So much has happened in the meantime — not least of which was the harm reduction sector also coming together for the first time in Melbourne for the Harm Reduction International Conference (HR23) in April.

From my perspective, however, the biggest news is that Stage 3 of the W3 Project has run its course and we are all heading off on new adventures. I am sure, though, that these adventures will continue to align and cross paths into the future.

So, I hope you enjoy this final blog post from Stage 3 of the W3 Project!

27th Harm Reduction International Conference (HR23), April 16–19

What an absolute triumph! W3 Project’s partner, Harm Reduction Victoria, and their partners did an incredible job pulling together this conference — which was originally to be held in 2020. The vibe was wonderful, as it is always bound to be when such a passionate group of people come together to learn from each other.

The W3 Project delivered a presentation about our preliminary findings. It was truly humbling to be presenting alongside incredible peer workers from Myanmar, Canada, and Australia.

We also delivered a workshop that guided participants through some activities to get them thinking about how to use the W3 Framework to understand and explain the full system-level impact of their work. Peer workers from several different sectors around Australia as well as participants from England joined the session, which made for some really interesting discussions.

12th IAS Conference on HIV Science, July 23–26

Congratulations must also to W3 Project partner Queensland Positive People for their role in supporting the 12th International AIDS Society Conference on HIV Science in Brisbane.

Graham was invited to speak about the system-level impacts of peer-led work in the HIV and hepatitis C response at one of the ‘satellite conferences’: the International HIV Coinfection + Viral Hepatitis Elimination Conference. His presentation provided an overview of our findings, and of the barriers and enablers that peer-led organisations face in trying to demonstrate their system-level impact and value.

New paper about the importance of peer-led PLHIV support

‘Congratulations!!’ to Living Positive Victoria’s Tim Krulic, who has published another paper from his PhD research. This new paper in ‘Frontiers in Public Health’ is about the implementation of Living Positive Victoria’s peer navigator program. The paper outlines the significant impact that peer support has on the quality of life for people living with HIV.

W3 Project Stage 3: the results are in

After what somehow feels like just a few months since we started, Stage 3 of the W3 Project is drawing to a close. (At this point, does anyone else — especially if you live in Victoria — feel like 2020 and 2021 were just a weird dream that kind of didn’t happen..?)

Over the course of the project, we pulled together and analysed more than 1,100 pieces of evidence. These included data generated and provided by our partner organisations, the results of extensive desktop research, and more than 30 hours of conversations with our partners. We have a shiny new report about what we found during the project. (If you’d just like to check out a summary of our work and findings, we’ve got you covered. Or if you’d like to deep dive into the background evidence, we’ve got that too.).

Watch this proverbial space for further publications and potential future research ideas. For now, though…

That’s a wrap

My current best piece of advice to anyone who will listen is: ‘Try not to start a health-related research project in partnership with community health organisations ten weeks before a pandemic.’ To say it has been challenging is an understatement.

To everyone — most especially and specifically the peer organisation staff — who have been involved and supported us along this journey, a sincere and heart-felt thank you. Thank you for your shared commitment to this work. Thank you for your patience and support as we navigated these weird few past years together. I have nothing but the deepest respect and admiration for you all and for all that you do.

Farewell for now
xo

The post Blog-voyage appeared first on W3 Framework.

On this page

[Open][Close]

• Background to Stage 3 of the W3 Project
• W3 Project Stage 3 purpose
• Overview of methods
  • The impacts of COVID-19
  • W3 Framework
  • LEAD Framework
• Achievements
  • Tailored evaluation indicators for peer-led work
  • Consolidated evidence base for the system-level impact of peer-led work
• Publications
  • Project reports
  • Conference presentations and posters

Background to Stage 3 of the W3 Project

Australia’s National HIV and Hepatitis C Strategies have consistently highlighted the importance of community involvement, particularly through peer-led approaches. These initiatives, orchestrated and executed by individuals most affected by HIV and Hepatitis C, are deeply rooted within affected communities and play a pivotal role in addressing these health concerns.

Drawing from their strong influence within communities and on overarching health systems, these peer-led endeavours encompass a wide spectrum of activities. These range from peer service delivery, like HIV rapid testing and needle and syringe programs (NSPs), to peer health promotion and leadership roles in policy reform. The effectiveness of these initiatives lies in their ability to resonate with and make a significant impact within communities, and their ability to influence both health systems and policies.

However, a challenge arises when evaluating the full extent of the impact of peer-led approaches. Traditional evaluation mechanisms tend to focus on individual-level factors, often overlooking broader system-level impacts. This makes it challenging for peer-led responses to demonstrate the full extent and value of their contributions.

The third stage of the What Works and Why (W3) Project attempted to address these challenges. We worked in close collaboration with six peer-led organisations from across four Australian states. These organisations were led by people living with HIV (PLHIV) and people who use drugs (PWUD).

W3 Project Stage 3 purpose

Building on the work of the first and second stages, this third stage set out to create a consolidated evidence base that captured the scope, quality, and overall impact of peer-led work within the public health response to HIV and Hepatitis C. By pooling together evidence about our partner organisations, the project sought to pave the way for more informed funding, oversight, and evaluations of future peer-led work.

Overview of methods

The impacts of COVID-19

The onset of the COVID-19 pandemic required us to adapt our research methods substantially. These adaptations were primarily driven by the practical challenges of the pandemic and the priorities of our partner organisations.

Extended lockdowns and travel restrictions throughout 2020 and 2021 significantly curtailed our ability to undertake planned activities, such as in-person workshops.

Furthermore, our partner organisations were at the front lines of the COVID-19 response, concentrating their efforts on protecting and assisting their communities. This inevitably impacted their capacity to fully engage in all research activities.

In light of these circumstances, we made the following key shifts:

• Changed methods: All activities from 2020 to 2021 were transitioned online. To support partner organisations, we redirected our methodology to use existing evidence, reducing the need for them to produce and collate new data.
• Adjusted study period: Initially, our research covered the 2020–2021 timeframe. As the pandemic persisted, we recognised that this window would not help us understand the typical work of these organisations. We therefore expanded our study period to encompass 2018–2022. This allowed us to incorporate insights from both pre-pandemic conditions and the evolving response and recovery phases.
• Refined study scope: Our initial plan encompassed a wider range of peer work to include the impact of peer-led programs overall as well as specific types of peer-led programs. However, given the above challenges, and the extended study period, we narrowed our focus to the role, impact, and value of peer-led organisations.

W3 Framework

We used the W3 Framework as the foundational theory for our project. Using the W3 Functions helped us develop evaluation indicators that could capture the full system-level impact of peer-led work.

LEAD Framework

To guide our work, we used the Locate evidence, Evaluate evidence, Assemble evidence, inform Decisions (LEAD) framework. This choice was driven by the framework’s ability to guide the collection of diverse and meaningful evidence. It’s especially adept at addressing complex public health problems by adopting a systems-thinking approach.

Although the LEAD framework appears linear, in practice, it was a dynamic and ongoing process. This is because we looked for evidence in diverse sources and contexts. As we uncovered, assessed, and gathered new evidence, we continuously revisited and improved previous steps. This was a continuous learning process that allowed us to improve our work over time.

Specifying questions

We developed evaluation indicators based on the W3 Functions through a three-round consultation process using a modified Delphi method. Input was sought from representatives of peer-led organisations and government health departments. We described this work in our report ‘W3 Project: Creating a set of evaluation indicators for peer-led work’. Indicators were further refined throughout the subsequent stages of the LEAD framework.

Locating evidence

The process began with preliminary identification and brainstorming sessions with partner organisations. Desktop research and targeted meetings with partner organisations assisted in further pinpointing data sources. Additional meetings with partner organisation staff provided a more comprehensive understanding of their work and helped to bridge evidence gaps.

Evaluating evidence

As we located evidence, we assessed it for its reliability. This included verifying source credibility and trustworthiness, ensuring accuracy and validity. We also looked at the strength and usefulness of the evidence in demonstrating each indicator, and in demonstrating work within each W3 Function.

