discuss SA's experiences with being a first year student, making the transition from high school to post-secondary studies, and also, to discuss their lived experiences with the peer mentor program developed for SAs. Using the findings from the inductive thematic analyses, the peer mentor program's effectiveness, areas of strengths, and areas of improvement are discussed to better align with the stakeholders' needs and experiences. Findings offer insights into a) the trials and tribulations of the first year SA experience, b) how peer mentor programs can better support SA's transition to post-secondary education, c) the benefits of conducting a program evaluation, and d) strategies to enhance the peer mentor program to better support students' needs.

Heads Together Online Peer Education (HOPE): co-design of a family-led, video-based resource for families affected by paediatric acquired brain injury.

Background Many families of children with acquired brain injuries (ABI) desire opportunities to connect with peers who have shared similar experiences, but such opportunities are often unavailable. Heads Together Online Peer Education (HOPE) is a co-designed online video-based resource that provides information and early support to families following paediatric ABI. This study is part of a larger co-creation project using a community-based participatory research approach to develop and implement HOPE for families impacted by paediatric ABI in Australia. This study aimed to explore parents' and clinicians' perspectives regarding HOPE's usability, acceptability, and future implementation. Methods Parents and clinicians were recruited from a state-wide, interdisciplinary rehabilitation service. Parents were eligible to participate if their child had sustained an ABI within 2 years of recruitment. Participants accessed HOPE, completed the System Usability Scale (SUS), and participated in a semi-structured interview. Transcripts were analysed using inductive content analysis. Results Ten parents and 13 rehabilitation clinicians participated. Average SUS scores were 80.5/100 and 81.73/100, respectively. Participants were satisfied with HOPE's family-centred content and delivery. They expressed having benefited from using HOPE and offered suggestions for its optimisation. Finally, participants reflected on how HOPE could be introduced to and used by families, and its potential usefulness in educating others about paediatric ABI. Conclusions HOPE was developed through a family-led co-design process and aims to provide information and support to families in the early stages following paediatric ABI. This study's findings demonstrate HOPE's usability and acceptability from end-users' perspectives and will guide implementation.

Pursuing Success in a Hybrid PhD Nursing Program.

BACKGROUND: Little is known about hybrid PhD nursing students' experiences. METHOD: The purpose of this study was to describe and analyze the experiences of PhD nursing students in a hybrid program using a convergent mixed methods design. Recent nursing PhD alumni (n = 18), and current PhD students (n = 4) were recruited at a research-intensive university in the southwestern United States. RESULTS: Four metainferences were identified: (1) the facilitator of faculty as both advisors and mentors; (2) the facilitator of peers as support, motivation, and a source of advice that preceded advisors; (3) the barrier of receiving conflicting feedback from advisory and dissertation committees; and (4) the barrier of not understanding the PhD student process. CONCLUSION: Peer support is fundamental for hybrid PhD nursing student success; conflicting feedback and not understanding the process are significant barriers. Strategies are recommended to mitigate barriers to facilitate hybrid PhD nursing students' success. [J Nurs Educ. 2024;63(5):328-331.].

Mitigating the affective and cognitive consequences of social exclusion: an integrative data analysis of seven social disconnection interventions.

BACKGROUND: Being socially excluded has detrimental effects, with prolonged exclusion linked to loneliness and social isolation. Social disconnection interventions that do not require direct support actions (e.g., "how can I help?") offer promise in mitigating the affective and cognitive consequences of social exclusion. We examine how various social disconnection interventions involving friends and unknown peers might mitigate social exclusion by buffering (intervening before) and by promoting recovery (intervening after). METHODS: We present an integrative data analysis (IDA) of five studies (N = 664) that systematically exposed participants to exclusion (vs. inclusion) social dynamics. Using a well-validated paradigm, participants had a virtual interaction with two other people. Unbeknownst to participants, the other people's behavior was programmed to either behave inclusively toward the participant or for one to behave exclusively. Critically, our social disconnection interventions experimentally manipulated whether a friend was present (vs. an unknown peer vs. being alone), the nature of interpersonal engagement (having a face-to-face conversation vs. a reminder of an upcoming interaction vs. mere presence), and the timing of the intervention in relation to the social dynamic (before vs. during vs. after). We then assessed participants' in-the-moment affective and cognitive responses, which included mood, feelings of belonging, sense of control, and social comfort. RESULTS: Experiencing exclusion (vs. inclusion) led to negative affective and cognitive consequences. However, engaging in a face-to-face conversation with a friend before the exclusion lessened its impact (p < .001). Moreover, a face-to-face conversation with a friend after exclusion, and even a reminder of an upcoming interaction with a friend, sped-up recovery (ps < .001). There was less conclusive evidence that a face-to-face conversation with an unknown peer, or that the mere presence of a friend or unknown peer, conferred protective benefits. CONCLUSIONS: The findings provide support for the effectiveness of social disconnection interventions that involve actual (i.e., face-to-face) or symbolic (i.e., reminders) interactions with friends. These interventions target momentary vulnerabilities that arise from social exclusion by addressing negative affect and cognitions before or after they emerge. As such, they offer a promising approach to primary prevention prior to the onset of loneliness and social isolation.

