The Role of Peer Support in Managing Occupational Stress: A Qualitative Study of the Sustaining Resilience at Work Intervention

Abstract

Background: Peer support at work may support psychological resilience by enhancing coping skills and providing social support. The current study aimed to examine how a workplace peer support program, “Sustaining Resilience at Work” (StRaW), may support employee mental health from the perspective of the trained peer supporter. Method: Nine individuals from various public and private organizations who had completed StRaW peer supporter training participated in semi-structured interviews to explore their views on the StRaW program. Data were analyzed using inductive thematic analysis. Findings: Three main themes emerged: the impact of workplace stressors on employee mental health, the impact of StRaW, and feedback on StRaW. The results suggested positive effects of StRaW training on practitioners’ ability to support colleagues and maintain their own psychological well-being. Discussion/Application to Practice: Our results indicated that peer support programs in the workplace may improve employees’ well-being and relationships between employees. As such, occupational health professionals should recommend that their organizations invest in these types of programs to improve organizational resilience. They should encourage employees they consider to be capable of supporting their colleagues to undergo this training as evidence suggests this is beneficial to the trained employees’ own well-being, rather than making them feel burdened or under pressure. Occupational health professionals should also view such programs as useful ways of improving attitudes toward mental health within their organizations.

Introduction

Research suggests that the average person spends a third of their life at work (Fotinatos-Ventouratos & Cooper, 2015). Work is an important aspect of an individual’s identity, and positive work experience is associated with increased organizational commitment, enhanced job performance, and job satisfaction (Butts, Vandenberg, DeJoy, Schaffer, & Wilson, 2009). However, occupational stress can lower organizational commitment, increase turnover intentions, and may lead to absenteeism (Bowling, Alarcon, Bragg, & Hartman, 2015), which can consequently lead to considerable physical and psychological problems for employees (Nixon, Mazzola, Bauer, Krueger, & Spector, 2011). Depression and anxiety at work account for 44% of occupational ill health and 57% of loss in productivity and absenteeism (Health and Safety Executive, 2018).

The main support for workers within their organizations often comes from colleagues and managers (Hancock & Page, 2013); and social support from immediate supervisors and colleagues can help decrease feelings of perceived work overload and occupational stress (Bowling et al., 2015). Consequently, peer support programs have increasingly been of interest to organizations as a way of facilitating employees’ abilities to support each other and decreasing perceived workplace stress.

According to Mead, Hilton, and Curtis (2001), peer support can be defined as “a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful” (p. 137). Systemic social reciprocity is an essential component of providing support because individuals who share similar life experiences may understand a peer’s situation better (Mead et al., 2001). Peer support programs aim to increase social support and develop resilience—often defined as “the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma” (Windle, 2011, p. 12). The development of resilience is a mechanism which can mitigate negative effects of stress-related psychological outcomes for an individual and increase well-being. Individual resilience is related to increased job satisfaction and organizational commitment (Sood et al., 2011); more resilient staff are also likely to perform better at work in a positive work environment (Shatté, Perlman, Smith, & Lynch, 2017). Peer support programs can prevent organizational mental ill health–related behaviors such as disengagement, absenteeism, and intentions to leave the organization (Whybrow, Jones, & Greenberg, 2015).

Studies suggest that peer supporters can have a positive effect on the individuals they provide support to, and the organizations where they work (Meehan, Bergen, Coveney, & Thornton, 2002; Salzer et al., 2013). Salzer et al.’s (2013) exploration of the benefits of being a certified peer specialist found statistically significant reductions in case management, crisis services, and inpatient hospitalizations in previously hospitalized individuals working as “case management aides”; certified peer specialists also reported experiencing benefits to their own well-being and felt that they had a positive impact on their agencies. Meehan et al.’s (2002) evaluation of an Australian program for mental health consumer peer support trainees found that participants’ levels of anxiety, perceived stress, locus of control, and self-esteem all improved over the course of the training (though not to a statistically significant level). In a focus group, the same participants suggested that they felt they had gained a lot from the training, which they perceived as benefiting both themselves and the patients they supported. Evidence further suggests that peer support can improve individuals’ attitudes toward work as well as their personal well-being (Gould, Greenberg, & Hetherton, 2007; Small et al., 2013) and is associated with more positive attitudes toward mental and physical health, increased positive coping strategies (e.g., exercise), and decreased negative coping strategies (e.g., using alcohol to cope with distress) (Hersey et al., 2008). Peer support programs can also decrease presenteeism and help lower sick leave rates (Odeen et al., 2013; Werner, Laerum, Wormgoor, Lindh, & Indahl, 2007). Salzer and Shear (2002) suggest that peer support training also increases the self-esteem of the practitioners.

