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Barriers and Facilitators to the Implementation of a Peer Support Intervention in Universities

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Title: Barriers and Facilitators to the Implementation of a Peer Support Intervention in Universities
Language: English
Authors: Sarah Maillé, Frédérique Beaulieu, Lise Lachance, Simon Grégoire
Source: Journal of College Student Mental Health. 2025 39(1):86-109.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 24
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Barriers, Influences, Program Implementation, Peer Relationship, Social Support Groups, College Programs, Mental Health, Intervention, Computer Mediated Communication, Stress Variables, Anxiety, Foreign Countries, Graduate Students, Undergraduate Students
Geographic Terms: Canada (Montreal)
DOI: 10.1080/28367138.2024.2325437
ISSN: 8756-8225
1540-4730
Abstract: A growing number of postsecondary institutions offer peer support interventions to promote mental health among their students. However, little is known about the key factors that influence the implementation of this type of intervention. This study explored barriers and facilitators to implementing an online peer support program based on Acceptance and Commitment Therapy aimed at reducing stress and anxiety among students of three universities in Montreal, Canada. Peer supporters were asked to complete a survey containing open-ended questions at the end of each semester. Interviews were also conducted with the program coordinator, three psychologists who acted as supervisors, and 14 peer supporters. The data were analysed with an inductive and a deductive approach using the Consolidated Framework for Implementation Research (CFIR). Perceived barriers to the implementation of the intervention included technical problems with the videoconferencing platform, psychosocial and comorbidity issues among peers, recruitment difficulties, and communication concerns between stakeholders. Key perceived facilitators were the theoretical and empirical foundations of the intervention, the support offered by directors, and the process used to recruit, select, and supervise peer supporters. Based on the results of this study, practical recommendations are provided for researchers and practitioners interested in implementing online peer support initiatives in postsecondary institutions.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1459137
Database: ERIC
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  Value: <anid>AN0182505406;[nm80]01jan.25;2025Jan30.04:21;v2.2.500</anid> <title id="AN0182505406-1">Barriers and Facilitators to the Implementation of a Peer Support Intervention in Universities </title> <p>A growing number of postsecondary institutions offer peer support interventions to promote mental health among their students. However, little is known about the key factors that influence the implementation of this type of intervention. This study explored barriers and facilitators to implementing an online peer support program based on Acceptance and Commitment Therapy aimed at reducing stress and anxiety among students of three universities in Montreal, Canada. Peer supporters were asked to complete a survey containing open-ended questions at the end of each semester. Interviews were also conducted with the program coordinator, three psychologists who acted as supervisors, and 14 peer supporters. The data were analysed with an inductive and a deductive approach using the Consolidated Framework for Implementation Research (CFIR). Perceived barriers to the implementation of the intervention included technical problems with the videoconferencing platform, psychosocial and comorbidity issues among peers, recruitment difficulties, and communication concerns between stakeholders. Key perceived facilitators were the theoretical and empirical foundations of the intervention, the support offered by directors, and the process used to recruit, select, and supervise peer supporters. Based on the results of this study, practical recommendations are provided for researchers and practitioners interested in implementing online peer support initiatives in postsecondary institutions.</p> <p>Keywords: Acceptance and commitment therapy; implementation; mental health; peer support; university students; videoconferencing</p> <p>In 2019, a significant proportion of Canadian postsecondary students reported feeling anxious (68.9%) or more stressed than usual (45.6%) within the last 12 months (American College Health Association, [<reflink idref="bib2" id="ref1">2</reflink>]). During this same period, nearly a quarter (23.7%) were diagnosed or treated by a professional for anxiety (American College Health Association, [<reflink idref="bib2" id="ref2">2</reflink>]). Evidence also suggests that stress and anxiety symptoms are on the rise on campuses. Linden et al. ([<reflink idref="bib28" id="ref3">28</reflink>]) showed that the proportion of Canadian postsecondary students reporting above average stress or symptoms of psychological distress who sought help for mental health-related challenges significantly increased between 2013 and 2019.</p> <p>As stress and anxiety symptoms become more prevalent among students, the pressure on campus mental health services increases. Professionals who provide such services are often understaffed and overwhelmed by student demands (Jaworska et al., [<reflink idref="bib25" id="ref4">25</reflink>]). Many have no choice but to reduce the number of counseling sessions they offer to students or put them on waiting lists (Ng & Padjen, [<reflink idref="bib35" id="ref5">35</reflink>]). In 2020, 77% of Canadian postsecondary students who felt they would benefit from psychological help did not receive such help inside or outside their campus (Bérard et al., [<reflink idref="bib4" id="ref6">4</reflink>]). This trend is not limited to Canada. In a survey conducted in 21 countries, Auerbach et al. ([<reflink idref="bib3" id="ref7">3</reflink>]) found that only 16.4% of college students with a mental health disorder received adequate treatment, either inside or outside their academic institution. Furthermore, students might be reluctant to consult a mental health professional on their campus for various reasons (e.g., they had a previous bad experience interacting with a mental health professional, they believe their difficulties are not serious enough, or they fear being stigmatized for having a mental disorder) (Booth et al., [<reflink idref="bib7" id="ref8">7</reflink>]; Salzer et al., [<reflink idref="bib42" id="ref9">42</reflink>]; Schwenk et al., [<reflink idref="bib43" id="ref10">43</reflink>]).</p> <p>Taken together, these results suggest that a significant proportion of postsecondary students struggle with mental health issues, and that only a minority receive even minimally adequate support. This unmet need for mental health support represents a significant public health issue (Sontag-Padilla et al., [<reflink idref="bib45" id="ref11">45</reflink>]). If postsecondary students do not receive proper psychological support, they are more at risk of dropping out (Ishii et al., [<reflink idref="bib23" id="ref12">23</reflink>]) or receiving lower grades (Hysenbegasi et al., [<reflink idref="bib21" id="ref13">21</reflink>]). Therefore, college and university students need early, preventive intervention.</p> <p>According to public health organizations (Cyr et al., [<reflink idref="bib12" id="ref14">12</reflink>]; Roberge & Déplanche, [<reflink idref="bib41" id="ref15">41</reflink>]) and student associations (Bérard et al., [<reflink idref="bib5" id="ref16">5</reflink>], [<reflink idref="bib4" id="ref17">4</reflink>]), peer support initiatives are one way to promote mental health on campuses. Peer support can be defined as a recovery-oriented approach in which a person (thereafter "the peer supporter") with a history of mental illness who has experienced significant improvement in their condition offers services and support to another person considered to be not as far along in their own recovery process (thereafter "the peer") (Jain et al., [<reflink idref="bib24" id="ref18">24</reflink>]). It is characterized in part by a relationship grounded in a sense of connection based on shared experiences, the use of experiential rather than formal (taught) knowledge in the peer supporter role, and the reciprocal nature of the relationship, with both peer and peer supporters learning from each other, in contrast to the unidirectional clinician-patient relationship (White et al., [<reflink idref="bib50" id="ref19">50</reflink>]). As described by Mead et al. ([<reflink idref="bib31" id="ref20">31</reflink>]), peer support involves offering understanding and care to someone empathetically through the sharing of emotional and psychological experiences, and represents a system of giving and receiving help respectfully in a mutual agreement.