Peer Enriched Environment for Recovery (PEER)

Peer Enriched Environment for Recovery (PEER): An Integrated Health Coaching Intervention Post-Stroke

The goal of this interventional study is to assess whether a peer coaching intervention (PEER) can improve the well-being in individuals who experienced a stroke. The main questions it aims to answer are

1. Is the PEER intervention feasible and acceptable for the intervention recipients who receive the intervention?
2. Is the PEER intervention feasible and acceptable for the peer coaches who deliver the intervention?
3. Do intervention recipients show a higher level of quality of life at immediate, 4-week, and 8-week post-intervention?
4. Do intervention recipients display increases in measures of psycho-social-spiritual well-being at immediate, 4-week, and 8-week post-intervention? Peer coach participants will a) take training sessions, b) deliver 5 coaching sessions to an intervention recipient participant, c) complete surveys before training, after training, and after intervention delivery, and d) participate in a personal interview Intervention recipient participants will a) attend 5 coaching sessions delivered by a peer coach participant, b) complete surveys before intervention, immediately post intervention, 4-week post intervention, and 8 week post-intervention, and c) participate in a personal interview.

For intervention recipient recruitment, stroke survivors who have been diagnosed with stroke in the past 12 months and have been discharged from hospitals will be recruited from the collaborating community services and open recruitment. Recruited intervention recipients will proceed to take a baseline survey which collects their demographic characteristics, stroke-related information, wellbeing measures, and quality of life measure (T1). For peer coach recruitment, experienced stroke survivors who have been diagnosed with stroke in the past 5 years will be invited to participate in the study as peer coaches.

Recruited peer coaches will be asked to complete a preliminary survey. The preliminary survey collects peer coaches' demographic characteristics and stroke-related information, which will be sued for the matching between peer coaches and intervention recipients. The preliminary survey will also assess their well-being outcomes, QoL, self-determination level, coaching skills, and cognitive ability. Peer coaches with limited cognitive ability to perform peer-coaching will not proceed to peer coach training. Following the preliminary survey, peer coaches will undergo peer coach training sessions and the post-training assessment before performing peer-coaching in the intervention. The post-training assessment will include measurement of well-being outcomes, QoL, self-determination level, coaching skills, and cognitive ability. Peer coaches with limited cognitive ability to perform peer-coaching will not proceed to the intervention delivery.

Following the post-training survey, each peer coach will be matched with an intervention recipient based to their demographic characteristics and stroke experience. Following the matching process, peer coaches and intervention recipients will proceed into the intervention process. During the intervention, intervention recipients will be asked to attend peer-coaching sessions led by the matched peer coaches. The time of peer-coaching sessions will be decided based on participants' schedules. In the peer-coaching sessions, intervention recipients and peer coaches will meet in-person, and peer coaches will guide them to carry out arranged activities collaboratively. After the last peer coaching session is completed, intervention recipients will proceed to a post-intervention survey, which measures their satisfaction with the intervention as recipients, and a personal interviews, in which they will be asked about their perceptions and opinions on the PEER program. Intervention recipient will also be asked to take the follow-up survey at 3 time points - immediately after the intervention (T2), 4 weeks after the intervention (T3), and 8 weeks after the intervention (T4). The follow-up survey measures intervention recipients' wellbeing and quality of life. After the delivery of all peer coaching sessions, peer coaches will undergo the post-intervention survey, which assesses their well-being outcomes, QoL, self-determination level, cognitive ability, coaching skills, and satisfaction with the intervention as peer coaches; peer coaches will also be asked to attend a personal interview, in which they will be asked about their perceptions and opinions on the PEER program.

The interviews for peer coaches and intervention recipients will be audio-recorded with participants' consent. The recordings will be transcribed verbatim and proceed to thematic analyses. The analysis results of collected quantitative and qualitative data will be synthesized to evaluate the feasibility and the effectiveness of the peer-coaching intervention and the feasibility of the evaluation procedures. Elements of the PEER programme and the evaluation procedure will be improved based on the analysis results for future research and implementation.

Inclusion criteria for peer coach:

• Aged 21 years and above
• Diagnosed with stroke within the past 5 years and discharged from the hospital

Inclusion criteria for intervention recipients

• Aged 21 years and above
• Diagnosed with stroke within the past 1 year and discharged from the hospital

Exclusion criteria for all participants:

• Unable to communicate in English
• Unable to provide informed consent
• Diagnosed with one or multiple conditions which affect cognitive and/or mental health severely
• Diagnosed with severe or potentially terminal co-morbidities