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Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common.
The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions.
This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results.
After duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual’s chronic condition, access to information, and empowerment.
There is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support—emotional, informational, and appraisal support—were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs.
In Canada, 1 in 5 adults live with cardiovascular disease, cancer, diabetes, or chronic respiratory disease [
Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions [
In the context of chronic disease management, peer support refers to providing assistance to other individuals with similar conditions [
With the increasing implementation of web-based peer support interventions, there is a need to examine the characteristics of these interventions and determine the gaps in this emerging literature. The purpose of this scoping review is to synthesize the existing literature and key characteristics (eg, duration; frequency; delivery setting; type of intervention; type of support provided, including emotional, informational, and appraisal; and underlying theories for the intervention, behavior change techniques, or mechanisms) of web-based peer support programs for persons with chronic conditions.
The methodology for this scoping review has been previously published [
A comprehensive literature search was conducted by an experienced librarian (LP) with input from the investigators. Literature search strategies were developed using medical subject headings and text words related to chronic conditions and peer support interventions. The MEDLINE search has been previously published in our protocol paper [
Chronic diseases identified by the Public Health Agency of Canada (PHAC), including cancer, heart disease (cardiovascular disease), hypertension, stroke, chronic respiratory diseases (asthma, chronic obstructive pulmonary disease, and sleep apnea), diabetes, inflammatory bowel diseases (Crohn disease and ulcerative colitis), multiple sclerosis, neurological conditions (eg, Alzheimer disease and other dementias), cerebral palsy, epilepsy, multiple sclerosis, Parkinson disease or parkinsonism, traumatic brain injury, traumatic spinal cord injury, arthritis, and osteoporosis, were included [
Our review was limited to peer support interventions delivered on the web. Studies were included if a web-based peer component was part of their intervention. Support must be provided by a peer who has the same chronic condition. Examples of web-based peer interventions include video-based discussions using formats such as Skype, social media peer interactions, and text messages from peers. Peer-led interventions that used a web-based modality in combination with another modality, such as telephone or face-to-face interventions, were included. Interventions describing professional-led groups involving community health workers who are not peers (eg, health care professionals), e-counseling service interventions, studies reporting on outcomes of usability testing but not the outcomes of the participants, support group interventions, and telephone-based peer support interventions were excluded. In addition, studies were excluded if they described the benefits of using the internet generally but did not describe an intervention and the reported outcomes of that intervention. If the study described an intervention that had a combination of peer- and professional-led support, it was excluded.
To further describe the types of articles that were included and excluded in this review, we provide an example of 1 study that was included and 2 that were excluded.
The study
The studies were screened using a 2-step process. First, the titles and abstracts were screened in duplicate by independent reviewers, followed by full-text screening, which was conducted in duplicate. Both level 1 and level 2 screening followed the same screening form. DistillerSR reference manager was used by independent reviewers to keep track of the decisions. Discrepancies were resolved by discussion between reviewers and, if necessary, the senior author (SEPM).
Data abstraction forms developed by the research team were used. The information abstracted included year of publication, country of study, purpose of the study, participant population (eg, chronic condition, age, sex, gender, and education), key characteristics of the intervention (eg, duration; frequency; delivery setting; type of intervention; type of support provided, including emotional, informational, and appraisal; underlying theories for the intervention, behavior change techniques, or working mechanisms; and context), outcome measures, and results. Results including
The literature searches yielded 13,286 articles. After duplicates were removed, 12,641 articles were screened. After level 1 screening, 368 articles were included in the full-text screening. Of these 368 items, 5 oral presentations and 37 abstracts from conferences were excluded, as it was not possible to obtain full-text articles. A total of 9 protocol papers were excluded because there were no data on the results of the reported interventions. After level 2 screening, data abstraction was completed for 41 articles. The reasons for article exclusion varied but were primarily related to not having a peer support component implemented in the studied intervention. Further rationale as to why articles were excluded are described above within the
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.