</p> <p>A growing number of peer support initiatives are implemented in colleges and universities for students with special needs, such as students with intellectual and developmental disabilities (Griffin et al., [<reflink idref="bib18" id="ref21">18</reflink>]) or students in certain faculties (e.g., medicine) (Ahmed et al., [<reflink idref="bib1" id="ref22">1</reflink>]). Since the COVID-19 pandemic, many of these initiatives are now available through videoconferencing software such as Zoom or Teams, removing traditional barriers to peer support programs such as accessibility and availability (Suresh et al., [<reflink idref="bib46" id="ref23">46</reflink>]). Unfortunately, studies on peer support programs are scarce and results are inconsistent (John et al., [<reflink idref="bib26" id="ref24">26</reflink>]). Some found no significant difference between students taking part in a peer support initiative and those in a control group in terms of anxiety, depression symptoms or quality of life (Moir et al., [<reflink idref="bib32" id="ref25">32</reflink>]). Other studies suggest that this type of support is effective in increasing well-being among peers and reducing stress, anxiety, and depression symptoms (Byrom, [<reflink idref="bib9" id="ref26">9</reflink>]). Some studies also provide evidence for the efficacy of online peer support programs. Grégoire et al. ([<reflink idref="bib17" id="ref27">17</reflink>]) found that compared to students on a waiting list, those who took part in an online peer support program self-reported reduced psychological inflexibility, stress, anxiety and depression, and increased psychological flexibility and well-being. Drysdale et al. ([<reflink idref="bib14" id="ref28">14</reflink>]) compared online and in-person peer support programs for higher education students. They concluded that online peer support is as effective as in-person peer support for improving students' well-being.</p> <p>There is also a lack of information in the literature on the factors that facilitate or hinder the implementation of peer support programs on campuses (Griffin et al., [<reflink idref="bib18" id="ref29">18</reflink>]). Studies conducted in mental health settings suggest that factors such as the type of training and supervision offered to peer supporters, the way their role is defined and the organizational culture in which they evolve can significantly influence the way these programs are rolled out (Ibrahim et al., [<reflink idref="bib22" id="ref30">22</reflink>]). For example, Vandewalle et al. ([<reflink idref="bib48" id="ref31">48</reflink>]) showed that blurring the boundaries between peer supporters and peers, poor team functioning, and inadequate training, supervision, and logistical support for peer supporters could jeopardize the implementation of peer support initiatives. Whether such factors also play a significant role in the implementation of peer support programs in postsecondary institutions remains an open question. But as May ([<reflink idref="bib30" id="ref32">30</reflink>]) points out, such programs cannot become properly embedded in mental health services departments if stakeholders are unwilling to integrate them into existing practice, or are unable to make sense of the information required to operationalize them effectively. To optimally plan and use peer support initiatives on campuses, more information is needed about specific factors that may help or hinder their implementation.</p> <hd id="AN0182505406-2">The current study</hd> <p>This qualitative study aimed to better understand the barriers and facilitators to the successful implementation of an online peer support program in three universities in Montreal, Canada. For this purpose, we used the Consolidated Framework for Implementation Research (CFIR), a tool that describes a multi-level set of constructs to enhance implementation and dissemination (Damschroder et al., [<reflink idref="bib13" id="ref33">13</reflink>]). The CFIR comprises 39 constructs organized across five major domains (intervention characteristics, outer settings, inner settings, individual characteristics, and implementation process), all of which interact to influence implementation and implementation effectiveness (Damschroder et al., [<reflink idref="bib13" id="ref34">13</reflink>]). The CFIR was chosen because it presents a unified taxonomy, terminology, and definitions that are applicable to a broad area of implementation studies. This meta-theoretical framework also provides a structure to analyze factors facilitating and impeding optimal intervention implementation in natural settings. In this study, the CFIR was used to analyze, interpret, and report findings.</p> <hd id="AN0182505406-3">Method</hd> <p></p> <hd id="AN0182505406-4">Context</hd> <p>During the spring of 2019, graduate students were recruited to work as peer supporters in three universities: 1) <emph>Université du Québec à Montréal</emph> (UQAM), 2) <emph>Université de Montréal</emph> (UdeM), and 3) <emph>Hautes Études Commerciales de Montréal</emph> (HEC). To be hired as a peer supporter, students had to possess certain skills, knowledge, and experience. For instance, they were required to have previously experienced anxiety problems or disorders and be able to skillfully share their personal recovery story. They needed a high level of self-awareness, effective interpersonal and communication skills, and the capacity to support others while maintaining their own mental health.</p> <p>Peer supporters were then invited to attend a five-day intensive training program held during the summer of 2019. This training aimed to teach peer supporters about various topics such as the fundamental principles of peer support, the role of peer supporters, the limits and boundaries within a peer relationship, as well as the values and ethics of peer support. The goal of the training program was also to provide important information regarding Acceptance and Commitment Therapy (ACT) (see below), the intervention protocol, and the videoconferencing platform used in this project (https://clicpro.net/?lang=en).</p> <p>Between September 2019 and April 2021, seventeen (<emph>n</emph> = 17) peer supporters offered the intervention described below to one hundred and seven (<emph>n</emph> = 107) undergraduate students (the peers). During that period, peer supporters were supervised by a psychologist working in the mental health services department of their institution. The three supervisors who took part in the project were already using ACT in their practice and had long experience offering mental health services to students. They would typically meet their peer supporters in groups every two weeks to discuss any issues, difficulties, or questions they had regarding the intervention or their peers.</p> <hd id="AN0182505406-5">Intervention</hd> <p>The intervention is based on ACT (Hayes et al., [<reflink idref="bib20" id="ref35">20</reflink>]), a third-wave cognitive behavior therapy (Hayes & Hofmann, [<reflink idref="bib19" id="ref36">19</reflink>]) that does not specifically target symptom reduction (e.g., anxiety), but rather encourages participants to engage in values-based actions regardless of the presence or absence of symptoms. ACT is designed to increase psychological flexibility, which is the ability to be mindful of experiences in the present moment, in an accepting and nonjudgmental way, while behaving in a manner that is consistent with one's values, even when one's thoughts and feelings oppose taking valued action (Ciarrochi et al., [<reflink idref="bib11" id="ref37">11</reflink>]). This peer support program included five 90-minute sessions offered over five consecutive weeks. To link all sessions together, the ACT matrix developed by Polk and Schoendorff ([<reflink idref="bib38" id="ref38">38</reflink>]) was used throughout the program. This simple visual framework provides a "point of view" on one's actions and psychological experiences. It aims to help participants notice and distinguish behaviors designed to avoid uncomfortable internal experiences from behaviors intended to move toward their personal values. The framework also allows discriminating between mental (i.e., inner experiences such as thoughts and feelings) and sensory experiences. The intervention was manualized in such a way that it would offer sufficient flexibility and spontaneity to peer supporters during their sessions, while also ensuring that they would offer those sessions in a comparable way. For further information on the intervention, see Grégoire et al. ([<reflink idref="bib17" id="ref39">17</reflink>]).