Challenge

Diabetes prevalence (both type 1 and 2) is steadily rising in young adult groups, who face a range of poor clinical and psychosocial outcomes, including widening inequalities and significant barriers to service engagement. New models of care are needed to support this patient group.

Group clinics are increasingly gaining traction as a way to engage patients, improve clinical outcomes and support self-management, in the context of rising healthcare costs and diminishing resources. Compared to usual one-to-one appointments, group clinics signify the importance of storytelling, shared lived experiences and supportive peer relationships. However, as the Q Lab essays suggest, organising services at the intersection of traditional clinical and peer support models creates new tensions and risks, requires a different skill-set for staff and assumes new ways of engaging voluntary and charitable organisations [1].

Although there is a large literature on group clinics for adults with chronic conditions (usually White, middle-aged or older patients), there is little emphasis on the distinct needs of younger patients (aged 16-25) with diabetes (type 1 and 2). Established peer support models are not adequately considered in research on group clinics and there is little practical guidance to support clinical care delivery that relies on positive peer relationships.

 

Idea

This project aims to develop implementation guidance to support healthcare staff in facilitating meaningful and supportive peer relationships as part of group-based clinical care for young adults with diabetes (aged 16-25) in diverse, deprived NHS settings. As emphasised in the Q Lab report, there are tensions between standardising peer support and allowing bottom-up, authentic solutions to emerge [1]. We do not intend our implementation guidance to be prescriptive, but to set out principles, stories, examples, ideas, strategies and transferable lessons. For example, we will provide suggestions on how to be adaptive and responsive to patient needs in group clinics, or how to think creatively about sustaining a safe and fun atmosphere.

Experience from our ongoing work highlights that peer support does not emerge automatically within group clinics. A proactive approach is required to address difficulties and unpredictable dynamics. This includes working with ‘challenging’ behaviours that often seem counter-productive but may lead to beneficial outcomes if managed appropriately. Our pilot work also emphasises that healthcare professionals delivering group clinics have a range of training needs in order to be able to harness and facilitate peer support effectively.

To develop guidance by foregrounding practical experiences of setting up peer support in group clinics, we will:

• Draw on qualitative interview and observation data from the researcher-in-residence evaluation of our ongoing feasibility study on group-based diabetes care for young adults piloted in an East London NHS Trust.
• Analyse successes and failures to develop transferable lessons on how peer support can be meaningfully embedded in group clinics.
• Draw on existing academic and grey literature, including example guides on peer support provided by the Q Lab, quality improvement frameworks and transferable knowledge from other sectors.
• Organise peer support-focused facilitation training for clinical teams to reflect on experiences and evaluation findings.
• Provide improvement coaching so that clinical teams implementing group clinics can identify systematic ways to address ongoing challenges in harnessing peer support.
• Organise co-design workshops with patients, health professionals, group facilitators and youth workers, to synthesise learning and collaboratively develop consensus on the implementation guide.
• Develop and test our resources further with an additional North-West London hospital.
• Create professionally designed outputs and carry out dissemination with the help of patient participants (e.g. at Peerfest).

Guidance will provide useful lessons on how to harness person-centred peer support to maximise the benefits of group clinics premised on a sense of equality and equity. This fits with the Q Lab vision: ‘…to create spaces in which to explore these areas of complexity, and to provide support to help people navigate them’ [1].

 

Anticipated benefits

Our implementation guidance will:

• Support innovative clinical care models based on peer relationships between young adults from ethnic minority groups and socio-economically deprived backgrounds.
• Improve patient experiences and engagement with an alternative clinical service, where young adults can feel less vulnerable – currently, we understand little about how group clinics are best delivered.
• Support healthcare staff in harnessing peer relationships in group-based care. This will fill a significant training need in a setting where one-to-one interactions are the norm. By equipping staff with expertise in youth peer support, it is more likely that they will experience their role in group clinics as rewarding and fulfilling.
• Provide transferable and scalable knowledge to the Q community for testing and implementation in different settings. We will build on the Q Lab reports and write up our findings for different audiences, with recommendations transferable to other long-term conditions and age groups.

[1] Q Lab (2018). Learning and insights on peer support. Available at: https://qlabessays.health.org.uk/essay/learning-and-insights-on-peer-support/