Community partnered peer support after traumatic brain injury: a feasibility case study
Janna Griffioen
A B * , Alyssa Turcott B , Kix Citton C , Adele Rogers C , Courtney L. Pollock A B D , Bill Miller A B E , Brodie M. Sakakibara A B E F , Nick Bansback G , Derry Dance H I J , Amy Schneeberg B , Noah D. Silverberg B K , W. Ben Mortenson A B E , Janice J. Eng A B D and Julia Schmidt A B E
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Abstract
Peer support can enhance the rehabilitation experience for people with traumatic brain injury (TBI). Understanding the feasibility of integrating peer support using a co-design approach can ensure effective delivery. This study aimed to evaluate the feasibility of implementing a community-based peer support program for people with moderate to severe TBI using a co-designed approach.
A case series pre-post feasibility study was conducted in partnership with a community brain injury organisation. Participants were adults who experienced a moderate to severe TBI <12 months earlier. Feasibility was assessed using process (recruitment and retention rates), resource (adherence to intervention), management (implementation fidelity) and scientific indicators (pre-post intervention changes).
Three participants were included, and most measures of feasibility were achieved. Process was achieved with a recruitment rate of 60% (3/5) and a retention rate of 100%. Resource feasibility was achieved with all peer support sessions (100%). Management feasibility was met through the completion of a co-created checklist of session management by peer support workers. Scientific feasibility outcomes showed limited change between pre- and post-intervention.
This study demonstrates the feasibility of a co-designed peer support program for people with TBI. Future research may examine the implementation of peer support to explore program scalability and refine outcome measures to better capture the benefits of a peer support focused intervention.
Keywords: brain Injury, co-design, community partners, neurorehabilitation, participatory research, peer support, psychosocial support, resilience.
Introduction
A traumatic brain injury (TBI) can cause long-term impairment (Silva et al. 2021). After experiencing a moderate to severe TBI, acute care focuses on life-threatening medical issues (e.g. elevated intracranial pressure), whereas rehabilitation settings and community care focus on individual needs based on the impairment and barriers in the environment (Borg et al. 2020; Covington and Duff 2021). Once discharged, healthcare supports can vary depending on geographical location (Graves et al. 2019), socioeconomic status (Haines et al. 2019) and funding available (Johnson and Diaz 2023; Grewal et al. 2024). Such a large life transition requires adjustment, highlighting the critical role social identity and group membership play in facilitating quality of life and access to social support outcomes (Haslam et al. 2008).
Peer support is a form of social support mentorship, using the expertise of someone with long-term lived experience of a brain injury to mentor people who have recently experienced a brain injury (Peer Support Canada 2024). Peer support is inherently a person-centred intervention, providing emotional and practical support unique to the person receiving peer support. Peer support programming has been established in other populations, such as spinal cord injury (Rocchi et al. 2022), cancer (Zhang et al. 2022) and mental health (Shalaby and Agyapong 2020). In these populations, systematic reviews have found that peer support has impacted quality of life, self-efficacy and reduced anxiety (Shalaby and Agyapong 2020; Rocchi et al. 2022; Zhang et al. 2022).