</p> <hd id="AN0182505406-6">Participants</hd> <p>Research has demonstrated the importance of obtaining feedback from various key stakeholders when implementing peer support initiatives in new settings, both to minimize difficulties and to maximize the likelihood of success (Shepardson et al., [<reflink idref="bib44" id="ref40">44</reflink>]; Vandewalle et al., [<reflink idref="bib48" id="ref41">48</reflink>]). In this study, data were gathered from one female graduate student who acted as the coordinator of the program (<emph>n</emph> = 1), three female psychologists (one in each university) who acted as peer supporter supervisors (<emph>n</emph> = 3) and fourteen peer supporters (<emph>n</emph> = 14). Peer supporters were recruited from the general student population through university counseling centers. Most of the peer supporters were women (79%), pursuing either a master (35.7%) or a doctoral degree (64.3%) in psychology (71.5%) or in management (28.5%). Six were studying at the <emph>Université du Québec à Montréal</emph>, four at the <emph>Université de Montréal</emph> and four at the <emph>Hautes Études Commerciales de Montréal</emph>. The mean age of peer supporters was 25.5 (<emph>SD</emph> = 1.26).</p> <hd id="AN0182505406-7">Study design and data collection</hd> <p>To elicit key stakeholders' perspectives on perceived barriers and facilitators to integrating the program into their university, we used an exploratory descriptive qualitative research design and two data collection methods: surveys and semi-structured interviews. At the end of each semester, peer supporters were invited to complete an online survey containing open-ended questions to gather information about perceived challenges and facilitators during program implementation (e.g., "What was difficult for you in this project during the last semester?" and "What was helpful in your supervision?"). After completing year one of the project, the first author of this paper conducted individual, semi-structured interviews with the program coordinator and the three supervisors. Interviews lasted between 40 and 75 minutes and were conducted through Zoom. They were based on a guide developed according to recommendations from several authors (Boutin, [<reflink idref="bib8" id="ref42">8</reflink>]; Magnusson & Marecek, [<reflink idref="bib29" id="ref43">29</reflink>]; Morgan, [<reflink idref="bib33" id="ref44">33</reflink>]). The questions were open and focused on factors facilitating or impeding the implementation of the program (e.g., "What do you think were the main obstacles to the implementation of the program at your university?" and "In your experience, what was the most helpful in this process?"). Corresponding prompts were added to questions to gain more clarity or details regarding responses.</p> <hd id="AN0182505406-8">Data analysis</hd> <p>The data analysis was conducted in two steps. First, the data from the surveys and interviews were imported into NVivo and analyzed with an inductive approach using the thematic analysis method (Paillé & Mucchielli, [<reflink idref="bib37" id="ref45">37</reflink>]). The aim was to extrapolate categories from the raw data, namely text or verbatim extracts in which participants described a barrier or facilitator to implementing the program. The texts and interview transcripts were independently coded by two researchers. The codes were then compared and inconsistencies were discussed. The researchers then compared and discussed coding with three more researchers with extensive experience in qualitative research methods until full agreement was reached.</p> <p>In the second step of the analysis, a deductive coding strategy based on CFIR was used to categorize implementation barriers and facilitators identified during the general inductive coding process. Categories were then grouped as themes and reviewed for consistency by all research members. Disagreements were resolved during meetings and themes definitions were further refined. Barriers and facilitators that could not fit into the CFIR were labeled as "emergent themes."</p> <hd id="AN0182505406-9">Results</hd> <p>A total of 17 themes emerged from the analysis, each one representing a factor influencing the implementation of the intervention. Most of them (<emph>n</emph> = 15) were aligned with the CFIR domains while four were new and not part of Damschroder et al. ([<reflink idref="bib13" id="ref46">13</reflink>]) framework. Eleven (<emph>n</emph> = 11) themes facilitated the implementation of the program, three (<emph>n</emph> = 3) impeded it and four (<emph>n</emph> = 4) both impeded and facilitated the implementation, depending on the context in which they were presented. Key themes in each CFIR domain are reported in Table 1 and described below.</p> <p>Table 1. Facilitators and barriers of the peer support intervention using the consolidated framework for implementation research.</p> <p> <ephtml> <table><thead><tr><td>CFIR Domain</td><td>Themes</td><td>Nature</td><td>Sample transcripts</td></tr></thead><tbody><tr><td>Intervention characteristics</td><td>Online modality</td><td>F & B</td><td><list list-type="Bullet"><list-item><p>"The fact that it's online. The fact that the meetings between peer supporters and students are online, I think that right now it makes a lot of sense". (S)</p></list-item><list-item><p>"I had multiple issues with ClicPro. Sometimes the image quality was not good (which made emotion reading more difficult) and the student I helped often had connection issues". (PS)</p></list-item></list></td></tr><tr><td>Framework rooted in ACT</td><td>F</td><td><list list-type="Bullet"><list-item><p>"We are framing the supervision inside the ACT matrix, and that is interesting. [...] It brings a reassuring frame for us and for the peer supporters as well". (S)</p></list-item><list-item><p>"I find that [the ACT framework] worked out very well in every context. It's a solid approach and the tools are well made". (C)</p></list-item><list-item><p>"The student I helped found the process very helpful. She said she would like to use de ACT matrix in other situations of her life, in moments of intense anxiety". (PS)</p></list-item></list></td></tr><tr><td>Diversification of services</td><td>F</td><td><list list-type="Bullet"><list-item><p>"I find it's a plus. Just in the way that it brings a certain diversity of things we can offer to the students who come to the student service center. For certain people, seeing a peer supporter instead of a psychologist is less intimidating... So, it diversifies our service offer and that's positive". (S)</p></list-item><list-item><p>"Some of them [the peers] had negative experiences in the traditional system and are willing to try something different". (C)</p></list-item></list></td></tr><tr><td>Empirical credibility</td><td>F</td><td><list list-type="Bullet"><list-item><p>"We know that right now in the research, in the empirical data, acceptance and mindfulness approaches have research to back them up. So their evidence is solid, we are not in the "we think that students could need that". (S)</p></list-item></list></td></tr><tr><td>Outer setting</td><td>Social relevance</td><td>F</td><td><list list-type="Bullet"><list-item><p>"What motivated me to participate was that it was about anxiety. It aimed to fill a need that we have right now, so it was directly connected to our work at the center". (S)</p></list-item></list></td></tr><tr><td>Peers' comorbidity and psychosocial challenges</td><td>B</td><td><list list-type="Bullet"><list-item><p>"I don't know if it's just this semester or it's a general tendency but students