Suicide attempts of friends and family during adolescence and long-term suicidal ideation and attempts: Findings from the 25-year Add Health study.

BACKGROUND: Suicide is a significant global public health concern. However, previous studies have predominantly focused on individual-level risk factors. Against this backdrop, microsystem suicide propinquity, which encompasses suicidal thoughts and behaviors (STB) within families and peer groups, is significant in elucidating the development and perpetuation of STB in adolescents. METHODS: This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, 1994-2018). Adolescents who reported instances of suicide attempts among their friends and family members during Wave 1 were selected (N = 4826). Generalized estimation equations (GEE) and structural equation models (SEM) were employed. RESULTS: GEE analyses indicated that individuals with friends who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.57 [2.13, 3.11]) and suicide attempts (OR [95 % CI] = 2.47 [1.78, 3.42]). Also, individuals with family members who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.37 [1.62, 3.46]) and attempts (OR [95 % CI] = 2.27 [1.17, 4.41]). However, friends' and family members' suicide attempts failed to show significant interactive effect. Besides, SEM analyses indicated that friends' and family members' suicide attempts were associated with one's long-term suicidal ideation and attempts via depressive symptoms. CONCLUSION: Suicide attempts of friends and family during adolescence were long-term risk factors for suicidal ideation and attempts from adolescence to young adulthood. Moreover, depressive symptoms served as long-term mechanisms in these associations.

Peer-led stay interviews to connect employees and develop retention strategies.

ABSTRACT: Stay interviews can strengthen employee engagement and increase retention. This quality improvement project aimed to determine nurses' motivations for staying on their current unit by conducting peer-led stay interviews. Participants responded positively to the stay interview process.

Informal peer support for rural doctors.

INTRODUCTION: Practising medicine exposes physicians to emotionally difficult situations, which can be devastating, and for which they might be unprepared. Informal peer support has been recognised as helpful, although this phenomenon is understudied. Hence, it is important to develop a better understanding of the features of helpful informal peer support from the experiences of physicians who have successfully moved through such difficult events. This could lead to new and potentially more effective ways to support struggling physicians. METHODS: Rural Canadian generalist physicians were interviewed. Using a hermeneutic phenomenological approach, data analysis was oriented towards understanding features of helpful informal peer support and the meanings that participants derived from the experience. RESULTS: Eleven rural generalist physicians took part. Peer support prompted the processing of difficult emotional experiences, which initially seemed insurmountable and career-ending. Participants overcame feelings of emotional distress after even brief encounters of informal peer support. Most participants described the support they received as vitally important. After the peer support encounter, practitioners no longer thought of leaving medical practice and felt more able to handle such difficulties moving forward. CONCLUSIONS: Informal peer support enabled recipients to move through an emotionally difficult experience. Empathy, shared vulnerability and connection were the part of the peer support encounter. In addition, the support offered benefits which are known to help physicians not only process emotionally difficult events but also to acquire 'post-traumatic growth'. Practitioners, healthcare leaders and medical educators all have roles to play in enabling the conditions for informal peer support to flourish. INTRODUCTION: La pratique de la médecine expose les médecins à des situations émotionnellement difficiles, qui peuvent être dévastatrices, et auxquelles ils ne sont pas préparés. Le soutien informel par les pairs a été reconnu comme utile, même si ce phénomène est peu étudié. Il est donc important de mieux comprendre les caractéristiques du soutien informel par les pairs à partir des expériences de médecins qui ont réussi à traverser des événements aussi difficiles. Cela pourrait conduire à de nouvelles façons, potentiellement plus efficaces, de soutenir les médecins en difficulté. MTHODES: Onze médecins généralistes canadiens ruraux ont été interrogés. En utilisant une approche phénoménologique herméneutique, l'analyse des données a été orientée vers la compréhension des caractéristiques du soutien informel utile par les pairs et des significations que les participants ont tirées de l'expérience. RSULTATS: Le soutien des pairs a incité à vivre des expériences émotionnelles difficiles, qui semblaient au départ insurmontables et mettant fin à une carrière. Les participants ont surmonté leurs sentiments de détresse émotionnelle après même de brèves rencontres de soutien informel par leurs pairs. La plupart des participants ont décrit le soutien qu'ils ont reçu comme étant d'une importance vitale. Après la rencontre de soutien par les pairs, les praticiens ne pensaient plus à quitter la pratique médicale et SE sentaient plus capables de faire face à de telles difficultés à l'avenir. CONCLUSION: Le soutien informel par les pairs a permis aux bénéficiaires de traverser une expérience émotionnellement difficile. L'empathie, la vulnérabilité partagée et la connexion faisaient partie de la rencontre de soutien par les pairs. En outre, le soutien a offert des avantages connus pour aider les médecins non-seulement à gérer des événements émotionnellement difficiles, mais également à acquérir une 'croissance post-traumatique'. Les praticiens, les dirigeants des soins de santé et les enseignants en médecine ont tous un rôle à jouer pour permettre aux conditions propices au soutien informel par les pairs de s'épanouir.