Assembling evidence

We synthesised the evidence using the framework analysis method. This involved getting to know the data, organising it against the evaluation indicators, and identifying patterns and trends.

Informing Decisions

This step involved interpreting the assembled data to understand the connections and the overarching story it told about the work of our partner organisations. We identified barriers and enablers to demonstrating the system-level impact of investing in peer work. We also developed recommendations to help leverage these enablers and mitigate against the barriers.

Achievements

Tailored evaluation indicators for peer-led work

We developed two sets of evaluation indicators:

• Organisation-level indicators for use by peer-led organisations
• Program-level indicators for use by peer-led programs in either peer-led or mainstream organisations

The lists include broad indicators that measure quality/process and impact across all the W3 Functions. They also include examples of ways peer workers might be able to go about demonstrating each indicator.

As we began to locate and sort evidence against the organisation-level indicators, we made further changes. The final list was more concise with fewer gaps and less overlap. Due to the impacts of the COVID-19 pandemic, however, we were unable to trial the program-level indicators.

Consolidated evidence base for the system-level impact of peer-led work

In total, we collated over 1,100 pieces of evidence. This evidence demonstrated that peer-led organisations had a clear commitment to long-term and sustained community engagement. They invested significantly in cultivating relationships and partnerships across the health and other sectors. They also demonstrated the outcomes of drawing on community insights and sector relationships to constantly adapt and refine their work. Furthermore, they brought influential peer expertise and insights to policy and strategy discourse.

Overall, we found that investing in peer organisations can exert system-level influence, not only within communities but also within policy and health systems, thereby strengthening the overall public health response to HIV and hepatitis C.

Publications

Project reports

2021 community report: Creating a set of evaluation indicators for peer-led work

2022 community report: Locating evidence against the W3 indicators for peer-led work

2023 community report: The impact of peer-led work in Australia’s HIV and hepatitis C response

(Executive summary and appendix with full reference list also available.)

Conference presentations and posters

• Structural and system impact of peer work: using the W3 Framework to improve and demonstrate the full value of peer-led work – presentation at the 2023 International HIV Coinfection + Viral Hepatitis Elimination Conference
• Using the W3 Framework to improve and demonstrate the full value of peer-led work with people who use drugs – presentation at the 2023 Harm Reduction International Conference
• Using the W3 Framework to improve and demonstrate the full value of peer-led work with people who use drugs – workshop at the 2023 Harm Reduction International Conference
• Proving the power of peers: Creating a practical toolkit to enable peer/community-led organisations to evaluate their work and better understand, demonstrate, and improve their impact – Poster at the 2022 Joint Australasian HIV&AIDS + Sexual Health Conferences
• Developing practical evaluation indicators for programs led by people living with HIV and people who use drugs – poster at the 2021 Joint Australasian HIV & AIDS and Sexual Health Conference

Partners

PLHIV-led organisations

PWUD-led organisations

Funding

Stage 3 of the W3 Project receives funding from the Australian Government Department of Health

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Our other research projects

PozQoL Project

The W3 Project, Stage 2 (2016-2019)

The W3 Project, Stage 1 (2014-2016)

Peer insights on barriers and motivators to direct-acting antiviral (DAA) treatment uptake

The post The W3 Project, Stage 3 (2020-2023) appeared first on W3 Framework.

Authors: Timothy Krulic, Graham Brown, Sara Graham, Jennifer Hoy, and Adam Bourne

Date published: 2023

Published by: Frontiers in Public Health

Full article »

Overview

Improving quality of life for people living with HIV through peer support

Research from Living Positive Victoria and the Australian Research Centre in Sex, Health and Society, La Trobe University, shows how peer support can improve quality of life for people living with HIV.

People living with HIV have unique resources to offer each other and health systems. In Australia, the communities most affected by HIV and AIDS, including gay men and people living with HIV, mobilised early to participate in leadership, policy development, and the promotion of HIV prevention and awareness. This collective effort, known as the Australian Partnership, saved thousands of lives and brought about lasting social change in communities.

In the post-ART area, HIV is sometimes thought of as a personal medical issue. In this context, peer programs are often evaluated as ways to improve viral suppression or treatment adherence. Yet, stigma, discrimination, and health inequity still have a major impact on the quality of life that people living with HIV experience in Australia.

In this study, we thought of peer support in terms of how it contributes to quality of life for people living with HIV. We wanted to recognise that quality of life, defined as how people view their overall position in life, is not solely determined by individual behaviour or psychological resilience to something like an HIV diagnosis. Among other social, cultural, and economic factors, quality of life relates to community, care, support, and service environments.

Insights from Living Positive Victoria’s peer navigation program

Our research examined Living Positive Victoria’s peer navigation program. The initial findings (published in this paper) focus on the perspectives of the peer workers and healthcare professionals involved in the program. These clinicians and peer workers had a close working knowledge of peer navigation and other factors relevant to the quality of life people living with HIV experience, such as the influence of stigma on relationships and engagement in healthcare and community.  

The exchange of insights and experiences during peer navigation was seen as a valuable source of acceptance, belonging, hope, and reassurance for people living with HIV. For newly diagnosed, socially isolated, or culturally diverse people living with HIV, peer relationships were thought to mediate the effects of stigma on self-esteem and their ability to access other kinds of help and support. Participants expected that navigation with an experienced peer could ease treatment-related and nonclinical aspects of life with HIV, such as relationships and discrimination, and guide people living with HIV in their journey towards becoming part of the people living with HIV community.  

Community environments were where program stakeholders hoped people living with HIV could meet their ongoing emotional and social needs. In this sense, peer navigation was seen as revealing a socially supportive environment that enables better quality of life. This program theory acknowledges the ways that peer programs work as part of and in collaboration with communities, and accounts for how a relatively short-term intervention may lead to sustained improvements in quality of life. This emphasises the value of the community and support structures that form part of health enabling environments. If there are no safe services or community structures that navigators can lead people to, their impact on quality of life may be limited.  

By speaking with a wide range of stakeholders we also learned important things about the quality of peer interactions with people living with HIV and the providers of clinical care. Peer workers were clear that the insights they co-produced with new clients are improved and refined though their engagement with many people living with HIV, including their experienced peer colleagues. There was also evidence that when clinicians and peers worked closely together, as they did in this program, they shared insights which were used to improve the quality and continuity of care, particularly for people living with HIV from culturally diverse and low-prevalence groups. Our findings underscore the value of such initiatives being led by peer organisations and the improvement that peer programs can contribute to healthcare services. 

Future research and acknowledgements

Future work, soon to be published, explores the experiences of the heterosexual men and women and the new and temporary migrants, including gay, bisexual, and queer people, who participated in the program.

The authors would like to express their appreciation to the 27 people living with HIV and the 30 peer workers and clinicians who made this study possible.

This post was originally published in July 2023 in Living Positive’s newsletter.

Other posts in our written publications series

The posts in this series take some of our most important written publications and talk about them in plain English.

Revealing an enabling environment

Drug user organisations, policy influence, and hepatitis C elimination

W3 Project Impact Analysis

The post Revealing an enabling environment appeared first on W3 Framework.

This was the first time we’ve come together face-to-face as a sector since before a new little virus called SARS-CoV-2 turned up to disrupt life as we know it. It was a great few days reconnecting with colleagues and friends, meeting in person for the first time with people we’d only ever met online, and (of course) meeting lots of amazing new people.

As always happens after these kinds of events, I’ve come away with renewed excitement and motivation about the work we do — and with a feeling of gratitude and humility to be part of a sector with so many diverse, passionate, compassionate, and just downright awesome humans.

So this month’s update is all about what we did there and what we took away from the experience.

I hope you enjoy!

Presentations from the W3 Project and related projects

W3 Project

The W3 Project presented a poster (with an accompanying handout) highlighting the fact that traditional evaluations do not capture peer work’s full impact, and promoting the co-designed resources that we have developed to help peer responses evaluate their work more effectively (i.e. this website and the W3 Framework Guide).

