Peer-Facilitated Decision Making in Mental Health: Promises, Pitfalls, and Recommendations for Research and Practice
Abstract
Recognition has grown that peer support workers serve an important role in facilitating decision making about treatment and recovery among people with mental health conditions. This article provides examples of peer-facilitated decision support interventions in the literature, discusses promises and potential pitfalls associated with peers serving in decision support roles, and offers recommendations for research and practice. Examples were selected from the literature on decision support interventions for people with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. Promises, pitfalls, and recommendations were informed by this research and by the literature on lived experience perspectives, the helper-therapy principle, and reported barriers to and facilitators of peers assisting with decision making. According to the included studies, peers may facilitate decision making in several ways (e.g., by asking service users about their goals or preferences, assisting them with using decision support tools, sharing stories, and facilitating access to information and resources). Peer-facilitated decision support may be associated with positive decision making and health outcomes for service users and peer support workers. However, providers need to carefully consider barriers to implementation of this support, such as inadequate resourcing, poor integration, and compromising of peer support values.
HIGHLIGHTS
This article provides examples of peer-facilitated decision support interventions in the literature, drawing attention to possible benefits and potential challenges of peers serving in decision support roles.
Future research should focus on elucidating how and for whom peer-facilitated decision support is effective.
Training programs for peer and nonpeer workers are needed to facilitate implementation of peer-based services in mental health decision making.
Peer support is considered a hallmark of recovery-oriented mental health care. Although several definitions and typologies have been proposed (1–3), here we define peer support as the services and support that individuals with lived experience of mental health challenges and recovery provide to service users in a mainstream mental health setting. In this context, peer support workers are specifically trained to use their lived experience in a multitude of roles, often striving to promote self-determination, health and wellness, hope, effective communication with treatment providers, illness management, and stigma reduction (4). Although peer support workers may function across numerous areas (e.g., training and education, group facilitation, care coordination, individual or systems advocacy, policy development, and research) (5), the focus of this article is on peer support workers with lived experience who volunteer or are employed to provide direct support to other people with similar experiences.
Individuals with mental health challenges often experience uncertainty related to decisions about their treatment and recovery (6). Peer support workers are ideally suited to assist individuals with decision making. Not only are the perspectives and support of people with lived experience desired when engaging in treatment decisions and self-advocacy (7, 8), but theories underlying peer-delivered services (9–11) suggest unique ways in which peer support workers may facilitate the decision-making process. For example, they may share their experiential knowledge (12), derived through their own lived experiences, to complement factual information provided by other treatment providers during service users’ decision-making processes (9). Peer support workers foster self-determination through their encouragement and modeling of self-responsibility and advocacy (4, 13), which may promote the sustainability of service users’ decisions (14). Peer support workers may also be an important source of emotional support (9), helping service users to feel less alone and to build self-efficacy needed for decision making (15, 16). These unique contributions add to what other treatment providers do to support service users in making decisions, which may include providing them with options, answering questions, asking about personal preferences, and helping them carry out decisions.
Although theories underlying peer-delivered services indicate that peer support workers can serve an important function in facilitating decision making, currently little guidance exists as to how they may do so or what could be done to circumvent known challenges in this area (17). The growing number of shared decision-making and decision support interventions in mental health provides an opportunity to analyze the contributions of peer support workers, as well as factors affecting implementation of peer support. These interventions typically involve decision coaching, guidance, and motivational or self-management approaches, with or without the use of decision aids (18–20). Regardless of format, their purpose is to help individuals make informed health care choices that are consistent with personal values and preferences. Peer-facilitated decision support involves the delivery of these interventions in whole or in part by peer support workers. For example, peers may provide coaching or motivational support to help individuals make or follow through with their decisions, or they may assist service users with using decision aids or other decision support tools. An examination of these interventions is needed to support implementation of peer decision support, especially given that the peer support workforce is rapidly expanding (21) and that decision support is an ideal area in which peers can work.
The aims of this article were to provide examples of peer-facilitated decision support interventions in the published literature and, on the basis of these examples and related literature, to discuss some benefits and potential pitfalls associated with peers serving in decision support roles and to provide recommendations for research and practice. In this article, we focused on studies that have been conducted with individuals with serious mental health conditions, including schizophrenia, bipolar disorder, major depression, and other disorders associated with significant functional impairment, because this population faces significant barriers to involvement in decision making about their care (22) and may benefit from peer-facilitated decision support.
