Trustworthiness: Judging qualitative research
Traditionally, the quality of qualitative research has been judged on measurement of
the adherence to criteriological measures of trustworthiness and validity (Lincoln & Guba,
1985). However, this position has been challenged due to the argument that qualitative
research should not be judged using a standardised, universal criteria as interpretative
research stands alone from positivist views based on the nature of ontological and
epistemological assumptions (Smith, Sparkes & Caddick, 2014). Qualitative researchers
argue that theory-free knowledge is not possible when capturing in-depth qualitative data and
therefore research must challenge how rigour is developed and qualitative work is judged
(Smith & McGannon, 2018).
We aimed to demonstrate research-specific criteria such as characterising traits of rich
rigour, sincerity, credibility and transparency (Smith et al., 2014). In practical terms, this
meant peer debriefing was adopted to challenge biases and meanings derived from
interpretation of the data was achieved through conversations with a fellow researcher to
collaborate, critique and reflect upon themes, and thus reflecting credibility. Transparency
was provided through reporting a detailed description of findings. Direct quotes were
provided throughout the results to allow the reader to judge quality of data by opening up the
text for interpretation whilst attempting to achieve aesthetic merit and coherence. Self-
reflexivity was carried out by the researcher which involved critically reflecting on one’s own
ideas, views and biases to enhance transparency and sincerity throughout the research
process.
Results
Study 1
Three themes were developed; a social environment for physical activity, shared lived
experience, and a supported mental health journey. Table 4.3 details the key themes and sub-
themes which have been organised into positive and negative experiences.
Table 4.3. Key themes and sub-themes of participants’ experiences of peer support
within a community-based PA programme
Component of PA
environment
The social
environment for
physical activity
Positive experiences of peer
support
All inclusive, safe and non-
judgemental
Vicarious reinforcement –
viewing others as role
models Increased self-confidence
Purpose or identity
Negative
experience
s of peer
support
Internalised
pressure
Session
changes
or cancellations
Controlled styles of
behavioural support
Shared lived experience Quality of connections
Social interaction
Group unity and belonging
No apprehension about
returning to sessions
Dissociation - no follow ups
after missed sessions
De-personalisation
Supported mental health journey
Ongoing peer support
Seek comfort in peer volunteers Understanding personal limits
Initial step to participation Fears for longevity of PA programme
The social environment for physical activity. GStG participants described the peer
supportive PA environment as conducive to their individual learning and development. The
social environment was perceived as being all inclusive and non-judgemental. As a result of
this supportive social environment created by peer volunteers, and exercising with fellow
MHSU, individuals felt safe from stigma or negative judgements. Through vicarious
reinforcement and seeing the benefits that PA engagement had on fellow peers, participants
gained confidence to engage in PA sessions and try out other physical activities within GStG,
“You get that bit of empowerment, maybe to give you that bit of confidence to try and start
and look for other things” (North West, focus group). The peer volunteers were viewed as
role models by MHSU by encouraging their participation in the GStG sessions to seek the
benefits of PA, “If they can show the benefits of exercise, the proven benefits then that’s
good” (Midlands, focus group). MHSU valued and trusted what the peer volunteers said to
them which was further highlighted, “I mean these are experts and I’m trying to pick up what
they’re telling me” (Midlands, focus group).
However, participants also discussed that at times they experienced internalised
pressure to perform at the same intensity as their fellow peers within PA sessions. The
internalised pressure led to excessive PA which further resulted in physical pain and fatigue,
“But when I burnt myself out, I slept for 24 hours. I just knew I did, I was overdoing it then”
(North West, focus group). Individuals expressed the need to get the balance right dependant
on their individual capabilities, “You need to push yourself as well, on some occasions but
it’s knowing when to pull yourself in or when to push yourself. That is about trial and error”
(North West, focus group).
Attending GStG sessions provided participants with a purpose and structure to their
day. The peer supportive environment helped to develop individual feelings of self-worth,
Well gave me a sense of worth, getting up, having something to look forward to and
again meeting other people. Because the weeks and days can sometimes mould into
one if you don’t sort of break it (London, focus group).