A summary of the included studies with information on patient characteristics, peer support intervention characteristics, outcome measures, and impact is included in
Around half of the studies included in this review were qualitative (20/41, 49%). Specifically, 14 of these studies analyzed content posted on web-based discussion forums, whereas the other 6 were qualitative studies that reported on the experiences of the patients participating in a web-based peer support program. The quantitative studies included in the review were randomized controlled trials (6/41, 14%) and cross-sectional studies using a survey design (8/41, 19%). The remaining studies were mixed methods studies (4/41, 10%), nonrandomized controlled trials in which matched controls served as the comparison group, quasi-experimental studies (1/41, 2%), and integrative reviews (1/41, 2%).
There were various limitations to the included studies. Among the randomized controlled trials, there were small sample sizes (sample sizes ranged from 30 to 227) [
The studies included participants with cancer (15/41, 36%), diabetes (9/41, 21%), and HIV (7/41, 17%). The remaining 10 studies included participants with arthritis (2/41, 4%), atrial fibrillation (1/41, 2%), chronic pain (1/41, 2%), inflammatory bowel disease (1/41, 2%), multiple sclerosis (2/41, 4%), peripartum cardiomyopathy (1/41, 2%), and stroke (2/41, 4%). The individuals included in the studies were aged between 19 and 70 years. This broad range of age groups made it difficult to summarize the studies based on specific age groups. In the majority of the studies, the ratio of male to female participants varied, except in studies on chronic conditions that are of higher prevalence in a specific sex (eg, breast cancer and prostate cancer) [
This section outlines the following key characteristics of the studies on web-based peer support interventions included in our review: duration; frequency; delivery setting; type of intervention; type of support provided, including emotional, informational, and appraisal; and underlying theories for the intervention, behavior change techniques, or mechanisms.
For the included studies, the duration and frequency of the interventions varied. Of the 41 included studies, 15 (36%) had interventions lasting for 2 weeks to 16 weeks [
A total of 15 of the 41 studies described a web-based discussion board as the means of delivering the intervention [
Of the included studies, 21 of the 41 studies reported on using a group-type intervention [
No studies have reported on interventions that included only one type of support. Instead, the interventions provided a mix of emotional, informational, and appraisal support. A total of 29 studies failed to define a theoretical framework underpinning the intervention.
In total, 12 studies included the following underlying theories, models, or approaches: social learning theory [
Among the randomized controlled trials (6/41, 15%), the outcomes used were participant openness, trust, motivation, knowledge, self-efficacy, self-care behavior levels, social relationships, emotional distress, depression, mastery, self-esteem, social support, and general well-being [
A total of 2 of the 6 randomized controlled trials on diabetes management reported no statistically significant differences between groups for self-efficacy, general well-being, or self-care behaviors (eg, general diet, exercise, and smoking) [
In the qualitative studies, some of the positive experiences of participating in an web-based peer support program included increased compassion and improved attitudes toward their condition (ie, people felt that they were not alone in their struggles or that peer support reduced isolation) [
An example of an article included in this study. De Simoni et al [
An example of an article included in this study. Lovatt et al [
This scoping review aims to determine what is known from the existing literature about the key characteristics (eg, duration; frequency; delivery setting; type of intervention; type of support provided, including emotional, informational, and appraisal; and underlying theories for the intervention or behavior change techniques or mechanisms) of web-based peer support interventions for adults with chronic conditions. The main findings of this review were as follows: (1) a lack of participant diversity in the included studies, specifically with respect to the conditions studied (ie, the majority of the studies included were related to cancer, cardiovascular disease, and HIV or AIDS) and the exclusion of older participants (ie, the age range for included studies was 19-70 years); (2) few studies used a randomized controlled trial design; (3) over one-third (15/41, 37%) of the interventions included involved web-based discussion boards, and just over half (21/41, 51%) of the included studies involved group-type peer support; (4) the interventions provided a mix of emotional, informational, and appraisal support, but the majority of studies did not report on an underlying theory or conceptual framework for the intervention; and (5) in terms of outcomes, among the quantitative studies, 4 of the 6 randomized controlled trials demonstrated increased feelings of acceptance and respect by others, health service navigation, self-efficacy, social participation, and constructive attitudes and approaches and decreased emotional distress [