that participated in the program have a lot of big diagnoses, serious disorders. The peer supporters find it difficult to bring them back to work on the matrix while the students are going through difficult issues on axis 2". (S)</p></list-item><list-item><p>"We've had issues of comorbidity with all sorts of psychological disorders that the peer supporters didn't feel ready or equipped to properly help". (C)</p></list-item><list-item><p>"One of my students is very resilient but has several issues affecting most of the aspects of her life, which has a negative impact on what we can work on together". (PS)</p></list-item></list></td></tr><tr><td>Funding and resources from the research project</td><td>F</td><td><list list-type="Bullet"><list-item><p>"Convincing my manager was easy since the program was developed by a research team and was coordinated by a dedicated student. So, it didn't add any logistic work to the workload and the salaries for the peer supporters didn't come from our budget. It would have been more difficult to implement it directly without that". (S)</p></list-item><list-item><p>"A factor that was helpful was that the main researcher listened and accepted all the modifications I suggested for the selection process of the peers and peer supporters. He had a flexibility that made it possible to change things that needed adjustment as we went". (C)</p></list-item></list></td></tr><tr><td>Inner setting</td><td>Director's support</td><td>F</td><td><list list-type="Bullet"><list-item><p>"Our director gives us a lot of latitude regarding the way we lead this project. In other words, she doesn't ask us how many hours we put on the project. We present her with a follow up occasionally, and she trusts us with it". (S)</p></list-item></list></td></tr><tr><td>Similar programs previously implemented*</td><td>F</td><td><list list-type="Bullet"><list-item><p>"The idea of peer support is well accepted and there are different groups and actors in my institution that are interested by it. Other peer support initiatives are also implemented so it's trending right now. It's developing and it's well seen in this institution". (S)</p></list-item></list></td></tr><tr><td>Characteristics of individuals</td><td>Supervisor's motivation and experience</td><td>F</td><td><list list-type="Bullet"><list-item><p>"I find it very rewarding to supervise peer supporters. They are really motivated, and they always bring up very relevant issues. When you've been a psychologist for many years, it's nice to share your knowledge; it's different". (S)</p></list-item><list-item><p>"What really helped I would say is that I don't really count my hours. So even if it took more time, I would have done it after my working hours. [...] We are always busy but when we are interested in something, we make the time". (S)</p></list-item></list></td></tr><tr><td>Peer supporter characteristics</td><td>F</td><td><list list-type="Bullet"><list-item><p>"I find it interesting to see those graduate students that are invested in the framework and really want to help, that have a true desire to support and assist others." (S)</p></list-item><list-item><p>"I would say that a facilitating factor was the commitment of the peer supporters. [...] They were very qualified, very committed and it was great to work with them because I need people who are proactive, reliable, that will answer the e-mails quickly because there are so many steps for me that if I can't get their feedback, it would make things much more difficult for me." (C)</p></list-item></list></td></tr><tr><td>Process</td><td>Peer recruitment process</td><td>F&B</td><td><list list-type="Bullet"><list-item><p>"Recruitment is easy around here; it goes through a newsletter that is sent to all the students once a month. And it works out well, we haven't had many recruitment problems". (S)</p></list-item><list-item><p>"For us, it can be a challenge to recruit enough students so that all the peer supporters are paired. But in general, we reach the goal, but we need to put a lot of effort to promote the program through e-mails and such". (S)</p></list-item></list></td></tr><tr><td /><td>Peer supporters' selection process</td><td>F</td><td><list list-type="Bullet"><list-item><p>"The student selection process might seem insignificant but it's really important because that's when we can make choices that will impact the fit with the peer supporter, make sure that the motivation level of the student is high enough that they will go through the whole process, make sure that the expectations of the students are compatible with the program, make sure that the student is a good fit for the program instead of being disappointed or quitting..." (C)</p></list-item></list></td></tr><tr><td /><td>Supervision process</td><td>F&B</td><td><list list-type="Bullet"><list-item><p>"This modality with a definite timetable every 15 days with small groups really helped. It was easier to have a fixed moment to meet for supervisions, this way even if not everyone could come, at least it gives a certain stability in terms of the supervision they were offered". (S)</p></list-item><list-item><p>"At first, there were some misunderstandings concerning the regularity and the level of support given to the peer supporters so we had to adjust. For example, in one university, there was confusion concerning the frequency and amount of supervision to dispense to the peer supporters so it created a certain disengagement in some students". (C)</p></list-item><list-item><p>"The lack of supervision meetings could have impacted the engagement level of the peer-supporters. At the second meeting, many peer-supporters were missing. I think one meeting every two weeks would be more adequate". (PS)</p></list-item></list></td></tr><tr><td /><td>Cohesion between stakeholders*</td><td>F</td><td><list list-type="Bullet"><list-item><p>"I felt like my work was respected by all the other collaborators and actors on the project. The work atmosphere was very pleasant and gratifying". (C)</p></list-item><list-item><p>"I would sometimes meet informally with my colleagues providing supervision in other universities. I found those meetings so helpful for us to be on the same page, but also for us to learn from each other". (S)</p></list-item></list></td></tr><tr><td /><td>Cooperation between supervisors*</td><td>F</td><td><list list-type="Bullet"><list-item><p>"It was really reassuring to have the support, advice and encouragement so fast. I really appreciated hearing the stories of my colleagues. Learning from their difficulties and the barriers they met and how they handled them was very instructive." (PS)</p></list-item></list></td></tr><tr><td /><td>Fragmentation of communication*</td><td>B</td><td><list list-type="Bullet"><list-item><p>"Sometimes I was writing to the coordinator to tell her 'oh there is this' or 'that student wrote to me' and I think if everyone was in the communication loop to know what was happening, it would avoid having to answer the same question, I think that could be something to improve." (S)</p></list-item><list-item><p>"It's as if the information channel wasn't 100% efficient yet so some people were taking some things for granted. During the first semester, I realized it was important to keep in touch with the supervisors. When a student quits for example, it had to follow up with the supervisors, with the student and pass on all the information. All kinds of adjustments had to be made". (C)</p></list-item></list></td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>: F = Facilitators, B = Barriers, S = Supervisors, C = Coordinator, PS = Peer supporters, * = Emergent themes not part of the CFIR.</p> <hd id="AN0182505406-10">Intervention characteristics</hd> <p>Factors related to the intervention refer to the program characteristics (e.g., its duration) (Damschroder et al., [<reflink idref="bib13" id="ref47">13</reflink>]).</p> <hd id="AN0182505406-11">Online modality</hd> <p>Most peer supporters appreciated the fact that the program was offered online and thought that this feature made implementation easier. When the COVID-19 pandemic broke during the spring of 2020 and students were required to stay home, peer supporters observed a significant increase in stress and anxiety among their peers. As the program was online, they could continue offering support without interruption, which was appreciated. Additionally, peer supporters thought the program was easily accessible to peers living far from the university and that weekly sessions were easy to plan as they didn't have to commute to school for their meeting or struggle to find a confidential space to discuss on campus.