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PubMed2006

The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial.

BACKGROUND: Peer support may improve breastfeeding rates but the evidence is inconclusive. Previous studies and reviews recommend trials in different healthcare settings. AIM: To test if a specified programme of peer support affects the initiation and/or the duration of breastfeeding. DESIGN OF STUDY: A two-group randomised controlled trial of peer support for breastfeeding with evaluation of breastfeeding initiation and duration on an intention-to-treat basis. SETTING: General practice in Ayrshire, Scotland. METHOD: Following informed consent, 225 women at 28 weeks gestation were allocated to control or peer support group by post-recruitment concealed allocation. All peer support and control group mothers received normal professional breastfeeding support. Additionally, those in the peer support group still breastfeeding on return home from hospital had peer support until 16 weeks. RESULTS: Thirty-five of the 112 (31%) women in the peer support group were breastfeeding at 6 weeks compared to 33/113 (29%) in the control group, a difference of 2% (95% confidence interval = -10% to 14%). The median breastfeeding duration for all women in the peer support group was 2 days compared to 1 day for the control group and the Kaplan-Meier survival plot shows the peer support group overall breastfeeding slightly longer than the control group, with no statistically significant difference by logrank test (P = 0.5). The median breastfeeding duration among primagravidae in the peer support group was 7 days, compared to 3 days for the control group. Among women who started to breastfeed the medians were 72 days in the peer support group and 56 days in the control group. These differences were not statistically significant. CONCLUSIONS: Peer support did not increase breastfeeding in this population by a statistically significant amount.

Breast Feeding↗

PubMed1994

Peer ratings of depression, anxiety, and aggression in inpatient and elementary school children: rating biases and influence of rater's self-reported depression, anxiety, and aggression.

Using parallel self-, peer, and teacher rating scales, several rating biases in children's peer ratings of depression, anxiety, and aggression were examined. Participants were 66 inpatient and 133 elementary school children (N = 199, 109 boys, 90 girls; 61% white, 39% black) aged 8 to 12, and their teachers. Results showed significant halo bias in both the children's peer ratings and the teachers' ratings. Children's self-reports on each of the three traits were significantly related to their peer ratings of the same trait, while adjusting for socioeconomic status and the peers' teachers' ratings of the same trait. Children who rated themselves as high on each trait rated their peers significantly higher on the same trait than children who rated themselves as medium or low; and for depression and anxiety, those who rated themselves as medium rated their peers significantly higher on those traits than those who rated themselves as low. For both depression and aggression, children's self-reports on the trait were significantly related to their peer ratings of the same trait, but not significantly related to their peer ratings of different traits. Disagreements between children's and teachers' ratings of the peers on all three traits were significantly related to child self-reports on each trait, indicating a possible distortion in children's peer ratings due to self-report. The implications of the results for both peer and others' assessments are discussed, and further investigation of rating biases in other informants' assessments is encouraged.

Aggression↗

PubMed2000

Integration of radiologist peer review into clinical review workstation.

Professional peer review of random prior radiologist's interpretations is mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The JCAHO expects documentation of 5% rate of random peer-review cases. Countless hours are spent in departments fulfilling these requirements. The integration of the peer-review process into the radiologist's interpretation workflow was expected to increase the percentage of documented peer review, yet decrease the time and effort for this documentation. radStation clinical review workstations are deployed at every reading station. When a requisition is bar-coded, radStation retrieves the patient's clinical information and automatically displays the prior comparison report. If the radiologist agrees with the prior report, a single click on a "quality assurance' agree box documents the agreement. In the case of a discordance, an additional dialog box automatically appears and the radiologist enters the reason for disagreement and then submits the case as a discrepancy. The system holds the discordance for 3 to 5 working days, then notifies the original radiologist via E-mail that a prior interpretation has been submitted for peer review, lists the submitted discrepancy reason, and provides a link to display the discordant report. The peer-review database is separate from the existing radiology information system (RIS). At the end of every month, summary reports of all peer-review activity are generated automatically. Initial benchmarks of our deployed system anticipate documentation of long-term random peer-review rate at greater than 50% of interpreted cases. The system enhances the peer-review process by integrating it with the normal interpretation workflow. The time to complete peer review using radStation is less than 1 second per normal case and less than 60 seconds for a discordant case. The E-mail notification system is fully automated, eliminating the need for secretarial involvement in the data collection. This system has completely replaced a manual paper-based system. The integration of peer review directly into the radiologist's interpretation workstation greatly enhances the capability to easily exceed JCAHO standards. The overall increase in peer-review documentation should continue to improve the ability to document a consistent high quality of patient care.