Peer support for people with a TBI has been implemented in various settings. Some programs have been conducted in person (Struchen et al. 2011), others have been online or by phone (Levy et al. 2019; Lau et al. 2021), whereas some were hybrid (Hibbard et al. 2002; Hanks et al. 2012). Many programs took place in the community (Hibbard et al. 2002; Struchen et al. 2011; Lau et al. 2021; Levy et al. 2021), with one taking place in the hospital (Hanks et al. 2012). Length of programs varied from 3 months (Struchen et al. 2011) to 1 year (Hibbard et al. 2002; Hanks et al. 2012). Frequency of meetings were typically once a week (Struchen et al. 2011; Levy et al. 2019; Lau et al. 2021), whereas others recommended a number of meetings throughout the month or bimonthly (Hibbard et al. 2002; Hanks et al. 2012). Partnerships were formed with non-profits (Hibbard et al. 2002; Levy et al. 2019; Lau et al. 2021) or rehabilitation centres (Hanks et al. 2012) to create or conduct research on ongoing programs. A systematic review reported inconsistent findings across studies, with some studies showing increased quality of life after peer support, whereas other studies found no significant differences in some areas, such as mood or self-efficacy (De Dios Perez et al. 2024). One systematic review indicated limited evidence on psychosocial effectiveness of peer support groups due to the varied methods used to deliver the intervention (Wobma et al. 2016; Hughes et al. 2020). Although, participants of all interventions reported positive experiences within the program, with reported increased social support, ability to cope, and increased knowledge of TBI and community resources (Hibbard et al. 2002; Struchen et al. 2011; Hanks et al. 2012; Levy et al. 2019; Lau et al. 2021).
Co-designed approaches emphasise the user experience in the design, implementation and knowledge translation (Manafo et al. 2018; McCarron et al. 2021). Co-designed approaches incorporate people with lived experience as partners to identify and address healthcare priorities (Kent 2019; Tsow et al. 2024). Such approaches ensure interventions are relevant to meeting the needs of a population, and facilitating sustainability and maintenance (Brett et al. 2014; D’Cruz et al. 2022). Needs alignment can contribute to achieving feasibility indicators through having buy-in, increasing support from those with lived experience and logistical integration into community programming (Brett et al. 2014; Levasseur et al. 2016; D’Cruz et al. 2022). As such, co-created research can produce effective and sustainable community programs underpinned by high-quality research (Sanders and Stappers 2008; Greenhalgh et al. 2016; Blomkamp 2018). Nevertheless, few studies describe using co-designed approaches when evaluating brain injury peer support programs (De Dios Perez et al. 2024), with many investigating programs already implemented in the community without co-designing the project (Schulz 1994; Schwartzberg 1994; Kessler et al. 2014; Lau et al. 2021; Levy et al. 2021). Additional work is needed to refine co-design methods for people with a TBI peer support interventions to appropriately respond to the diverse range of needs of people post-injury, and create sustainable and relevant programming.
Co-designed approaches are helpful to understand the feasibility of peer support for people with TBI through identifying recruitment pathways, creating buy-in, creating resources used by participants, and assisting in identification and delivery of outcome measures. Few studies evaluating a brain injury peer support program have used co-designed approaches, despite the potential to increase relevance, feasibility and impact. The aim of this case series was to evaluate the feasibility of a co-designed peer support intervention for people with moderate to severe TBI with a community brain injury organisation. Feasibility was assessed using process, resource, management and scientific indicators.
Methods
The present study evaluated the feasibility of a peer support-focused intervention (Thabane et al. 2010). The intervention was created and conducted using aco-design approach (Canada Institute of Health Research 2014). Ethical approval was obtained through the University of British Columbia Clinical Research Ethics Board (H22-02689). Findings are reported using the CONSORT guidelines for reporting feasibility studies (Supplementary File S1; Eldridge et al. 2016), and the TIDiER checklist to ensure material is properly reported (Supplementary File S2; Hoffmann et al. 2014).
A case series design was used to assess the feasibility of the intervention to evaluate multiple feasibility domains (e.g. process, resource, management, scientific). As previous studies have already evaluated effectiveness, a case series approach was sufficient to provide contextual and practical insights to inform the design and delivery of a larger intervention (Hugentobler et al. 2015; Kleffelgaard et al. 2016).
