Developing an initial program theory for peer support groups for substance-affected family members: a participatory realist evaluation

BackgroundAmidst an unregulated drug crisis in Canada, the needs of affected family members have been largely ignored. Evidence supports the efficacy of peer support group interventions in health and social care; however, a better understanding of how peer support groups produce outcomes is required for successfully implementing interventions for substance-affected family members. MethodsThe study uses a participatory realist evaluation framework to develop an initial program theory (IPT). Data collection includes interviews of program staff and participants, program evaluation surveys, internal program documents, and observational field notes. We employ deductive and inductive coding and retroductive analysis theorizing contexts, mechanisms, and outcomes configurations (CMOCs). ResultsWe present three nested implementation contexts containing 10 CMOCs. Our IPT suggests: Strong organizational support in an environment that values lived expertise promotes program sustainability; a skilled facilitator with lived experience will leverage unique approaches to foster a positive group culture; a positive group culture activates the programs pillars of emotional support, education and skill-building to produce reduced social isolation, improved emotional wellbeing, increased self-efficacy, and improvements in relationships. ConclusionThis participatory realist evaluation presents an IPT of a peer support group for substance-affected families that will inform future implementation and evaluation of family supports.