Computer Communication Networks↗

PubMed1997

Adolescent AIDS prevention in context: the impact of peer educator qualities and classroom environments on intervention efficacy.

Peer-led, school-based interventions show promise for preventing AIDS among adolescents, but little is known about the processes underlying effective peer education or the conditions that promote its efficacy. This study examined the implementation in one school of an effective, peer-led AIDS prevention program for inner-city 7th-grade participants (n = 123) and identified the qualities of peer educators (n = 15) and classroom environments (n = 5) that contributed to improvement in participants' postintervention AIDS-related attitudes. The Peer Educator Rating Scale was developed to assess two dimensions of participants' perceptions of peer educators: "positive regard" and "perceived similarity." Participants reported greater positive regard for more highly individuated and less shy peer educators, and participants' positive regard for peer educators in turn was associated with lowered AIDS risk as measured by perceptions of peer norms regarding sexual activity and self-efficacy for peer communication regarding sexual topics and condoms. Participants' perceived similarity was not associated with any postintervention improvements in AIDS-related knowledge and attitudes. Participants' classroom membership was associated with improvements in all 5 knowledge and attitude scales, and exploratory classroom-level findings indicated that classroom intervention environments perceived as more organized by participants showed slightly greater overall improvements across AIDS-related knowledge and attitudes scales. Consistent with individual-level findings regarding participants' positive regard for peer educators, the two classrooms with the greatest positive regard for their peer educator teams showed the most student improvement. Implications for further research and the design of future prevention and promotion programs for adolescents are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Peer relations in childhood.

We present a developmental model that describes normal peer relations and highlights processes that underlie the emergence of problems with peers in childhood. We propose that children's relationships with peers begin in the first years of life, with stable individual differences and preferences for particular peers emerging by three years of age. Social skills that facilitate peer relationships consolidate in the preschool years, during which time peer groups become structured with respect to friendship groups, gender, and dominance relations; some children begin to be rejected by their peers. In later childhood some children develop entrenched problems with peer relationships, in terms of loneliness, bullying and victimisation. Underlying cognitive and emotional processes that facilitate successful peer relationships at all ages are identified, and the extent to which peer relations play a causal role in the genesis of disorder is evaluated. A review of the evidence suggests that, rather than a simple pathway from problematic peer relations to disorder, there is a reciprocal relationship between children's problems with peers and their psychological problems from infancy to adolescence.

Affect↗

PubMed2002

Peer-led HIV prevention among gay men in London: process evaluation.

A peer-led HIV prevention initiative, based on a diffusion of innovation model, was developed for gay men attending gyms in central London. Peer educators were recruited from people who used the gym regularly according to standard selection criteria. After initial training, peer educators agreed to talk to gay men at their gym about HIV prevention, focusing on sexual risk and steroid injecting behaviour. Outcome evaluation revealed that the peer education programme had no significant impact on the risk behaviours of gay men using the gyms. Process evaluation, based on interviews with peer educators, the health promotion team and gym managers threw light on this finding. While it was feasible to set up a peer education programme among gay men in central London gyms, attrition was an important factor. Only one in five potential peer educators initially identified remained with the project throughout, thus limiting the potential for diffusion. Those who did work as peer educators reported barriers to communication within the gyms further limiting the extent to which diffusion occurred. In fact, it appears that the critical mass required for diffusion was never established. This could explain why the intervention had no significant impact on gay men's risk behaviours. A person-time analysis demonstrated that the peer education programme required a substantial input from the health promotion team, equivalent to one team member devoting 2.5 days a week to recruit, train and support peer educators over 18 months. Peer education should not, therefore, be viewed as a low-cost approach to prevention. Many of the insights gained through this process evaluation can inform others planning peer education programmes in other settings.