PLHIV Peer Navigation Implementation Study

Tim Krulic (Living Positive Victoria and Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University) presented results from his PhD research. His presentation, ‘Navigating Quality of Life: Effects of a peer navigation program for PLHIV in Victoria‘, described some of the diverse experiences of PLHIV with migrant backgrounds.

PozQoL, PozQol everywhere!

It was so exciting to see so much of PozQoL at the conference! There were several presentations showcasing various pieces of work using PozQoL. The ViiV Healthcare team were there as well, promoting their new Quality of Life Hub. The site provides information and resources to help healthcare workers use PozQoL to improve health outcomes among PLHIV.

The power of peers

A theme that came through strongly was the critical importance of PLHIV involvement in all aspects of the HIV response. And we’re talking everything — from clinical research to conversations about overarching HIV sector strategies to decisions about people’s own individual healthcare.

The sessions where I felt this came through the most strongly proved (perhaps unsurprisingly) to be some of my favourites.

Beyond Undetectable: Achieving long-term treatment success through patient-led care — Gilead’s Platinum Satellite Session (Monday)

The discussion panel was facilitated by NAPWHA’s Aaron Cogle and featured:

• The W3 Project’s very own Graham Brown
• Jane Costello, CEO of Positive Life NSW, one of the W3 Project’s partner organisations
• Jamie McCoy, General Manager at Gilead Science
• Darren Russel, Director of Sexual Health at Cairns Sexual Health Service

The session centred the voices of PLHIV and focussed strongly on what patient-led care means, and why it is important, to PLHIV.

HIV cure: All in the mix – Bench, Bedside, Community (Tuesday)

The idea of a cure for HIV is exciting on many levels. (And the science behind it is absolutely fascinating!) But we cannot forget that, in HIV cure clinical trials, it’s PLHIV putting their bodies on the line.

NAPWHA’s Brent Clifton spoke powerfully about community perspectives of, and their role in, HIV cure research. Brent’s presentation highlighted some of the realities of what partaking in these clinical trials might mean for PLHIV. Overall, he really drove home why this kind of research simply cannot and will not be successful without meaningful involvement of PLHIV.

Quality over Quantity? Going beyond viral suppression in HIV care — NAPWHA and ViiV Healthcare’s Satellite Session (Wednesday)

The absolutely fabulous Vanessa Wagner facilitated this session.

Vanessa was joined by panellists:

• Graham Brown, W3 Project, Node Director (Acting) and Research and Evaluation Director, Centre for Social Impact, University of NSW and Adjunct at ARCSHS, La Trobe University
• Brent Allan, Global Community Engagement Advisor at ASHM
• Jenny Hoy, Director of HIV Medicine at the Alfred
• Nneka Nwokolo, ViiV Healthcare Senior Global Medical Director

This highly entertaining session saw discussions of two case studies. The case studies featured people living with HIV experiencing a range of challenges and included each person’s PozQoL responses.

As in the Gilead session above, the voices of PLHIV were central to the conversation. Once again, the importance of patient-centred care came through strongly. This included the need for clinicians to focus, not only on clinical markers, but also on PLHIV quality of life.

Social, Political & Cultural Aspects: HIV Cascades of Care (Wednesday)

The HIV Cascades of Care session gave PLHIV the opportunity to highlight what the HIV cascades of care mean to them.

Like Brent’s HIV cure presentation above, the session highlighted some of the realities of what experiencing the HIV cascade of care is actually like. (And featured this brilliant slide from QPP’s Chris Howard, which I think spectacularly sums up why PLHIV insights are important when considering what the cascade means in the day-to-day lives of the people expected to be on it).

So much left to do…

As uplifting as the centrality of PLHIV and their peer organisations and programs was throughout the conference, it is clear that there is a lot left to do. It’s always beyond frustrating to hear the extent to which stigma, discrimination, and criminalisation continue to impact PLHIV’s lives.

We heard sobering accounts of the gaps we still need to strive to close — from Adam Bourne’s (ARCSHS) presentation on PLHIV sexual satisfaction, to Jen Power’s (ARCSHS) reflections on the changes in HIV stigma research over the past quarter of a century, to the many presentations about PLHIV quality of life and of the experiences of people ageing with HIV, of women living with HIV, of people from migrant backgrounds living with HIV…

However, these same sessions often also spoke to the many incredible sector partnerships and the amazing people who are working together to close these gaps. I think as well, that the diversity of topics that we saw is testament to the sector’s determination to leave no one behind. And these are both things we can celebrate.

That wraps up another update

If you made it this far, thanks for reading.

As always, feel free let us know your thoughts by commenting below or sending us a message.

You’re also welcome to send us your questions about anything on the site. And from today, you can also check out our new FAQs page (link in the footer).

Take care, everyone!

The post When a sector reunites appeared first on W3 Framework.

It’s been a busy month here at the W3 Project!

We have started gathering the evidence we located against our W3 Indicators . It’s so exciting to see the stories of peer work’s impacts coming together.

We have also been presenting (and preparing to present) our work in various places. Keep reading to find out more!

Webinar: Improving health outcomes for LGBTIQ+ people and communities

Last month, we presented a webinar for LGBTIQ+ Health Australia. It was a really great opportunity to connect to, and engage with, Australia’s incredible LGBTIQ+ peer worker community.

The webinar covered:

• A brief history of the W3 Project and how we created the W3 Framework
• An overview of what the W3 Framework is and how it works
• How using the W3 Framework can help LGBTIQ+ peer work
• What using the W3 Framework might look like in practice

You can download the slideshow now from our publications page. Once LGBTIQ+ Health have published the webinar recording, we will share that with you too. Watch this space.

The 24th International AIDS Conference (AIDS 2022)

Our lead investigator Graham headed to beautiful Montreal for AIDS 2022 with three posters:

• From the W3 Project:
  • Maintaining long term and meaningful community and research partnerships by responding to and leveraging system-level enablers, barriers and benefits
• From the PLHIV Peer Navigator Implementation Study:
  • Navigating quality of life: Effects of a peer navigation program for PLHIV in Australia
  • Valuing expertise: Community and clinical collaboration in an Australian HIV peer navigation program

AIDS 2022 theme was ‘re-engagement’ — and that was certainly the flavour. Graham and colleagues had the opportunity to engage with the many peer and community-led programs and community-led research initiatives around the world, and the progress that has occurred in advocacy, activism, and research since the last face-to-face International AIDS Conference in 2018.

If you’re eager for more information, the AIDS 2022 rapporteurs page provides links to conference summaries and key outcomes.

Images from Graham Brown

New publication from the PLHIV Peer Navigator Implementation Study

Congratulations goes to Tim Krulic for his recent publication in AIDS and Behavior ‘A scoping review of peer navigation programs for people living with HIV: form, function and effects ’.

Tim’s paper maps the recent research about peer navigation programs for people living with HIV, and outlines recommendations for the future.

‘Research Lunchbox’

Join Tim Krulic online while he presents about his PhD research with the PLHIV Peer Navigator Implementation Study.

Tim’s presentation is part of La Trobe University School of Psychology and Public Health Higher Degree by Research (HDR) Seminar Series.

• Topic: Navigating quality of life: the experiences of new and temporary migrants living with HIV
• When: 12:30pm, Tuesday 23 August
• Where: https://latrobe.zoom.us/j/83844666486

W3 is heading to the Sunshine Coast for ASHM’s Joint Conferences

We are heading to the 2022 ASHM Joint Australasian HIV&AIDS and Sexual Health Conferences.

I am so excited to finally have the opportunity to meet some of you in 3D (and — on a personal note — to be travelling from chilly, regional Victoria to my home state for the first time since the start of the pandemic)!

W3 Project

The W3 Project team will be loitering around our poster during the breaks. If you’re around, come and say hi!

PLHIV Peer Navigator Implementation Study

Tim Krulic is presenting on his PhD research. Come along if you can!