Examples of Peer-Facilitated Decision Support Interventions
Examples of peer-delivered decision support interventions were identified within the literature on shared decision making and decision support for people with serious mental illnesses. We did not perform an exhaustive review of peer-facilitated decision support interventions for this population, because such review was beyond the scope of this article. The included interventions, discussed below, are not necessarily the only ones that exist but provide examples of the formalized role of peer support workers in supporting decision making.
The most well-established and extensively researched of these peer support interventions is Deegan’s CommonGround (23–30), which combines digital technology and peer support to help individuals prepare for psychiatric medication consultations. In this intervention, peer support workers are primarily responsible for assisting individuals in using a software program that provides education about recovery and elicits individuals’ perspectives about their mental health and questions and concerns about medication. Educational materials within the program also contain video vignettes from peers about their recovery experiences. Finally, peer support workers are available to the individuals after their medication consultations to provide any additional support needs identified during the meeting (e.g., assistance with using wellness tools) (23).
Inspired by this process, the Choices About Healthcare Options Informed by Clients Experiences and Expectations (known as Choice) project of Simmons and colleagues (31) evaluated the impact of an online decision support tool and engagement with a peer support worker during the intake process at a youth mental health service. Peer support workers (young people with lived experience of mental health challenges) greet participants in the waiting area before their first appointment and assist them in using the decision support tool. The tool gathers information about participants’ preferences for treatment and provides education about treatment options available at the service. It includes prompts for the youths to discuss with their intake clinician the potential benefits and risks associated with each option. Peer support workers are also available after participants’ appointments to provide further support.
Metz and colleagues (32) developed an intervention, called SDM-Digital Intake (known as SDM-DI), to foster shared decision making during the intake process within outpatient clinics about the management of depression, anxiety, or personality disorders. The intervention consists of digital e-health modules designed to gather information about the service user’s treatment needs and preferences, routine monitoring of clinical outcomes, and interactions with peer support workers for assistance in completing the e-health modules and preparing for the intake session.
A self-management and collaborative care planning intervention for chronic mental illness, developed by Lawn and colleagues (33), involves a comprehensive assessment of strengths and barriers to self-management, a clinician- and service user–developed care plan created on the basis of this assessment, and partnership between the peer educators and case managers in delivering a self-management skills group. Peer support workers are also available to provide education and encouragement to the service users as they work with their clinicians during care planning.
Paudel et al.’s (34) shared decision–making model also consists of a group intervention that encourages participants to set recovery goals, educates them about psychiatric medications, and provides support from a peer worker and assistance from a nurse with accessing information about medications. The aim of the Paudel et al. intervention is to prepare individuals to engage in shared decision making about medication with their psychiatrist. Peer support workers ask participants about their preferences related to medication and share their personal experiences in decision making about medication and negotiating and communicating with treatment providers.
Munson and colleagues (35) tested an intervention, Just Do You, that aims to improve treatment engagement among young adults with serious mental illnesses. This two-session intervention targets key variables relevant to decision making (e.g., beliefs about the advantages and disadvantages of engaging in treatment) through expressive art activities, personal narratives, psychoeducation, and motivational interviewing. The intervention is cofacilitated by clinicians and peer support workers. Peer support workers share their lived experiences, encourage self-acceptance and trust of providers, and promote a belief in the service user’s ability to communicate with providers about treatment decisions. The peer workers also provide mentoring and check-ins, answer questions, and build relationships with the participants between the intervention meetings.
Taken together, the findings of these studies have demonstrated that peer support workers may facilitate decision making in several ways. In these peer-facilitated interventions, peer support workers ask service users about their goals and preferences, assist them with using decision support tools, share their own stories related to decision making and self-advocacy, enhance motivation, facilitate access to information and resources, support effective communication with treatment providers, and provide follow-up support.
Promises of Peer-Facilitated Decision Support
Although the research designs of the aforementioned studies precluded isolating the effects of peer support within these multifaceted interventions, the results of these studies indicate promising decision-making and health outcomes. As reported by a recent systematic review of shared decision-making interventions for individuals with serious mental illnesses (36), these outcomes include enhanced patient-centered communication (24), increased treatment engagement and health care service use (26, 35), improved symptoms and recovery attitudes (30, 32), greater perceived shared decision making (31, 32), reduced decisional conflict (31, 34), and increased self-management and functional outcomes (33). These findings suggest that decision support interventions that are delivered fully or partially by peer support workers may confer several benefits to service users, at least among people experiencing serious mental illnesses in high-income countries, where these studies took place.