However, on occasions, peer volunteers cancelled pre-arranged sessions at the last minute
which were not always communicated to the participants. When there was a breakdown in
communication between participants and paid GStG programme staff and peer volunteers
about changes to the scheduling of PA sessions (e.g., time, day or location), or if a volunteer
was not available to lead a session, participants’ daily structure and continuity was disrupted.
Participants often spoke of their day being centred round a PA session and therefore
spontaneous alterations, or a lack of change updates caused negative consequences for
participants’ engagement, “They’re all talking, they’re all coming up with these great ideas
and then change it in a heartbeat and then everybody gets cocked up” (North West, focus
group).
Participants reported negative experiences of peer support when peer volunteers’
delivery styles did not facilitate a supportive environment conducive to PA engagement, “But
he came in ordering it, like this must be done this way, and I said well you know we don’t do
it this way, and he said to me well, if you don’t like it don’t come” (North West, focus group).
Controlling styles of behavioural support adopted by volunteers within PA sessions led peers
to feel demotivated to engage in further PA. Individuals perceived it was the responsibility of
the peer volunteers to create an environment supportive to MHSU to drive their PA
engagement,
That’s what makes you go isn’t it, whoever’s running it, you know if they’re friendly
and understanding and you have a laugh with them, then obviously you want to go, it
makes you feel like going more but if they’re not very friendly or they’re not giving
you much information, obviously you think like I’ll not bother going (North West,
focus group).
Shared lived experience. The quality of connections developed through social
interaction focused on the shared lived experience of mental health problems being key to
facilitating participants’ engagement. Participants valued being alongside individuals who
understood mental illness and how they might be feeling. Feelings of belonging to a
community enhanced their motivation to sustain engagement in the PA sessions. Interacting
with others appeared to strengthen the social networks between peers, as well as relationships
between the GStG participants and the peer volunteers. Individuals felt valued for who they
were and what they could bring to the PA sessions with their peers, as opposed to being
individuals with a mental illness,
And I also feel like when you do exercise is that you’re just like everybody else there,
you’re not the one, you’re not separate, you’re not the one who’s got the MH
problem, you’re fitting in, everybody’s there to do just one thing, so nobody’s
thinking ‘she’s got MH problems there’, you don’t feel like that, you feel like you’re
part of the group (Midlands, focus group).
Participants explained that if they missed a session due to health or personal reasons, they did
not feel apprehensive about returning due to the shared understanding of individuals’ needs,
“But it’s not somewhere that I’m worried about going back to because again it’s going back
to that non-judgemental approach” (North East, focus group). However, participants
highlighted that if they felt their absence went unnoticed by the peer volunteers, or there was
no follow up to actively encourage them to return to PA sessions, their future attendance
could be affected,
Especially if someone would just give you something to say, well why is X not
coming back? You know, that would have been nice. Because what I find is, the
saddest thing about it, because I didn’t go back to the cycling it actually had a knock-
on effect to the other class I was joining (London, focus group).
Similarly, if messages from GStG staff and peer volunteers were not personalised to that
individual, participants felt dissociated from the group community, devalued and demotivated
towards participating in PA. This feeling was exacerbated if they were prone to feelings of
isolation,
I get texts and I look at them but it’s not personal to me, it was sent out to everyone.
And to me, people that are isolated for whatever reason or finding it difficult to
engage in anything, they need contact, it really doesn’t work for people that are
needing to engage, that’s just the number one. People need to see it, touch it, feel it
(London, focus group).
Supported mental health journey to recovery. Participants reported that an initial
barrier of engaging in the GStG programme was making the initial step of attending their first
PA session, “I think even, you know, coming out your house and then going to the actual
venue and whatever, the project, just the beginning, just that getting there, if you can get past
that…” (North West, focus group). Perceptions of judgement from others attending sessions
was a significant concern for new starters, “Because in the beginning you think you’d walk in
and then you’ve got this sign above your head, I have mental health issues, you know” (North
East, focus group). Once individuals made the initial step of attending a PA session and
experiencing peer support, this particular barrier was reduced, “They did meet my
expectations because they were there to like, even like keep you occupied all the time on the
activity and keep you encouraged” (London, focus group).