</p> <p>However, peer supporters experienced several difficulties with the online platform chosen for this project. Some felt the interface was complex and counterintuitive while others had technical issues such as video lag or low sound quality. These technical issues, in turn, had various consequences. For example, some peer supporters had to reconnect or change to another videoconference platform such as Zoom or Skype, thus wasting time needed to cover all the material planned for their session. Others pointed out that these technical issues interfered with the development of a good working relationship with their peers.</p> <hd id="AN0182505406-12">Framework rooted in ACT</hd> <p>The fact that the intervention was based on ACT facilitated its implementation in various ways. Firstly, according to peer supporters, the ACT metaphors, exercises, and practices that were integrated into the program were coherent, easy to explain, and beneficial for peers. Peer supporters also felt reassured by the manual provided to them because it gave a clearer direction to their sessions. The manual provided a "safety net" in times of doubt, a structure to lean on when there was confusion. Secondly, the ACT matrix used to structure the program proved to be an effective framework to guide supervision sessions as well. Supervisors explained that during their meetings, they would pay attention to how peer supporters navigated their way through the matrix with their peer. However, they would also use the framework to ask questions (e.g., "What did you notice at that point in your body?" and "Was there something you were trying to avoid?"), explore peer supporters' experience or clarify important themes in ACT. Thus, the matrix was not only used to better understand peer issues and help them improve their quality of life, but also to invite peer supporters to reflect on their own intervention.</p> <hd id="AN0182505406-13">Diversification of the services</hd> <p>According to the supervisors, the unique nature of the program also influenced its implementation. Most support services in universities are offered by mental health professionals. Supervisors reported that a program in which help was offered by and for students was seen by their manager and their colleagues as a positive way to complement and diversify traditional mental health services and therefore was easy to adopt.</p> <hd id="AN0182505406-14">Empirical credibility</hd> <p>Lastly, supervisors felt that the program had strong empirical credibility. None of the supervisors had difficulties convincing their manager to adopt it, as the program was developed by a team of researchers and was based on an approach for which abundant empirical data were already available. For them, the program was easy to "sell" because it was theoretically sound and empirically solid.</p> <hd id="AN0182505406-15">Outer setting</hd> <p>Factors related to external context refer to the economic, political, and social aspects of the implementation, and client/patient needs and resources (Damschroder et al., [<reflink idref="bib13" id="ref48">13</reflink>]).</p> <hd id="AN0182505406-16">Social relevance</hd> <p>Considering the prevalence of stress and anxiety among students and the strong demand for mental health services in universities, supervisors felt that the program was socially relevant. For that reason, their director was interested in adopting the peer support route and investing in a program that would allow them to reach more students in need.</p> <hd id="AN0182505406-17">Peers' comorbidity and psychosocial challenges</hd> <p>Psychosocial and comorbidity issues faced by peers were seen as challenging by peer supporters. In some cases, peer supporters were paired with students dealing with serious psychosocial stressors (e.g., financial precarity) or struggling with comorbidity issues. Indeed, in addition to their anxiety, some peers had an history of abuse and trauma while others were dealing with depressive, personality, or autism spectrum disorders. In those situations, peer supporters often felt confused, overwhelmed or unprepared, and had to rely on their supervisor for guidance. They reported that the sessions with those students were often "heavy," "sad," "depressing," "emotionally charged," and "draining." They felt that they weren't sufficiently prepared to deal with comorbidity issues and that the program was not useful for addressing such issues.</p> <hd id="AN0182505406-18">Funding and resources from the research project</hd> <p>Supervisors highlighted that since the program was funded by a government research agency, their department did not have to pay peer supporters' salaries. Additionally, the program was coordinated by a dedicated graduate student which means that they did not have to worry about the logistics surrounding the project. When faced with problems, they could also rely on members of the research team for advice or adjustments. Taken together, these factors helped implement the program smoothly and successfully. On the other hand, supervisors also mentioned that without funding or support from a research team, it may be more difficult to develop and sustain peer support programs in universities, as the students' mental health services department would need to find the financial resources to pay for peer supporters and coordinators, as well as spend time to recruit, select, train, and supervise peer supporters.</p> <hd id="AN0182505406-19">Inner setting</hd> <p>Factors related to internal context refer to the characteristics of the setting in which the program is implemented (Damschroder et al., [<reflink idref="bib13" id="ref49">13</reflink>]).</p> <hd id="AN0182505406-20">Director support</hd> <p>According to the supervisors, the support provided by the directors of mental health services departments in each university played a significant role in the implementation of the program. This support took various forms. For example, directors allowed the supervisors to reorganize their schedule and find time to meet with their team of peer supporters once per week for the duration of the project.</p> <hd id="AN0182505406-21">Similar programs Previously implemented</hd> <p>Supervisors also explained that peer support was becoming increasingly popular in higher education and that various initiatives were already in place at their university. For this reason, it was easy to convince their director to take part in this project.</p> <hd id="AN0182505406-22">Individual characteristics</hd> <p>Factors related to individuals refer to the characteristics of the people involved in the intervention (Damschroder et al., [<reflink idref="bib13" id="ref50">13</reflink>]).</p> <hd id="AN0182505406-23">Supervisor motivation and experience</hd> <p>Supervisors' engagement and enthusiasm toward the program helped its implementation. All of them mentioned appreciating their role as supervisors and felt that during their meetings with peer supporters, they could easily pass on their knowledge. This positive vision of their role helped reinforce the perceived relevance of the program in their setting and facilitated making time for the program in their schedule. Furthermore, the supervisors had prior ACT experience. They had all received extensive training on the approach and had used it for several years with students, both in individual and group settings. One supervisor was also involved in another peer support program in her university and was familiar with this type of support. Partly for these reasons, supervisors joined the project feeling competent, had no major apprehensions about the program, and were quick to familiarize themselves with their role as supervisors. During their interview, they all insisted that these factors had contributed to the success of the program.