Besides the findings of the studies described above, literature on the power of lived experience perspectives has suggested additional benefits associated with peers serving in decision support roles. For example, the voices of those with lived experience, including peer support workers, can inform systems transformation to better support service users’ dignity, self-determination, and empowerment (37). As part of the decision support process, peer support workers can use their personal experience of decision making, as well as their observations about supporting others in these efforts, to identify and help reduce barriers associated with the mental health system, such as concern about the ability of service users to participate in decision making. This support may entail sharing their success stories and advocating for others to have the opportunity to make autonomous treatment choices. Furthermore, the sharing of lived experience may help peer support workers to achieve a level of credibility and connection with service users that is qualitatively different from that of mental health service providers without such lived experience (38). As peer support workers share their stories about their health care and recovery choices and experiences with service users, they are likely to simultaneously build the trusting relationships needed to support the service users with their own decision making and recovery.
The opportunity to deliver decision support may also have a positive impact on the peer support workers themselves. According to Salzer and Shear (39), the helper-therapy principle indicates that peer support workers may benefit in several ways from serving as helpers, including experiencing greater perceived interpersonal competence, equality in the peer-to-peer relationship, gains in personal knowledge, and social approval. In a qualitative study of how peer support workers benefit from serving in these roles, Salzer and Shear (39) found support for all of the benefits identified by the helper-therapy principle, as well as gains in personal recovery, professional growth, and other job-related benefits. In the case of peer-facilitated decision support, peer support workers may gain a sense of accomplishment from helping others to make choices about their health care and recovery and by empowering them to advocate for their preferences. Peer support workers also may grow in their own knowledge and skills related to decision making and may feel fulfilled by developing mutually beneficial relationships with service users. Furthermore, as proposed by Fiddian-Green and colleagues (40), sharing personal stories related to decision making may help peer support workers make sense of their own experiences, promote a sense of mastery and self-efficacy, and aid in the formulation of goals and plans for future decision making. Finally, hiring and training peer workers to deliver decision support interventions could lead to increased role clarity for peer support workers employed in mainstream mental health settings, where role confusion has been a prevalent issue for the workforce (41).
Potential Pitfalls of Peer-Facilitated Decision Support
Although there are many possible benefits to peer support workers serving in decision support roles, several potential challenges also exist. Across the aforementioned studies of peer-facilitated decision support interventions, implementation barriers were largely related to resourcing issues, team integration, professional stigma toward peer support workers, and poor uptake of peer support services (27, 32, 33, 42). Although these issues do not appear to be specific to peer-facilitated decision support, and have been reported in other studies more broadly focused on peer support (43–45), they indicate potential obstacles to the implementation of these services.
Other research has identified challenges more closely related to the provision of decision support by peers. In a qualitative study of barriers to and facilitators of supporting service users’ participation in shared decision making (17), peer support workers reported experiencing conflict between their roles as advocates and expectations of management, and they felt challenged by power dynamics that placed decision-making authority in the hands of clinicians. Extrapolating on these findings, we surmise that peer support workers may be expected to persuade those they support to make specific choices (e.g., those that align with clinicians’ preferences), which runs counter to foundational principles associated with peer support, such as person-centeredness, voluntary participation, and respect for alternative worldviews (46). Peer support workers may also be put in positions of giving treatment advice or providing information beyond their expertise to persuade service users to make the decisions the clinicians believe are in the service users’ best interests. A complementary qualitative study (47), conducted with mental health nurses, has highlighted concerns about the potential for the sharing of lived experience to create undue influence and to undermine decision making. These concerns have been echoed by sentiments within the literature on personal narratives (48, 49) that urge caution when using such narratives to support decision making, because of their persuasive power, potentially biasing effects, and ability to spread misinformation. These possible pitfalls associated with peer-facilitated decision support require careful attention and have implications for training and supervision, as discussed below.