Participants felt comfort in knowing there was always someone on hand to provide
guidance and encouragement during and leading up to the PA sessions, “It’s knowing there’s
somebody there, somewhere to go, somebody to help you, to listen to you” (North West,
focus group). One participant provided an example of how a peer volunteer encouraged them
to attend, ‘“could be just a text, could be as simple as a text message or you know, “do you
want me to come along with you today”’ (Midlands, focus group).
Participants discussed that they felt supported throughout their engagement in GStG
sessions as peer volunteers were perceived to fulfil an educator role. MHSU perceived the
peer volunteers to be important in helping them to understand when they were pushing
themselves too hard, and when it would necessary to reduce their exercise intensity, which
participants were not always able to see for themselves,
I know I’m probably at this certain speed but I want to go a bit faster and then I
realised quite quickly that I can’t go this speed, I’m doing too much, so it’s somebody
else looking from the outside and they can see the difference, they said ‘slow down’
(North West, focus group).
However, participants raised concerns over the longevity of GStG and the peer support.
Participants discussed how funding was key to the continuation of the programme and how
they were apprehensive to join a PA programme outside of GStG. This was due to MHSU
feeling safe in the exercise context they were in which fell under the safety umbrella of Mind,
“If I went mainstream, I’d probably end up going back indoors again. It needs [the charity] at
the head. It’s too big a step” (North East, focus group).
Summary of study 1
Study one explored participant experiences of face-to-face peer support within a
community-based PA programme. Each theme - an environment for learning and
development, shared lived experience and a supported mental health journey - were discussed
as both facilitators and potential barriers of PA engagement. For instance, participants
benefitted from communicating with similar others and shared a sense of group belonging
within an inclusive, safe and non-judgemental environment. Participants’ development was
facilitated through seeing fellow peers participate in PA sessions and experience benefits to
both physical and mental health. However, participants also highlighted that their
development could be hindered as they were prone to pushing themselves beyond their
individual capabilities when watching others performing sporting skills successfully. In these
situations, peer volunteers were important in helping MHSU understand their personal limits.
Participants thrived when they perceived to be supported, and the provision of peer
support helped participants to maintain their engagement in the PA programme. However,
some participants raised concerns about discontinued peer support once the programme had
finished and feared joining mainstream activities.
Study 2
Two themes were developed from the phone and online messenger interviews: a
reciprocal relationship and a supportive community environment. Table 4.4 details the key
themes and sub-themes which have also been organised into positive and negative
experiences.
A reciprocal relationship. Participants discussed how the online community
provided a platform to generate reciprocal relationships with other online users. Peer support
was facilitated through a two-way relationship where individuals felt they had a part to play
in both providing and receiving peer support to/from online peers. Sharing and learning from
past experiences, individual advice and suggestions from similar others relating to coping
with mental illness were acknowledged as part of the support,
It’s just nice being able to speak with people that understand it or support others that
are on their journey but a little bit behind you, or talk to others that are a little bit in
front of you and it just gives you that hope that, you know, things can get better
(Participant 12, phone interview).
Participants felt connected to their online peers through their mental health problems, “It’s
good to see others in the same boat, a similar boat” (Participant 1, online messenger
interview). As well as sharing stories about their mental health, participants highlighted how
sharing experiences and successes of PA engagement encouraged other online users to share
their daily activities and engage in conversations about PA,
Well seeing someone post about how great it was to do A or B…then someone else
adds something. Then I think ‘oh I’ll post a photo about my walk around the park’.
Then someone else does…it can have a ripple effect (Participant 1, online messenger
interview).