Co-design of a peer-support approach
The research team collaborated with a community brain injury association to understand the feasibility of conducting a one-to-one peer support program within a hospital context. The community association had been conducting various forms of peer support programs for 7 years (e.g. group, individual, online), but aimed to increase impact with a structured and formal process. The co-design team consisted of five members, including leaders of community brain injury organisations, people with brain injury who have experience providing peer support and researchers. Co-building was based on four principles from the Canadian Institute of Health Research Strategies for Patient-Oriented Research guidelines: inclusiveness, support, mutual respect and co-building (Canada Institute of Health Research 2014; Kent 2019; Abelson et al. 2022). Inclusiveness referred to the integration of diversity of perspectives. This was assessed through examining the composition of experiences represented in the research team. Support for co-design is defined as ensuring all members were able to contribute fully. This was examined by identifying instances to adjust and ensure participation from all members. Mutual respect involved the acknowledgement of each member’s expertise. This was assessed by reviewing communication strategies to acknowledge varying forms of expertise and perspectives. Co-building is used through identifying gaps and setting priorities for research priorities. This was assessed through tracking decision-making processes.
Participants receiving the peer-support program
Inclusion criteria were: (1) <1 year after a moderate to severe traumatic brain injury; (2) aged between 19 and 75 years; and (3) able communicate in English effectively (with or without assistance). Exclusion criteria were: (1) currently participating in a formal peer-support program; and (2) currently participating in another study that may affect outcomes of the present study.
Participants were recruited from two locations: a rehabilitation centre and regional hospital in British Columbia, Canada. Participants were identified and screened for eligibility by a member of their healthcare team. Participants provided informed consent to research team members. Research team members included an associate professor and occupational therapist with experience working with people with a brain injury, and a graduate student with experience working with people with a brain injury and trained on project outcome measures.
Intervention
The intervention was a one-on-one conversation between a peer support worker and a participant; the intervention was 30 min, once a week, for 10 weeks. The intervention was tailored to each participant, with trained peer support workers responding to individual needs and experiences. At the end of each intervention, peer support workers completed a reflection checklist aligned with the Peer Support Canada competencies, assessing topics typically covered in sessions (see management feasibility).
The intervention was conducted by peer support workers with lived experience of brain injury. Peer support workers were selected based on time since injury (>3 years). The community partner provided referrals for potential peer support workers, based on their knowledge of the individuals and their previous experience providing peer support. Peer support workers participated in training, aligned with Canadian Peer Supporter Competencies (Peer Support Canada 2024). Peer support training took place over 3 days for 3 h each day, consisting of topics including role boundaries, active listening and research protocols. The structure of the training included presentations, small-group discussions and example scenarios. Peer support workers were paid during the training and sessions with participants.
Participants were matched with a peer support worker by a project team member based on aspects such as age, gender and life experience. Contact with the peer support worker and participant took place through institutional emails to protect peer support worker privacy. A team member was available via email and phone throughout the duration of sessions to be contacted in the event of an adverse psychological event or emergency.
Outcome assessments
Self-reported demographic and injury characteristics were recorded by a research team member using a study-specific survey. Feasibility outcomes were organised into four indicators: process, resource, management and scientific (Thabane et al. 2010). All feasibility indicators had pre-determined thresholds for success, shown in Table 1.
| Feasibility indicator | Outcome | Criteria for success | Result | Success | |
|---|---|---|---|---|---|
| Process | |||||
| Recruitment rate | % of those approached vs those who consented to the study | >20% | 3/5 (60%) | Yes | |
| Retention rate | % of those who consented to the study and completed all elements of the program | >80% | 3/3 (100%) | Yes | |
| Perceived benefit | % of those who would recommend the program to a friend or have perceived benefit | >80% | 3/3 (100%) | Yes | |
| Resources | |||||
| Adherence to sessions | % of participants who completed the full 30 min of each session | >80% | 3/3 (100%) | Yes | |
| Peer support worker training adherence | % of peer support workers who completed a 3-day training program | >80% | 8/8 | Yes | |
| Alliance formed with peer support worker | % of participants who indicated forming a working alliance with the peer support worker | >80% | 100% | Yes | |
| Management | |||||
| Peer support worker completion of reflection checklist of fidelity | % of checklist items completed for each session | >80% | 95% | Yes | |
| Community facilitator contact with participant and peer support worker | Average contacts with peer support workers from program facilitators throughout the intervention | n/a | 5 contacts | ||
| Scientific | |||||
| Safety | No. of psychologically adverse events | <1 per participant | 0 | Yes | |
| Program efficacy | See Table 2 | n/a | n/a | ||
Process feasibility was assessed by documenting recruitment rate, retention rate and perceived benefit from the program. Recruitment rate was calculated by dividing the number of those who agreed to take part in the program by the total number of people approached over the recruitment period. Retention rate was determined by dividing those who completed the whole intervention by the total number of those who consented to the study. Working alliance, and program barriers and facilitators were assessed through qualitative interviews, to be reported elsewhere. Questions, such as ‘would you recommend the program to a friend?’, with scores of agree/strongly agree indicating perceived benefit, are reported in the present article to evaluate process feasibility.