Although there appears to be some evidence of the effectiveness of such interventions, the impact of peer support training programs has not been fully explored and further research is needed to recognize which elements of such programs are most important. There is also a lack of research—particularly qualitative research—on the practitioners’ own perceptions of the training programs and the impact it has had on their lives.

This study examined one such intervention called Sustaining Resilience at Work (StRaW). StRaW is a peer support system which was developed by a company called March on Stress Ltd., subsequent to a review of the literature on workplace stress (Brooks & Greenberg, 2018). (Readers can learn more about StRaW via March on Stress; http://www.marchonstress.com/page/p/ort_straw.) StRaW aims to help detect, prevent, and/or minimize the effect of everyday stressors at work or home and on employees’ well-being (March on Stress, n.d.), and essentially, StRaW is a peer support system which teaches and enables individuals to support colleagues and encourage resilience. StRaW practitioner training involves a 2-day course in which participants receive education about how stress and mental health problems can affect people at work; training in the use of a structured interview schedule to ascertain whether colleagues might be experiencing significant levels of distress, information about how to practically manage stressed individuals, and training about how to mentor them to take positive, resilience enhancing actions such as positive coping, speaking to people who can positively influence their lives such as managers, colleagues, and family members. The training course also provides guidance on how to recognize more complex symptoms requiring professional intervention and provides trainees with the skills, based on the principle of motivational interviewing (Prochaska et al., 1994) to encourage these employees to speak with a health care professional. The training includes a mixture of educational sessions and facilitated role-plays.

StRaW training focuses on the recommendations of an expert group that explored the rationale for organizational-focused peer support training which concluded that peer supporters should (a) provide an empathetic, listening ear; (b) provide low-level psychological intervention; (c) identify colleagues who may be at risk to themselves or others; and (d) facilitate pathways to professional help (Creamer et al., 2012). Importantly, the StRaW interview process includes telling the individual that the only reason that a StRaW practitioner would break confidentiality without the express permission of the interviewee is whether they considered there was a significant risk of serious harm (to self or others) occurring. Such an approach is important to facilitate the open discussion of mental health issues between a distressed employee and a StRaW practitioner.

This study explored the views of employees who had become peer supporters by completing StRaW training to identify what difficulties StRaW may help with, how StRaW might affect their colleagues’ or their own mental health, and suggestions for improvement to the StRaW program.

Method

Design and Study Participants

The study used qualitative analysis of nine interviews carried out by one researcher (B.A.) in May through June 2017. Seven interviews were carried out via telephone, and two face-to-face interviews were conducted in individuals’ workplaces. All participants were employees who had completed a 2-day StRaW peer support training package. These peer supporters, known as StRaW practitioners, were not specialists in occupational health and safety or counselors but were employee volunteers who performed their StRaW practitioner role in addition to their usual job.

The study received full ethical approval from the King’s College London Ethics Committee (Reference No. LRU-16/17-4175) before commencement of the study. All participants read detailed information sheets regarding the study before providing informed consent. Participants were assured that their confidentiality would be respected by removing any identifying details from transcripts and were informed they could stop the interview or request withdrawal of their data at any time.

Procedures

Three organizations trained in StRaW were identified by the company who trained them, March on Stress Ltd, and approached via email to ascertain if they would be willing to participate in the research. The StRaW leads of two organizations agreed to participate in the study after approval from their respective StRaW teams and their organizational management. Eligible participants were over the age of 18 and had attended StRaW training at least 2 months previously to ensure they had the opportunity to gain a degree of experience of supporting colleagues and thus consolidate training. Eligible practitioners (i.e., those employees who have been trained as StRaW practitioners) who were interested in taking part were further contacted individually via email, provided by the StRaW leaders. Before the commencement of interviews, participants were provided with study information sheets and consent forms. Interviews began after formal informed consent was received.