Participants could choose to post their PA achievements online to share with peers. Positive
feedback from others was valued by the participants, “It felt really sort of special actually,
just noticed and valued and that other people could see it was a big deal for me, and that they
liked sharing in that news of me, and it was nice” (Participant 16, phone interview). Through
shared understanding and lived experience of mental illness, online users appeared to develop
a sense of virtual care and responsibility for others experiencing difficulties,
If someone is struggling and it’s related to something I have experienced personally
then I offer my own personal suggestion or support. But sometimes if I post that I
am struggling then you might get two or three comments to say that they are thinking
of you or they say, ‘I hope you have called the doc or spoken to a friend’ and you
can feel the love (Participant 1, online messenger interview).
However, the reciprocal peer supportive relationships were dependent on participants’ mental
health at that time. If participants felt positive, they were more likely to want to comment on
posts and support other online users,
It depends on my mood when I’m using [online community]. When I’m feeling
positive and go on [online community], I am more able to respond to the posts of
others who are struggling and also respond more positively to those who had their
own positive things to share (Participant 4, online messenger interview).
Additionally, participants’ immediate emotional stability determined how they perceived
comments from their peers or dealt with having no feedback or responses on their own posts.
Posting something online could in fact result in negative consequences on their mental health
and a breakdown of reciprocal relationships. In particular if individuals felt they were
expressing their true identity, regardless of any stigma they had previously faced outside of
the online peer environment, but received no support in return (i.e., likes or comments),
If I’m posting something positive, it’s nice to get feedback but not essential as long as
you get a few likes. If I’m asking for support or commenting about how bad I feel and
you get nothing back, that is depressing. It can be quite bad because you are putting
yourself out there with people who have similar problems and if they have a bad day
too then they may not feel like commenting. Getting no comments or likes makes you
feel worse and like nobody likes you (Participant 5, online messenger interview).
Participants further discussed how they would restrict their online interaction when they had
low mood, to avoid feeling worse, It got to the point I actually found, I could only go on
there if I was feeling strong and if I was having maybe a bit of a wobble, I couldn’t go on
there because I started to, it started to make me feel worse (Participant 9, phone interview).
Supportive community environment. Participants perceived the online community
environment to be a place they could talk freely to peers without worrying about the effect of
what they said had on close friends and/or relatives. Individuals felt they were able to talk
openly because their thoughts and feelings were normalised within the peer supportive
community,
It’s nice to be able to say, especially some things that, if you say them to friends, they
sound, that they’re coming from a very dark place or they sound frightening even
sometimes, and they’re not really, but if you don’t know that situation then you might
feel that, whereas you can say to somebody, this is what happened or this is how I felt
today, without them worrying, without you worrying that they’re going to be
concerned or freaked out if, it’s quite comforting (Participant 16, phone interview).
The online peer community was described by one participant as “very supportive and a bit
like a wider family” (Participant 3, online messenger interview) but with an element of
anonymity, giving individuals the freedom to express and offload within an inclusive, safe
environment while reducing feelings of isolation,
It’s quite nice to kind of just have like a platform where you can be really open and
honest about exactly how you’re feeling without any judgement either. I think
especially with mental health, it always feels like you’re the only person in the world
and then when you look at [online community] you think, oh I’m actually not the only
person in the world, and actually there’s loads of people a lot worse off than I am
(Participant 19, phone interview).
The larger peer community could provide immediate responses, likes and feedback to posts
which they did not always get from personal friends but felt they sometimes needed. The
speed that the feedback was provided was deemed important to the online users,
Sometimes I can message a friend but if they’re busy, it could take a long time for
them to get back to me, whereas on [online community], you’re not actually
contacting one person in particular so there’s quite often somebody that will respond,
just say hello or hi, very rarely that you don’t get a reply at all (Participant 18, phone
interview).
The 24 hour availability of the online community played a crucial role when participants
were at crisis point (e.g., contemplating suicide) and needed immediate support, “I’ve had
some really good support on there and it really has made a difference to me being here and
not being here” (Participant 21, phone interview).