</p> <hd id="AN0182505406-24">Peer supporter characteristics</hd> <p>The coordinator and the supervisors mentioned the engagement and the motivation of peer supporters as a facilitating factor for the implementation of the program. They highlighted that some qualities shared by the peer supporters played an important role in helping them face the challenges of their work with the peers. These qualities were mainly perseverance, openness, capacity for introspection and desire to help. Such qualities facilitated the implementation in that they lead to an excellent retention rate of peer supporters and demanded very little crisis management from the supervisors.</p> <hd id="AN0182505406-25">Process</hd> <p>Factors related to the process refer to activities such as planning, execution, and assessment of the intervention (Damschroder et al., [<reflink idref="bib13" id="ref51">13</reflink>]). Three types of processes played a significant role in the implementation of the program: 1) peer recruitment, 2) peer supporter selection, and 3) peer supporter supervision. Additionally, three processes emerged from the analysis and were not part of the CFIR: cohesion between stakeholders, cooperation between supervisors, and fragmentation of communication.</p> <hd id="AN0182505406-26">Peer recruitment process</hd> <p>In this project, various strategies were used to recruit peers. For instance, the program was advertised in newsletters and on the students' mental health services department website. According to the coordinator and the supervisors, some strategies were more effective than others as they allowed quick recruiting of many peers (e.g., mass e-mails sent to students briefly presenting the program). In two universities, recruitment was easy. However, recruitment was more laborious in one institution as students were slow or reluctant to enroll in the program.</p> <hd id="AN0182505406-27">Peer supporter selection process</hd> <p>Different strategies were also used to rigorously select peer supporters. For instance, they were asked to complete a screening questionnaire and then met for a selection interview held by members of our research team and supervisors. The supervisors and coordinator reported that this thorough selection process was an important facilitator of implementation. It ensured that the students chosen to be peer supporters were perseverant, autonomous, resourceful, and engaged in their role. These qualities also greatly facilitated the coordinator's work and contributed to high staff retention.</p> <hd id="AN0182505406-28">Supervision process</hd> <p>During the first semester, no clear modalities were established regarding how or when supervision sessions were to be held. The lack of clear modalities created confusion and frustration for both peer supporters and supervisors and impeded the implementation process. In the second semester, it was decided that supervisors would meet with their peer supporters every two weeks in small groups (no more than five peer supporters per session) to give everyone a chance to speak. When possible, supervisors were also invited to use the ACT matrix to give feedback to peer supporters, with the aim of helping them consolidate their knowledge of ACT. With these new parameters, supervisors thought that they could better help their peer supporters. Peer supporters also reported that these supervision sessions were valuable as they allowed them to verbalize their concerns regarding the process with their peers. They could ask questions, get reassurance, receive feedback, and reflect on their interventions. During these sessions, peer supporters appreciated the opportunity to ask for advice if their peers had special needs or were experiencing other challenges than stress or anxiety.</p> <hd id="AN0182505406-29">Cohesion between stakeholders</hd> <p>Transparent and respectful cooperation between the different actors involved in the implementation of the program was essential to its success. The coordinator reported that meeting several times with peer supporters and supervisors before the launch of the program was beneficial in establishing a climate of cohesion, trust and respect that facilitated subsequent collaborations.</p> <hd id="AN0182505406-30">Cooperation between supervisors</hd> <p>The supervisors also reported that an important facilitator to the program implementation was their punctual meetings throughout the implementation process. These meetings helped them compare different ways of doing things and readjust, if needed, the way they assisted their peer supporters and supported each other.</p> <hd id="AN0182505406-31">Fragmentation of communication</hd> <p>Communication between the coordinator, supervisors, peer supporters, and members of the research team was a challenge at the beginning of the project. This challenge was reported by all stakeholders as one of the key barriers to implementation. For example, the fact that information was shared individually rather than with all actors, as well as the lack of clarity concerning who should be notified when logistic issues arose, sometimes slowed down the problem-solving process and led to confusion. Furthermore, misunderstandings regarding the peer and peer supporter matching process contributed to confusion and communication breakdowns during the first semester. During the second semester, more open and efficient communication between actors that included everyone in the feedback loop helped clarify misunderstandings and brought clarity to everyone's role.</p> <hd id="AN0182505406-32">Discussion</hd> <p>In postsecondary institutions, peer support interventions are gaining in prominence (Ahmed et al., [<reflink idref="bib1" id="ref52">1</reflink>]; Griffin et al., [<reflink idref="bib18" id="ref53">18</reflink>]). However, research on these interventions is still in its infancy (John et al., [<reflink idref="bib26" id="ref54">26</reflink>]). This study examined key factors that could serve as barriers or facilitators to the implementation of an online peer support intervention based on ACT created for postsecondary students struggling with stress and anxiety. Data were collected from key stakeholders (program coordinators, supervisors, and peer supporters) using questionnaires and semi-structured interviews and analyzed using the CFIR. In the next sections, we will discuss what appears to be the main barriers and facilitators to the implementation of this intervention and offer a few recommendations for researchers and practitioners in higher education institutions who wish to launch peer support initiatives.</p> <hd id="AN0182505406-33">Barriers</hd> <p>Four factors significantly impeded the intervention implementation. First, peer supporters experienced technical issues with the videoconferencing platform. Not only were these technical issues a source of frustration for them, but they also undermined the quality of their relationships with their peers. During the meetings that were disturbed by image lag or sound problems, peer supporters felt that they were unable to offer the same quality of listening and presence. They also thought they were losing valuable time fixing these issues, reconnecting, or changing to another videoconferencing platform. In an online peer support program, it is essential to rely on a videoconferencing platform that is stable and easy to use, while also ensuring the confidentiality of exchanges. When we launched this project, there was still some uncertainty about the confidentiality of calls conducted on commercial platforms such as Zoom. For this reason, we decided to choose a platform developed in compliance with the Personal Information Protection and Electronic Documents Act of Canada, and thus secures all calls with end-to-end data encryption. Now that most commercial videoconferencing platforms offer this kind of protection, we believe products such as Zoom or Teams could very well be used in the future for online peer support interventions.