• Title: Navigating quality of life: the experiences of new and temporary migrants living with HIV
• Description: People living with HIV have unique resources to offer one another. This research explores the quality of life experienced by new and temporary migrants who participated in a peer navigation program operating in Victoria.
• Session Time: Wednesday 31 August, 11am-1:30pm

That’s all from us for this month!

Thank you all for you continued support of the W3 Project.

Let us know below what you think, or if you would like to hear about anything specific in future. We are always keen for your feedback.

Until next time, take care and stay safe.

The post Recent publications and upcoming events appeared first on W3 Framework.

Greetings everyone!

Yes, we are back, and we are coming back with a vengeance (again).

If you’re feeling de ja vu, it might be because I said the same thing this time 2 years ago. We did have a pretty good run for a while. We put out a couple of project updates and a 3-part series about how peer responses were adjusting to COVID-19. (If you haven’t seen those posts yet, I highly recommend them. They are a great testament to how skilfully peer-led responses adapt and respond to change.)

We decided not to continue updating the old blog while we were working on pulling together the new site. However, now that we have finally finished, we are back.

New W3 Framework website and resources

If you’re unfamiliar with W3, or if you need a refresher, these new resources might help get you started.

The W3 Framework Guide

The W3 Framework Guide is a 3-part guide that includes:

1. Background information about peer work and the W3 Framework
2. A step-by-step guide to applying the W3 Framework to peer work
3. A toolkit of templates and examples to help you apply the W3 Framework to your work

Essential guides

The essential guides on aim to give you the basic information you need to understand and use the W3 Framework. Currently, we have essential guides on the following topics:

• The W3 Framework
• Peer work
• Evaluating peer work
• Improving peer responses

W3 Project Stage 3 update

Throughout the COVID and the lockdowns, we continued working as much as we could with our project partners on Stage 3 of the W3 Project. It’s been a tough couple of year for everyone, but we’ve made some good progress.

W3 Indicators for evaluating peer-led work

Locating evidence against the W3 Indicators

Until next time!

If you made it this far, thanks for reading.

As always, please get in touch if you have any thoughts or stories you’d like to share. We’d love to hear from you.

The post I’m a blog, I’m a blog, oh the blog is back (Take 2) appeared first on W3 Framework.

Improving peer responses using the W3 Framework

The W3 Framework can help peer responses:

• Know what should be happening in their work
• Ensure their evaluations capture the full impact of all their work

Peer responses can use this to help them adapt and improve their work through:

• Improving their understanding of their own work
• Strengthening their ability to communicate about their work
• Strengthening their evaluation processes
• Using the knowledge gained from strong evaluations to improve their work

Improving peer responses’ understanding of their own work

Understanding what each of the W3 Functions means for their particular work, and how they interrelate, can help peer responses know:

• What they need to do to achieve their goals
• How the environment they work in affects their work
• How to support peer workers to do their best work (and to do it safely)

They can also use this to support other actors in the health sector and policy environment to create enabling environments for peer work.

Case example

AIVL’s Peer Workforce Capacity Building
Training Framework

The Australian Injecting and Illicit Drug Users League (AIVL) is Australia’s national peak organisation for people who use drugs and their peer organisations.

AIVL used the W3 Framework to develop a best practice guide for the employment of people who use drugs (PWUD) as peer workers.

This guide aims to support both peer and non-peer organisations to create an organisational culture and environment where PWUD peer workers are:

• Safe and respected in their workplace
• Well supported and resourced to make effective contributions to the blood-borne virus response

It includes a best practice tool that takes users through each of the W3 Functions, prompting them to consider:

• What the function means in the context of PWUD peer work
• What achieving the function should look like in practice
• What impacts they should be seeing if things are going well
• How to create positive change

Strengthening communication with others

Improved understanding of their own work can also support peer responses to:

• More effectively articulate and describe what they do
• Better communicate their work to others
• Showcase their achievements and impact in a more compelling way

Stronger communication can lead to a range of benefits, such as:

• Better engagement with communities
• Increased credibility within the health sector and policy environment
• Creation of a stronger position from which to apply for and secure funding and other support
• Decreased stigma towards peer workers and their work

Case example

Adapting the W3 Framework to create a sector-appropriate common language

The Australian Injecting and Illicit Drug Users League (AIVL) is Australia’s national peak organisation for people who use drugs and their peer organisations.

AIVL adapted the W3 Framework to help create a common language among peer-based drug user organisations.

This enabled AIVL and its
members to:

• Define what the W3 Functions meant to them in the context of their own work
• Identify actions that may help achieve impact in each of the functions
• Demonstrate their impact within each of the functions

The standard language is also helping overcome longstanding stigma towards drug user organisations and peer workers.

W3 is giving us a framework that [mainstream stakeholders] can read, understand, and know that we are doing what we need to do. This is important to our community, that a consistent framework is implemented that is also familiar to us.

Staff member

AIVL

Strengthening evaluation processes

Of course, a key way that the W3 Framework can help improve peer responses is by helping them strengthen their evaluation processes. We discuss this at length in our Essential guide to evaluating peer work. To summarise, peer responses can use the W3 Framework to guide evaluations that:

• Are tailored, streamlined, and highly relevant
• Effectively capture everything the peer response does
• Show the full value and impact of the peer response’s work

Stronger evaluation processes also help peer responses better understand their own work and communicate their impact and value to others.

Case example

Harm Reduction Victoria

Harm Reduction Victoria is a peer-led organisation for people who use drugs.

Harm Reduction Victoria uses the W3 Framework to drive consistent data collection and evaluation across all their programs.

This has helped them:

• Enhance data collection tools to capture important and nuanced information about their demographic reach
• Develop new indicators to capture previously unmeasured impacts (e.g. its peer leadership actions)
• Collate evaluation data across programs and activities to more accurately capture overall impact at an organisational level
• Better communicate its unique contribution to the blood-borne virus (BBV) response

[The W3 Framework is] definitely improving the way we think about our impact, how we report, and how we think about what we do. […] It’s given us a framework to talk to [funders] about the importance of peer-led work.

CEO

Harm Reduction Victoria

Using knowledge gained from strong evaluations

In the ‘Essential guide to evaluating peer work’, we talk about what we called the ‘true value of evaluation’. First and foremost, evaluation should help peer responses with their own goals. When done well, it should tell the full story about all of a peer response’s work and impact.

It should also guide peer responses to ways they can continually improve their work.

When evaluations work for peer responses (instead of just for funders), they provide a wealth of information. Peer responses can use this information to identify and understand:

• How and when their work achieves the most positive impact
• How they can build on their strengths
• Where they can improve what they’re doing
• Gaps in their work and barriers to achieving their goal

Having this knowledge — and keeping it up to date with changes in their environment — puts peer responses in a strong position to constantly adapt and improve their work. This information is key to knowing when change is needed. It can also help guide how to make the change.

Where to next?

In summary, peer responses can use the W3 Framework to help them understand, communicate, adapt, and improve their work.

If you’re after further information, check out these other posts to help you:

• Better understand the W3 Framework and the W3 Functions
• Use the W3 Framework to help you understand and describe peer work
• Understand how and why evaluations of peer work need to differ from evaluations of non-peer work

Finally, if you work in a peer response and would like to use the W3 Framework to help improve your work, check out the W3 Framework Guide and tools.

The post Essential guide to improving peer responses appeared first on W3 Framework.

Why do we need to focus on evaluating peer work?

Current evaluation methods are falling short for peer responses.

Most peer workers can talk at length about the positive and proactive influence that their work has. They know their work has positive effects. But it is often hard to back up that knowledge with robust and accessible evidence.

This comes down to the strength of a peer response’s evaluation processes. Unfortunately, most evaluations of peer responses do not:

• Effectively capture everything they do
• Show the full value and impact of their work

This is because traditional evaluation methods do not work well for evaluating peer work.

Why do current evaluation methods fail peer responses?