Individuals often worried about other online users if they felt they could not offer
appropriate support because of their own mental health, “It is very easy to get sucked into
other people’s problems and depression. I end up worrying about them and causing myself
more anxiety” (Participant 5, online messenger interview). Posts could trigger a detrimental
effect to a user’s mental health leading to disengagement from the online support,
If it’s a negative, I’ll tend to log off, and there seems to be quite a lot of that, before I
used to feel as though I had to try and help somebody with a negative, feeling down,
but there are times when it starts to pull me down a bit, sort of triggers (Participant
18, phone interview).
Although the wider community was often seen as a positive, some participants found the
community had become too large and online users could not interact with the same
individuals when they regularly logged in. They therefore could not always develop
meaningful connections with peers,
It used to be the same names popping up, now it seems more varied. If you were in a
room with 30 people, you may get to see them all during a 24-hour period. If the room
had 3000 people, you may not (Participant 1, online messenger interview).
Participants predominantly discussed the peer support for their mental health during their
interviews but did also discuss experiences of online peer support for facilitating PA.
Online users felt accountable for their comments or interaction on the community
platform and preferred to have full control of what personal PA information they chose to
share, whether this was positive or negative experiences. The accountability could strengthen
the desire to engage in PA. One participant in particular only chose to share positive
experiences of PA participation in a desire to be positively acknowledged by other online
users,
[online community] can be somebody that you can hold yourself accountable to so
you know, I wouldn’t tell him I hadn’t bothered going swimming but I probably
would tell him if I’d had a really good session swimming, so that accountability and
knowing that somebody is going to notice if I said something nice reinforces my sort
of desire to go I think (Participant 16, phone interview).
The PA information uploaded by Mind acted as a readily available motivational tool to access
at any time, encouraging individuals to engage in PA. However, despite participants
experiencing some initial motivation to be active, the volume of information available to
participants could be overwhelming and have an opposing effect,
The negatives are sometimes there is too much information to deal with, you get
caught up reading everything on the webpage and it’s too much to take in. Then I tend
to shut down and lose motivation again (Participant 5, online messenger interview).
Summary of study 2
Study two explored participant experiences of online peer support as part of GStG.
within an existing online community. Findings unique to study two include a reciprocal
relationship between online users by both providing and receiving peer support. Participants
experienced feelings of care and responsibility towards fellow peers. The anonymity was a
facilitator of perceiving greater control and accountability over their level of access to the
online platform. Findings also indicate the significance of the participants’ mood when they
logged into their accounts on how they perceived the quality of support they received.
The online platform provided 24-hour support to users. However, despite this being
perceived as a benefit by some, participants also perceived the community as too large to
develop supportive connections with other online users. Participants appeared to rely on
immediate feedback from other online users. An absence of comments or likes could have a
negative consequence to participants’ mental health. This supports that although participants’
experiences of peer support are largely positive, both forms (face-to-face and online) can
produce negative experiences.
Through online peer support, participants were able to share their PA achievements,
as well as providing advice and getting information specific to their shared lived experience
of mental health problems. Despite PA information being embedded within the online
platform, participants reported greater benefit of the online peer support on their mental
health, as opposed to enhancing PA engagement.
Discussion
The aim of both study 1 and study 2 was to explore participant experiences of peer
support within a community-based PA programme. Study 1 explored experiences of face-to-
face peer support, whilst study 2 considered online peer support through an existing online
community platform. Both studies incorporated MHSU who were registered participants of
GStG (study 1) or exposed to PA related information (study 2).