HIV Infections↗

PubMedDate not supplied

Child care and children's peer interaction at 24 and 36 months: the NICHD study of early child care.

Data from the National Institute of Child Health and Human Development Study of Early Child Care were examined to determine how children's experiences in child care were related to peer competence at 24 and 36 months of age, after controlling for the effects of family and child characteristics. Peer competence was assessed using mother and caregiver ratings as well as observations of children with their peers in child care, and at 36 months from observations of dyadic play with a familiar peer. Consistent, albeit modest, relations were found between child-care experiences in the first 3 years of life and children's peer competencies. Positive, responsive caregiver behavior was the feature of child care most consistently associated with positive, skilled peer interaction in child care. Children with more experience in child-care settings with other children present were observed to be more positive and skilled in their peer play in child care, although their caregivers rated them as more negative with playmates. Children who spent more hours in child care were rated by their caregivers as more negative in peer play, but their observed peer play was not related to the quantity of care. Child-care experiences were not associated with peer competence as rated by mothers or as observed in dyadic play with a friend. Maternal sensitivity and children's cognitive and language competence predicted peer competence across all settings and informants, suggesting that family and child-care contexts may play different, but complementary roles in the development of early emerging individual differences in peer interaction.

Adult↗

PubMed2005

Medical students' views on peer assessment of professionalism.

BACKGROUND: Although peer assessment holds promise for assessing professionalism, reluctance and refusal to participate have been noted among learners and practicing physicians. Understanding the perspectives of potential participants may therefore be important in designing and implementing effective peer assessment. OBJECTIVE: To identify factors that, according to students themselves, will encourage or discourage participation in peer assessment. DESIGN: A qualitative study using grounded theory to interpret views shared during 16 focus groups that were conducted by leaders using a semi-structured guide. PARTICIPANTS: Sixty-one students in Years 1, 3, and 4 in 2 mid-western public medical schools. RESULTS: Three themes students say would promote or discourage peer assessment emerged: personal struggles with peer assessment, characteristics of the assessment system itself, and the environment in which the system operates. Students struggle with reporting an unprofessional peer lest they bring harm to the peer, themselves, or their clinic team or work group. Who receives the assessment and gives the peer feedback and whether it is formative or summative and anonymous, signed, or confidential are important system characteristics. Students' views of characteristics promoting peer assessment were not unanimous. Receptivity to peer reports and close positive relationships among students and between students and faculty mark an environment conducive to peer assessment, students say. CONCLUSIONS: The study lays a foundation for creating acceptable peer assessment systems among students by soliciting their views. Merely introducing an assessment tool will not result in students' willingness to assess each other.

Attitude of Health Personnel↗

PubMed2006

Outcomes of Project Wall Talk: an HIV/AIDS peer education program implemented within the Texas State Prison system.

We report select outcomes from an evaluation of Project Wall Talk, a community-based, peer-led HIV prevention education program implemented in 36 Texas State prison units. Peer educators completed questionnaires prior to receipt of a 40-hour intensive training (N = 590) and at 9-month follow-up (N = 257). Students (N = 2506) completed questionnaires pre- and post-receipt of peer educator-led HIV education sessions. Peer educators and their students showed significant increases in HIV-related knowledge. Peer educators showed significant increases in assessment of their skills as educators. For both peer educators and students, significant differences in HIV-related knowledge were indicated across categories of prior educational level attained and race/ethnicity; no such differences were indicated at follow-up. Compared with baseline, a significantly greater proportion of peer educators reported ever having had an HIV test. After receiving peer-led education, a significantly smaller proportion of students reported they knew their HIV status and more indicated plans to take an HIV test. Additionally, in months 12 and 18 following program implementation, the numbers of HIV tests at the five units that implemented the peer education program were roughly twice that of five, matched comparison units without the peer education program. Based on peer educator reports, we projected that peer educators (N = 257) may have as many as 84,000 or more annual opportunities to share HIV-related knowledge with other prisoners outside the classroom.

