PA interventions incorporating peer support
A recent systematic review considered the effectiveness of using peers to help
promote and deliver PA programmes for older adults (Burton et al., 2018). The benefits of
incorporating peer support included peers providing motivation, empathy and understanding
to participants rather than solely delivering the programme (Burton et al., 2018); peers acting
as positive role models through relational similar experiences (Sadler, Sarre, Tinker, Bhalla,
& McKevitt, 2017); and peers enhancing natural social networks using experiential
knowledge (Dennis, 2003).
Peer support has become increasingly popular in the delivery of quality healthcare.
Research suggests that peer-led or peer support programmes may be as effective in
maintaining participation of individuals in PA programmes as those using health
professionals (Burton et al., 2018). Benefits of peer programmes for MHSU outside of a PA
context have been well documented. It has been reported that MHSU show interest in
helping, and gain a sense of value, self-efficacy and purpose from helping others (Grant,
Reisweber, Luther, Brinen, & Beck, 2014). There is paucity of research that includes peer
support within PA programmes for mental health, as the existing research has predominantly
focused on the impact of peer support for the recipients. Much less is known about the
experiences of volunteers providing peer support and their motivation towards peer
volunteering behaviour (Hallett, Klug, Lauber, & Priebe, 2012; Smith, Drennan, Mackenzie,
& Greenwood, 2018). Research is therefore needed to identify the underlying motivational
processes that underpin helping behaviours such as peer volunteering (Moran, Russinova,
Gidugu, Yim, & Sprague, 2012) to better understand how volunteers experience the provision
of peer support within PA programmes, and how this behaviour can be sustained.
Motivation and peer volunteering
Retention of peer volunteers is seen as a challenge in programmes aimed to support
MHSU due to implementation difficulties, “fragility” of peer volunteers, and relapse
resultant of volunteers’ own mental health problems (Davidson et al., 2012). Research
looking to understand individuals’ motivation towards sustained volunteering can help
ameliorate attrition rates of volunteers. Sustained volunteering can lead to better outcomes for
the volunteers and more effective delivery of programmes. To understand the psychosocial
processes that underpin volunteering behaviour, it is important to consider individuals in the
context of the combined influence of psychological factors and the surrounding social
environment (Omoto & Packard, 2016; Solomon, 2004).
Self-determination theory (SDT; Deci & Ryan, 2000), a macro theory of motivation,
can be used to explain human motivation. Two sub-theories of SDT include Basic
psychological needs theory (BPNT) and relationships motivation theory (RMT). BPNT
explains that the origins of self-determined forms of motivation are based on three innate
psychological needs (Deci & Ryan, 2000); autonomy (feelings of volition and free will),
competence (feeling effective in carrying out behaviours and handling situational demands)
and relatedness (a need to feel related and connected to others) (Ryan, Patrick, Deci, &
Williams, 2008). These three needs are complimentary to optimal psychological functioning
and their need satisfaction is fuelled by an individual’s social context ( Ng et al., 2012).
Opposingly, need thwarting, a negative experiential state described as ‘feelings which arise
when individuals perceive their psychological needs to be actively undermined by others’ is
likely to lead to maladaptive outcomes (Bartholomew et al., 2011).
RMT specifically focuses on relatedness need satisfaction (Ryan et al., 2008). This
sub-theory of SDT posits that human social interactions are not only desirable for most
individuals, but in fact essential for one’s psychological adjustment and wellbeing (Ryan et
al., 2008). MHSU can benefit from opportunities for social interaction to combat feelings of
isolation (Hayes, Hawthorne, Farhall, O’Hanlon, & Harvey, 2015). Using these two sub-
theories to explain our findings, the current study will extend the literature by exploring
motivation which underpins peer volunteering with MHSU in a PA context.
SDT theorists argue that if motivation was simply studied as a unitary quantitative
construct, an essential dimension of the quality of human motivation would be missed, (i.e.,
the degree to which individuals experience either self-determination or control when
regulating a behaviour such as peer volunteering; Ryan et al., 2008). SDT therefore suggests
that human motivation and behavioural regulations lie along a continuum of ranging from
controlled to more self-determined forms of motivation (Güntert et al., 2016).
Self-determination theorists assume quality of motivation affects a variety of
behavioural and psychological outcomes, with self-determined motivation associated with
increased overall functioning, personal growth, and both physical and psychological health
(Ryan et al., 2008). SDT has been used to address the link between motivation and the
wellbeing of volunteers in a number of prosocial studies (Bidee et al., 2013; Güntert et al.,
2016; Millette & Gagné, 2008). In a volunteering context, autonomous motivation has been
linked to positive outcomes such as individuals’ intentions to continue volunteering (Stukas
et al., 2016) as well as volunteers’ work effort (Bidee et al., 2013). Quality of motivation may
explain why motives are differentially associated with need satisfaction and therefore
motivation to volunteer (Guntert et al., 2016). However, the mechanisms underlying these
associations, and how they are experienced by the individual remain unclear and little is
known about the degree to which motivation to volunteer is self-determined, or how peer
volunteering affects volunteers’ subjective wellbeing within the context of PA programmes.