Findings from the current studies are in line with previous research and support that
peer support is largely beneficial to individuals with mental illness (Davidson et al., 2012;
Webber & Fendt-Newlin, 2017). Both study 1 and 2 illustrated that a sense of belonging
within a group of similar others could facilitate a positive experience of peer support (Quirk
et al., 2017). Study 2 found that participants favoured the element of anonymity as part of the
online peer support, which is the opposite to the face-to-face support in study 1. Our findings
partly support existing research by Berger and colleagues (2005) which showed that
individuals with stigmatised illnesses were more likely to turn to online platforms for health-
related information due to increased self-disclosure and the absence of self-identifying as an
individual labelled with a mental illness (Berger, Wagner, & Baker, 2005). However, in the
current study, participants did turn to, and benefited from, face-to-face support which adds to
the previous research. An explanation for the differences found in peer support preferences
may be a result of levels of self-stigmatisation MHSU place on themselves (Corrigan & Rao,
2012). Individuals with mental illness have long experienced stigma and discrimination,
however some MHSU did not mind self-disclosing their mental illness by attending the GStG
sessions and experiencing face-to-face peer support. Greater fears of self-disclosure may be
apparent for MHSU who turned to the online social support, demonstrating an underlying
need to seek support for their mental illness, rather than to facilitate PA behaviour. Future
research should consider the role of self-stigmatisation in MHSU experiences of both forms
of peer support.
Current study findings suggested that participants perceived inclusivity as an
important facilitator of positive experiences of peer support within GStG. There is growing
recognition that social inclusion, community participation and citizenship are pivotal to social
and mental recovery (Stevenson, Dixon, Hopkins, & Luyt, 2015) and can increase PA
participation (Quirk et al., 2017). Individuals who are provided with an external focus
directed to PA participation and social inclusion, rather than a narrow focus on mental illness,
perceived more positive experiences of peer support. This is due to MHSU feeling a sense of
normalcy within the face-to-face supportive peer environment, allowing individuals to focus
on the activity they were participating in rather than on how they were feeling.
The main findings reported in study 1 included MHSU perceiving individuals as role
models. MHSU highly valued the peer volunteers which enabled them to feel comfortable in
trusting their word within PA sessions. Further, this demonstrates that peer volunteers were
viewed as ‘significant others’ also described as ‘experts’ by the participants. SDT defined
significant others’ as individuals viewed in a position of authority who can positively impact
motivation towards behavioural adoption, maintenance and adherence towards PA (Duda et
al., 2014). Findings from this study support that peer volunteers were viewed in a position of
authority by MHSU, providing an original contribution to the literature.
Within the peer supportive environment, MHSU reported increased levels of self-
esteem, as well as the development of their self-identity through having a strengthened
purpose. In support of Huber et al., (2018) and research comparing face-to-face and online
peer support groups within cancer patients, current findings showed that face-to-face peer
support was more effective for increasing PA engagement compared to online peer support
because of more effective knowledge exchange. MHSU gained social, psychological and
physical benefits through the face-to-face peer support, whereby social interactions led to
quality connections and a sense of belonging and unity to a group. Regular attendance of PA
sessions and receiving face-to-face peer support led to participants developing familiarity
with their peers and their surroundings. This was different to the online community platform
where MHSU felt part of a larger peer community, despite an absence of familiarity resultant
from its greater number of members.
However, some negative experiences of face-to-face peer support were reported in
study 1. These included participants not being aware of their personal limits when
participating in PA sessions, and feelings of dissociation when participants were unable to
attend sessions and did not receive follow up communication. Research identified that social
networks, based on social support and social connectedness, are associated with higher levels
of mental wellbeing, reduced depression and anxiety, and greater life satisfaction (Grieve et
al., 2013). According to belongingness theory, individuals are driven to develop and maintain
positive social relationships in order to experience a sense of belongingness and to enhance
wellbeing (Baumeister & Leary, 1995). Individuals’ social connectedness is therefore related
to positive psychological outcomes, for example social connectedness being a mechanism
underpinning the relationship between dysfunctional interpersonal relationships and
psychological distress (Lee, 2001). Participants displayed a need to feel noticed when they
were not present at the sessions. However, when MHSU received no contact following a lack
of attendance to PA sessions, this may have inhibited feelings of social connectedness to the
programme community, further leading to negative consequences such as psychological
distress.