</p> <p>Second, peer supporters were sometimes paired with peers dealing with problems beyond anxiety. Many expressed that they felt helpless when faced with the distress of students with a history of trauma or struggling with personality disorders. Not having struggled with these issues themselves, it was difficult for them to fully understand their complexity and properly support their peers. This finding highlights the importance of appropriately recruiting peers. In this project, students who showed to be at risk of suicide were immediately referred to a health professional within their institution. However, additional screening tools could have been used to assess the severity of students' anxiety or depressive symptoms, or interviews with peers could have been implemented to see whether they were struggling with issues other than anxiety. These interviews would also have allowed for a better assessment of their needs and expectations, and the complexity of their situation. It should be noted, however, that comorbidity among people with anxiety disorders is the norm rather than the exception. People with a current anxiety disorder frequently have a comorbid current (63%) or lifetime (81%) depressive disorder (Ter Meulen et al., [<reflink idref="bib47" id="ref55">47</reflink>]). Furthermore, 50% of those with depressive and anxiety comorbidity had two disorders, while the other 50% had three or more depressive and/or anxiety disorders (Ter Meulen et al., [<reflink idref="bib47" id="ref56">47</reflink>]). For this reason, it is also critical to train peer supporters to deal with comorbidity issues and to provide them with the necessary support during their supervision to deal with crisis situations (e.g., a person with suicidal thoughts). Although peer supporters appreciated the training they received at the beginning of the project, some suggested that short training sessions on specific topics (e.g., personality disorders, trauma sensitive interventions, medication use) be offered throughout the project. That said, with the increasing number of postsecondary students struggling with mental health issues and seeking help (Linden et al., [<reflink idref="bib28" id="ref57">28</reflink>]), postsecondary institutions have to find a balance between carefully screening the students who enroll in peer support programs and not denying access to those who would most benefit from those programs.</p> <p>Third, in one institution, peer recruitment was difficult for a variety of reasons. For instance, in this smaller university, all students were enrolled in business programs, and many were older, were employed, and had family responsibilities. Thus, they may not have had the time nor the interest to undertake the program. Furthermore, stakeholders argued that asking for help from a peer may not have been part of the culture in that institution since students may have perceived it as a sign of weakness. Taken together, these findings suggest that before implementing a program, it is essential to assess the compatibility between the intervention, the target population and the implementation setting (Durlak, [<reflink idref="bib15" id="ref58">15</reflink>]). It is what Proctor et al. ([<reflink idref="bib39" id="ref59">39</reflink>]) called "appropriateness," also referred to as the acceptability of the intervention by the target population.</p> <p>Finally, communication between stakeholders was difficult at the beginning of the project. This difficulty is in part because the roles and responsibilities of each actor were not properly defined, and no clear communication process was put in place. These findings echo the conclusions drawn by Visser ([<reflink idref="bib49" id="ref60">49</reflink>]) in his study on the implementation of a peer support program in a school setting. The author argues that it is crucial to maintain feedback loops between all actors involved in implementation. This feedback facilitates access to information and support, but also accelerates the adaptation of different aspects of the intervention to the setting where the implementation takes place. In any peer support program, we would recommend using a centralized communication stream (such as Teams or Slack) through which all actors involved (coordinator, supervisors, peer supporters, managers) have access and use to signal any issue, question, or new information.</p> <hd id="AN0182505406-34">Facilitators</hd> <p>Participants also noted several factors that significantly eased the intervention implementation. For instance, the fact that it was grounded in a credible theoretical approach (e.g., ACT) supported by empirical evidence greatly facilitated its acceptability and implementation. For this reason, supervisors reported that they had no difficulty in convincing their director to undertake this project. In addition, due to the manualization of the intervention, peer supporters were able to better orient themselves during their sessions and introduce key ACT concepts or exercises. From a methodological standpoint, an intervention protocol has several advantages. Among other things, it ensures that peer supporters make use of comparable processes. However, this standardization also risks "professionalizing" peers' support (Cyr et al., [<reflink idref="bib12" id="ref61">12</reflink>]). Peer supporters may be drawn to support their peers not so much based on their personal experience, but more from their knowledge of an approach. Thus, they run the risk of offering support that is more akin to therapy than peer support. While it is desirable to build peer support programs on sound theoretical and empirical foundations, it is also important to ensure that these programs remain flexible and are developed in the spirit of peer support (i.e., allowing peer supporters to open up and share their experiences). Without such precautions, the program may lose its distinctive features and become another form of therapeutic assistance (Repper & Carter, [<reflink idref="bib40" id="ref62">40</reflink>]).</p> <p>The intervention would never have been implemented without the support of mental health services directors. Supervisors all agreed that feeling supported by their director allowed them to meet the challenges inherent to the program implementation. Before launching a peer support initiative on campuses, we recommend ensuring you have the full support of relevant directors. Birken et al. ([<reflink idref="bib6" id="ref63">6</reflink>]) showed that middle managers are in a unique position to promote the implementation of evidence-based practices.</p> <p>In this project, it was decided that peer supporters would be supervised by psychologists working at the student's mental health services departments of their institution. Given peer supporters' insecurities and concerns about their skills at the beginning of the project, but also the comorbidity issues described above, this decision proved appropriate. Shepardson et al. ([<reflink idref="bib44" id="ref64">44</reflink>]) argue that few studies have explored best practices in peer supporters' supervision and that additional studies are needed given the rapid proliferation of this type of support. In this project, supervision was conducted as a group. This format allowed for rich and democratic exchanges during which the "answers" came not only from the supervisors, but also from peer supporters so that they could learn from each other. That said, supervision can be offered in other ways (e.g., individually). Our results are coherent with those obtained by Murphy et al. ([<reflink idref="bib34" id="ref65">34</reflink>]) in their scoping review of peer support interventions aimed at young people between 12 and 25 years. The authors conclude that providing sufficient supervision and training to peer supporters is a key process in insuring their self-confidence. We believe it is essential that peer supporters be able to seek guidance from a mental health professional in their institution and be counseled as needed in their duties.</p> <p>The process of finding qualified peer supporters can be challenging, but it is worthwhile to take the time to find individuals with the right skillset and personality (Shepardson et al., [<reflink idref="bib44" id="ref66">44</reflink>]). In this project, peer supporters were carefully selected using screening questionnaires and interviews. As others have stated (Chinman et al., [<reflink idref="bib10" id="ref67">10</reflink>]), we believe that students who act as peer supporters should have personal experience of the issue targeted by the program. We chose to hire graduate students, but undergraduates could also have played this role. It is critical that peer supporters can offer credible support, share their personal stories maturely and be perceived as a source of hope and inspiration by those being helped. Peer supporters do not need a mental health degree. We even showed that having studied psychology can lead to confusion between the preferred posture in therapy and the posture in peer support (Grégoire et al., [<reflink idref="bib17" id="ref68">17</reflink>]). On the other hand, it is critical that the selected peer supporters have certain skills and traits (e.g., listening, caring, resourcefulness) and that they have the time, energy, and motivation to invest in a peer support program. Furthermore, peer supporters should be compensated. As Cyr et al. ([<reflink idref="bib12" id="ref69">12</reflink>]) point out, "compensating individuals at a fair wage is a sign that their work is valued by the system that pays for the service" (p. 85).