title: Peer support for people with chronic conditions in rural areas: a scoping review.
abstract: BACKGROUND
  Chronic conditions are a growing healthcare concern. People living in rural regions are particularly affected because many barriers exist to accessing services and supports. Peer support for chronic condition self-management, where people living with chronic conditions learn about how to care for themselves and maintain their health from people also living with chronic conditions, is one approach gaining recognition. What remains unknown are the unique challenges and strategies associated with peer support for chronic condition self-management in rural contexts. In order to inform the development of peer supports in the authors' local context in rural eastern Canada, a scoping review was undertaken to discover community-based peer support initiatives for adults in rural settings living with chronic conditions.
  
  
  METHODS
  The authors followed established scoping review methods to answer the research question What is known from the existing literature about the key features and potential formats of community-based peer support initiatives for adults living with chronic conditions in rural settings? Six databases (CINAHL, PubMed, Sociological Abstracts, Embase, Cochrane Libraries and PsycInfo) were searched using the following concepts: chronic conditions, peer support, community-based and rural context. Two researchers reviewed the titles and/or abstracts of the 1978 articles retrieved from the initial search to include articles that were in English, published in 2000 to 2014, and that explicitly discussed rural programs/interventions with peers that were community-based. The initial screen excluded 1907 articles, leaving 71 articles, which were read by two research members in light of the inclusion/exclusion criteria. Thirteen articles representing 10 separate programs were included and analyzed using qualitative content analysis.
  
  
  RESULTS
  Included programs were from the USA, Australia and Canada. A range of formats (telecommunications only, in-person meetings only, or a combination of both) were used. Peer leaders had varied experiences with chronic conditions and received training in content and facilitation skills. Peer leaders were provided with ongoing support. Program participants received training on chronic conditions, and programs provided opportunities for social support and the development of new skills. Programs focused on creating social connections, reducing stigma, ensuring relevance and promoting empowerment. Of the nine programs that reported outcomes, eight reported positive outcomes and one reported mixed results.
  
  
  CONCLUSIONS
  Consistent with the extant literature, the programs identified unique issues faced by people with chronic conditions in rural areas that these programs addressed. The key findings of this scoping review are as follows: 1. A combination of telecommunications with some face-to-face meetings can support the accessibility of peer support programs in rural areas. 2. Core elements of these programs are the provision of social support and skill development. 3. Peer leaders benefit from skills training and ongoing support. 4. Sustainability of such programs is complex and requires multiple strategies.
  
  
  CONCLUSIONS
  Cultural relevance, ongoing support and the use of telecommunications were key features of rural peer support programs. Guiding questions to facilitate a community consultation around these findings are provided. Peer support chronic condition self-management programs require further research.
authors.affiliation: School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada . heidi.lauckner@dal.ca.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Lauckner
authors.affiliation: School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada. susan.hutchinson@dal.ca.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hutchinson
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010379:Peer Group; D000067074:Peer Influence; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services / Q000458:organization & administration*
keywords: Allied Health; Cardiovascular health; Community Participation; Diabetes; Evidence-based Care; Health Promotion; North America; Researcher