Across the 41 included studies, the age range was 19-70 years. Although it is recognized that some conditions are more common among younger individuals (eg, HIV or AIDS), the absence of recent evidence on web-based peer support interventions for individuals aged ≥70 years is noteworthy. For example, in Canada, about 20% of breast cancers are diagnosed in women aged <50 years, whereas almost 30% are diagnosed in women ≥70 years. Individuals ≥70 years are more likely to be socially isolated and lonely [
The findings of this review suggest that there is a need for more studies on web-based peer support interventions for individuals ≥70 years, in these and other specific disease populations, and for improved methods to target these vulnerable groups. Furthermore, Statistics Canada indicates that rates of internet use vary across age groups within the senior population, with 81% use among older adults aged 65-69 years, compared with 74% use among those aged 70-74 years, 64% use among those aged 75-79 years, and 49% use among those aged ≥80 years [
We determined that there was a lack of consistency in terms of reporting intervention characteristics. Similarly, in a systematic review of peer support interventions for individuals with acquired brain injury, cerebral palsy, and spina bifida, members of our research team concluded that experts from relevant disciplines collaborated to develop the peer support interventions, but they did not specify the methods by which the key components of the interventions such as session duration, frequency, and intervention length were chosen or how these decisions were informed. Given this lack of consistency, it is suggested that future studies reporting on web-based peer support interventions consistently use the better reporting of interventions: a Template for Intervention Description and Replication checklist and guide [
Other important aspects of this review were the delivery settings and the types of interventions. In terms of the randomized controlled trials, as previously mentioned, the number included was too small to draw any associations between the delivery setting and the type of interventions and outcomes. Among the studies involving nonexperimental designs, 37% (15/41) used web-based discussion boards with a group type of intervention. Group peer-to-peer discussion boards may be particularly valuable, as noted by a qualitative study on the perspectives of individuals with type 1 diabetes using an internet self-management system, as they allow patients to share tips and advice on managing their conditions and provide an opportunity to relate to fellow patients [
In our review, we identified all 3 types of support—emotional (eg, communicating a sense of belonging, inclusivity, and reinforcing the presence of others), informational (eg, asking others for guidance and providing detailed explanations), and appraisal (eg, goal setting and action planning that can provide opportunities for constructive feedback)—across the included studies. A review by Lauckner and Hutchinson [
Only 12 of the 41 studies provided an underlying theory or model or approach, with some of these studies reporting only an underlying approach (ie, person-centered care approach). Previous research suggests that a thorough approach to intervention development, including a clear rationale for the design and development of interventions, is recommended [
Lauckner and Hutchinson [
We acknowledge some limitations of this scoping review. This review did not include primary mental health conditions and a variety of other disabilities. As previously mentioned, interventions that focused on mental illness were excluded from our list of chronic diseases, given that peer support interventions for this group may have unique features not generalizable to other patient populations with chronic disease, and a systematic review of digital peer support interventions for people with lived experience of a serious mental illness has recently been completed [
The results of this review demonstrate that there is a limited, recent high-level evidence (ie, randomized controlled trials) on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. However, these trials were limited to 4 conditions only: diabetes, HIV, cancer, and stroke. Thus, we recommend the study of web-based peer support in a much broader range of conditions. We further recommend the use of web-based peer support for older adults (ie, aged >70 years) with chronic conditions. We determined that some of the included studies incorporated a theoretical framework, and all forms of support—emotional, informational, and appraisal—were identified in the studies included in this review. Future peer support interventions should implement an underlying theory or model to inform interventions, which in turn would support the intended outcomes of the intervention. Future studies should also consistently report on the intervention characteristics, including the frequency and duration of the intervention, to promote replicability and to draw associations between intervention characteristics and specific outcomes. Overall, the results of this review have identified key gaps in the area of web-based peer support that will serve to inform the development, implementation, and evaluation of future programs.
Complete data set.
Frequency of delivery settings.
Public Health Agency of Canada
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
The authors would like to acknowledge the following contributions of their team: Nigel Barnim for contributing to the level 1 screening process and Mehdi Sabour for assisting with data abstraction.
None declared.