Within this cluster it was argued that: ‘Success of the programme, from the point of view of the participants, was due to the content of the learning being chosen by the participants and not imposed by the facilitator’.121, Findings from the Diabetes Sharing Stories79 and Healthy Living Older People clusters80 suggest that involvement in the planning stages can engender a greater sense of ownership by those delivering and receiving the peer-support intervention, and this could be a factor in encouraging participants to continue their involvement with peer-support interventions. Although the original recruitment model was followed initially: . Propositional statement Training that is tailored to meet individual and group learning needs is perceived as more relevant by peer supporters. . The included studies covered a wide range of types of recruitment with variation in how PSs themselves were recruited and also in how they, themselves, might be further used to recruit more PSs or participants to the programmes. Logistical planning and project support included consideration of the help needed with child care, travel expenses, language barriers, setting and organisational factors (such as attitudes, funding, resources, etc.). Authors of the Diabetes Sharing Stories programme discussed how the project team engaged with the wider NHS organisation when developing and trialling the intervention. One smoking cessation programme was located in secondary schools, where support activities can be integrated with daily routines.128 Conversely, settings that require activities to conform to existing routines – such as some of the breastfeeding programmes that were reviewed – can constrain the ability of PSs to gain access and implement support.127. Where these processes were used, engagement could lead to a feeling of collective ownership over the design process. Participant recruitment and participation may not work when the values of the institution hosting the intervention are in conflict with the health issue that is being addressed. Some men described the scene as being tribal, or based around clans or . For example, breastfeeding project teams commissioned the La Leche League to provide their peer-support programme and, consequently, in developing a recruitment process for potential PSs.123 Clearly, such an approach has advantages if the local programme can draw upon its experience and local connections for recruitment, but there may also be potential disadvantages depending on how the local organisation is perceived. For example, the Smoking in Schools programme was delivered within the school setting,128 whereas the Breastfeeding cluster was delivered both within the hospital and in community settings, often via breastfeeding drop-in centres. . The propositions for recruitment (Table 10) both build upon and add to the propositions that were identified at the stage of programme design. Reading cases is one important way that you will learn the law, and case synthesis is the act of connecting the elements in the cases you have read to create an understanding of the law as a whole -- you should work to identify the relevant pieces of authority for a legal issue and put the corresponding pieces together to determine a framework that reasonably supports the legal issue in question. Many barriers to recruitment of PSs are mirrored more widely in difficulties in recruiting participants more generally: The negative perception concerning smoking may have been a barrier for recruitment and participation. .’.108. When this happened it created an environment in which PSs felt that their experiential knowledge was recognised and valued. The people who participated in training came from many walks of life. The Diabetes Sharing Stories cluster79 described development of their programme using action research processes, working with staff who would deliver the peer-support programme (in this case, bilingual health advocates). It’s best to have no rules or limitations about who can join or what you have to do (e.g. They agreed that ‘being valued to be part of it and being trusted to be part of it’ was key to becoming a peer supporter (Advisory Network #11) (Figure 16). This will help researcher better identify the similarities and differences of cases (Yin, 2014). When using cross-case synthesis, Yin (2014) suggests that it’s better to create a table about all the cases and categorize them. second step is to cross analyze each conclusion. . The engagement process promotes more relevant and appropriate interventions that are better targeted to community needs. For the purposes of this review, the design stage is considered to end once the programme begins, people are recruited to the programme and the training of PSs has occurred. Support for the proposition that involving stakeholders at an organisational level in the development of a peer-support intervention through regular updates and dialogue leads to the intervention being more easily embedded within existing service provision: Understanding the wider cultural context in which a programme would be delivered was discussed by several authors. Cross-synthesisis the technique of impressing the spectral envelopeof one sound on the flattened spectrumof another. At the same time, the study contributes to theory development by integrating two competing theories. Peer-led interventions that recruited older PSs appeared to encounter fewer barriers to recruitment. At first it was a usefu . . The PSs were very dependent upon professional staff in the broader NHS context to ‘buy in’ to the initiatives, and ‘in some cases there was palpable resistance from middle management to what was seen as a radical new service model’.79 When there was a lack of support from management, it was difficult for groups to become embedded in the service model. For example, in the Diabetes Sharing Stories programme: ‘. . Although the idea of experiential learning appears to be new, it embodies the notion of drawing upon experiential knowledge with the outcome of enablement. In some cases a researcher recruited PSs, for example in one study121 a researcher encouraged members of the participant group who were willing to volunteer as peer educators (volunteer peer educator, VPE). A realist review. Our emerging theory for programme design is that when a wide range of stakeholders are involved in the design stage then partnership