Why is mobilizing social networks so powerful for health? Michele Heisler, MD, MPA, Professor of Internal Medicine, Health Behavior, and Health Education at the University of Michigan emphasizes two reasons that we often don’t think about when developing health care programs: purpose in life and social connectedness.
“People who report having a strong purpose in life live longer and healthier lives than those with a weak purpose — and that’s even accounting for baseline health,” says Heisler. “Having a strong purpose of life predicts lower rates of heart attack, Alzheimer’s, stroke, and getting diabetes. That’s pretty powerful.” As for social connectedness, she adds, “being socially isolated puts you at a higher risk of dying than smoking cigarettes. Receiving social support is clearly a benefit, but people who provide social support to others reap even greater benefits. Helping others helps us in turn gain a greater sense of purpose.”
Peer support programs help provide that sense of purpose and social connectedness. Receiving support from someone with similar characteristics and experiences to you, particularly someone who shares the same condition or challenge, can be quite powerful, says Heisler. Many people don’t have strong peer networks on their own or the right kind of network to be of benefit to their health. For example, diabetes is a common disease, but that doesn’t necessarily mean someone with diabetes would know someone else in their circle of friends and family who shares the disease.
Heisler describes three effective peer support models. The first is peer coaching. Patients with the same health condition — ideally those who have struggled with that condition and are now doing better — meet with their peer partner in person to develop trust and rapport. They then follow up, typically weekly, by phone, email, or text, to see how their partner is doing, to help them with behavioral goals, and simply to listen. These regular communications provide accountability from someone who cares. The coaches derive benefits, too. “I knew that if I was going to go out and get an ice cream sundae, I just told him not to, so how could I do that?” one peer coach said, according to Heisler. There’s also the power of feeling needed, of having a purpose in helping others struggling with the same condition.
“We health professionals care, and we work hard to convey that care, whether by face or out through digital methods, but we just can’t reach out that effectively, and we can’t reach out that frequently, and we just can’t talk as long with our patients,” says Heisler.
Group sessions are another effective peer support model. An example of this is shared medical appointments. Clinicians are available to answer questions, while patients share their experiences and strategies with each other. “It’s nice to be able to be heard instead of having to listen all the time,” said one patient. A clinician facilitator added, “We clinicians do a lot of telling patients what to do. I’ve come to realize there’s a huge benefit from hearing from equals rather than just from us professionals.”
A third model is mutual, or reciprocal, peer support, in which two people struggling with the same health condition pair up to give and receive support from each other. Heisler found this model to be powerful in her own life, having never participated in a group exercise class until she pledged to another class participant that she would — and they shared shoes. Mutual peer support works best as a complement to other structured programs, says Heisler, noting that ideally patients would use a combination of all three.
“Improving support between face-to-face clinic visits is one of the most important challenges health systems face,” Heisler concludes. “Programs that rely only on health professionals are expensive, and many people need more support than they can provide. Peer support programs can complement other programs to provide that needed support. And they can do so in a way that can also meet very fundamental human needs.”
From the NEJM Catalyst event Hardwiring Patient Engagement to Deliver Better Health at Kaiser Permanente Southern California, April 13, 2017.