Abstract
BACKGROUND: Peers with lived experiences of being in recovery of mental health difficulties volunteering in non-governmental organizations (NGOs) to engage in peer support show significant promise in supporting personal recovery for individuals with similar mental health difficulties. "The 'Paths to Everyday Life' (PEER) intervention was evaluated in a randomized trial during 2020-2022. As part of a process evaluation, qualitative studies were conducted to explore the perspectives of both recipients and facilitators of the community-based peer support. This qualitative study, underpinned by critical realism, examined how the delivery of the intervention is achieved, the training, and the working conditions from the perspective of the peers volunteering in the NGO operating the project. METHODS: Nine peer volunteers were recruited for two focus groups (n = 8) and a telephone-based interview (n = 1). The semi-structured realist inspired interviews were audio recorded and transcribed verbatim. The analysis was guided by reflective thematic analysis and through an abductive framework based on knowledge in the field and the PEER intervention context. Data were coded and analysed in Nvivo software version 1.7 (QSR International). RESULTS: Two overarching themes were identified: (1) 'The contradictory dual role of facilitating groups and sharing equally'; (2) 'Equipped to facilitate groups', as well as several sub-themes. In addition, a minor theme has been identified: (3) 'Volunteer one-on-one peer support is unscripted'. CONCLUSION: Peer volunteers providing group-based peer support in the community show significant promise. Training in trauma-informed, structured formats and fostering equal, reciprocal relationships among peer co-facilitators and participants greatly enhanced group impact. The organizational support and supervision enhanced peer volunteers' preparedness for co-facilitation roles, yet the one-on-one peer support for community engagement, sought by only a few participants, requires further clarification and exploration. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04639167, Registered on Nov. 19, 2020.