Evaluation of lived experience Peer Support intervention for mental health service consumers in Primary Care (PS-PC): Study protocol for a stepped-wedge cluster randomised controlled trial

Abstract Background The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers. Methods This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3–4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site’s involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site’s involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention. Discussion This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715摘要 背景：澳大利亚心理健康服务需求庞大，且已超出当前从业人员的服务承载能力，致使众多民众难以获取二级医疗保健服务。不过，在二级医疗保健领域，具备自身应对心理健康疾病康复历程的同伴工作者（peer workers）正日益被聘用，旨在凭借自身的康复经历，为其他罹患心理健康疾病的人群及其所在社区提供支持。尽管该模式与全科医生（GPs）及二级医疗保健机构协同提供支持具备潜在益处，但目前同伴工作者在基层医疗中的应用仍较为有限。 方法：本项整群阶梯式随机对照试验（stepped-wedge cluster randomised controlled trial, RCT）旨在评估针对基层医疗心理健康服务的同伴支持干预方案（PS-PC）。澳大利亚境内的四家医疗诊所将被随机分配，从对照组切换至干预组，直至所有诊所均开展PS-PC干预。本研究每家诊所招募66名患者，总样本量为264名。在3至4个月的周期内，参与者可获得由具备自身康复经历的同伴工作者提供的12小时实践与情感支持。基于量表的问卷调查将在四个时间点收集数据，以评估干预在心理健康结局（如自我效能感）及其他健康结局（如医疗相关成本）方面的有效性。此外，本研究还将通过量表采集其他视角的数据：约150名家庭成员或护理者（评估护理负担）、16名同伴工作者（评估自我效能感）在干预前后完成量表；20名医疗诊所工作人员则在各研究站点参与干预结束时完成关于对同伴工作者态度的量表。本研究还将开展60人次访谈，并在各研究站点参与末期举办六场焦点小组讨论，以进一步探索参与者、家庭成员/护理者、同伴工作者及诊所工作人员的看法，从而更深入地理解该干预方案的有效性与可接受性。 讨论：这项混合方法学、多中心整群阶梯式对照研究，将是首个评估在基层医疗心理健康服务领域引入同伴工作者的相关研究。 试验注册：澳大利亚新西兰临床试验注册库（Australian New Zealand Clinical Trials Registry, ANZCTR）ACTRN12623001189617，于2023年11月17日完成注册，注册链接：https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715