Resource feasibility, assessing time and resource problems, was measured by two adherence categories: the number of sessions attended by the participant and the number of training sessions attended by peer support workers.
Management feasibility was assessed by recording the frequency of team members connecting with peer support workers to monitor fidelity of intervention. The research team emailed peer support workers and participants after each of the first three sessions, then followed up over Zoom or email as needed. This achieved the feasibility threshold of three contacts for each participant. Management feasibility was also assessed by an reflection checklist to understand fidelity. The checklist was co-developed with the co-design team to assess essential components of the program and ensure the intervention was delivered as intended. The checklist had 16 items with broad topics of conversation (e.g. ‘I made a connection through shared experience’) and an area to add general comments. The checklist was completed by peer support workers after every session as a self-reflection, similar to previous research on self-reflection fidelity after therapy delivery (Toglia et al. 2020), researchers then tallied the number of items completed.
To understand the influence and impact of peer support workers within the sessions, therapeutic alliance was examined. Therapeutic alliance between the peer support worker and participant was examined by the Working Alliance Inventory, a self-report measure (Horvath and Greenberg 1989). A research team member administered the Working Alliance Inventory at post-intervention. The scale has 36 questions, with a Likert scale of 7. Scores can range between 36 and 252, with higher scores meaning higher therapeutic alliance.
Scientific feasibility was assessed based on understanding the risks and benefits of implementing the intervention. Participating in a peer support intervention carries some risks, such as psychological distress (Struchen et al. 2011). As such, risk was operationalised by the number of psychologically adverse events, reported adverse events from either the peer support worker or the participant, recorded by the research team. The research team monitored for events (e.g. suicidal ideation, aggression, need for psychological support) through post-session check ins for the first three sessions, then relied on a peer support worker or participant report of adverse psychological events. In the event of an adverse event being reported, a trained neuropsychologist was available to consult regarding the management of neurobehavioural concerns. The potential risk or benefit of participating in the intervention were understood through examination of changes in primary and secondary outcome measures conducted at baseline and post-intervention, noted below.
Baseline and post-intervention measures were completed by participants, with a research team member available for clarification or support as needed. The participants started the intervention within a week of completing baseline outcome measures, then completed post-intervention outcome measures <1 week after completing the intervention. The primary outcome was resilience using the Connor–Davidson Resilience Scale, which is widely used in the brain injury population (Neils-Strunjas et al. 2017; Reid et al. 2018; Sun et al. 2024). The measure is a 25-item self-report questionnaire. Scores range from 0 to 100, with higher scores indicating higher resilience. Although not directly established, the measure has been assumed to have clinically significant change within the TBI population of 10 points (Assonov 2021). The measure has good internal consistency, test–retest reliability, convergent validity and criterion validity (Stoner et al. 2015). Resilience has been used to evaluate previous peer support programs and is important to consider in the context of brain injury, as it can provide a protective factor against negative health outcomes, such as a decrease in mental health, self-efficacy and quality of life (Neils-Strunjas et al. 2017; Sadler et al. 2017). Although experiencing a brain injury can initiate adversity, resilience allows an individual to meet adversity with a positive mindset (Neils-Strunjas et al. 2017).