Inappropriate evaluation frameworks

The evaluation frameworks used are better suited to non-peer work than peer work.

Both peer and non-peer responses contribute to the goal of improving community health. They also provide some similar kinds of supports and services (such as health education, clinical testing, and providing access to resources for harm reduction).

Because of these similarities, the frameworks used to guide evaluations of peer work often:

• Were originally developed to evaluate non-peer work
• Measure direct and short-term to medium-term impacts of a program on its individual participants
• Result in the use of generic service-delivery indicators

However, there are important differences between peer and non-peer work that these generic service-delivery indicators do not (and cannot) account for.

Peer responses have important impacts on their community’s health that are not the direct result of service delivery

Peer responses have an important role in enhancing both individual and community empowerment and positive sense of self. However, these impacts are neither immediate, nor can they be attributed to single programs or interventions. Rather, these impacts are the indirect, collective result of sustained, high-quality work over time within communities.

Peer responses also play an important role in providing policy and other advice to the health sector and policy environment. When peer responses have strong relationships within the health sector and policy environment, this advice can lead to changes within the sector that improve community health outcomes.

To effectively evaluate peer work, evaluation frameworks need to somehow also account for these broader impacts.

Interactions between peer workers and their communities in their personal lives are relevant and vital inputs

Peer responses often know what they need to do because of the knowledge and insights their peer staff pick up through interactions in their personal lives (rather than through direct service delivery). However, these interactions are not strictly part of the work being evaluated. Hence, traditional evaluation processes ignore them as ‘confounding’ factors.

This results in evaluations that do not accurately reflect how peer responses:

• Create positive impact
• Adapt the way they work in response to changes in their community or the health system and policy environment
• Maintain effectiveness and relevance in a changing environment

Engagement with communities is not just a process, but also an impact

Engagement with communities gives peer response the knowledge needed to act properly (making engagement an input). However, the actions of high-quality peer work often also result in strengthened community engagement (making strong engagement an impact). Traditional linear evaluation frameworks do not capture these kinds of cyclic relationships.

Overemphasis on funder priorities

Evaluations often focus too strongly on funder priorities, and not strongly enough on those of the peer response itself.

First and foremost, evaluation should help the peer response with its own goals. When done well, evaluation should tell rich, exciting, and persuasive stories about all the innovative and positive impacts that peer responses have. It should also guide peer responses to ways they can continually improve to make their work even more responsive and targeted. This is the true value of evaluation.

Evaluations are also useful for providing feedback to external funders and donors. Of course, this is important, but it should be secondary.

Despite this, reporting to funders is often the main (if not the only) focus of a peer response’s evaluation processes.

Community organisations often receive multiple streams of funding from diverse funders. These different funders are usually only interested in supporting particular aspects (or outcomes) of a peer response. They tend not to value or understand the peer response’s overall impact. Rather, they information about the direct, short-term to medium-term impacts of the program (or programs) they are funding.

By focusing on the direct and short-term to medium-term impacts of a program on its individual participants, evaluations of peer responses miss a lot of information about:

• Non-direct impacts on personal agency and self-worth
• Community mobilisation and empowerment
• Policy participation
• Providing advice to the health and social services sectors

This makes it difficult (or impossible) for peer responses to show their full impact and value.

It also creates two further barriers to a peer response’s capacity to conduct robust evaluation:

• Inadequate resources
• Inappropriate evaluation indicators

Inappropriate evaluation indicators

Evaluations of peer responses often use inappropriate or incomplete indicators. This is related to the previous two points we discussed (inappropriate evaluation frameworks and overemphasis on funder priorities).

The evaluation indicators that interest donors often fail to measure the full extent and impact of peer work. (This is not least of all because most of these indicators originally came from evaluating non-peer work).

These indicators typically focus on individual-level impacts, leaving system-level impacts and synergies unseen and unmeasured. However, these system-level outcomes often add significant extra value for both communities and funders.

The upshot of this is that both the peer response and the funders miss out on the opportunity to learn so much more.

Insufficient resources

Peer responses often lack the resources to carry out robust evaluation.

Cost is a very real barrier for many organisations. Evaluation is a resource-intensive process that requires specific skills and expertise. Peer responses often lack adequate funds, staff, and other resources to conduct robust evaluations of their work.

Funders can often exacerbate this barrier by actively opposing evaluation activities that look beyond their own priority impacts.

How can we improve evaluations of peer responses?

Peer responses need to have evaluation processes that capture everything they do, so they can both:

• Share stories about and improve their work
• Collect the information that funders want

One solution to this is to use evaluation frameworks that are tailored to peer work. At the same time, evaluation processes need to be as streamlined and as relevant as possible.

This is precisely what the W3 Framework can help peer responses achieve.

Using the W3 Framework to improve evaluations of peer work

The W3 Framework can be used to guide evaluations of peer work. Peer responses that have used the W3 Framework in this way report that it has helped improve their evaluation processes, including through:

• Developing appropriate evaluation frameworks
• Streamlining data collection
• Showing impact beyond individual-level service access or knowledge and behaviour change
• Converting peer insight into compelling evidence
• Generating evidence to enhance organisational credibility within the health system and policy environment

Developing appropriate evaluation frameworks

The W3 Framework can be a starting point for developing theories of change that cover all four W3 Functions. Such theories of change can:

• Help peer responses better understand and describe their work
• Cover all areas of a peer response’s work, including those that are often missed, such as adaptation, positive impacts on the health system, and policy participation
• Broaden focus from individual-level impacts to include also community-level and system-level impacts

Peer responses can use this to help them design evaluation frameworks that result in more robust and more useful evaluations.

Case example

AFAO and AIDS Councils’ Theory of Change

The Australian Federation of AIDS Organisations (AFAO) is Australia’s national peak organisation for the community-led HIV response.

It adapted the W3 Framework to create a ‘Theory of Change’ for its peer-led work and that of the AIDS Councils within the overall HIV sector.

The resulting theory of change shows the:

• Unique role of AFAO and the AIDS Councils within Australia’s overall HIV response
• Link between their on-the-ground work and community-level and system-level impacts

Streamlining data collection

Applying the W3 Framework to peer work can help streamline data collection by helping peer responses:

• Tailor evaluation indicators to their specific needs
• Find the smallest number of data points that give the largest amount of information
• Gain more value out of the information that they already collect
• Convert the wealth of peer knowledge that peer workers have into usable evidence

Moving beyond individual-level impacts

As mentioned above, evaluations of peer work tend to focus on direct, individual-level impacts that cannot measure the full range of a peer response’s work. This ultimately:

• Results in substantial misrepresentation and underestimation of its effectiveness and overall impact
• Undermines its credibility within the sector
• Results in lost funding
• Reduces its overall effectiveness

The W3 Framework provides a structure to help peer responses develop indicators across all four W3 Functions. This helps them show their impact, not only on individuals but also at community and policy levels. It also helps them describe how these broader, higher-level impacts flow back through the system to improve individual and community health outcomes.

In other words, the W3 Framework can help peer responses to show the full breadth and depth of their work.

Case example

Living Positive Victoria

Living Positive Victoria is a peer-led organisation for people living with HIV (PLHIV).

In 2016, Living Positive Victoria merged with Straight Arrows, Victoria’s lead organisation for heterosexual PLHIV and their families.

The organisation experienced a period of rapid growth and began working with new communities.

This created a need for consistent and streamlined organisational evaluation processes to help:

• Understand its impact across all its programs and activities
• Adapt to its changing environment

Living Positive Victoria developed an organisation-wide W3 Framework–led evaluation process that enabled it to:

• Ensure that its evaluation processes support its work across all four W3 Functions
• Demonstrate the impact of individual programs and of the whole organisation
• Collate insights gathered through programs and feed them into annual business planning
• Enhance the link between program outcomes and strategic goals
• Better articulate and communicate its impact to stakeholders and funders

The value in what we are finding is across all of [W3’s Functions] because we aren’t just looking at program delivery — we are looking at systematic approaches to improve supports for people living with HIV.

