The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness.
OBJECTIVE
Persons with serious mental illnesses (SMI) have elevated rates of comorbid medical conditions, but may also face challenges in effectively managing those conditions.


METHODS
The study team developed and pilot-tested the Health and Recovery Program (HARP), an adaptation of the Chronic Disease Self-Management Program (CDSMP) for mental health consumers. A manualized, six-session intervention, delivered by mental health peer leaders, helps participants become more effective managers of their chronic illnesses. A pilot trial randomized 80 consumers with one or more chronic medical illness to either the HARP program or usual care.


RESULTS
At six month follow-up, participants in the HARP program had a significantly greater improvement in patient activation than those in usual care (7.7% relative improvement vs. 5.7% decline, p=0.03 for group *time interaction), and in rates of having one or more primary care visit (68.4% vs. 51.9% with one or more visit, p=0.046 for group *time interaction). Intervention advantages were observed for physical health related quality of life (HRQOL), physical activity, medication adherence, and, and though not statistically significant, had similar effect sizes as those seen for the CDSMP in general medical populations. Improvements in HRQOL were largest among medically and socially vulnerable subpopulations.


CONCLUSIONS
This peer-led, medical self-management program was feasible and showed promise for improving a range of health outcomes among mental health consumers with chronic medical comorbidities. The HARP intervention may provide a vehicle for the mental health peer workforce to actively engage in efforts to reduce morbidity and mortality among mental health consumers.
Druss
Benjamin G
BG
Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30316, United States. bdruss@emory.edu
Zhao
Liping
L
von Esenwein
Silke A
SA
Bona
Joseph R
JR
Fricks
Larry
L
Jenkins-Tucker
Sherry
S
Sterling
Evelina
E
Diclemente
Ralph
R
Lorig
Kate
K
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012648:Self Care / Q000379:methods*; D012657:Self-Help Groups; D012720:Severity of Illness Index; D055815:Young Adult