Interviews

Semi-structured interviews were conducted to explore StRaW practitioners’ experiences of supporting colleagues and identify whether they had experienced any positive or negative impacts from using StRaW themselves. For example, a negative impact could possibly occur if they did not find the training helpful and could lead them to feeling unable to assist their colleagues. Questions about suggestions for improvement were also asked.

As interviews were semi-structured, participants had the freedom to guide the direction of their interviews; however, a general topic guide was developed by the researchers to ensure some level of consistency throughout the interviews. The interview schedule was developed through a combination of discussion with the StRaW leads within the organizations, reviews of other papers investigating peer support training (e.g., Gould et al., 2007), and discussions with other professionals in the field. The final schedule consisted of 13 broad questions which covered the relationship of the participant with their colleagues and immediate supervisor, whether the StRaW training had any impact on their relationship with their colleagues and supervisors, and whether the StRaW training had been useful to them both personally and professionally. Examples of questions included “looking back, what were the most useful parts of the course for you?”; “what else might the course have included which you would have found helpful?”; and “how have you found using the principles of StRaW at your place of work; what has worked well; what has not worked so well?” Interviews lasted for an average of 30 minutes. The first two interviews were conducted as pilot interviews; however, as no changes to the interview schedule needed to be made after these pilots, all interviews were included in the analysis.

Data Analysis

Interviews were audio recorded, then transcribed verbatim. Following multiple re-readings of the transcripts to allow familiarization, one researcher (B.A.) used thematic analysis (Braun & Clarke, 2006) to code the data using NVivo Software (2012). The type of thematic analysis used was inductive, in that the data itself was used to generate codes without predetermined ideas about what might be found, and similar to phenomenology, in that its goal was to understand and describe how participants thought and felt in relation to the research topic. Data were coded by allocating excerpts of text to thematic codes representing meanings in the data. Related codes were combined to create “themes,” which were reviewed and organized until we had a master list of thematic codes. This approach was utilized to best understand the experience of the participants and develop any emerging themes from the data. Our working definition of resilience, used to aid analysis, was that it is the sum of the dynamic processes that help individuals cope with adversity (MacManus et al., 2014).

Results

Nine individuals took part in the study; four male and five female. Participants were from one public and one private organization; they worked in Human Resources (HR), Commercial, Advertising, or Administrative roles. Time in their current role ranged from 2 to 20 years. All participants were StRaW practitioners at the time of the interviews and had been trained for at least 1 year.

Thematic analysis yielded three main themes: workplace stressors and their impact on employee mental health, the impact of StRaW, and feedback on StRaW. References to specific individuals, organizations, or places have been changed to “(name)” to retain participants’ anonymity. Text in square brackets within an extract indicates text that has been added by the authors to clarify what the participants were referring to if this was not clear from the extracts. “(. . .)” within an extract indicates some text has been omitted.

Workplace Stressors

Discussion of workplace stressors was prevalent throughout the discussions, and such stressors appeared to be a contributing factor to how participants perceived their own and their colleagues’ work before the StRaW program, their experience with StRaW, and StRaW’s role in mitigating workplace stress. Work characteristics (such as heavy workload, a high level of workplace demands, and inadequate resources) and specific workplace responsibilities were highlighted as the main workplace stressors experienced by employees in the workplace.

Participants described experiences of employees feeling stressed due to hectic work schedules, needing to keep up to date with new trends, meeting deadlines, competitive working environments, and a multitude of tasks which affected how they managed their work and maintained a work–life balance.

It is a hard-paced environment and organizations like ours have always been. I think people still have their moments of stress of the work environment and achieving targets. (Participant 8)

Satisfaction (or lack of) with the immediate supervisor was important in how participants felt about their jobs. Participants had varied views of their supervisors, with some being positive:

I have always had a very good relationship with my supervisor. He has always been very supportive, I can confide him in any work issues or even personal things and I know he would have some good advice. He’s a very good listener. (Participant 7)

Relationships with supervisors tended to be perceived as positive if participants felt able to talk to them and felt both respected and supported. Others described more negative relationships:

I think he [supervisor] is very driven and has a very opinionated view about things like where we should be, and I have always admired that about him but in terms of his team management, I don’t find his ways effective at all. (Participant 5)

Negative relationships with supervisors tended to be characterized by inefficient management, poor communication, or feeling unable to approach them regarding problems.