Staff member

Living Positive Victoria

This process resulted in a shift in organisational culture where evaluation is now:

• A central part of project planning
• A strong feature of budgeting
• An element of staff recruitment

Converting peer insight into compelling evidence

When it comes to providing evidence for evidence-based interventions, peer insights are usually not valued as highly as social or epidemiological research or health service data.

However, the sectors where peer-based responses work can change so rapidly that these formal data become outdated by the time of release. This means that peer insights are often the only source of real-time information the sector has. Additionally, formal research and epidemiological findings can be misconstrued in the absence of nuanced, contextual interpretation that skilled peers can provide.

The W3 Framework provides a structure to help peer responses draw data from peer insights and community anecdotes, and present them in more meaningful, useful, and persuasive ways.

Enhancing peer response credibility

Policy participation is a core part of quality peer responses.

Policy advice from peer responses draws heavily from peer insights, which (as discussed above) are often perceived as less credible than other types of evidence.

Because of this, successful policy advice often requires peer responses to partner with allies (such as researchers and other sector advocates). This enables them to develop a reputation of credibility over time so that policymakers and sector partners increase their trust and confidence to act on peer input.

For peer responses to provide relevant, high-quality input, they need strong relationships and influence within their communities. The W3 Framework can inform the collection and presentation of evidence to monitor and show how peer leadership activities and peer leaders:

• Authentically engage with their communities
• Draw on high-quality engagement to identify key insights about emerging issues
• Package these in a way that justifies the need for the changes while also acknowledging pressures faced by other actors in the policy system
• Propose effective, practical, sustainable, and feasible changes

In other words, the W3 Framework can help peer responses generate evidence to improve their credibility within the health system and policy environment.

Case example

Harm Reduction Victoria’s Peer Network Program

The goal of the Peer Network Program is to engage people who inject drugs (PWID)
who are not being reached by mainstream needle and syringe programs (NSP).

Staff knew they were achieving this but the program’s data collection tools were not sensitive enough to record it in a meaningful way.

They used the W3 Framework to adapt and improve the program’s existing data collection tools and processes.

The improved tools can are helping the program:

• Produce data about the numbers of PWID who would not have obtained sterile injecting equipment if not for the Peer Network Program
• Demonstrate its reach and impact on the community
• Provide robust and compelling evidence of its value

Where to next?

To sum up, peer responses can use the W3 Framework to help guide evaluation of the full breadth and impact of their work.

Our Essential guide to improving peer responses talks about how peer responses can use the results of evaluations to help improve their work.

If you work in a peer response and would like to use the W3 Framework to help improve your evaluation processes, check out the W3 Framework Guide and tools.

The post Essential guide to evaluating peer work appeared first on W3 Framework.

What to expect from this essential guide

This guide explains in plain English the role of peer work in a public health response. We explain peer work in plain language first, and then provide information about how this fits into the W3 Framework.

Looking through a W3 lens

In each section like this, you will find information about how what we are talking about fits into the W3 Framework — the outcome of a process we call ‘looking through a W3 lens’.

You could skip these sections if you would prefer to read just the plain-language information. However, you can use these sections to help you understand how the W3 Framework works or how to use it to help describe peer work.

To get the most out of these sections, it helps to be familiar with the W3 Framework and the W3 Functions.

What is peer work?

Before we begin, it’s important to clarify what we mean by ‘peer work’ on this site. We also explain some of the other terms we use to help us talk about peer work.

Here is what we mean by the terms: peer work, peer response, peer, and peer worker.

Peer work and peer responses

These terms refer to the work that is done and the entities that do it.

When we talk about peer work, we mean work that is all of the following:

• Part of an organised community response within a broader overall public health response
• Organised by members of marginalised, vulnerable, or ‘at-risk’ communities (peers)
• Developed and led by peers (or at least involving strong and authentic participatory processes, and consultation with and leadership from peers)
• Carried out by peers (or a mix of peers and non-peers)
• Undertaken with the purpose of improving the wellbeing of the communities that the peers come from

We use peer responses as an umbrella term to refer to any of the following:

• Peer movements
• Peer-led organisations
• Peer programs
• Any other peer interventions or activities (such as peer support or peer education)

Peers and peer workers

These terms refer to the humans who do the work.

Although there is some debate about how to define ‘peer’, for our purposes, a peer is someone who both:

• Considers themselves a member of a community
• Is recognised by that community as one of its members

This two-way relationship is very important in peer work, as we will show later.

When we refer to peer workers, we mean any peers who are working as part of a peer response. This may include, for example:

• Paid staff or volunteers
• Those involved in direct service delivery
• Front-of-house staff
• Executive leadership and management teams
• Board members and other advisors

It is also important that workplaces and non-peer colleagues:

• Know and acknowledge that the peer workers are peers
• Value and act upon the contributions and advice of peer workers

Why is peer work important in public health?

Peer work is a crucial part of any effective public health response. This stems from the way peer responses can reach populations and tackle topics that challenge mainstream health services. It is also important because of how it helps empower people and decrease inequity.

Reaching vulnerable communities

Peer work typically promotes the health of communities whose members:

• Have diverse and complex unmet needs
• Face high levels of prejudice and stigma
• Experience criminalisation because of unjust laws
• Do not have many (if any) voices in positions of power

This work often centres on controversial, complex, and sensitive topics, such as:

• Highly stigmatised personal traits (such as diverse gender identity or expression, diverse sexuality, and disability)
• Highly stigmatised health issues (such as HIV, hepatitis C, mental illness, and alcohol or drug dependence)
• Behaviours that people tend to feel uncomfortable talking about and/or that are taboo or criminalised (such as sex, sex work, and drug use)

Mainstream health services often find working in these contexts difficult. Furthermore, people from these communities often feel nervous or uneasy about accessing mainstream health services. There are many reasons for this, but some important ones are:

• Community members might feel judged or unsafe in mainstream healthcare settings
• Mainstream health workers might not fully understand the issues faced by different communities
• Mainstream health services often aren’t set up to provide the specialised services community members need or want

Peer responses play a vital role in overcoming these barriers. Because peer workers are from the communities in question, they know who the communities are and how they work. They know about the issues faced by people from the communities — not because they’ve studied it (although they often have) but because they actually live it. It also means they know how to connect with people and support them to feel safe, unjudged, and understood.

Promoting health

The way peer responses work embodies the core features and values of health promotion. They do this through:

• Enabling people to take control of the things that determine their health
• Helping create political, economic, social, cultural, and physical environments that promote health
• Advocating for social justice and equity

Peer responses can contribute enormously to the wellbeing, safety, and rights of their communities. This has certainly been the case for peer responses led by people living with HIV (PLHIV), people who use drugs (PWUD), and consumers of mental health services (to name just a few).

Peer work can also contribute enormously to broader public health efforts. One example is the Australian response to HIV and hepatitis C. Peers from affected communities — including PLHIV; gay men, and other men who have sex with men; sex workers; and people who inject drugs (PWID) — have played a central role in the response from the very start of the epidemics. Many of the response’s internationally recognised successes come down to the powerful impact of this peer work.

How do peer responses work in a public health response?

In a public health response, peer responses work by being a bridge between two systems:

• Their communities
• The health sector and policy environment

It is important to understand that peer responses don’t just work in both systems. They are also a part of both systems.

Looking through a W3 lens: Overlapping systems

The W3 Framework shows this by placing peer work between two clouds that represent two systems: communities and the health sector and policy environment.

It is helpful to remember that even though these clouds don’t overlap in the diagram, peer work is a part of both systems. The clouds represent the parts of each system other than the peer response.

Think of it as a map of an overall public health response that focuses in on the role of peer work. The image below shows what we mean by this using overlapping boxes — yellow for communities and blue for the health sector and policy environment — across peer work in the middle.

Membership in the community

Peer responses emerge when members of vulnerable or marginalised communities come together to improve their health and wellbeing. The most effective peer responses are governed, staffed, and ultimately ‘owned’ by their communities. In other words, they are part of their communities.

