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This report explores the 24-hour dietary recall (24HDR) form used for the Expanded Food and Nutrition Education Program (EFNEP). Dietary supplement use, amount of money spent on food, time being physically active, portion size consumed, foods reported by meals, and preparation of the meal were common components collected among 61 EFNEP programs. Components not included were instructions for the peer educator, use of food models/measuring cups, examples of foods/beverages, time food/beverages were consumed, color coding, and a prompt to review what was written. A standardized 24-hour dietary recall form with training protocols is recommended to uphold the integrity of data collection.

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Objective To investigate the general well-being of breast cancer peer educators and to analyze its influencing factors.Methods Convenience sampling method was used to select 210 breast cancer peer educators from 8 tertiary hospitals in China from January to February 2023.General information questionnaires,General Well-Being Scale,Cornor-Davidson Resilience Scale,and Social Support Rating Scale were used for investigation.Multiple linear regression analysis was used to explore the influencing factors of the general well-being in peer educators of breast cancer.Results A total of 206 breast cancer peer educators were investigated.The general well-being score was(86.70±14.08).The results of multiple linear regression analysis showed that psychological resilience,the utilization of social support and the current self-funded treatment of less than 1,000 yuan per month were the influencing factors of general well-being(P＜0.001).Conclusion The general well-being of breast cancer peer educators is at a high level.Improving the social support system for breast cancer patients,selecting peer educators with strong psychological resilience,high utilization of social support and low self-funded treatment,and paying attention to the psychologic status of peer educators,providing timely and positive psychological interventions will help to raise the general well-being of breast cancer peer educators and ensure the quality and continuity of peer education.

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OBJECTIVE: Determine acceptance of unfamiliar recipes and investigate the practicality of a hybrid (remote and in-office) method of evaluating recipes. METHODS: Peer educators from the University of Georgia's Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education programs used a hybrid home-use test method to evaluate 8 recipes before and after preparation and tasting. We collected perceived and actual measures of recipe acceptance. The main outcomes included overall liking and preparation behaviors, analyzed using nonparametric approaches. RESULTS: No significant differences (P > 0.05) were found between prepreparation and postpreparation overall liking or preparation behaviors for each recipe, supporting the practicality of the method. Liking of recipe preparation exceeded 7 out of 9 for all recipes, but ratings for recipe preparation willingness and perceived program participant ratings decreased after tasting. CONCLUSIONS AND IMPLICATIONS: Although tasting new recipes is necessary to determine specific modifications, a hybrid recipe evaluation format is practical for introducing new recipes to peer educators when resources are limited.

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Objective: The current study evaluated the long-term effectiveness of a peer delivered suicide prevention gatekeeper training program for college students. Participants: 1,345 undergraduate students (Mage = 20.24, SD = 3.27; 89.6% White) received the peer led training during a single class-period. Method: Participants completed pre- post- and 3-month follow-up surveys assessing knowledge, perceived intervention skills, willingness to intervene, and self-efficacy. Engagement in gatekeeper behaviors were assessed at follow-up. Two open-ended questions provided data for qualitative analysis. Results: Both quantitative and qualitative data indicated that participants showed substantial increases in all outcomes from pre- to post-training, and these gains were maintained at follow-up. Participants reported engaging in gatekeeper intervention behaviors at follow-up and qualitative results provide evidence this was due to the training. Conclusion: Peer led suicide prevention gatekeeper training is feasible, appears to be effective, and can enhance campus' capacity to provide sustainable suicide prevention programming on campus.

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This study of a South Asian community in the midwestern USA examines what bystanders do when they witness an incident of intimate partner violence (IPV). Because of ethical and safety constraints, in lieu of observation in a natural setting, data were collected at a Peerformance, a peer-led IPV prevention program, using the forum theatre method introduced in Augusto Boal's Theatre of the Oppressed. Event attendees were invited to respond to an IPV incident enacted by peer educators in which a controlling husband's behavior escalates to the point of suggesting physical violence. Using a grounded theory approach, we analyzed the videotaped bystander actions while applying pertinent aspects of visual analysis. Event attendees responded in variety of ways, exploring and/or de-escalating the situation, providing information, and encouraging the couple to resolve their conflict and/or seek outside help. They expressed empathy, support, and (dis)agreement with the husband and the wife. Their actions encompassed a number of dimensions: introductory, investigative, supportive/empathic, informational, instructional, instrumental, and confrontational. Participants' vastly varied responses to IPV within the same scenario suggest difficulty in developing a generic IPV bystander program. The findings also suggest possible directions for developing bystander programs to address IPV. In lieu of prescribing and/or proscribing specific actions in a given risk situation, bystander training can help participants build their repertoire of actions while collectively examining the strengths and limitations of various actions in their sociocultural context. Such bystander training is complex and difficult to manualize; it will involve reflexive and critical discussions and learning and trying out various possible alternatives. A Peerformance is a site of action, a realistic and familiar milieu where community members can imagine and try out interventions that may be different from the norm of indifference and non-intervention. It can open up new possibilities for addressing IPV in diverse communities.