Another workplace stressor was organizational change in the form of relocation, role adjustment, and administrative changes, which were all cited as factors which could lead to role ambiguity and feelings of disengagement and stress. StRaW was viewed as a possibly useful way of mitigating the stress experienced as a result of organizational change as helped generate feelings of a supportive network and structure. StRaW practitioners reported commonly supporting new staff or staff in new roles to help them adjust to the change.

We have had a lot of structural change here, there have been lots of new people coming who are not aware of the history. So that’s one thing we talk about more in our StRaW group, of how we can help. (Participant 3)

Impact of StRaW

No participant reported any negative effects of having attended StRaW training or taking on the role of StRaW practitioner. Participants felt that StRaW had a positive impact on both themselves and those they supported in their organizations.

First, StRaW-trained staff reported feeling more aware of their own mental health needs and the needs of others in terms of situational, personal, and environmental circumstances. They noted that they were more likely to recognize problems in others and more able to self-reflect than pre-StRaW training.

I would say that I have learned how to reflect upon myself, become more self-aware and I feel more aware of the people around me in general. And on a conscious level, I try to be more aware of things and I know it’s a big difference since last year. (Participant 5)

Some participants felt that they could cope better personally, even when workplace stressors persisted, indicating an overall increase in their personal resilience.

I was quite distraught and could not get my thoughts in order . . . I am still dealing with the problem (with supervisor). But now I feel more resilient and know how to pull myself together and calm down. (Participant 4)

Most participants felt more confident because the skills they had learned in the StRaW course had increased their ability to deal with stressors and challenges.

I would say that it (StRaW training) has made me more confident. It has helped me on an organizational level but I could see how it can help me personally as well. (Participant 8)

The StRaW practitioners also felt that they had become more approachable after the training and reported that colleagues more often wanted to speak to them for advice or to gain an understanding of what might help them by going through the formal StRaW process. Some felt that StRaW had added more credibility to their role.

I am someone who has been through a major problem, has done a (StRaW) training and hence people feel that they can always talk to me. It has made me more approachable. (Participant 7)

In addition to increased confidence and perceived approachability, participants also suggested they perceived improvements in their own emotional intelligence and social intelligence. Often, these were skills participants felt they already possessed, but StRaW had enhanced them: “I already had most of those skills but StRaW enhanced them . . . I think I was quite emotionally intelligent anyways but perhaps it just added to it” (Participant 8).

Feedback on StRaW

Overall, participants found the concept of peer support beneficial and suggested such programs were essential because they allowed employees to approach a familiar, trusted figure with their problems. Many felt that people were more likely to approach a StRaW-trained colleague than HR, for example, and felt that StRaW created a safe space for people to talk about problems without judgment.

I think people don’t always want to go and talk to HR. So, having a peer in the department that people trust is a good thing, moreover they do not want things on record officially and want to talk to someone who can keep it confidential and would not use it against them. (Participant 3)

Most participants reported that the StRaW techniques were easy and practical to implement; “I find it easy, very straightforward and simple to follow” (Participant 7). They felt empowered by using the techniques they had learned, such as the decision-making matrix, a tool taken from a psychotherapy technique called motivational interviewing, and having a structured approach to problem solving had helped them make decisions and take actions to improve their own and their colleague’s mental health.

The decision-making matrix (. . .) has fit in with a lot of reasons why someone has come to talk to me. I use it to make decisions myself as well. (Participant 4)

Participants appreciated the concept of peer support in an organization which they felt had encouraged the development of resilience, provided a structure for providing social support and created a safe space for staff to talk about their mental health problems. Overall, the program was perceived to be empowering and fostered resilience in both the practitioners and those they supported: “it has given the ability and empowerment to people to come back to work next day [after a stressful event]” (Participant 7).