working may occur, resulting in collective ownership of the design process and more chance that the programme will become embedded in existing service provision. Programmes may have different underpinning rationales that determine appropriate recruitment, for example an initiative may seek to broaden the representation across all sectors of the community, it may identify a target community opportunistically or according to convenience or it may target those perceived to be at greatest risk (from the health problem) or seek to address perceived inequalities. The cross-case synthesis was one of the few viable options given the study’s lack of dependent and independent variables. . They are characterized by their flexible nature, multiple forms of data collection, and are mostly informed by qualitative data. The authors of the nutritional programme for Aboriginal Australians also described that culturally appropriate and accessible interventions can be developed only through community control of the programme or extensive community consultation.122. Propositional statement When cultural needs are taken into consideration during the design stages of peer-support interventions, via formal or informal assessments, programmes are better aligned with community values, increasing the potential that they become embedded in social practice. This aligns with Nutbeam’s assets-based model for HL.15,16 For example, authors of the Diabetes Sharing Stories cluster explained how the intervention built on common cultural beliefs, attitudes and behaviours – rather than trying to ‘remedy deficiencies’,79 whereas authors of the Breastfeeding cluster stated: ‘Bottom up changes in the service model places emphasis upon understanding the local culture and implementing change in a creative, systemic and culturally sensitive way’.127. Recruitment in such cases focuses on identifying and recruiting individuals within the network who have credibility as a PS. The term ‘stakeholder’ may include: Propositional statement Involving PSs and/or peer-support participants as part of the team in the development of peer-support interventions leads to interventions being more relevant to participants needs, and creates a sense of ownership by those delivering and receiving the intervention. Similarly, the UK Feeding Initiative funded breastfeeding programmes to consolidate and expand as part of a national programme.123 The Smoking Fag Ends cluster built on, and aligned its efforts with, national activity to maximise marketing and recruitment to the programme: ‘I remember a couple of years ago we got wind that nationally there was going to be a campaign which would be targeting mothers of young children . Programme criteria for identifying appropriate peers includes the programme designer’s definition of the important characteristics when recruiting peers, as well as practitioners’ and beneficiaries’ perspectives, on the characteristics that need to be sought during recruitment. Such communication skills need to be augmented by interpersonal skills involving the positive building of connections: You need to establish some sort of connection to people who might be interested in becoming peer supporters . Propositional statement Appropriate methods for recruitment of PSs are determined by the cohesiveness of the community that is being targeted. For example, in schools the incentives for completion were a £10 voucher and certificate of achievement for PSs who completed the trial. Authors of the Breastfeeding cluster stated: ‘Senior managers must anticipate resistance when staff see support programmes as a radical new service model. There was some evidence that concerns about being able to perform the task could be alleviated if people were given a clear idea of expectations for the role. J Med Internet Res. The goal of this cross-case synthesis is to explore, validate, and test associations among concepts (Yin 2009). A definition for each programme stage was constructed based on the data reported in the clusters. There is ‘the need for continual reinforcement among health professionals of the potential benefits of a scheme . Some of our cluster studies noted that certain types of topic, for example breastfeeding and risky sexual behaviour, were particularly challenging for PSs to discuss. For example, the opportunity to gain additional qualifications or credentials was viewed positively because of the potential to enhance future employment opportunities. This is how our culture works’.124. In the Healthy Living Older People programme, PSs were quite anxious about the training workshops and their roles.119 Roles were clarified in the initial session, where the programme emphasised that ‘peer educators were not expected to become nutritionists nor try to learn enough about the subject to answer all the nutrition questions that could arise . For example, smoking is taboo to many church leaders, so potential participants – members of the congregation – are then embarrassed about their behaviour and do not want to identify themselves to the church leaders who are facilitating recruitment: ‘However, the negative perception concerning smoking may have been a barrier for recruitment and participation. Training that encouraged a sense of ownership felt relevant to the lives of PSs121 and may have improved their motivation,79 engagement and participation83,128 in the intervention. Propositional statement PSs value training when they perceive it to be of personal benefit to themselves. Communication style and values congruent with the Latino culture were also considered, including: familismo; collectivism; simpatía; personalismo; and respeto.126. .’