Peer responses:

• Take part in, and interact with, their community
• Take part in community debate, tensions, and challenges
• Built and maintain long-term relationships with their community

They do this through both their work and the personal lives of their peer workers.

This means that peer responses have a strong and up-to-date understanding of their community’s diversity, needs, and experiences. Most importantly, they use this understanding to guide their work.

This article about Australian LGBTI-led organisation ACON illustrates this relationship.

Looking through a W3 lens: Membership in the community

To use the W3 Framework to describe the processes discussed above, follow the arrows:

1. That form the loop between communities and engagement. This represents the interactions and relationship between the community and the peer responses.
2. From engagement to practitioner learning, both directly and through peer-based activities. This represents the way peer workers learn and keep an up-to-date understanding of their community’s needs through their personal lives and their work.
3. To organisational knowledge, practices, and resources from engagement and practitioner learning. This represents the way peer responses learn and keep an up-to-date understanding through their work and through their peer workers.
4. From practitioner learning and organisational knowledge, practices, and resources through adaptation and back into peer-based activities. This represents peer responses using their understanding to guide their work.

Membership in the health sector and policy environment

Peer responses are professional services. Their peer workers have the requisite skills, training, and expertise to provide high-quality care and support.

As mentioned before, a deep understanding of community informs the services provided. Similarly, a deep understanding of the health sector and policy environment informs their work. This includes things like:

• Keeping up to date with current best practices, health technologies, research, and so on
• Providing services that are needed but that no-one else in the sector is providing (or providing well)
• Working with other services or individuals to provide them with peer expertise and/or to gain from their different expertise

Peer work includes all kinds of public health and social services, such as:

• Medical services, such as testing and treatment
• Social services, such as housing support
• Support navigating the healthcare system
• Training and health promotion workshops
• Relevant health information in plain, non-judgemental language

Additionally, to help create healthy and safe environments for their communities, peer responses:

• Provide professional development and training to enable mainstream organisations and their workers provide more culturally safe, inclusive, and appropriate services
• Advise organisations and government on relevant issues in order to promote more equitable polices and laws
• Take part in relevant public discussions and debates in order to give voice to their community’s needs and concerns

Looking through a W3 Lens: Membership in the health sector and policy environment

You can use the W3 Framework to describe this with the following pathways:

1. Health sector and policy environment to peer-based activities through alignment, organisational knowledge, practices, and resources, and adaptation. This pathway includes the way peer responses use their understanding and place in the health sector and policy environment to inform their work.
2. Engagement to communities through peer-based activities and influence. This includes how peer responses provide services and support to communities in order to create positive change within their communities.
3. Alignment to communities through peer-based activities, influence, and the health sector and policy environment. This includes how peer responses create changes within the health sector and policy environment that positively impact communities.

What makes peer responses so effective?

In a nutshell, peer work is so effective because peer workers are simultaneously:

• Community members, so they have a personal understanding of the needs and dynamics of their community
• Health professionals, so they can understand the health system and provide professional health services

Because of this combined expertise, peer workers are:

• Highly skilled and effective in supporting their peers to navigate both community and health systems
• Supported by their communities, other peer workers, peer organisations, and other partner organisations

Peer insight and skill

Because peer workers come from, and are constantly engaging with, their community, they have a uniquely nuanced understanding of their community and its members.

We call this uniquely nuanced understanding peer insight. With each peer-to-peer interaction, these insights become broader, deeper, and more up-to-date.

Peer workers draw their insights not just from their own personal lived experience but also from:

• Their professional lives as peer workers
• The insights of other peers and peer workers

This means that peer workers build an especially strong understanding of their community, which helps them develop the unique ability to:

• Engage deeply and authentically with their community
• Develop rapport with clients and consumers, even if their identity or experiences aren’t the same
• Pre-empt and adapt to their community’s changing needs
• Predict how changes to the environment the peer response is working in might impact their community
• Understand how (and why) their community might respond to these changes

We call this unique ability peer skill. Peer skill underpins peer work and sets it apart from mainstream service provision.

Looking through a W3 lens: Peer insight and skill

You can use the W3 Framework to describe this with the following loops:

1. Peer-based activities through practitioner learning and adaptation back to peer-based activities. This represents a constant process of peer workers learning from their work, improving the way they work because of their new knowledge, and then being able to learn and improve even further.
2. Engagement to practitioner learning (directly and through peer-based activities), then through adaptation, peer-based activities, influence, and communities back to engagement. This adds to the first pathway by including the way peer workers learn from their work and their personal life, improving the way they work, which also improves the quality of the work itself. This helps them build better rapport and connect more effectively with others in their community.
3. Both of the loops above plus the arrows from engagement and practitioner learning through organisational knowledge, practices, and resources to adaptation and influence. This addition represents the fact that it is not just the individual peer workers who benefit from their peer skill. The response also benefits from the collective peer skill of its peer workers.

The fact that these are loops means they are cycles of constant improvement: improved peer skill leading to improved peer responses leading to better community connection leading to improved peer skill, and so on and so forth.

Targeted service provision

Peer responses provide high-quality, targeted support and health services that are:

• Appropriate for, and accessible to, their community members
• Wanted, needed, and trusted by their community members

Because peer workers are health professionals, they have the expertise and experience to:

• Develop comprehensive health promotion interventions
• Understand and navigate the health sector
• In some circumstances, provide clinical services

Because they are also community members with a deep understanding of (and genuine concern for) their community’s experiences, needs, and priorities, they can make sure that the services and interventions they provide are nuanced, specialised, and targeted to the specific needs of their communities. This results in services that community members are more likely to use and benefit from.

Looking through a W3 lens: Targeted service provision

You can use the W3 Framework to describe this overall process in the following steps:

1. Communities through engagement to organisational knowledge, practices, and resources (directly and through peer-based activities and practitioner learning). This is how peer responses gain their expertise about their communities. They are continuously learning from their work and lived experiences in their communities.
2. Health sector and policy environment through alignment to organisational knowledge, practices, and resources (directly and through peer-based activities and practitioner learning). This is how peer responses gain their expertise about the health sector and policy environment. They are continuously learning from their work in this system.
3. Practitioner learning and organisational knowledge, practices, and resources through adaptation to peer-based activities. This is where the peer responses and their workers take what they’ve learned and use it to make sure their services are high quality, based on the most recent understanding of the issues being tackled and targeted to community needs.
4. Peer-based activities to communities through influence. This represents how the resulting (high-quality, targeted) peer work positively benefits the community.

Adaptability

Peer responses are acutely aware of changes in their environment and rapidly adapt their approach to stay relevant and effective. They can do this because of the way they are embedded in both their community and the health sector and policy system.

Peer workers pick up signals and experience the changes in their community firsthand through their work and lived experiences in their communities.

They are also made aware of changes as they happen in the health system, through their work and their networks of connections within this system.

An effective peer response can often accurately:

• Understand how changes may affect its community
• Pre-empt how its community might react or respond to changes

Peer responses use this knowledge to adapt their approach to protect and enhance their community’s safety and wellbeing.

This might mean taking advantage of positive changes to further improve their work. An example of this could be incorporating new or improved medical technologies or information into their work.

Or it might mean taking steps to mitigate negative changes. An example of this could be starting an advocacy campaign against new legislation that discriminates against their community members.

Looking through a W3 lens: Adaptability

You can use the W3 Framework to describe this overall process in the following steps:

1. Communities through engagement to organisational knowledge, practices, and resources (directly and through peer-based activities and practitioner learning). This is how peer responses know what is changing in their communities.
2. Health sector and policy environment through alignment to organisational knowledge, practices, and resources (directly and through peer-based activities and practitioner learning). This is how peer responses know what is changing in the health sector and policy environment.
3. Practitioner learning and organisational knowledge, practices, and resources through adaptation to peer-based activities. This is where the peer responses and their workers make sure they respond to the changes they’ve learned about in order to benefit or protect their communities.
4. Peer-based activities to communities through influence. This represents the times that the peer response’s activities directly benefit the community (for example, through direct service provision).
5. Peer-based activities to communities through influence, and the health sector and policy environment. This represents the times that the peer response’s activities indirectly benefit the community by improving the way the health sector and policy environment works for their communities.

