Table 3 Barriers and facilitators to offering peer support
Rank | Barriers identified from survey | Total rank priority score | Top 5 qualitative barriers |
1 | Lack of access to program | 261 | 1. Limited awareness of peer support programs (13 participants) Reduced healthcare provider awareness of peer support programs available for individuals with CKD. “I don’t really know very much about it [peer support], honestly. I just knew that it was supposedly available and initially in some of the package information I had it was available, that they [patients] could reach out and be in touch with others.” – Nurse 1 2. Challenges of virtual formats (10 participants) Inability to identify and offer peer support to eligible patients due to reduced capacity for in-person encounters. “To put a damper on it, I really feel like this virus [COVID-19] kind of ruined those [peer support] possibilities.” – Social worker 6 3. Workload and competing priorities (9 participants) Restricted integration of peer support into CKD care resulting from large clinic rosters with accompanying workloads and competing priorities. “Some of the clinics are so huge, we may not be able to identify ahead of time which patients may particularly need [peer] support at that time.” – Nurse 3 4. Perceived patient hesitancy (6 participants) Perceived patient reluctance to initiate peer support conversations or encounters. “If I put myself in that [patient’s] place… It’s going to take me a while to feel comfortable. I would be very worried about [not] knowing what to say.” – Nurse 2 5. Lack of time and resources (5 participants) Need for adequate resources to promote, offer, and deliver peer support in CKD clinics. “You need to find some time in doing that [off] the side of your desk.” – Social worker 7 |
2 | Lack of awareness of peer support options | 255 | |
3 | Workload | 246 | |
4 | Lack of resources to provide patient | 193 | |
5 | Too much information to provide patients at clinic visits | 155 | |
6 | Lack of patient receptivity | 111 | |
7 | Limited staff receptivity | 37 | |
8 | Feeling uncomfortable talking to patients about peer support | 31 | |
Rank | Facilitators identified from survey | Total rank priority score | Top 5 qualitative facilitators |
1 | Leadership (e.g., local program champion) | 294 | 1. Collaborations between and within organizations (5 participants) Ability to collaborate with other programs and organizations offering peer support. “I know some other community units were interested [in peer support] and emailed me and asked additional questions. So some other programs picked up on it as well to try to initiate [it].” - Social worker 7 2. Systematic process for integrating peer support (5 participants) Having consistent processes in place for identifying, discussing, and referring patients to peer support. “We have two other social workers that will do the referrals as well, and sometimes a nurse might bring it our way and we follow it from there.” – Social worker 6 3. Staff receptivity (4 participants) Staff engagement in promoting and/or integrating peer support within their clinic. “I think for the social workers or whoever would be running the groups to keep it consistent and keep going, even if it didn’t work out once to not give up and to keep trying.” – Social worker 8 4. Patient motivation (4 participants) Patient interest to drive implementation and sustainability of a peer support program “There are some people that tend to be really keen, they really want to learn from others. They want more information. We thought there would be more interest and more likely people to attend.” - Social worker 1 5. Strong patient-provider relationships (3 participants) Reliance on trusting relationships between providers and patients for encouraging peer support. “We can make that connection not only through social work but through nursing with the patients that we are seeing and connect them with peer support.” – Nurse 3 |
2 | Training and preparation | 256 | |
3 | Availability of patient volunteers | 254 | |
4 | Assistance with inviting patients to peer support program | 204 | |
5 | Management support | 195 | |
6 | Funding support | 152 | |
7 | Close relationship with external organization | 133 | |
8 | Adequate space | 127 |