Secondary outcomes included the Hope Hearth Index evaluating hope using dimensions inner sense of temporality and future, inner positive readiness and expectancy, and interconnected with self and others (Herth 1992). Hope was identified as a secondary outcome based on evidence showing peer support programs can enhance hope among participants (Levy et al. 2019; Moss et al. 2022). The Hope Hearth Index has high internal consistency (α = 0.97) and high test–retest reliability (r = 0.91) (Herth 1992). The measure has 12 questions, with scores ranging from 1 to 4. The lowest possible score is 12 and highest score is 80, with a higher score indicating high hope.
The General Self-Efficacy Scale (GSES) was used to measure self-efficacy (Payne and Jahoda 2004). Self-efficacy was included given prior evaluation within previous peer support programming (Levy et al. 2019). The scale has strong internal consistency (α = 0.78; Schwarzer et al. 1995). The measure has 10 questions, with a scale from 1 to 4. The lowest possible score is 10 and highest score is 40, with higher scores indicating higher self-efficacy. The GSES has a minimal clinically important difference of 4.33 (Ohno et al. 2017).
Health-related quality of life was assessed by the EuroQol-5 Dimensions (EQ-5D-5L) using the dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression (Herdman et al. 2011). All dimensions evaluated within the measure have been previously evaluated within peer support research and demonstrate relevance to common constructs considered in peer support programming (Struchen et al. 2011; Sadler et al. 2017; Levy et al. 2019; Hilari et al. 2021). The EQ-5D-5L Index results are between 1, being full health, 0, being dead, and −1, being worse than dead. The scale also consists of a visual analogue scale rating subjective health-related quality of life from 0 to 100. The scale is a reliable and valid measure for the brain injury population (Golicki et al. 2015). Results are calculated using Canadian value sets (Yan et al. 2024).
Data analysis
Outcome measures were scored using measure-specific criteria. Results for individual participants were compared between pre-intervention and post-intervention, to provide a description of any changes for individuals. Statistical comparison was not appropriate due to the small sample size. Other data, such as demographic and injury characteristics, were described using frequencies and ranges to appropriately describe the sample without risk of de-identifying participants.
Results
All participants were men, with an average age of 36 years and had experienced a moderate to severe TBI (GCS of 12 or less) within the past year (Table 2). Two participants identified their race as white, with one identifying their race as Middle Eastern. All participants had functional impairments related to their injury, such as reduced mobility, decreased cognition and upper extremity deficits (e.g. decreased strength and range of motion). Results of the co-design approach and feasibility indicators are reported below and in Table 1.
| Characteristics | n (%) | |
|---|---|---|
| Age | ||
| 21–30 years | 1 (33.3) | |
| 31–40 years | 1 (33.3) | |
| 41–50 years | 1 (33.3) | |
| Gender/sex | ||
| Cis-gender male | 3 (100) | |
| Gender | ||
| Man | 3 (100) | |
| Ethnicity | ||
| White | 2 (66.7) | |
| Middle Eastern | 1 (33.3) | |
| Mechanism of injury | ||
| MVA | 1 (33.3) | |
| Brain bleed | 1 (33.3) | |
Note: MVA = motor vehicle accident.
Co-design approach
The Canadian Institute of Health Research Strategies for Patient-Oriented Research principles for patient-oriented research were achieved. The principle of inclusiveness was achieved through formation of a collaboration with a community brain injury organisation with experience in peer support programming, experienced peer support workers and researchers with expertise in brain injury rehabilitation. Having >3 years of lived experience of brain injury, peer support workers brought the knowledge of lived experience and could show by example what life can look like after brain injury. The research team was created with partners with multiple perspectives, including people with lived experience of brain injury, employees of the community brain injury organisation and researchers.