It is likely that peer support was not delivered in the same manner within study 1
across each of the local charity sites, due to individual differences between peer volunteers
and that each local charity, although affiliated to the National charity, are governed
separately. Negative experiences of peer support were discussed by MHSU when peer
volunteers demonstrated more controlled styles of peer support delivery. Moreover, peer
volunteers adopted different styles of behavioural support despite the underlying definition of
such support being uniform across the charity sites and their respective GStG participants.
Such controlled styles of peer support were experienced negatively by some MHSU and
resulted in MHSU being less likely to engage in PA. Behavioural styles were not measured
within the study, therefore future research could consider the characteristics and personality
traits of the peer support providers to establish the impact this might have on MHSU’ PA
engagement.
Within study 1, MHSU also expressed their concerns over the longevity of GStG.
MSHU felt apprehensive about participating in mainstream PA when the programme
had finished because they felt safe in the context of GStG but not in mainstream
facilities.
Therefore, when designing future community PA programmes for MHSU, it is important to
consider training sports providers to be better equipped to support MHSU to participate
within mainstream physical activities, particularly through their transition from service user
specific activities to mainstream PA (Castelein et al., 2015). Whilst supporting MHSU, it is
essential to support sports providers within mainstream too. The planning process should
consider how best to translate the strengths of the peer community programme’s
environment, to mainstream PA environments (e.g., allowing MHSU to experience
similarities of the programme within mainstream in preparation for when the community
programme comes to an end).
The online platform in study 2 was used for developing reciprocal supportive
relationships. Such findings are in line with the definition of peer support by Solomon (2004,
pg.393) which described peer support as ‘social emotional support, frequently coupled with
instrumental support, that is mutually offered or provided by persons having a mental health
condition to others sharing a similar mental health condition to bring about a desired social or
personal change’. Participants felt they could use their lived experience to provide support to
others whilst gaining the necessary support in return to help aid their personal mental health
recovery and at times, facilitate their PA engagement. This was a unique difference between
the two types of peer support within the programme. More emphasis was placed upon the
peer volunteers and their responsibility of facilitating the supportive environment for the
MHSU in study 1. Despite volunteers having an unpaid role and having a shared lived
experience of mental health problems, participants perceived them to have more authority
than other programme users. In the absence of peer volunteers to formally facilitate
discussions around PA, participants in study 2 viewed the peer supportive relationship as one
that was of mutual responsibility and both the giving and receiving of peer support was of
equal value to MHSU.
However, such reciprocal relationships were only beneficial to participants if they
perceived their mental health to be relatively stable. Participants tended to access online peer
support during periods of low mood, and therefore did not always feel like they had the
capacity to reciprocate the support. Previous research has shown that the use of social
network resources depends on the successful activation of social ties to others (Lin, 1999).
Individuals activate their social network ties to help manage crisis and uncertainty (Perry &
Pescosolido, 2015) which supports the current findings in that MHSU often reach out when
they are experiencing poor mental health (Perry & Pescosolido, 2015) and log on when
feeling low. However, some participants logged off from the community platform if they
were experiencing low mood as the negative comments served to facilitate further negative
emotions. The current findings add to previous research by providing context and
emphasising differences and the complexity of individuals’ needs.
Within study 2, MHSU were able to discuss the importance of engaging in PA whilst
learning about peers’ exercise experiences which, at times, led to online users feeling
motivated to get physically active. Research has suggested the need to investigate whether
skills learned from peers online translated into tangible and meaningful improvements to
mental and physical wellbeing (Naslund, et al., 2016). Study 2 adds to the literature and
supports the increase of MHSU mental wellbeing; however, online peer support did not
appear to increase PA behaviour. Participants focussed less on peer support for engagement
in PA but primarily used online peer support for coping with their mental illness and
interacted with peers to share feelings and emotions.