Recommendations for Research and Practice
As the above studies indicate, peer-facilitated decision support interventions have yielded promising outcomes, but we also note a clear need for additional research in this area. For instance, studies designed to understand the unique contributions of peer support to decision-making outcomes are necessary. Many of the interventions discussed in this article included components other than peer support—such as decision support tools—that may have affected decision making. Furthermore, several interventions were cofacilitated by peer support workers and clinicians. Studies that may be especially useful are those designed to assess the relative utility of various components of multielement interventions and include mixed-methods approaches exploring whether and how various aspects of peer support influence decision making. This research could examine mechanisms of action, as well as which peer support core values or principles are most useful in the context of peers facilitating decision making. Additionally, the impact of peer-facilitated decision support on service users and on peer support workers themselves merits further investigation. According to the literature, service user outcomes of interest may include decisional conflict, perceived shared decision making, treatment engagement, and clinical and functional outcomes, whereas peer supporter outcomes may focus on professional and personal growth, self-efficacy, and job-related benefits.
Because the studies of peer-facilitated decision support interventions discussed in this article were conducted in high-income countries, their findings may not generalize to the global population of individuals with serious mental illness. Research is needed on how interventions could be tailored to meet the specific needs of racial, ethnic, and cultural minority populations or could be reimagined through culturally appropriate participatory methods if the current approaches are not culturally appropriate (50, 51). This tailoring may be accomplished through modifications to the interventions themselves (e.g., translation of decision support tools), reconceptualization of decision support for different cultural groups (e.g., family decision making), new models of peer support (e.g., having one peer support worker and one community elder providing decision support to an extended family), or greater representation among intervention providers. Because peer work is one role that typically has fewer barriers to entry (at least in terms of required educational and training credentials), it offers a pathway to increased diversity and relevance of the mental health workforce.
Further integration of the literature on personal narratives with that of peer support would also benefit the field. Although a body of research has been established on how narratives influence medical and health-related decision making (52, 53), comparatively little of this research exists in the mental health field, and even less has been conducted in the context of peer support. This is an important and surprising gap given the frequency with which peer support workers share their personal experiences as part of their work with service users (4). As recommended by Mancini (54), an application of narrative methods and theory is needed to better understand the nuances of peer practices. We affirm and extend this recommendation by adding that narrative research should be used to inform studies of the influence of peer support on decision making. This research may also be useful for establishing best practices related to the sharing of lived experience to facilitate decision making.
The potential pitfalls identified here point to several practical implications for peer-facilitated decision support. First, peer support workers may need additional training in how to strategically share their experiences in a way that aids decision making. Although broader training programs for peer support workers in storytelling and self-disclosure exist (55), the extent to which these approaches apply to decision-making discussions is not clear. Because personal narratives can be used for many purposes (e.g., to engage, inform, model, or comfort) (56), peer support workers should receive instruction in how to craft their stories in alignment with what they hope to accomplish by sharing them. They should also be made aware of the persuasive power that personal stories have and should be encouraged, as appropriate, to acknowledge experiences that differ from their own.
Second, supervisors and fellow team members may require training in how to support the role of a peer in facilitating decision making. As suggested by Gates and Akabas (43), improving nonpeer staff attitudes toward peers and enhancing peer integration on the treatment team may be accomplished by making it clear what the peer role is and how it contributes to the mission of the agency. Because peer roles vary widely across localities, states, and organizations, this training should be tailored to the specific expectations of peers in the local area. Training should also include education about the foundational principles of peer support (46) and how these principles may align or conflict with expectations of how peers may promote decision making. Supervisors and team members may also benefit from training and consultation in shared decision making to foster greater involvement of service users, and others, in the decision-making process. Professional development opportunities in this area may help to rectify perceived power imbalances between clinicians and those with lived experiences in decision-making discussions.
Conclusions
The literature cited in this study points to peer-facilitated decision support as a promising approach in need of further study. We have offered several future directions for research and practice, including seeking a better understanding of the specific impacts of peer support within multielement decision-making interventions, investigating how peer-facilitated decision support influences service user and peer worker outcomes, and developing training programs for peer workers, supervisors, and coworkers to support the unique role of peers in facilitating the decision-making process. As such, we hope to encourage further development and more widespread implementation of peer-based services in this important area.
