Assessing the impact of the iPeer2Peer program for adolescents with juvenile idiopathic arthritis: a mixed-methods randomized controlled trial

doi:10.1186/s12969-024-01052-5

Randomized Controlled Trial

. 2024 Dec 27;22(1):109.

doi: 10.1186/s12969-024-01052-5.

Assessing the impact of the iPeer2Peer program for adolescents with juvenile idiopathic arthritis: a mixed-methods randomized controlled trial

Fareha Nishat¹, Lauren Kelenc¹, Roberta Berard², Ciaran Duffy³, Brian Feldman^{1

4}, Paula Forgeron⁵, Adam M Huber⁶, Nadia Luca⁷, Heinrike Schmeling^{8

9}, Lynn Spiegel⁴, Lori Tucker¹⁰, Karen Watanabe-Duffy³, Tieghan Killackey^{1

11

12}, Chitra Lalloo¹, Brittany Wiles¹, Anya Nair¹, Sofia Olaizola¹, Brenna McDermott¹, Farideh Tavangar¹², Sara Ahola Kohut¹³, Jennifer N Stinson^{14

15}

Affiliations

¹ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 686 Bay Street, Room 06.9715, Toronto, ON, M5G 0A4, Canada.
² Division of Rheumatology, Children's Hospital, London Health Sciences Centre, London, ON, Canada.
³ Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
⁴ Department of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.
⁵ School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
⁶ Division of Pediatric Rheumatology, IWK Health Centre, Halifax, NS, Canada.
⁷ Division of Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
⁸ Alberta Children's Hospital, Calgary, AB, Canada.
⁹ Section of Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁰ Division of Rheumatology, British Columbia Children's Hospital, Vancouver, BC, Canada.
¹¹ University Health Network, Toronto, Canada.
¹² Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
¹³ Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁴ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 686 Bay Street, Room 06.9715, Toronto, ON, M5G 0A4, Canada. jennifer.stinson@sickkids.ca.
¹⁵ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. jennifer.stinson@sickkids.ca.

PMID: 39731098
PMCID: PMC11674074
DOI: 10.1186/s12969-024-01052-5

Randomized Controlled Trial

Assessing the impact of the iPeer2Peer program for adolescents with juvenile idiopathic arthritis: a mixed-methods randomized controlled trial

Fareha Nishat et al. Pediatr Rheumatol Online J. 2024.

. 2024 Dec 27;22(1):109.

doi: 10.1186/s12969-024-01052-5.

Authors

Affiliations

¹ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 686 Bay Street, Room 06.9715, Toronto, ON, M5G 0A4, Canada.
² Division of Rheumatology, Children's Hospital, London Health Sciences Centre, London, ON, Canada.
³ Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
⁴ Department of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.
⁵ School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
⁶ Division of Pediatric Rheumatology, IWK Health Centre, Halifax, NS, Canada.
⁷ Division of Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
⁸ Alberta Children's Hospital, Calgary, AB, Canada.
⁹ Section of Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁰ Division of Rheumatology, British Columbia Children's Hospital, Vancouver, BC, Canada.
¹¹ University Health Network, Toronto, Canada.
¹² Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
¹³ Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁴ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 686 Bay Street, Room 06.9715, Toronto, ON, M5G 0A4, Canada. jennifer.stinson@sickkids.ca.
¹⁵ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. jennifer.stinson@sickkids.ca.

PMID: 39731098
PMCID: PMC11674074
DOI: 10.1186/s12969-024-01052-5

Abstract

Background: Juvenile Idiopathic Arthritis (JIA) is a chronic pediatric illness, whereby youth experience physical, emotional and psychosocial challenges that result in reduced health related quality of life (HRQL). Peer mentoring has been shown to improve disease self-management in adults with chronic conditions, with mixed results in younger populations. Building on our pilot work - which supported the feasibility and initial effectiveness of the iPeer2Peer program - the objective of this study was to assess the clinical effectiveness of the program in youth with JIA through a waitlist randomized controlled trial.

Methods: Eighty-one youth (aged 12-18) were randomized to the intervention group and matched with trained peer mentors (18-25 years; successfully managing their JIA), completing of up to ten 30-min video calls over a 15-week period. Eighty-three youth in the control group received standard care. Outcome assessments occurred at enrollment, 15 weeks post randomization and 6-months post randomization. The primary outcome was self-management, measured using the TRANSITION-Q. Secondary outcomes were HRQL, pain, emotional distress, disease knowledge, self-efficacy, and perceived social support. These were assessed using linear mixed effects models. Content analysis of semi-structured interviews and focus groups was used to assess satisfaction with the program with mentors and mentees upon study completion.

Results: In total, 164 youth (mean age 14.4 ± 1.9 years, 78% female) were randomized to the study. The proposed sample size was not reached due to challenges in recruitment, likely impacted by the COVID-19 pandemic. The iPeer2Peer program did not show significant improvement in self-management (p = 0.7), or any of the secondary outcomes. Three key categories emerged from content analysis: (1) Fulfillment and Support Through Shared Experience, (2) Enhancing Program Delivery and (3) Strategies to Boost Engagement. These findings highlight that mentees valued the ability to converse with mentors who empathized with their disease experience, while mentors found it fulfilling to support mentees, and noted that they could have benefited from this type of support themselves.