The principle of support was attained by accommodating schedules and using agreed upon terms for roles, such as ‘peer support worker’, where the community brain injury association used ‘peer’. The principle of mutual respect was evaluated by continual check ins with all team members throughout meetings to ensure all voices were heard. Finally, the principle of co-building was achieved to collaborate on a gap within the peer support research, to quantitatively evaluate the feasibility of peer support using a co-design approach. The team co-built the methods of the intervention by making the intervention 10 weeks in duration, which is the typical length for a community organisation program. The team collaborated on training, matching and supporting peer support workers.
Feasibility indicators
Recruitment took place at both sites from June 2023 to February 2024. A total of five participants met eligibility criteria and were approached to participate. Three participants agreed to participate and provided written consent, making the recruitment rate 60% (3/5). Fig. 1 describes the flow of participants in the study.
All identified participants were from one site, a rehabilitation centre in an urban setting. All participants completed the entire 10-week program, yielding a retention rate of 100%. All participants reported a perceived benefit from taking part in the program and would recommend the program to a friend.
One participant requested a different peer support worker after their first session due to differences in interests and rehabilitation goals. In consultation with community partners, the participant was paired with an alternate peer support worker outside of their region. As such, all sessions were conducted online using UBC Zoom. All participants were provided options for in-person or online peer support, and all participants preferred online sessions.
For intervention adherence, all participants engaged in at least 30 min of peer support in each session, once a week, for 10 weeks, indicating 100% intervention adherence. The average time for each peer support session was 35 min. Adhering to intervention protocol, all peer support workers completed the required 3-day training.
Management feasibility was achieved, in that community team members (e.g. researchers or community partners) contacted peer support workers an average of five times during the intervention (ranging between 4 and 8 contacts), reaching sufficient feasibility. The team commonly discussed intervention protocols, schedule changes and match suitability. All items of the post-session checklist were completed, suggesting adequate intervention fidelity. All participants reported developing a working alliance with their peer support worker during the intervention. Therapeutic alliance was demonstrated by Working Alliance Inventory scores between 146 and 155.
The risk of all participants and peer support workers was monitored, and no psychologically adverse events were reported.
There was variability in the observed changes in outcome measures from pre- to post-intervention for all participants (see Fig. 2). For the primary outcome measure of resilience, post-intervention, two participants showed increased scores on the Connor–Davidson Resilience Scale (14 and 15 points), whereas one participant showed a decrease of 15 points on the Connor–Davidson Resilience Scale. All participants experienced substantial change on this measure, two being positive, one being negative. For the secondary outcome measures, participant scores varied on the Hope Hearth Index between 1 and 2 points from pre-intervention. Two participant scores decreased at post-intervention by 1 and 2 points. Scores from baseline on the GSES (measuring self-efficacy) increased by up to 4 and decreased by 2. No participants had meaningful change from pre- to post-intervention scores on the GSES. For quality of life, the EQ-5D-5L pre-intervention index scores increased in a range from 0.1 to 0.16. For the visual analogue scale of the EQ-5D-5L, participant scores ranged from an increase of 20 to a decrease of 9.
Discussion
This feasibility case study met many areas of pre-determined indicators of feasibility for conducting a study evaluating a co-design peer support program for people with moderate to severe TBI.
Our study used co-design principles to help guide effective partnership with a community brain injury association (Canadian Institute of Health Research 2014; Sanders and Stappers 2008; Greenhalgh et al. 2016; Blomkamp 2018). For example, community partners helped facilitate aspects of the study design and intervention including recruitment and matching peer support workers with participants. Research indicates that co-design and delivery of interventions can increase sustainability (Kent 2019). Additionally, previous research indicates that effective communication and transparency can be a facilitator to partnership in research (Babatunde et al. 2023). Similar to previous co-creation research, communication with researchers and community partners in our study was frequent and efficient during project execution (Babatunde et al. 2023).