As well as providing positive feedback, participants made suggestions for how StRaW could be improved. Six participants suggested that StRaW training should be longer than 2 days to have more time to learn and reflect on the training. Three participants suggested follow-up training to learn more, discuss the training, and enhance their skills. The majority felt the materials provided were sufficient, but three suggested more materials (such as videos, online material) should be provided for future reference. Participants also suggested that StRaW should be developed for organizations with smaller group dynamics, although participants did not suggest how this might effectively be done.

Three participants said that potential StRaW beneficiaries might find it difficult to differentiate between the role of StRaW practitioners and HR, which led to a recommendation that StRaW practitioners as being confidential and wholly independent of HR are important:

The most difficult part of my StRaW experience has been trying to reassure people that it is not HR. The questions are similar to HR and people are very sceptical about the motivations as they are scared of it in any large organisation. (Participant 8)

Discussion

This study aimed to examine the possible benefits of peer support within an organization using qualitative interviews with personnel trained in the StRaW peer-led support program. Our results showed that StRaW practitioners felt that peer support would be helpful for mitigating the impact of a wide range of stressors and had helped them become more aware of their own psychological health and better understand the psychological health needs of others. StRaW training was also viewed as equipping trainees with skills to support distressed colleagues who might be contending with significant occupational and personal stressors. Furthermore, the skills learned on the course were also viewed as helping to maintain their personal resilience.

Our results suggest that employees’ satisfaction with their immediate supervisor was extremely indicative of how supported the participants felt in their organizational environment. Perceptions of having good support from one’s supervisor were seen as being indicative of support from the entire organization. Healthy working relationships and supervisor support have been previously shown to be positively correlated with job performance (Alessandri, Borgogni, & Latham, 2017), job satisfaction (Alessandri et al., 2017), and role clarity (Zheng, Thundiyil, Klinger, & Hinrichs, 2016). While most of the participants felt they had a healthy working relationship with their immediate supervisor, a minority described it to be strained. However, they felt that StRaW training equipped them to cope better with the associated stress and made them more resilient. In these cases, they felt that their stress was also possibly mediated by peer support and by implication potential StRaW beneficiaries would also likely benefit from peer support if they faced difficulties with their supervisors.

Another psychosocial effect of the StRaW training was a perceived increase in confidence and self-esteem of the practitioner. Practitioners felt more equipped to deal with problems and everyday stressors and provide adequate support to their colleagues when approached. The results can also be understood in the context of the job demands–resources model (Demerouti & Bakker, 2011). In this model, factors associated with job stress can be classified as either demands (aspects of the job which require physical or psychological effort, and are thus associated with certain physical or psychological costs) or resources (aspects of the job which help to achieve goals or reduce demands and their costs). In this study, peer support was viewed as being an important resource to deal with the stressful demands from work or home life.

However, peer support training might well enhance organizational and personal resilience more than simply by mitigating the impact of one’s supervisor. Although resilience may come from many sources (Rutter, 2006; Sarkar & Fletcher, 2014; Windle, 2011), our results suggest that peer support may protect employees from the potentially harmful effects of a range of stressors by bolstering an individual’s resilience and consequently increasing personal well-being and improving their mental health (Grant, Curtayne, & Burton, 2009; Vanhove, Herian, Perez, Harms, & Lester, 2016). The present study also found that the resources provided by the StRaW training could possibly strengthen an individual’s coping mechanisms which may lead to improved mental health, self-esteem, and ability to access social support (Taylor & Stanton, 2007). Most participants perceived they had become more resilient and could deal with day-to-day stressors and by implication they felt that potential StRaW beneficiaries would also experience improved coping skills. From an organizational viewpoint, improved ability to cope with adversity should also lead to increased productivity.

Employees who had volunteered to be StRaW practitioners expressed that they had hoped that the training would help themselves and others. This desire is in keeping with social support theory (Salzer, 2002; Solomon, 2004) and the helper therapy principle (Salzer & Shear, 2002) as practitioners felt able to help their colleagues with whom they felt a sense of camaraderie. Practitioners also experienced positive feelings from being approached for help by potentially distressed colleagues. Being better able to understand their colleague’s situation and being able to help them seemed to not only help the colleagues receiving StRaW support but also the practitioners themselves. Being able to deal with distress in the workplace is likely to improve social relatedness and bolster employee self-determination (Ryan & Deci, 2000) and autonomy (Cherrington et al., 2015), both of which are associated with the development of healthy coping behaviors.