.79, In some cases, however, use of an existing social setting may not increase participation because the activity is not seen to be congruent with the setting. Cross-Case synthesis and Analysis. those receiving the peer-support intervention. However, this is not always the case. Cross-Case Analysis Methods onto the Literature Review Process Anthony J. Onwuegbuzie (Corresponding author) ... Keywords: Literature review, Synthesis, Data analysis, Data displays, Cross-case analysis, Within-case analysis . Propositional statement Recruitment is successful when a connection is established with potential PSs. . The primary motivation of many beneficiaries for taking part in Altogether Better projects was to meet new people and improve their social networks.113. There is a cross-cutting theme indicating that engagement at all stages increases successful design, recruitment and training. Partnership working in which organisational stakeholders interacted with PSs and participants in some cases facilitated health service ownership and increased the chances that the programme would be embedded within existing service provision. You need to find something in common when recruiting to make individuals feel welcome . Propositional statement Training is more effective when it takes into account the personal needs of peer supporters. of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC 27695 In terms of context, organisations that adopted an inclusive approach by working with relevant stakeholders at the design stage were able to tap into experiential knowledge and codesign approaches to recruitment and training that increased the perceived relevance and appropriateness of the intervention. It was argued that the most successful models of drop-in centre associated with the breastfeeding peer-support schemes were located in a venue ‘that was both acceptable and accessible to the target group of women . Based on the types of bias that are inherent in some study designs we can rank different study designs based on their validity. The nutritional programme for the Health Eating Aboriginal Australians cluster reported that the provision of free transport to the facility promoted attendance to the cooking course and enabled participants to make use of other health facilities at the primary care centre.122, When needs assessments were conducted, programme designers found that peer-support workers were needed who could offer support in native languages. Journal of Educational Issues ISSN 2377-2263 When it comes to training accreditation is an important motivator for many people. We describe a worked example of three such methods where three independent teams synthesized two studies that investigated critical factors of trust in outsourced projects through thematic synthesis and cross-case analysis, and compared these to each other and also to an already published narrative synthesis. . This refers to the knowledge, skills, attitudes or other attributes that were conveyed during the training activities. thematic synthesis in SE as a scientific inquiry consisting of five steps based on the extent literature (See also Table 2). Cross-case analysis and synthesis by stage of programme development, Involving PSs and/or peer-support participants can lead to more relevant interventions and create a sense of ownership, Involving stakeholders in the sponsor organisations, through regular updates and dialogue, can lead to the intervention being more easily embedded within existing services, When cultural needs assessments are conducted during the design stage of a peer-support programme, the design team are able to gain greater understanding of local practices and potential constraints to behaviour change, which may lead to interventions that are better targeted to local needs, When cultural needs are taken into consideration during the design stages of peer-support interventions, via formal or informal assessments, programmes are better aligned with community values and structures, increasing the potential that they become embedded in social practice, When the peer-support venue chosen is one that the peer-support recipients trust then they will attend the programme, Greater participation is enabled when logistical barriers to attending a peer-support programme are identified and addressed during the initial design phase, Aligning peer-support programmes with national policy and advertising campaigns can maximise organisational support, and help programmes to become embedded within existing provision, Clarifying expectations of the role enables people to make informed decisions about becoming PSs, Recruitment is less effective where potential PSs feel uncomfortable about the issues, condition, the prescribed approach to peer support or the objective of improved HL, Conflicting values within a community act as a barrier, Existing commitments may act as a barrier, Payment to PSs reduces the likelihood of programme failure without necessarily ensuring the likelihood of programme success, Non-monetary benefits for self and family (or the community more widely) are effective in recruiting PSs, Older citizens, specifically, are motivated in order to maintain an active life, A feeling of being singled out for attention motivates people to join, Monetary benefits are effective as a mechanism, Potential recruits may see involvement as offering access to social networks, Appropriate methods for recruitment of PSs are determined by the cohesiveness of the community that is being targeted, An inclusive recruitment process will be more credible than one for which there is less community involvement in the process, Recruitment is successful when a connection is established with those who are thinking of becoming involved, Criteria for what is meant by a peer need to be appropriate for the programme and context, Barriers in engaging PSs are mirrored in recruitment of participants, Clarifying expectations for participants in the training, When roles are clarified, anxiety about responsibilities is reduced and confidence in implementing the support programme increases, Training is more effective when it is timed to fit with the recruitment of PSs, Training is more effective when it takes into account the personal needs of PSs, PSs value training when they perceive it to be of personal benefit to themselves, Identifying learning needs and preferences, Training that takes into account the preferences of individuals/groups encourages engagement and participation, Training that is tailored to meet individual and group learning needs is perceived as more relevant by PSs, Building on existing knowledge, skills and attitudes, Training that was designed to build on the pre-existing abilities of PSs maintained PSs’ self-esteem and confidence to deliver the intervention effectively, When PSs contribute to the development of the training programme they have ownership of the process, which increases their engagement with the intervention, Training which incorporates experiential learning gives PSs the skills and confidence to deliver the intervention. 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