Adult↗

PubMedDate not supplied

Peer education: the nursing experience.

BACKGROUND: The two-fold purpose of this study was to explore the peer education experiences of registered nurses and solutions for developing peer education as an effective method of adult learning. METHODS: Eleven designated peer nurse teachers and 13 peer nurse learners were asked to complete a questionnaire. Three peer nurse teachers and three peer nurse learners were further interviewed in focus groups. RESULTS: The metathemes of peer role conflict, organizational stress, and the timing of new role integration were identified. CONCLUSIONS: The study found nurses believed that to have a successful peer education program, the scope of the peer education program and the peer roles should be clarified, peer time should be available and accessible, positive motivational techniques (including a just peer selection process) should be present, and other resources should be provided.

Attitude of Health Personnel↗

PubMed1999

Peer involvement in bullying: insights and challenges for intervention.

The purpose of this research was to examine the peer processes that occur during bullying episodes on the school playground. These processes were examined from a social learning perspective, allowing us to consider the effects of various types of reinforcement among bullies, victims, and peers. Fifty-three segments of video tape were examined. Each segment contained a peer group (two or more peers) that viewed bullying on the school playground. Peers were coded for actively joining or passively reinforcing the bully, and for actively intervening on behalf of the victim. On average, four peers viewed the schoolyard bullying, with a range from two to 14 peers. Averaged across all episodes, peers spent 54% of their time reinforcing bullies by passively watching, 21% of their time actively modelling bullies, and 25% of their time intervening on behalf of victims. Older boys (grades 4-6) were more likely to actively join with the bully than were younger boys (grades 1-3) and older girls. Both younger and older girls were more likely to intervene on behalf of victims than were older boys. The results were interpreted as confirming peers' central roles in the processes that unfold during playground bullying episodes. We discuss the results in terms of the challenges posed to peer-led interventions. Peers' anti-bullying initiatives must be reinforced by simultaneous whole-school interventions.

Aggression↗

PubMed2001

Ethnic variation in peer influences on adolescent smoking.

Previous research has indicated that the influence of peers on adolescent smoking may differ across ethnic groups. Although many studies have focused on African Americans, Hispanics, and Whites, few studies have included Asian Americans, Pacific Islanders, and multi-ethnic adolescents as distinct groups. Using data from a statewide sample of 5870 eighth-grade adolescents in California, this study examined ethnic differences in the association between peer influence variables and smoking behavior and susceptibility. Informational peer influence (best friends' smoking behavior) and normative peer influence (prevalence estimates of peer smoking) were investigated. We hypothesized that informational peer influences would be stronger among Whites (whose families originate primarily from the individualistic cultures of the USA and Western Europe) than among Asian Americans, Pacific Islanders, Hispanics, and African Americans (whose families originate primarily from collectivist cultures). Conversely, we hypothesized that normative peer influences would be stronger among ethnic minority adolescents from collectivist cultural backgrounds than among Whites. Consistent with previous studies, friends' smoking and prevalence estimates of peer smoking were risk factors for past 30-day smoking and susceptibility to smoking across ethnic groups. The influence of friends' smoking behavior was stronger among Whites than among several other groups: Pacific Islanders, African Americans, and Hispanic/Latinos. The influence of prevalence estimates of peer smoking was stronger among Whites than among multiethnic adolescents. Results indicate that cultural factors may play a role in peer influences on smoking initiation. Smoking prevention interventions for adolescents should address the differences in peer influences across ethnic groups.

Adolescent↗

PubMed2004

Applying depression-distortion hypotheses to the assessment of peer victimization in adolescents.

This study examined whether adolescents' depressive symptoms and aggressive behavior were associated with discrepancies between self- and peer-reports of peer victimization experiences. A sample of 203 10th-grade adolescents completed self-report measures of victimization and depressive symptoms as well as peer nominations of victimization and aggression. Residual scores were computed as a measure of discordance between peer- and self-reported peer victimization. Adolescents' aggressive behavior was associated with underestimations of peer victimization on self-reported measures, as compared to peer-reports, whereas depressive symptoms were associated with overestimations of peer victimization on self-report, as compared to peer-reports. Different patterns of findings were revealed for different forms of victimization (overt, relational, reputational) and by gender. Findings have implications for studies of adolescent peer victimization using multiple reporters and suggest that adolescents with high levels of depressive symptoms may be vulnerable to misperceptions of their social experiences among peers.