Conclusion: While the iPeer2Peer did not result insignificant changes in clinical outcomes, both mentors and mentees were satisfied with the program and felt that mentorship provided real-world benefits for disease management and overall wellbeing.

Trial registration: ClinicalTrials.gov, NCT03116763. Registered 31, March 2017, https://www.

Clinicaltrials: gov/study/NCT03116763.

Keywords: Adolescent; Juvenile idiopathic arthritis; Online; Peer support; Randomized control trial; Self-management.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Research ethics board approvals were obtained from SickKids (REB #1000054878), Children’s Hospital for Eastern Ontario (REB #17-77X), BC Children’s Hospital (REB #H17-00285), IWK Health Centre (REB #1022331), Alberta Children’s Hospital (REB #17-2098_REN3), and London Health Sciences (REB #112368). Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

**Fig. 2**
Consolidated standards of reporting trials flow diagram. Note. Screening and eligibility data collected during recruitment was not available from study sites. As a result, it is not provided in the flow diagram

See this image and copyright information in PMC

Cited by

What have we learned from long-term studies in juvenile idiopathic arthritis? - Prediction, classification, transition.
Rygg M, Ramos FO, Nordal EB. Rygg M, et al. Pediatr Rheumatol Online J. 2025 Feb 19;23(1):18. doi: 10.1186/s12969-025-01070-x. Pediatr Rheumatol Online J. 2025. PMID: 39972461 Free PMC article. Review.

References

1. Sacks JJ, Helmick CG, Luo Y, Ilowite NT, Bowyer S. Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001–2004. Arthritis Rheum. 2007;57(8):1439–45. - PubMed
1. Schanberg LE, Gil KM, Anthony KK, Yow E, Rochon J. Pain, stiffness, and fatigue in juvenile polyarticular arthritis: contemporaneous stressful events and mood as predictors. Arthritis Rheum. 2005;52(4):1196–204. - PubMed
1. Reiter-Purtill J. A controlled longitudinal study of the social functioning of children with juvenile rheumatoid arthritis. J Pediatr Psychol. 2003;28(1):17–28. - PubMed
1. Hoff AL, Palermo TM, Schluchter M, Zebracki K, Drotar D. Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain. J Pediatr Psychol. 2006;31(10):1046–56. - PMC - PubMed
1. Fair DC, Rodriguez M, Knight AM, Rubinstein TB. Depression and anxiety in patients with juvenile idiopathic arthritis: current insights and impact on quality of life, a systematic review. Open Access Rheumatol. 2019;11:237–52. - PMC - PubMed

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[1] Sacks JJ, Helmick CG, Luo Y, Ilowite NT, Bowyer S. Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001–2004. Arthritis Rheum. 2007;57(8):1439–45. - PubMed

[2] Sacks JJ, Helmick CG, Luo Y, Ilowite NT, Bowyer S. Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001–2004. Arthritis Rheum. 2007;57(8):1439–45. - PubMed

[3] Schanberg LE, Gil KM, Anthony KK, Yow E, Rochon J. Pain, stiffness, and fatigue in juvenile polyarticular arthritis: contemporaneous stressful events and mood as predictors. Arthritis Rheum. 2005;52(4):1196–204. - PubMed

[4] Schanberg LE, Gil KM, Anthony KK, Yow E, Rochon J. Pain, stiffness, and fatigue in juvenile polyarticular arthritis: contemporaneous stressful events and mood as predictors. Arthritis Rheum. 2005;52(4):1196–204. - PubMed

[5] Reiter-Purtill J. A controlled longitudinal study of the social functioning of children with juvenile rheumatoid arthritis. J Pediatr Psychol. 2003;28(1):17–28. - PubMed

[6] Reiter-Purtill J. A controlled longitudinal study of the social functioning of children with juvenile rheumatoid arthritis. J Pediatr Psychol. 2003;28(1):17–28. - PubMed

[7] Hoff AL, Palermo TM, Schluchter M, Zebracki K, Drotar D. Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain. J Pediatr Psychol. 2006;31(10):1046–56. - PMC - PubMed

[8] Hoff AL, Palermo TM, Schluchter M, Zebracki K, Drotar D. Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain. J Pediatr Psychol. 2006;31(10):1046–56. - PMC - PubMed

[9] Fair DC, Rodriguez M, Knight AM, Rubinstein TB. Depression and anxiety in patients with juvenile idiopathic arthritis: current insights and impact on quality of life, a systematic review. Open Access Rheumatol. 2019;11:237–52. - PMC - PubMed

[10] Fair DC, Rodriguez M, Knight AM, Rubinstein TB. Depression and anxiety in patients with juvenile idiopathic arthritis: current insights and impact on quality of life, a systematic review. Open Access Rheumatol. 2019;11:237–52. - PMC - PubMed

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Assessing the impact of the iPeer2Peer program for adolescents with juvenile idiopathic arthritis: a mixed-methods randomized controlled trial

Affiliations

Assessing the impact of the iPeer2Peer program for adolescents with juvenile idiopathic arthritis: a mixed-methods randomized controlled trial

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Abstract

Conflict of interest statement

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