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AIM: To compare the effect of school-based education programs, by peer group versus health practitioner on Premenstrual Syndrome (PMS) in adolescent girls. DESIGN: Non-masked three-armed clinical trial. METHODS: Ninety 11th-grade students with moderate to severe PMS will be allocated to Intervention Group 1 (IG1), Intervention Group 2 (IG2) and Comparison Group (CG). Three weeks (six online sessions) of parallel education will be implemented in IG1 by trained peer educators and in IG2 by a health practitioner. The primary outcome will be changes in PMS severity score between three groups over time (measured by Daily Record of Severity of Problems). Secondary outcomes include changes in Premenstrual Dysphoric Disorder and General Health. Data collection will be conducted in two-time points, at baseline, and at the end of the intervention. RESULTS: Our study will explore the effect of school-based education programs, by peer group versus health practitioner on PMS. This will add to the evidence-based interventions to PMS management and the effectiveness of peer education in health promotion of adolescents girls.

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BACKGROUND: Native Hawaiians and Pacific Islanders (NHPIs) experience a disproportionate burden of type 2 diabetes and related complications. Although diabetes self-management education and support (DSMES) interventions have generally yielded positive results, few NHPIs have been included in these studies, and even fewer studies have been evaluated using a randomized controlled trial design and/or implementation research methods. The purpose of this pilot study was to evaluate implementation outcomes of a culturally adapted diabetes self-management education intervention delivered by peer educators to Native Hawaiians and Pacific Islanders residing in Honolulu, Hawai'i. METHODS: In three study sites, the peer educators and 48 participants randomized to the intervention were invited to participate in the mixed methods implementation research. We used a convergent parallel design to collect implementation data including fidelity, feasibility, acceptability, appropriateness, adoption, and sustainability. Data were collected from class observations, participants' class feedback, and post-intervention focus groups with participants and peer educators. RESULTS: In 314 end-of-class feedback surveys, 97% of respondents expressed that they were satisfied or highly satisfied with the class content and activities, 98% reported that the classes and materials were very useful, 94% reported very applicable, and 93% reported materials were culturally appropriate. Respondents identified several aspects of the program as especially enjoyable: interactions with peer educators, meeting in groups, learning about other participants' experiences with diabetes, and the information presented in each class. Major themes that emerged from the end-of-intervention focus groups were the relevance of the educational materials, strategies to manage blood glucose, hands-on activities, cultural aspects of the program, including the stories and analogies used to convey information, and appreciation of the group format and peer educators. CONCLUSIONS: Results from this research support a culturally tailored, peer educator approach to DSMES among NHPIs. Delivery of the Partners in Care program is feasible in health care and community settings and is a reimbursable DSMES program. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01093924 prospectively registered 01.20.09.

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There is a debate in scientific literature about the effectiveness of a peer-led approach to anti-bullying interventions. In order to understand which circumstances and for whom these approaches work best, the present study was carried out within the NoTrap! anti-bullying program. Using a cluster design, classes were randomly assigned into two different peer educator recruitment strategies: volunteering (N = 500; 48% females; mean age = 13.5 years, ds = 1.3) vs peer nominated (N = 466; 38% females; mean age = 13.9 years, ds = 1.3). Results showed that voluntary peer educators suffered a higher level of victimization, while the nominated ones tended to be more popular and likable. Furthermore, a set of linear mixed-effect models showed that the program was effective in reducing bullying and victimization, and in increasing defending behaviour only in the voluntary recruitment condition. On the contrary, in classrooms under the peer nominated recruitment condition, bullying and victimization remained stable, and defending behaviour increased only for peer educators, but not for their classmates. This implies that the step of peer selection and recruitment must be kept into consideration in developing and validating an intervention, because of its possible impact on the effectiveness of the whole intervention.

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Despite numerous health challenges, African healthcare systems are faced with limited financial and human resources. In this context, the epidemiological transition witnessing an explosion in the prevalence of non-communicable diseases, particularly diabetes, there are tremendous challenges to be met. Given the lack of human resources in these health systems, therapeutic education relies on networks of trained peer educator patients who also provide significant psychosocial support.