SDT acknowledges a qualitative perspective is essential for the complexity of human
motivation (Deci & Ryan, 2000). Qualitative research can provide insight into how
psychological need satisfaction, quality of social relationships and motivation to volunteer
are experienced by people with mental health problems.
Current study
Research has shown an interest in peer support volunteers in recovery-oriented
services (Jacobson, Trojanowski, & Dewa, 2012). However, little is known about helping
behaviours, such as peer volunteering, within community PA programmes aimed to facilitate
mental health recovery (Firmin et al., 2015). Previous research has documented the benefits
of peers providing support through volunteering from the perspective of the peer support
recipients (Dennis, 2003; Oostlander et al., 2014; Read & Rickwood, 2009a) . However, to
better understand individuals’ motivation towards volunteering within mental health settings,
research is required to investigate individual experiences from the perspectives of the peer
support providers. Therefore, this study aims to qualitatively explore volunteers’ experiences
of their role as a peer support provider and motivation to volunteer within a community-based
PA programme for MHSU.
Method
Study design
The present study used a qualitative approach driven by a social constructivist
paradigm. Within this paradigm, the study was rooted in a relativist ontology to understand
the subjective experience of reality and multiple truths (Levers, 2013) where the truth is
relative to a frame of reference (e.g. socially or culturally) and there is a the belief that reality
is a finite subjective experience (Denzin & Lincoln, 2005). This allowed for insight into how
peer volunteers experience peer support from their own perspective, constructing their own
reality through personal experiences to make meaningful sense of the world (Creswell, 2013).
A transactional epistemological view supports this study. By asking peer volunteers to
describe their experiences, multiple versions of reality peer support provision could be better
understood, and motivation underpinning helping behaviours within a PA programme could
be explored. The researcher generated a reality which was co-constructed between
participants and the researcher, where values and beliefs of peer volunteers influenced the
researcher’s chosen actions (Crotty, 1998). Such an epistemological viewpoint acknowledges
that the researcher’s disposition is tied to the interpretation (Levers, 2013). However, the
process of co-construction means data can be analysed in a way to deepen the understand and
explore peer volunteers’ experiences. Again, despite adopting a social constructivist
viewpoint for this empirical chapter, the overall philosophical stance remains pragmatic in
that alternative methods are recognised as being necessary within different aspects of the
thesis overall.
Participants
A purposeful criterion-based recruitment process was conducted. Participants
included 31 (15 male, 16 female) peer support volunteers within the GStG programme aged
between 26 and 65 years (M age=48 years, SD=9.5 years). Participants were recruited from
local programme delivery sites across four regions in England (Midlands n=10, London n=5,
North East n=8 and North West n=8) and had a range of mental health diagnoses including
depression (n=6), anxiety (n=6), stress, (n=5), personality disorder (n=2), bipolar disorder
(n=1), and obsessive-compulsive disorder (OCD; n=2). The length of time as a peer support
volunteer ranged from six to 20 months.
The peer volunteering role required tailored training and supervision to ensure peer
volunteers felt confident they can work safely to support participants who may have a range
of mental health problems. Prior to the start of the programme, a brief was provided to the
eight local Minds outlining the core areas of training for the peer volunteers involved in the
GStG programme and sets out optional areas which can be incorporated depending on the
experience that already exists within the volunteer group. These suggested core areas to be
included within volunteer training are outlined in Table 1.
Table 1. Volunteer induction training core areas and descriptions of the core area
components
Core training areas Components of core training area
Introduction to the
GStG programme
How sport and PA
helps people with
mental health
problems
Key qualities of a peer volunteer
Effective communication
A
brief
overvi
ew of
the
progr
amme
and
how
the
peer
volunt
eer
role
fits
within
it
Programme
aims,
objectives and
timescales
Introductions
and icebreaker
Why people
wanted to
volunteer on
GStG?
The
Natio
nal
conte
xt and
why mental health important to the funder (Sport England)
Successes from phase one and the impact GStG has had on past
volunteers
Support from Mind e.g. Elefriends, sharing good practice, the
wider evaluation
The importance of the peer volunteer role and the benefits
previous volunteers have taken from the role
Benefits that sport and PA can have on MH, common barriers
to participations, and the ways in which volunteers can work
with participants to sustain long-term participation
Group exercise to explore the commonly held perceptions of sport
Different benefits that sport and physical exercise can bring
Barriers to sports participation including supporting and
signposting participants into community activities
Overview of local sport partners involved in GStG and what they
can offer
Peer volunteers to develop a shared understanding of the role and
subscribe to the key qualities they identify as being vital to the
role
Group exercise to explore key qualities and review them in light of
their volunteer role description
An exploration of values and attitudes around areas such as
being non-judgemental, prejudice, tendencies to stereotype
Effective communication necessary to build a rapport with
participants and understand their goals and hurdles as they move
through the programme
Listening – barriers to listening, concept of active listening, what
makes a good listener?