Adolescent↗

PubMedDate not supplied

Middle-class mothers' perceptions of peer and sibling victimization among children with Asperger's syndrome and nonverbal learning disorders.

This article describes the yearly prevalence and frequency of peer and sibling victimization as reported by a large national sample of middle-class mothers of children with Asperger's syndrome and nonverbal learning disorders. An anonymous, mailed survey was sent to families solicited from two national Internet sites for parents of children with Asperger's and nonverbal learning disorders using the Comprehensive Juvenile Victimization scale and three questions designed to measure peer shunning. The overall prevalence rate reported by mothers of peer victimization was 94%. Mothers reported that almost three-quarters of their children had been hit by peers or siblings in the past year and 75% had been emotionally bullied. On the more severe end of peer victimization, 10% of the children were attacked by a gang in the past year and 15% were victims of nonsexual assaults to the genitals. Peer shunning also was common. A third of the children had not been invited to a single birthday party in the past year, and many were eating alone at lunch or were picked last for teams. Peer shunning was significantly correlated with peer bullying and assault. The high rates of peer shunning and peer victimization reported suggest that children with Asperger's and nonverbal learning disorders may require further scrutiny and attention concerning their victimization experiences by peers and siblings. Implications for nursing professionals are reviewed.

Adolescent↗

PubMed1999

A method for proficiency testing of small peer groups in the College of American Pathologists Coagulation Surveys.

OBJECTIVE: To develop a grading scheme for the proficiency testing of small peer groups of fewer than 10 members for the prothrombin time (PT) and activated partial thromboplastin time (APTT). METHODS: A modified target value for small peer groups was derived based on the assumption that measurement variability in the PT and APTT is more greatly influenced by variations in reagents than in instruments. Criteria for grading were established by statistical simulation to achieve misclassification errors of less than 5% for both incorrectly passing and failing participants. College of American Pathologists Coagulation Survey data were analyzed to determine the number of additional laboratories graded using the proposed scheme, as well as the failure rates among participants in the small peer groups. RESULTS: The modified target value for small peer groups is a weighted average between the mean of the peer group and the mean of all participants using the same reagent (reagent group). Peer groups with as few as 4 members can be graded provided that specific criteria are satisfied: there must be at least 5 peer groups for the same reagent, at least 3 of these 5 peer groups must have more than 3 members, and the coefficient of variation for the reagent group must be less than 10%. This proposed grading scheme decreased the number of ungraded laboratories by 44% to 46% for the PT and 42% to 55% for the APTT. The percentage of failing grades among participants in the small peer groups ranged from 1.3% to 4.1% for the PT and 1.4% to 7.2% for the APTT. These failure rates were 2.8- to 13.0-fold higher than the failure rates in large peer groups (P < or = .05). CONCLUSIONS: The proposed small peer group grading scheme can improve the effectiveness of College of American Pathologists proficiency testing for the PT and APTT and may also be generally applicable to other test methods and analytes.

Anticoagulants↗

PubMed2002

The effect of peer support on breast-feeding duration among primiparous women: a randomized controlled trial.

