Driving equity at a community level: Case studies of community-based peer-delivered health-care services and programs (pp. 67-78)
Authors: Margot Lettner, Estelle Sun, and Bob Gardner
Abstract: Phase 1 of this project, reported here, is an exploratory investigation into the effectiveness of community-based, peer-delivered healthcare services and programs in a diverse urban community, the Greater Toronto Area (GTA), Ontario, Canada. Peer health workers have shown promise in working with marginalized or other hard-to-reach groups who face complex barriers to good healthcare, well-being and quality of life. Inconsistent definitions and reporting measures have made formal and comprehensive evaluation challenging. This study uses two complementary research methods: a Literature Review, and Case Studies constructed from key informant interviews at selected health and social service providers in the GTA. It analyzes where peer healthcare initiatives tend to be located, what services they provide, and how their context and design interact to determine their workability and success. It highlights the facilitators, success conditions and best practices, as well as the challenges or barriers. Peer health workers are “the best messengers” to penetrate communities that non-peers cannot. Peer models drive enriched data collection and analysis, enhanced capacity for relevant and actionable research-into-policy and practice, and innovative community collaboration and broader partnerships. Peer work experience also provides “pathways” to professional education and employment. Resourcing is difficult. Peer models take more project management time, particularly around role clarity and mentoring. Gender and remuneration are key issues. The findings suggest promising directions for program development and service interventions that build community-engaged scholarship, practice and capacity; and will interest researchers, policymakers, providers and advocates aiming to drive health equity into practice.