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Project Title: Community-based peer support: Developing a model for promoting health literacy (COPES)
Reference number: 09/3008/04
Lead: Dr Janet Harris
Lecturer, School of Health and Related Research
Institution: University of Sheffield
Start date: 1 July 2011
Status: Research in progress
Plain English summary:

We are surrounded by health information, but many of us have problems using it to improve our health. The process of accessing health information and using it to stay healthy is called 'health literacy'. Health literacy is much more than reading and writing – it means being a critical consumer, deciding whether information is relevant to our particular situation and can be used to improve health. It's also about being able to communicate health needs and understand what health professionals are saying.

Research says it might be easier for people to be 'health literate' if they have support from family, friends or support groups. Peer support happens when people who have things in common give each other emotional support, reassurance and advice about health issues. Peers can help us to make sense of complicated information, and to decide if it is useful for our particular needs. Peers can also help us to prepare for visits to the doctor and help in making sense of information after the visit.

Community engagement is now being used in many places to show us how to use information to improve our health. Research indicates that community engagement can be successful for many reasons, but we think that the peer support that occurs during community projects may be one of the main factors that helps us to be health literate. This project aims to bring all of the research on community engagement and peer support together, and systematically review it to find out

(1) What approaches to community engagement are most effective in promoting peer support, to which people and in what circumstances? and (2) How does community-based peer support impact on understanding of existing health information and use of health information and health services to improve health and reduce health inequalities?

We will collaborate with people who are experts in engaging communities by establishing an Advisory Group to review the published research. We will also work with community experts - key informants - with experience in promoting health literacy, to find out what works for different types of people in different situations. The findings from published research and interactions with key informants will be used to develop a model of community-based peer support that successfully promotes health literacy across different types of people in different settings. Community engagement experts will then review the feasibility of using the model across a range of conditions to improve health literacy in areas such as diabetes, cancer prevention, and cardiovascular disease.

A systematic review of existing research does not directly ask participants to share their experiences. We will be working with people who have already evaluated community-based projects and the project therefore does not have the potential to harm the people who are reviewing the research. It could, however, benefit participants by acknowledging their community-based expertise.

The review team will be comprised of people in the University of Sheffield who have international experience in community engagement and systematic reviewing. The Advisory Group will consist of community engagement experts who have previously worked with reviewers on a range of community engagement projects.

The funding will support the academic salaries of reviewers, as well as community-based costs of organising participatory review meetings and costs that participants incur in attending the meetings.


Methods: This systematic review will use participatory realist synthesis, including key informant review of existing CE case studies; realist synthesis of findings; and participatory review of the proposed peer support community engagement model. Our network includes key informants from 6 SHA regions who have produced participatory evaluations and would like an opportunity to reflect on health literacy issues. We will review existing project reports and set up meetings to review the types of peer support that existed in health literacy projects. Case studies will identify what promoted support, barriers to effective peer support, and how peer support contributed to meaningful outcomes.

A systematic review will be conducted in tandem, identifying the types and components of CE that promote peer support and health literacy. A conceptual analysis (Walker & Avant, 2005) based on a comprehensive search of health, social science and community development databases will be used to create a theoretical model.

Case studies from the published and unpublished literature, retrieved from search 1 (above) and from targeted supplementary searches of databases and the Internet, will be analysed against the theoretical framework using realist synthesis approaches (Pawson et al 2004).

Target population and setting: The population to be included will be participants in community engagement interventions across a range of community settings.

Intervention being evaluated: The intervention is community engagement with the aim of promoting peer support, increasing health literacy, and subsequently improving health and reducing health inequalities.

Search strategy: We will search electronic databases including: MEDLINE, CINAHL, EMBASE, Cochrane Library, Google Scholar, Social Science Citation Index. Additional searches of bibliographies of previous systematic reviews and included papers will be undertaken. Content experts will also be approached and relevant internet sites will be searched including NGOs known to be active in community engagement programmes. We will also use pearl-growing strategies (Papaioannou et al 2009). All study types that evaluate a community engagement intervention that aims improve health and reduce health inequalities will be included. A flow chart will summarise the number of papers included and excluded at each stage and each study excluded at the full- paper screening will be listed in the appendix with the reason for exclusion described.

Review Process: The quality of included quantitative studies will be evaluated using the Cochrane Collaboration tool for assessing risk of bias (Higgins 2008). Where cluster randomised studies are included, the method of analysis will be assessed to ensure clustering has been taken into account. Rigour across study types will be assessed using critical appraisal tools appropriate to the study design, such as tools developed by the NHS Public Health Resource Unit Critical Appraisal Skills Programme (CASP 2006). The appropriateness of tools by study type will be considered and adapted where appropriate. Experience from a previous realistic synthesis (Harris et al, 2010) indicates that a tool specifically developed to evaluate education interventions (Reed et al, 2005) may be appropriate to assessing the quality of health literacy projects.

Expected output of research: The review will produce a narrative synthesis of qualitative and quantitative research, supplemented by views of community engagement experts. Conclusions will be presented in tabular format to identify the key factors contributing to effectiveness of community engagement in promoting peer support. Data will be synthesised to describe the relationship between CE, peer support and health literacy. Results will be used to propose a theoretically underpinned CE peer support model for promoting health literacy. Communities will review the proposed CE model for feasibility. Generalisability of the model will be assessed through dissemination to groups working on public health issues. A model describing the relationship between community-based peer support and literacy will be produced with hypotheses that can be tested in further empirical research

Project timetables: the anticipated duration of the study is 24 months. The main stages of the review are

Month 1-9: Retrospectively analyse case studies from previous CE research. Conduct an exhaustive search of primary studies in tandem with case study review. Compare factors contributing to effectiveness.

Month 10 - 18: Identify candidate theories. Confirm, refute or refine theories through constant comparison.

Month 19 - 22:Coordinate participatory review of feasibility and relevance of peer support model.

Month 22 - 24: Write up model and propose testable hypotheses for dissemination.

Protocol: Access protocol


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The Public Health Research Programme is managed by the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC). NETSCC is part of the University of Southampton.The Public Health Research Programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales and HSC R&D Division, Public Health Agency in Northern Ireland.

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