The study results showed that peer supporters in diabetes self-management programs aim to provide encouragement for other people with diabetes and to receive support for themselves. They view providing peer support as a responsibility, and they also benefit from their peer support role. These benefits include creating interpersonal connections, experiencing opportunities for growth through self-awareness and self-reflection, and finding reward in the commitment that comes with supporting. Notwithstanding the benefits, African Americans described some challenges associated with peer support, especially when supporting peers who were seriously ill or who struggled with medication management despite the education provided during the program. One initial challenge for some of peers was creating a trusting relationship. Others struggled with accepting the terms of their roles as trained supporters. Nonetheless, the reasons African Americans partake in peer support consist of educating themselves to help others, decreasing diabetes-related stigma in African American communities, and receiving support themselves.
Our study adds to the existing literature on peer support in several ways. First, our study adds a new dimension to the benefits of providing peer support. Prior studies of peer support only emphasize the clinical benefits of the programs to the peers involved(2, 22, 23). Analogously, a study of key features of peer support in chronic disease management revealed that people participating in peer support interventions only express interest in receiving information and answers to their questions, rather than gaining emotional support(24). However, when African Americans shared the benefits of the Peers LEAD program they focused on the social and emotional benefits of the program. They mentioned how the program helped them grow, open up and its impact the program had on their relationships with their peers. They also mentioned the reward they feel because of their commitment to their role. Other studies exploring peer support should consider examining the psychosocial benefits of the programs to the participants and the impacts these benefits may have on other outcomes of interest.
Second, existing literature recognizes peer support as a mutually beneficial relationship where individuals give and receive support from each other(25). Our Peer Ambassadors reflected this finding by recognizing the benefits of peer support as an experience that enlightens their self-awareness and reflection on their journeys of living with diabetes. One of the benefits of peer support for African Americans is forming meaningful connections with their peers through trust-building. Trust is significantly associated with participant retention and peer support programs are recommended to include as strategies to enhance trust within their interventions(26).
Third, trust has been associated with reasons why African Americans living with type 2 diabetes do not seek out support from their peers. A study revealed that African Americans were distrustful about disclosing their type 2 diabetes status to their peers and seeking out support(27). One of the peers in our study described the African American community as “a very secretive world.” Therefore, the Peer Ambassador joined the Peers LEAD program to contribute to decreasing diabetes-related stigma in African American communities. Other Peer Ambassadors recognized that African Americans have difficulties opening up about their diabetes. A Peer Ambassador identified that the most challenging part of the Peers LEAD program was the first conversations they had with their buddies before building trust. Another participant revealed that our Peers LEAD program is the first time they had spoken to anyone other than their physician about their diabetes. The reluctance to be vulnerable with peers has been identified in one study as relating to the stigma attached to type 2 diabetes in African American communities(27). Effective peer support programs must respect and acknowledge the needs of the person with diabetes and take into consideration privacy concerns while building trust with peers to ultimately embolden them to open up about their diabetes.
Familial relationships are ingrained in cultural beliefs that impact medication adherence among African Americans(28). For African Americans who had concerns about trust, they felt that they depend upon their family and friends for support. In another study, African Americans revealed that their impression after their type 2 diabetes diagnosis was that their families would be their primary support system (27). Another study sought input from African American pastors and found that families carry the burden of caring for someone with diabetes(29). Therefore, it is not surprising that African Americans in our study shared their challenges in supporting peers who were focused on the burden of caring for family members with type 2 diabetes. Due to the high prevalence of diabetes in African American communities and the burden shared with family members, there is a possibility that during peer support programs peers may want to discuss their family members' experiences with diabetes. One Peer Ambassador discussed their rationale for joining the program as an opportunity to become more knowledgeable about diabetes and to learn how to help their family members living with diabetes. Peer support programs can be encouraged to invite participants to share about their burdens of caring for their family members living with diabetes.
Peer Ambassadors had difficulties seeing their peers suffer from diabetes-related complications. Peer support programs can provide emotional support to peers in their roles of supporting individuals struggling with type 2 diabetes. Other studies can further explore in-depth the challenges peers face when providing support and design interventions to equip them with the necessary tools to cope and be efficient in their roles. These roles do not require professional expertise, and although two peers in our study identified as nurses, their professional training was not necessary to provide peer support.
While African Americans experience challenges in their roles as peer ambassadors, they participate in peer support programs to benefit themselves and their communities. A study of peer support in low-income African Americans found that sharing illness experiences in the group setting gave participants practical ideas on how to manage their illness(30). Peer Ambassadors spoke about the growth they experience in opening up, building trusting relationships, and learning about diabetes to help themselves and their communities. Our study offers a basis for further exploration of the experiences of African Americans providing peer support. It is evident that the benefits of providing peer support are not limited to the individual receiving the support, rather, it is a mutually beneficial relationship.
Limitation
There are several limitations to our study. Focus groups have the advantage of eliciting the views, feelings, and perceptions of a group(31, 32). However, participants who share different views may not be comfortable sharing them in a focus group.
The study findings were based on perceptions of middle-aged African American adults with diabetes in one Midwestern state. Experiences of ambassadors providing peer support might differ among age groups and regional locations. Future studies should consider exploring these experiences among other age groups of African Americans in different geographic locations. It is important to note that the sample size was 12 participants, which is consistent with the acceptable sample size in qualitative research for focus groups. However, two Peer Ambassadors that participated in the program did not participate in the focus group due to time constraints. Despite these limitations, the findings of this study can inform future research, as well as peer support training and programs.