1. : Peer support among adults with serious mental illness: a report from the field. Schizophr Bull 2006; 32:443–450Crossref, Medline, Google Scholar
2. : Peer support among individuals with severe mental illness: a review of the evidence. Clin Psychol 1999; 6:165–187 Google Scholar
3. : Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr Serv 2014; 65:429–441Link, Google Scholar
4. : Certified peer specialist roles and activities: results from a national survey. Psychiatr Serv 2010; 61:520–523Link, Google Scholar
5. : “Consumer consultant”: expanding the role of consumers in modern mental health services. Int J Ment Health Nurs 2006; 15:29–34Crossref, Medline, Google Scholar
6. : Decisional conflict in mental health care: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:161–169Crossref, Medline, Google Scholar
7. : Information and decision-making needs among people with mental disorders: a systematic review of the literature. Health Expect 2015; 18:1856–1872Crossref, Medline, Google Scholar
8. : Service users’ experiences of participation in decision making in mental health services. J Psychiatr Ment Health Nurs 2015; 22:688–697Crossref, Medline, Google Scholar
9. : Consumer-delivered services as a best practice in mental health care delivery and the development of practice guidelines. Psychiatr Rehabil Skills 2002; 6:355–382 Crossref, Google Scholar
10. : Peer support and service engagement; in Person-Centered Care for Mental Illness: The Evolution of Adherence and Self-Determination. Edited by Corrigan PW. Washington, DC, American Psychological Association, 2015 Crossref, Google Scholar
11. : Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatr Rehabil J 2004; 27:392–401Crossref, Medline, Google Scholar
12. : Understanding Self-Help/Mutual Aid: Experiential Learning in the Commons. Piscataway, NJ, Rutgers University Press, 1999 Google Scholar
13. : Peer support, self-determination, and treatment engagement: a qualitative investigation. Psychiatr Rehabil J 2013; 36:209–214Crossref, Medline, Google Scholar
14. : Intrinsic Motivation and Self-Determination in Human Behavior. New York, Springer, 1985 Crossref, Google Scholar
15. : Self-esteem, self-efficacy, and the balance of peer support among persons with chronic mental health problems. J Appl Soc Psychol 2008; 38:436–459 Crossref, Google Scholar
16. : Self-efficacy as a mediator of the relationship between social support and recovery in serious mental illness. Psychiatr Rehabil J 2016; 39:352–360Crossref, Medline, Google Scholar
17. : “Walking the tightrope”: the role of peer support workers in facilitating consumers’ participation in decision-making. Int J Ment Health Nurs 2018; 27:1266–1272Crossref, Medline, Google Scholar
18. : Coaching and guidance with patient decision aids: a review of theoretical and empirical evidence. BMC Med Inform Decis Mak 2013; 13(suppl 2):S11Crossref, Medline, Google Scholar
19. : Decision aids that facilitate elements of shared decision making in chronic illnesses: a systematic review. Syst Rev 2019; 8:121Crossref, Medline, Google Scholar
20. : Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions. Ment Health Rev 2017; 22:191–213 Crossref, Google Scholar
21. : The peer support workforce: results of a national survey. Psychiatr Rehabil J 2016; 39:211–221Crossref, Medline, Google Scholar
22. : Shared decision making in mental health: the importance for current clinical practice. Australas Psychiatry 2017; 25:578–582Crossref, Medline, Google Scholar
23. : A program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatr Serv 2008; 59:603–605Link, Google Scholar
24. : The effect of CommonGround software and decision support center. Am J Psychiatr Rehabil 2014; 17:166–180 Crossref, Google Scholar
25. : Enhancing clients’ communication regarding goals for using psychiatric medications. Psychiatr Serv 2017; 68:771–775Link, Google Scholar
26. : Use of a Web-based shared decision-making program: impact on ongoing treatment engagement and antipsychotic adherence. Psychiatr Serv 2018; 69:1215–1221Link, Google Scholar
27. : Implementation and use of a client-facing Web-based shared decision-making system (MyCHOIS-CommonGround) in two specialty mental health clinics. Community Ment Health J 2019; 55:641–650Crossref, Medline, Google Scholar
28. : Exploring the experiences of client involvement in medication decisions using a shared decision making model: results of a qualitative study. Community Ment Health J 2015; 51:267–274Crossref, Medline, Google Scholar
29. : Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence. Community Ment Health J 2013; 49:185–192Crossref, Medline, Google Scholar
30. : Consumer outcomes after implementing CommonGround as an approach to shared decision making. Psychiatr Serv 2017; 68:299–302Link, Google Scholar