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Within community-engaged research, education and social care, peer models that partner with local "insiders" are increasingly common. Peer models are composed of insider "lay" community members who often share similarities or background with a project's target population. Peers are not academically trained, but work alongside researchers and professionals to carry out specific tasks within a project, or in the truest sense of partnership, peers collaborate throughout the project from start to finish as an equal member of the team. Although peer models are used widely, the literature lacks consistency and clarity. This systematic review of literature used a qualitative thematic synthesis to examine and report how, where and why peer models have been used in research, education and social care. We examined the language and titles used to describe the peers, details of their involvement in community-engaged projects, the setting, content/topic of study, level of engagement and related benefits/outcomes of such models. Focusing on the last 10 years, we conducted a comprehensive literature search twice between September 2016 and June 2017. The search resulted in 814 articles which were assessed for eligibility. Overall, 251 articles met our inclusion criteria and were categorised into three categories: empirical (n = 115); process/descriptive (n = 93); and "about" peers (n = 43). Findings suggest that there is a wide variety of peers, titles and terminology associated with peer models. There is inconsistency in how these models are used and implemented in research studies and projects. The majority of articles used an employment peer model, while only a handful involved peers in all phases of the project. The results of this literature review contribute to understanding the use, development and evolution of peer models. We highlight potential benefits of peer models for peers, their communities and community-engaged work, and we offer recommendations for future implementation of peer models.

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BACKGROUND: Peer outreach harm reduction initiatives are being developed with and for people who use drugs in Dakar, Senegal. This is in response to growing injecting drug use across the West Africa region and linked emerging epidemics of HIV and hepatitis C. We undertook formative qualitative research to explore the feasibility and potential of peer outreach in this context and in particular how outreach could be linked to fostering community-level processes of change. METHODS: We undertook a total of 44 semi-structured qualitative interviews. Thirty-four interviews were with people who used drugs (comprised of 25 participants who had injected at least once in their life) and included 11 peer educators who delivered "awareness-raising" harm reduction activities. We also interviewed 10 service providers involved in the planning and monitoring of peer outreach initiatives. We used thematic analysis to identify key characteristics of how peer-led outreach is being delivered, beneficiary need, and the nature of the social networks in which the awareness-raising activities operate. RESULTS: Through interviews with peer educators, people who use drugs, and service providers, four main overlapping themes are identified as follows: peer educators as a bridge to responsibilization through awareness-raising activities, awareness-raising activities as an enactment of recovery, awareness raising through social network diffusion, and the contexts and constraints of peer outreach engagement through awareness-raising activities. CONCLUSIONS: The study results suggest that peer education is on a trajectory to develop into a central role for harm reduction interventions in Dakar, Senegal. This research shows how peer education is bound in processes of responsibilization and self-change, which link to varying possibilities for risk reduction or recovery. For peer education to achieve a range of significant goals, broader structural and system changes should be implemented in the region. We caution that without such changes, awareness-raising activities and the role of peer educators may instead become part of state- and agency-sponsored processes of seeking to responsibilize individuals for health and harm reduction.

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BACKGROUND: Although opioid-dependent patients are disproportionately impacted by hepatitis C (HCV), many do not receive treatment. In addition to HCV treatment-access barriers, substance-using patients may be reluctant to pursue treatment because of wariness of the medical system, lack of knowledge, or stigma related to HCV treatment. Implementation of a formal peer education program is one model of reducing provider- and patient-level barriers to HCV treatment, by enhancing mutual trust and reducing stigma. METHODS: We used thematic qualitative analysis to explore how 30 HCV patients and peer educators perceived a HCV peer program within an established methadone maintenance program in the USA. RESULTS: Participants unanimously described the program as beneficial. Participants described the peer educators' normalization and dispelling of myths and fears around HCV treatment, and their exemplification of HCV treatment success, and reductions in perceived stigma. Peer educators described personal benefits. CONCLUSIONS: These findings indicate that HCV peer educators can enhance HCV treatment initiation and engagement within opioid substitution programs.