Trustworthiness, credibility, and influence

Peer responses are trusted sources of credible information for both their communities and the health sector and policy environment. This comes down to three strengths that stem from membership and work in both systems.

Firstly, that peer responses are part of, working for, and owned by their communities promotes community trust in their work. This is especially important among communities who have experienced of discrimination and poor service at the hands of mainstream healthcare providers.

Secondly, they have unique expertise about the issues facing their community. This expertise comes not only from their community expertise but also from their expertise as health professionals. This gives credibility to any advice or information they develop related to their community.

Finally, they are professional health service providers, which promotes confidence in the quality of their services.

Peer responses are vital points of information for community members about any changes in the health sector and policy environment. (This was shown during the start of the COVID-19 pandemic, when communities turned to their peer responses for answers about how the new coronavirus might affect them.)

Similarly, they are often the health sector and policy environment’s only source of real-time information about what is happening in communities.

All of this together creates a unique platform from which peer responses can:

• Create positive, meaningful, lasting change within communities
• Support mainstream health services to improve their services for vulnerable communities
• Generate high-level system and policy changes

Looking through a W3 lens: Trustworthiness, credibility, and influence

You can use the W3 Framework to describe this in the following pathways:

1. The loop between communities and community. This represents how peer responses are embedded in communities.
2. Communities through engagement to organisational knowledge, practices, and resources (directly and through peer-based activities and practitioner learning). This shows how peer responses gain expertise about the issues facing their community through their lived and professional experience.
3. Health sector and policy environment through alignment to organisational knowledge, practices, and resources. This shows how peer responses gain further expertise about the issues facing their communities from the perspective of health professionals.
4. Practitioner learning and organisational knowledge, practices, and resources through adaptation to peer-based activities. This is where the peer responses and their workers use their expertise to develop credible advice, information, and services.
5. Peer-based activities and organisational knowledge, practices, and resources through influence to communities. This represents the way peer responses work to benefit their communities.
6. Peer-based activities and organisational knowledge, practices, and resources through influence and health sector and policy environment to communities. This represents where peer responses work to support the health system and policy environment to benefit (or at the very least, not harm) their communities.

The combination of 5 and 6 above are how peer responses can create positive, meaningful, and lasting change within communities.

Challenges faced by peer responses

Despite its effectiveness, peer work faces considerable challenges.

Community membership makes peer responses susceptible to the same environmental factors and changes that impact their communities. Discriminatory and stigmatising social attitudes, policies, and laws create challenges and barriers, which are often amplified by limited funding.

Peer responses are also susceptible to the same factors that affect any other health services, such as:

• Funding limitations
• Public opinion
• Changing policies
• Politics and elections

These challenges mean that often, peer responses must work harder than mainstream services to:

• Ensure safe working environments for their workers
• Secure funding and support for their work

Using the W3 Framework to overcome challenges

The W3 Framework provides a structured way of looking at and describing how peer responses work.

In addition to being useful for explaining what is happening, the W3 Framework can help peer responses look at what should be happening. This can help peer responses evaluate and identify where they can improve their work.

In time, this information should help peer responses better demonstrate their value to potential funders.

Keen to learn more about peer work in public health?

If you’re still eager for more information about how peer-led responses work, you may enjoy ‘Five surprising things we learned about peer-based programs‘.

The post Essential guide to understanding peer work in public health appeared first on W3 Framework.

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• Background to the PozQoL Project
• Objectives
• Methods and results
  • Stage 1: Reviewing the literature
  • Stage 2: Testing the items
  • Stage 3: Testing sensitivity and usability
• Using the PozQoL Scale

Background to the PozQoL Project

The PozQoL Project came about during our work with HIV organisations during Stage 2 of the W3 Project. They were finding it hard to evaluate their programs without having a simple way to measure client quality of life (QoL). They expressed a need for a short, practical, and reliable way to both measure and track changes in QoL among people living with HIV (PLHIV).

The PozQoL Project was built on the principles of Greater Involvement of PLHIV (GIPA).

What this meant in practice was that:

• The study was a direct partnership with peer-led organisations representing PLHIV
• PLHIV had meaningful involvement in all aspects of the planning, research, analysis, and decision making
• The insights from consultations with PLHIV and other stakeholders helped us balance statistical rigour, conceptual accuracy, and practical use

Objectives

We wanted to create a new, validated scale for PLHIV that was:

• Able to measure QoL overall as well as within specific domains of wellbeing
• Sensitive enough to detect changes in QoL over time
• Relevant to the experiences of people living today with HIV
• Short enough — and easy enough to use — for clinical, community, and peer workers to use in their day-to-day practice
• Freely available for anyone to use

Methods and results

The PozQoL Project had 3 stages:

• Reviewing the literature and currently available scales
• Drafting and testing the scale items
• Piloting the scale in practice

Stage 1: Reviewing the literature

Stage 1 involved a systematic review of the literature and QoL scales that currently existed. At this time, we identified 4 important domains of wellbeing:

• Psychological
• Social
• Health concerns
• Functional

We also generated a draft scale of over 100 items that covered these 4 domains.

Stage 2: Testing the items

In the 2nd stage, a panel of 13 experts from PLHIV peer organisations, as well as 5 other HIV experts and stakeholders, pre-tested the 100 draft items. During this process, we reduced the pool of draft items to 64.

We then created a survey that included these remaining items as well as other validated measures of health and wellbeing. 465 adult PLHIV from across Australia completed the survey two times, one month apart.

Comparison of people’s answers to the PozQoL and the validated items showed us that the PozQoL items did in fact measure what we wanted them to measure.

Comparison of people’s answers from one survey to the next showed us that their answers were consistent across time. (In other words, it showed us that the results reflected their overall QoL, rather than how they felt on the day).

Finally, the analysis allowed us to narrow the scale down to 13 items across the 4 domains of wellbeing.

Stage 3: Testing sensitivity and usability

In the last stage, we piloted PozQoL across 12 community and clinical settings to assess :

• If it could detect changes in PLHIV’s QoL over time (sensitivity)
• How easy staff found PozQoL to use and whether they thought it was useful (usability)

The results showed us that PozQoL was, indeed, sensitive enough to detect changes in quality of life. This was true for PozQoL Scores for overall quality of life and for each domain of wellbeing.

We also found that most staff found PozQoL easy to use in their day-to-day work and that it provided a range of other benefits, including:

• Helping them to better understand the client groups they were working with
• Enhancing their communication with clients
• Raising important topics of conversation that may not have come up otherwise

Using the PozQoL Scale

Using the PozQoL Scale when working with PLHIV can help improve care quality and outcomes, program evaluation, and research.

PozQoL is now the quality of life indicator used to inform the Australian National HIV Strategy. Most Australian PLHIV peer programs, an increasing number of community support programs, some clinical services, and a growing number of research studies around the world use PozQoL in their work.

If you are interested in using PozQoL in your work, the PozQoL website has:

• The PozQoL Scale in 16 languages
• Simple instructions for using PozQoL in practice
• Tools and calculators to help you calculate, understand, and use PozQoL results
• Specific information for clinicians, peer and community workers, and researchers
• Stories and experiences from people using PozQoL in their own work

Partners

Funding

The PozQoL Project received funding from ViiV Healthcare.

It also received funding from Living Positive Victoria, Positive Life NSW, and Queensland Positive People through the National Association of People Living with HIV as well as the Australian Research Centre in Sex, Health and Society.

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Our other research projects

The W3 Project, Stage 3 (2020-2023)

The W3 Project, Stage 2 (2016-2019)

The W3 Project, Stage 1 (2014-2016)

Peer insights on barriers and motivators to direct-acting antiviral (DAA) treatment uptake

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