The sufficient retention rate and adherence identified may reflect the positive value of engaging in a brain injury peer support program. Sufficient resource feasibility aligns with previous qualitative studies showing the connection and community experienced in peer support (Coles and Snow 2011; Kessler et al. 2014; Masterson-Algar et al. 2020; Levy et al. 2021). In this study, participants reported a moderate therapeutic alliance with their peer support worker. Previous studies investigating working alliance with patients and clinicians in brain injury indicate a positive correlation with increased rehabilitation outcomes (Stagg et al. 2019). It is possible that the working alliance experienced in a peer support relationship may also impact rehabilitation outcomes. All sessions, except one, were conducted online. Online sessions provided more flexibility in the matching process of participants and peer support workers outside of their region.
There was limited change from pre- to post-intervention outcomes on all measures. It is possible participants experienced impaired self-awareness and lack of recognition of current difficulties and challenges, creating complexity when assessing outcomes. Impaired self-awareness is common after TBI, particularly in acute stages (Schmidt et al. 2011; Sansonetti et al. 2022). Baseline assessments in our study occurred while participants were still in a rehabilitation hospital, as such, they may not have had awareness of the extent of impairments and functional consequences of the injury (Sansonetti et al. 2022). Future studies could consider the input and perspectives of carers to further understand outcomes at baseline. For those with significant self-awareness impairment, it may be more acceptable to provide peer support more than a year after the time of injury, as self-awareness may improve. Research indicates that people with TBI may improve self-awareness when they return home and engage in pre-injury life roles and activities, as their injury-related function becomes evident (Fleming et al. 2011).
The study assessed key areas of resiliency, hope, self-efficacy and quality of life to evaluate the potential benefit of the intervention impact. It is possible other domains, such as social participation, may have shown improvement after peer support, as seen in a peer support pilot randomised control study for the acquired brain injury population (Struchen et al. 2011). It is possible that the parameters of the intervention may impact outcome measures. Intervention intensity (e.g. dose, frequency) is particularly important in obtaining change on psychosocial outcomes (Jhunjhunwala et al. 2024), physical outcomes (Klassen et al. 2020) and social communication (Ali et al. 2021) outcomes in neurological populations. Future research in peer support for TBI should build on study findings to refine the length and intensity of the intervention before scaling to a larger efficacy study.
Results from the present study indicate that peer support conducted using a co-design approach is a promising and feasible intervention. Partnering with a community brain injury association provided key knowledge to support intervention delivery (e.g. expertise of lived experience, experience in program delivery). Future studies could include a multi-side implementation trial of peer support after brain injury partnered with community brain injury associations.
Limitations
This study had two main limitations. First, our study used a case series design and thus the sample size was small. Although this study builds knowledge on the feasibility of peer support focused interventions, the scope of the study limits the generalisability of findings and the ability to identify significant changes. Second, there was no control group, which limited the assessment of the benefit and impact of peer support for people with a TBI. Our study provided preliminary and exploratory evidence on the benefit of peer support within a case series, but did not provide information on the efficacy of the intervention. Implementing a control group in future studies could allow for a more robust assessment of the benefit of peer support.
Conclusion
The co-designed intervention achieved all main indicators of feasibility within a case series design. Findings suggest peer support is a feasible intervention within a community-partnered context. Future studies can include a multi-site implementation study of peer support after TBI partnering with community brain injury associations.
Data availability
The data that support this study cannot be publicly shared due to ethical or privacy reasons and may be shared upon reasonable request to the corresponding author if appropriate.
Declaration of funding
The research received funding from the Government of Canada Canadian Institute of Health Research Project Grant (F22-01287). The funder played no role in the preparation of the data, manuscript or decision to submit for publication.
Ethics
Ethics approval was received from the University of British Columbia’s Clinical Research Ethics Board (H22-02689).
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