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BACKGROUND: Participation is an accepted means of increasing the effectiveness of public health programs, and as such, it is considered an important component of HIV interventions targeting at-risk youth. The situation of young women sex workers in Thailand is alarming on many fronts, including that of HIV risk. As a result, HIV programs in Thailand are the key interventions undertaken in relation to young women sex workers' health. A small-scale study used semistructured interviews to explore the participation reports of five young women sex workers, as well as the related views of two community support workers, who lived and worked in Bangkok, Thailand. DISCUSSION: This study is considered in the light of current research on - as well as new opportunities and challenges offered for - participation by vulnerable groups in the context of digital society. Thematic analysis of the interview data identified barriers to participation, including the illegality of sex work, fear, and lack of trust of the authorities, as well as widespread social stigma. Such barriers resulted in young women seeking anonymity. Yet, promisingly, young women positioned themselves as experts; they are involved in peer education and are supportive of greater involvement in HIV programs, such as further educational initiatives and collective actions. CONCLUSION: There is a need for a more empowerment-oriented participation practice positioning young women sex workers as expert educators and codecision makers within a model of participation that is also accountable, such as including young women as members of program boards. Beyond current norms, there are new opportunities emerging because of the increasing availability of smartphone/Internet technology. These can support activist and codesign participation by young women sex workers in HIV programs. However, any developments in participation must maximize opportunities carefully, taking into consideration the difficult social environment faced by young women sex workers as well as the need for strategies to address illegality and stigma.

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OBJECTIVE: Inclusion in work and education remains problematic for many people with a mental illness. We describe a structured programme - the Health Optimisation Program for Employment - that supported people with a mental illness to gain employment or commence studies. METHOD: Twenty hours of the Health Optimisation Program for Employment were delivered to 600 individuals. Participants were asked to complete an evaluation survey encompassing vocational status and ratings of self-efficacy. RESULTS: Of the 364 participants who completed the baseline assessment, 168 responded to the evaluation survey 6 months after the delivery of the Health Optimisation Program for Employment. Of these, 21.5% had started a new job, while a further 42.8% were either volunteering or studying. Satisfaction with the programme was high and self-efficacy ratings improved significantly over the short term only. CONCLUSIONS: The Health Optimisation Program for Employment requires further evaluation using rigorous scientific methodology but these initial results are encouraging in terms of vocational attainment for people with a mental illness, in the Australian context.

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BACKGROUND: The increasing prevalence of chronic diseases puts a high burden on the health care systems of Low and Middle Income Countries which are often not adapted to provide the care needed. Peer support programmes are promoted to address health system constraints. This case study analyses a peer educator diabetes programme in Cambodia, MoPoTsyo, from a health system's perspective. Which strategies were used and how did these strategies change? How is the programme perceived? METHODS: Data were collected through semi-structured interviews with patients, MoPoTsyo staff and peer educators, contracted pharmacy staff and health workers, health care workers and non-contracted pharmacists and managers and policy makers at district, provincial and national level. Four areas were purposively selected to do the interviews. An inductive content analysis was done independently by two researchers. RESULTS: MoPoTsyo developed into three stages: a focus on diabetes self-management; a widening scope to ensure affordable medicines and access to other health care services; and aiming for sustainability through more integration with the Cambodian public system and further upscaling. All respondents acknowledged the peer educators' role and competence in patient education, but their ideas about additional tasks and their place in the system differed. Indirectly involved stakeholders and district managers emphasized the particular roles and responsibilities of all actors in the system and the particular role of the peer educator in the community. MoPoTsyo's diagnostics and laboratory services were perceived as useful, especially by patients and project staff. Respondents were positive about the revolving drug fund, but expressed concerns about its integration into the government system. The degree of collaboration between health care staff and peer educators varied. CONCLUSION: MoPoTsyo responds to the needs of people with diabetes in Cambodia. Key success factors were: consistent focus on and involvement of the target group, backed up by a strong organisation; simultaneous reduction of other barriers to care; and the ongoing maintenance of relations at all levels within the health system. Despite resistance, MoPoTsyo has established a more balanced relationship between patients and health service providers, empowering patients to self-manage and access services that meet their needs.

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African-American women continue to be disproportionately affected by HIV-related morbidity and mortality. To address the burden of HIV/AIDS among this at-risk population, there is need to gain a better understanding of the factors that influence and affect their care-seeking behavior and specifically adherence to antiretroviral treatment. A preliminary qualitative study was conducted with a sample of the target population (n = 10) using grounded theory as the methodological approach. Similarly, 21 healthcare providers - physicians, pharmacists, nurses, and case managers - were then interviewed. A thematic analysis of the transcripts compared care-provider perceptions and narrated experiences with those from the patient participants. Themes related to patient care perceived to enhance medication adherence included (1) provider-patient relationship; (2) holistic and patient-centered care; (3) adequacy of patient education and counseling; (4) modeling adherence behavior; and (5) motivation. Two intervention strategies are proposed - Peer educators as an integral part of the care team and Patient Advisory Groups as a feedback mechanism to enhance effective delivery of patient care in the target population. This exploratory research lays a foundation for the design of targeted interventions to improve linkage to care and enhance medication adherence in African-American women living with HIV/AIDS.

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