Different question types and how to use them
Non-verbal communication/body language – links to active
listening
Importance of positive feedback
Goal setting Participants will be asked to set personal goals and peer volunteers
will need to understand how they can support participants to set
and achieve their goals
What are goals and why have them - how goals contribute to
greater motivation
SMART goals
Reviewing goals
Safeguarding and
keeping people safe
How volunteers can
support research
Confidentiality and
data protection
Supporting volunteer
wellbeing
Ensure peer volunteers have a good working understanding of
safeguarding policies and how they can apple them to their role to
benefit both volunteers and participants
Defining abuse – categories and indicators
How to record and report instances of abuse
Keeping yourself safe – lone working, awareness of risks, setting
boundaries
Key contacts
Overview of relevant sections of organisation policies and
procedures
Address the evaluation and monitoring requirements of the
programme and the role that volunteers will play in supporting
data collection (e/g., information staff of what works, best
practice
Importance of recording outcomes
Overview of how volunteers can support participants with the
resources (e.g., PARQ)
Paperwork that will need to be completed as part of their role
Ensure volunteers understand data protection policy and how it
should be applied in their role for the benefit of their local Mind,
participants and themselves
Overview of the relevant sections of their local Mind’s
organisational policies and the Data Protection Act
Consequences of breaking confidentiality or the breaching of data
Circumstances when they might break confidentiality without
consent and the reasons why
Support their local Mind can offer volunteers and an opportunity
to explore how volunteers can support each other
Ways the volunteers will formally be supported i.e., supervision
sessions, catch ups, tips on helping volunteers make the most of
their supervision
An exercise to look at how the volunteers want to support each
other as a group
Through Mind centrally, the development and delivery of volunteer training was left
up to each individual local Mind. Therefore, training was bespoke and intended to be flexible
acknowledging that different local Minds required different support needs. Each of the local
Minds decided on how each of these areas would be delivered to fit in with their own existing
volunteer induction training. For example, some local Minds included the volunteer training
as part of their standard volunteer induction and therefore a set training session or process to
follow was not prescribed. Thus, peer volunteers constructed their own understanding of the
role and how they might achieve the core areas as included within the training suggestions.
The volunteering role was based on individuals perceived understanding of the role
requirements which as a result, may have shaped both volunteers’ and participants’
experiences of peer support within GStG. Therefore, each local Mind delivered both the
programme and training differently.
Procedure
Ethical approval was obtained from a Research Degrees Board of a University in the
East Midlands of England. All peer volunteers from the GStG programme were invited, via
email, to participate in one of four focus groups at their nearest programme delivery site.
Alternatively, participants could opt to have a one-to-one telephone interview with the
research team. Four participants chose this option.
A semi-structured interview schedule was developed in consultation with a Lived
Experience Panel representing a variety of mental health backgrounds. Such a collaborative
approach is consistent with the ethical standards for research involving individuals with
mental health problems (Davidson, Ridgway, Kidd, Topor, & Borg, 2008). The interview
questions explored participants’ motivation to volunteer, their personal relationship with
sport and exercise, perceptions of their role as a volunteer, experiences with examples of
their roles and how they themselves had been supported throughout their role. The questions
were designed to be open-ended and non-leading, such as ‘How have your own experiences
of mental health shaped your role?’
Each focus group was conducted by the same two interviewers and lasted between 60
and 90 minutes. The telephone interviews lasted between 30 and 40 minutes depending on
the individual’s level of engagement and expression. With permission, all focus groups and
interviews were audio recorded. Field notes were collected to record both descriptive
(observations, behaviours and facial expressions) and reflective (researcher’s thoughts,
concerns, ideas) notes providing further meaning and understanding to the context being
explored (Emerson, Fretz & Shaw, 2001).
Analysis
Interviews were transcribed verbatim and analysed using thematic analysis following
guidance from Braun and Clarke (2006). The flexibility and variability of thematic analysis is
useful within applied research where a complex phenomenon (e.g., PA, peer support and
mental health) is less understood (Braun & Clarke, 2014). The themes developed required a
level of interpretation from the researcher to reflect meanings attributed to the experience of
the participants (Marks & Yardley, 2004). Although presented as a linear,
step-by-step procedure (Braun & Clarke, 2006), the research analysis was an
iterative and reflexive process (Fereday & Muir-Cochrane, 2006).
A hybrid approach of inductive and deductive thematic analysis was
adopted, whereby an inductive approach was used to identify themes before
returning to the literature and using theory to deductively help explain the themes
further (Gale, Heath, Cameron, Rashid, & Redwood, 2013). As a result, peer
volunteers’ experiences were analysed and categorised into hierarchical themes
reflecting individual experiences particularly pertaining to motivation of being a
peer volunteer in a community-based PA setting.
