"You are helping from the heart not just from the head": a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use

Abstract

Background: Increasingly, substance use and homelessness services have peer workers, those with lived or living experience of substance use and homelessness, who provide support to those experiencing similar challenges. While research regarding the effectiveness of such peer workers in helping others achieve better outcomes is growing, little is known about their experiences in this role.

Methods: A systematic review and qualitative evidence synthesis was conducted to better understand the experiences of peer workers who have lived/living experience of substance use and homelessness who are providing support to those experiencing similar challenges within substance use and homelessness settings. Nine electronic databases were searched for primary qualitative research published from 1990. Studies meeting the inclusion criteria were quality assessed using the Critical Appraisal Skills Programme checklist. Data from included studies were extracted, entered into NVivo, and analysed using a thematic synthesis approach.

Results: Nine studies were identified, published from 2006 from three countries with 272 participants. Three themes were identified: peer workers' reflections on the key components of their role; peer work as enabling individual growth and recovery; and destabilising challenges peer worker growth and recovery.. Peer workers described many essential qualities, and their lived experience was valued as a way of enabling deeper trust and empathy with the people they supported. Strong relationships with other peer workers were described as important. Many benefits to the peer workers were described, including positive life changes and increased responsibility. Challenges were also identified, with professional boundaries causing particular tensions.

Conclusions: This qualitative evidence synthesis provides unique insight into the experiences of peer workers who are working at the intersection of homelessness and substance use. Their experiences highlight the real benefits that peer workers have, whilst working in challenging situations in often precarious contracts. Such insights can inform the employment of peer workers. Those employing peer workers should prioritise clear job descriptions encompassing specific peer qualities, training and education opportunities, and peer-to-peer, professional, and organisational support.

Keywords: Homelessness; Peer support; Peer workers; Qualitative; Qualitative evidence synthesis; Substance use; Systematic review.

Fig. 1

PRISMA flow diagram. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71