MHSU used the platform to seek out advice from peers who may have, or be,
experiencing similar situations relating to mental illness. This provides support to a
comparison study within a sample of breast cancer patients which found that online peer
support had higher emotional expression and advice scores, whereas face-to-face had higher
emotional support and insight (Setoyama, Yamazaki, & Nakayama, 2011). Online peer
support was utilised as a space to express negative feelings and discuss concerns relating to
individuals’ mental illness (Thompson et al., 2016). The online support was beneficial to
MHSU because of its accessibility which was deemed highly important by MHSU. There
were no time restrictions, with access to immediate support from any location. This is in
support of previous research which found that emotional support could be exchanged within
online contexts at any given time with greater accessibility (Vitak & Ellison, 2013). In study
2, MHSU felt emotionally supported by other online users which supported previous research
which found that online contexts compliment emotional support that individuals receive in
offline contexts (Trepte et al., 2014). Online users engaged in multimodal
communication to engage in supporting others’ needs in times of crisis and stress
(Trepte et al., 2014).
However, a different study reported that online users were often reluctant to post
requests for emotional support online due to the fear of being perceived as ‘needy’
(Vitak & Ellison, 2013). The current study opposed these findings, as MHSU chose
to access online peer support to receive emotional support for their mental illness.
Overall, study 2 findings were consistent with previous research which
found that valued social interactions emerged as a perceived advantage of the
peer support.
Opportunities to disclose or express feelings were also seen as a valued benefit
(Griffiths et al., 2015). However, MHSU in study 2 also had negative experiences of
peer support (e.g., reading content that triggered a negative emotional response).
Participants reported that a lack of immediate responses, unanswered online posts or
sharing of incorrect or misleading information about mental health and PA led to
negative emotions. Research has identified the presence of adverse events with
online peer support including emotional and behavioural contagion (Mueller &
Abrutyn, 2015) and negative interactions with others (Naslund et al., 2016).
However, the potential for adverse events within a moderated online peer support
community is a recent area of research exploration and needs further investigation
(Easton et al., 2017). Negative experiences of peer support from study 2 emphasises
the importance for future research to consider online communities being monitored
and moderated as a matter of course to ensure the protection of MSHU when
engaging in online peer support platforms.
Study limitations and future research
This study was not without its limitations. All participants volunteered to be
interviewed in a focus group or as part of a one to one phone interview which could
have introduced an element of self-selection bias. Although this is common in
qualitative research (Charlesworth et al., 2017), it does limit the generalisability to
participants of the programme who were more engaged in the research (Costigan &
Cox, 2001). The researchers aimed to engage participants who had dropped out of
the programme with no success. However, two (out of 37) participants whose
experiences were included in study 1 had lapsed from the programme for periods of
time due to physical and mental health problems. Future research should consider
how to capture the experiences of participants who are less engaged to help mitigate
poor experiences and facilitate positive experiences of peer support within
community PA programmes.
Qualitative data collection methods such as focus groups and phone
interviews require intimate self-disclosure and can therefore lead to a sample
containing individuals that
are more open than others. In particular, research has shown that females are more
likely to put themselves forward to participate, with a higher tendency towards self-
disclosure compared to males (Robinson, 2014). Study 2 had a heavier ratio of
females to males, with 3 males and 18 females being interviewed, supporting the
idea of greater self-disclosure by females through the online messenger interviews
(Robinson, 2014). Effective ways to encourage males to access online support and
recruit them to share their experiences as well as females, should be considered for
future research.
Conclusion
Peer support has been shown to have benefits for MHSU through facilitating
social interaction and group belonging (Quirk et al., 2017). However, little research
has considered the role of peer support in facilitating MHSU engagement within
community PA programmes. This research gave insight into how peer support is
experienced by MHSU within a community PA programme, both face-to-face and
through an existing online community. interventions and programmes that include
peer support within community-based PA programmes can help facilitators towards
PA engagement of MHSU. Programme planners should not only focus on promoting
the positive experiences of peer support offered both in person and via an online peer
support community, but also work to minimise the negative experiences to improve
PA participation of MHSU. These fresh insights are worth considering in designing
more acceptable and effective community-based PA programmes that meet
participants’ needs and expectations.
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