BACKGROUND: Most mothers stop breast-feeding before the recommended 6 months post partum. A systematic review showed that breast-feeding support programs by health care professionals did not substantially improve breast-feeding outcomes beyond 2 months post partum. We conducted a randomized controlled trial to evaluate the effect of peer (mother-to-mother) support on breast-feeding duration among first-time breast-feeding mothers. METHODS: We recruited 256 breast-feeding mothers from 2 semi-urban community hospitals near Toronto and randomly assigned them to a control group (conventional care) or a peer support group (conventional care plus telephone-based support, initiated within 48 hours after hospital discharge, from a woman experienced with breast-feeding who attended a 2.5-hour orientation session). Follow-up of breast-feeding duration, maternal satisfaction with infant feeding method and perceptions of peer support received was conducted at 4, 8 and 12 weeks post partum. RESULTS: Significantly more mothers in the peer support group than in the control group continued to breast-feed at 3 months post partum (81.1% v. 66.9%, p = 0.01) and did so exclusively (56.8% v. 40.3%, p = 0.01). Breast-feeding rates at 4, 8 and 12 weeks post partum were 92.4%, 84.8% and 81.1% respectively among the mothers in the peer support group, as compared with 83.9%, 75.0% and 66.9% among those in the control group (p < or = 0.05 for all time periods). The corresponding relative risks were 1.10 (95% confidence interval [CI] 1.01-2.72) at 4 weeks, 1.13 (95% CI 1.00-1.28) at 8 weeks and 1.21 (95% CI 1.04-1.41) at 12 weeks post partum. In addition, when asked for an overall rating of their feeding experience, significantly fewer mothers in the peer support group than in the control group were dissatisfied (1.5% v. 10.5%) (p = 0.02). Of the 130 mothers who evaluated the peer support intervention, 81.6% were satisfied with their peer volunteer experience and 100% felt that all new breast-feeding mothers should be offered this peer support intervention. INTERPRETATION: The telephone-based peer support intervention was effective in maintaining breast-feeding to 3 months post partum and improving satisfaction with the infant feeding experience. The high satisfaction with and acceptance of the intervention indicates that breast-feeding peer support programs, in conjunction with professional health services, are effective.

Adolescent↗

PubMed2002

Measuring the quality of editorial peer review.

CONTEXT: The quality of a process can only be tested against its agreed objectives. Editorial peer-review is widely used, yet there appears to be little agreement about how to measure its effects or processes. METHODS: To identify outcome measures used to assess editorial peer review as performed by biomedical journals, we analyzed studies identified from 2 systematic reviews that measured the effects of editorial peer review on the quality of the output (ie, published articles) or of the process itself (eg, reviewers' comments). RESULTS: Ten studies used a variety of instruments to assess the quality of articles that had undergone peer review. Only 1, nonrandomized study compared the quality of articles published in peer-reviewed and non-peer-reviewed journals. The others measured the effects of variations in the peer-review process or used a before-and-after design to measure the effects of standard peer review on accepted articles. Eighteen studies measured the quality of reviewers' reports under different conditions such as blinding or after training. One study compared the time and cost of different review processes. CONCLUSIONS: Until we have properly defined the objectives of peer-review, it will remain almost impossible to assess or improve its effectiveness. The research needed to understand the broader effects of peer review poses many methodologic problems and would require the cooperation of many parts of the scientific community.

Evaluation Studies as Topic↗

PubMed1997

Peer relations in adolescents: effects of parenting and adolescents' self-concept.

In this study we examined the link between the parent-adolescent relationship and the adolescent's relationship with peers. The proposed model assumes that the quality of the parent-child relationship affects the adolescent's self-concept, which in turn affects the adolescent's integration into the world of peers. The sample consisted of 508 families with adolescents (12- to 18-years-old). The data were obtained at the subjects' homes, where a battery of questionnaires was administered individually to mothers, fathers and adolescents. Several constructs relating to the quality of parent-child relationship were assessed: parental acceptance, attachment, involvement, responsiveness, love withdrawal and monitoring of the child. The measures of the adolescent's self-concept included Harter's Perceived Competence Scale for Adolescents and Rosenberg's Self-Esteem Scale. The indicators of the quality of peer relations were: degree of peer activity, having a best friend, perceived acceptance by peers and attachment to peers. Assessment of the hypothesized model showed that the adolescent's self-concept serves a mediating role in the relationship between maternal child-rearing style and involvement with peers. The mediating role of self-concept was greatest for maternal acceptance. Paternal child-rearing style, however, appeared to have an independent effect on the adolescent's involvement with peers that is not accounted for by the adolescent's self-concept. The prediction of the quality of adolescents' peer relations yielded similar results for both mothers and fathers. The results suggest that a positive self-concept and warm supportive parenting each contribute unique variance to satisfactory peer relations.

Adolescent↗