31. : The Choice Project: peer workers promoting shared decision making at a youth mental health service. Psychiatr Serv 2017; 68:764–770Link, Google Scholar
32. : Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in shared decision making: a cluster randomised controlled trial in a specialist mental health outpatient setting. PLoS One 2018; 13:e0199795Crossref, Medline, Google Scholar
33. : The mental health expert patient: findings from a pilot study of a generic chronic condition self-management programme for people with mental illness. Int J Soc Psychiatry 2007; 53:63–74Crossref, Medline, Google Scholar
34. : Development of a shared decision making model in a community mental health center. Community Ment Health J 2018; 54:1–6Crossref, Medline, Google Scholar
35. : Outcomes of a metaintervention to improve treatment engagement among young adults with serious mental illnesses: application of a pilot randomized explanatory design. J Adolesc Health 2021; 69:790–796Crossref, Medline, Google Scholar
36. : A systematic review of shared decision–making interventions for service users with serious mental illnesses: state of the science and future directions. Psychiatr Serv 2021; 72:1288–1300Link, Google Scholar
37. : Integrating lived experience perspectives into clinical practice; in A Clinical Introduction to Psychosis: Foundations for Clinical Psychologists and Neuropsychologists. Edited by Badcock JC, Paulik G. San Diego, Elsevier Academic Press, 2020 Crossref, Google Scholar
38. : The value of lived experience with the criminal justice system: a qualitative study of peer re-entry specialists. Int J Offender Ther Comp Criminol 2019; 63:1861–1875Crossref, Medline, Google Scholar
39. : Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatr Rehabil J 2002; 25:281–288Crossref, Medline, Google Scholar
40. : Restor(y)ing health: a conceptual model of the effects of digital storytelling. Health Promot Pract 2019; 20:502–512Crossref, Medline, Google Scholar
41. : An exploration of factors that effect the implementation of peer support services in community mental health settings. Community Ment Health J 2018; 54:127–137Crossref, Medline, Google Scholar
42. : The CHOICE pilot project: challenges of implementing a combined peer work and shared decision-making programme in an early intervention service. Early Interv Psychiatry 2018; 12:964–971Crossref, Medline, Google Scholar
43. : Developing strategies to integrate peer providers into the staff of mental health agencies. Adm Policy Ment Health 2007; 34:293–306Crossref, Medline, Google Scholar
44. : A systematic review of influences on implementation of peer support work for adults with mental health problems. Soc Psychiatry Psychiatr Epidemiol 2020; 55:285–293Crossref, Medline, Google Scholar
45. : Challenges faced by mental health peer support workers: peer support from the peer supporter’s point of view. Psychiatr Rehabil J 2012; 35:337–340Crossref, Medline, Google Scholar
46. : Intentional Peer Support: An Alternative Approach. The author, 2012 Google Scholar
47. : Two approaches, one goal: how mental health registered nurses’ perceive their role and the role of peer support workers in facilitating consumer decision-making. Int J Ment Health Nurs 2018; 27:1212–1218Crossref, Medline, Google Scholar
48. : Do personal stories make patient decision aids more effective? An update from the International Patient Decision Aids Standards. Med Decis Making 2021; 41:897–906Crossref, Medline, Google Scholar
49. : Illness Narratives in Practice: Potentials and Challenges of Using Narratives in Health-Related Contexts. Oxford, Oxford University Press, 2018 Crossref, Google Scholar
50. : The need for representative research on shared decision making. Psychiatr Serv 2021; 72:1245Link, Google Scholar
51. : How is Etuaptmumk/Two-Eyed Seeing characterized in Indigenous health research? A scoping review. PLoS One 2021; 16:e0254612Crossref, Medline, Google Scholar
52. : Changing health-promoting behaviours through narrative interventions: a systematic review. J Health Psychol 2018; 23:1499–1517Crossref, Medline, Google Scholar
53. : Impact of narratives on persuasion in health communication: a meta-analysis. J Advert 2015; 44:105–113 Crossref, Google Scholar
54. : Strategic storytelling: an exploration of the professional practices of mental health peer providers. Qual Health Res 2019; 29:1266–1276Crossref, Medline, Google Scholar
55. : Initial training for mental health peer support workers: systematized review and international Delphi consultation. JMIR Ment Health 2021; 8:e25528Crossref, Medline, Google Scholar
56. : All stories are not alike: a purpose-, content-, and valence-based taxonomy of patient narratives in decision aids. Med Decis Making 2013; 33:4–13Crossref, Medline, Google Scholar