The interviews also suggested that StRaW had the potential to help initiate an organizational culture change. Respondents felt that the introduction of StRaW had increased mental health awareness in their organizations and the majority of participants perceived their organization to be more proactive in raising mental health awareness and providing support since the introduction of StRaW. This organizational change was viewed positively by the practitioners and some felt it had empowered them to be more responsible to bring about further positive culture change.

Participants were mostly satisfied with the content and significance of the StRaW training. The decision-making tools, conversation structuring techniques, and role-play activities were found to be useful and relevant. However, some participants had difficulty with the 2-day training program and felt they required more time to learn and reflect on the course content. In addition, four participants felt the two full-day training should be split into four half-day training programs to make it less hectic. However, there is limited evidence to suggest that programs which are longer in duration lead to more positive outcomes (Robertson, Cooper, Sarkar, & Curran, 2015) and organizations need to balance the needs to provide their peer supporters with effective training with the need for them to also be effective employees.

Limitations

We acknowledge that our sample size was small; however, it was determined that “saturation” (the point at which no new themes were emerging from the data) had been achieved after seven interviews. Transcripts were coded by one author (B.A.), and although they were discussed with the other authors, it may have been useful to have all transcripts double-coded. In addition, the possibility of selection bias must be considered, in that perhaps only those who were particularly satisfied with their StRaW training decided to take part.

Implications for Occupational Health Practice

The findings of this study provide additional evidence with respect to the effects of peer support resilience training by providing three key insights. First, the presence of a peer support program at work may improve employees’ resilience and well-being. This finding should help occupational health professionals recommend that the organizations they work for should invest in increasing the bonds between employees, through provision of a peer support program or in another fashion, as this may help improve organizational resilience. Second, StRaW-trained participants felt more emotionally aware in their personal and professional lives and, having developed more sympathy and understanding toward other people, felt their personal resilience had improved. This suggests that StRaW training may have a direct positive impact on those who complete it. This finding suggests that occupational health professionals should feel confident in encouraging employees they consider capable of supporting their colleagues to undergo the training and should not fear that those who become practitioners will feel overly burdened by their work as a peer supporter. Finally, as a consequence of participants feeling better equipped to support their peers, StRaW practitioners also felt they were well placed to foster positive improvements in their organization’s culture in respect of mental health over time. As such, occupational health professionals should view the implementation of a peer support program as a useful element to improving organizational attitudes toward mental health. As there is limited research on such programs, however, there are implications for further research as well as practice: Future studies could adopt a mixed-methods approach to incorporate quantitative elements to the study to evaluate and measure variables of work stress; for example, self-administered stress audit tools such as a shortened stress evaluation tool (ASSET; Faragher, Cooper, & Cartwright, 2004) could be used before and after the implementation of the StRaW intervention to assess whether there is an improvement following StRaW training. Resilience training evaluation studies could also use randomized controlled trials with a StRaW-trained group and a control group (Robertson et al., 2015), comparing scores on—for example—measures of organizational and colleague support, work–life balance, psychological well-being and individual resilience, as well as rates of work satisfaction and sickness absence. These comparative data would provide a better understanding of the effect of StRaW training across an organization.

Applying Research to Practice

Occupational stress can lead to physical and psychological health problems, lowered productivity, absenteeism, and poor organizational commitment. Research suggests that feelings of pressure and stress at work can be decreased if employees feel supported by immediate colleagues and supervisors; therefore, many organizations are becoming increasingly interested in peer support programs. We evaluated the “StRaW” program by interviewing employees who had received StRaW training. Overall, they reported increased understanding of mental health, the ability to recognize distress and support colleagues, and improved confidence and self-esteem. While more research is required to fully understand the impact of peer support programs such as StRaW, the results of this study and evidence from other studies of peer support programs suggest that occupational health professionals can use peer support as mechanism both to improve the mental health of the workforce and to help identify individuals who require professional interview early on. In this sense, StRaW may well help managers foster employee resilience in the workplace while also allowing occupational health staff to have earlier access to individuals who may benefit from formal health care interventions.