</p> <hd id="AN0182505406-35">Strengths and limitations</hd> <p>One of the strengths of this study is that multiple actors involved in the intervention implementation were consulted. Also, the use of the CFIR as a guiding theoretical framework allowed for a better understanding of the systemic levels influencing the execution of the intervention and provided a shared taxonomy with other implementation studies, an aspect that is considered lacking in multiple studies (Durlak & DuPre, [<reflink idref="bib16" id="ref70">16</reflink>]; Nilsen, [<reflink idref="bib36" id="ref71">36</reflink>]). To our knowledge, this is the first study to use a qualitative method and a theoretical framework to study the facilitators and barriers to implementing an online peer support program targeting university students. In this sense, it provides relevant information on what needs to be considered during the planification and implementation of such programs. It also offers guidance regarding potential pitfalls to avoid or strategies to facilitate the most efficient and successful implementation of peer support initiatives in colleges and universities.</p> <p>Despite its strengths, this study also has limitations. Some concern CFIR's use. As previously mentioned, this framework was chosen to guide data analysis after the program implementation. According to Kirk et al. ([<reflink idref="bib27" id="ref72">27</reflink>]), this might have been a missed opportunity since studies that used the CFIR prior to implementation were able to identify potential barriers to implementation, refine their implementation strategy, and adapt the program before it was rolled out on a large scale. The authors suggest that using the CFIR prospectively increases the likelihood of successful program dissemination and implementation. Doing so in this project could have helped prepare for some of the barriers encountered, such as communication issues. The fact that the intervention was implemented in only three universities and that one of them had unique features (i.e., a small university with business students only) limits the transferability of the results. Further research on a larger number of universities and colleges is needed to confirm the observations made in this study. Social desirability could also have affected participants' responses to questionnaires and interviews as the coordinator, supervisors, and peer supporters all knew the head researcher of the study. Future studies should also consider feedback from directors of mental health services in universities. This feedback would provide perspectives that may be less focused on intervention aspects and more directed toward inner and outer setting characteristics or the logistics of implementation, feasibility, and ability to recruit and retain peers and supervisors.</p> <hd id="AN0182505406-36">Conclusion</hd> <p>In conclusion, this study showed that various factors may impede or facilitate the implementation of peer support interventions in postsecondary institutions. In the future, it might guide choices by researchers and practitioners when implementing this type of initiative on campuses. We believe that peer support is a promising way of promoting mental health among college and university students and we hope this study will contribute to its dissemination.</p> <hd id="AN0182505406-37">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <ref id="AN0182505406-38"> <title> References </title> <blist> <bibl id="bib1" idref="ref22" type="bt">1</bibl> <bibtext> Ahmed, A., Nault, T., Rizos, J., Taneja, K., & Kim, G. P. (2020). Peer support: A medical student-driven mental health workshop. Medical Education, 54 (5), 469 – 470. https://doi.org/10.1111/medu.14125</bibtext> </blist> <blist> <bibl id="bib2" idref="ref1" type="bt">2</bibl> <bibtext> American College Health Association. (2019). 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  Data: Barriers and Facilitators to the Implementation of a Peer Support Intervention in Universities
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  Data: <searchLink fieldCode="AR" term="%22Sarah+Maillé%22">Sarah Maillé</searchLink><br /><searchLink fieldCode="AR" term="%22Frédérique+Beaulieu%22">Frédérique Beaulieu</searchLink><br /><searchLink fieldCode="AR" term="%22Lise+Lachance%22">Lise Lachance</searchLink><br /><searchLink fieldCode="AR" term="%22Simon+Grégoire%22">Simon Grégoire</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+College+Student+Mental+Health%22"><i>Journal of College Student Mental Health</i></searchLink>. 2025 39(1):86-109.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 24
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Influences%22">Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Implementation%22">Program Implementation</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Relationship%22">Peer Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Support+Groups%22">Social Support Groups</searchLink><br /><searchLink fieldCode="DE" term="%22College+Programs%22">College Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Mediated+Communication%22">Computer Mediated Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Students%22">Graduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink>
– Name: Subject
  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22Canada+%28Montreal%29%22">Canada (Montreal)</searchLink>
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  Data: 10.1080/28367138.2024.2325437
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  Data: 8756-8225<br />1540-4730
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  Data: A growing number of postsecondary institutions offer peer support interventions to promote mental health among their students. However, little is known about the key factors that influence the implementation of this type of intervention. This study explored barriers and facilitators to implementing an online peer support program based on Acceptance and Commitment Therapy aimed at reducing stress and anxiety among students of three universities in Montreal, Canada. Peer supporters were asked to complete a survey containing open-ended questions at the end of each semester. Interviews were also conducted with the program coordinator, three psychologists who acted as supervisors, and 14 peer supporters. The data were analysed with an inductive and a deductive approach using the Consolidated Framework for Implementation Research (CFIR). Perceived barriers to the implementation of the intervention included technical problems with the videoconferencing platform, psychosocial and comorbidity issues among peers, recruitment difficulties, and communication concerns between stakeholders. Key perceived facilitators were the theoretical and empirical foundations of the intervention, the support offered by directors, and the process used to recruit, select, and supervise peer supporters. Based on the results of this study, practical recommendations are provided for researchers and practitioners interested in implementing online peer support initiatives in postsecondary institutions.
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  Data: 2025
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        Value: 10.1080/28367138.2024.2325437
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      – Text: English
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        PageCount: 24
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      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Influences
        Type: general
      – SubjectFull: Program Implementation
        Type: general
      – SubjectFull: Peer Relationship
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      – SubjectFull: Undergraduate Students
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      – SubjectFull: Canada (Montreal)
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