'Getting addicted to it and losing a lot of money it's just like a hole.' A grounded theory model of how social determinants shape adolescents' choices to not gamble.

BACKGROUND: Gambling abstinence when underage lowers the risk of harmful gambling in later life. However, little research has examined why many young people refrain from gambling, even though this knowledge can inform protective strategies and lower risk factors to reduce underage gambling and subsequent harm. This study draws on the lived experience of adolescent non-gamblers to explore how social determinants while growing up have shaped their reasons and choices to not gamble. METHODS: Fourteen Australian non-gamblers, aged 12-17 years, participated in an in-depth individual interview (4 girls, 3 boys) or online community (4 girls, 3 boys). Questions in each condition differed, but both explored participants' gambling-related experiences while growing up, including exposure, attitudes and behaviours of parents and peers, advertising, simulated gambling and motivations for not gambling. The analysis used adaptive grounded theory methods. RESULTS: The grounded theory model identifies several reasons for not gambling, including not being interested, being below the legal gambling age, discouragement from parent and peers, concern about gambling addiction and harm, not wanting to risk money on a low chance of winning, and moral objections. These reasons were underpinned by several social determinants, including individual, parental, peer and environmental factors that can interact to deter young people from underage gambling. Key protective factors were parental role modelling and guidance, friendship groups who avoided gambling, critical thinking, rational gambling beliefs, financial literacy and having other hobbies and interests. CONCLUSIONS: Choices to not gamble emanated from multiple layers of influence, implying that multi-layered interventions, aligned with a public health response, are needed to deter underage gambling. At the environmental level, better age-gating for monetary and simulated gambling, countering cultural pressures, and less exposure to promotional gambling messages, may assist young people to resist these influences. Interventions that support parents to provide appropriate role modelling and guidance for their children are also important. Youth education could include cautionary tales from people with lived experience of gambling harm, and education to increase young people's financial literacy, ability to recognise marketing tactics, awareness of the risks and harms of gambling, and how to resist peer and other normalising gambling influences.

How peer relationships affect academic achievement among junior high school students: The chain mediating roles of learning motivation and learning engagement.

BACKGROUND: Despite the recognition of the impact of peer relationships, learning motivation, and learning engagement on academic achievement, there is still a gap in understanding the specific mechanisms through which peer relationships impact academic achievement via learning motivation and learning engagement. METHODS: This study aims to investigate how peer relationships affect junior high school students' academic achievement through the chain mediating roles of learning motivation and learning engagement, employing the self-system model of motivational development as the theoretical framework. In January 2024, 717 participants were selected from two middle schools in eastern China (mean age = 13.49 years, SD = 0.5). The data analysis in this study was performed using the structural equation model (SEM) in AMOS 24.0 and SPSS 24.0. RESULTS: The results showed that peer relationships were directly and significantly related to junior high school students' academic achievement, and that peer relationships were indirectly and positively related to junior high school students' academic achievement via learning motivation and learning engagement respectively. The results also revealed a significant indirect and positive relationship between peer relationships and junior high school students' academic achievement, mediated by the sequential mediating roles of learning motivation and learning engagement. Moreover, the path "peer relationship→learning motivation→academic achievement" has the strongest indirect effect. CONCLUSION: For junior high school students to achieve academic success, the appropriate interventions should be implemented to improve peer relationships, learning motivation, and learning engagement.