Tipos, Descripción, Causas y Procedimientos de Reparación Falla Tipo 1: Piel de cocodrilo

When peer support is provided, active engagement in health decision-making is encouraged, with an intermediate outcome of developed knowledge and capability. We were interested in exploring the concept of developing capability because there has been interest over the past 5 years in conceptually integrating the social determinants of health as conceptualised in health research, with the concept of capability in the context of social justice.104

The capabilities approach frames health and well-being as having opportunities to do what a person chooses to do and to be what they value.105_{A central tenet of the model is the concept that people}

should have the freedom to achieve well-being. This is directly related to social justice in health and the right to be capable of being healthy.106_{Peer support may motivate people to reflect on their circumstances.}

Out of this interaction and action arises what is called a‘capability set’. The capability set includes:

l What people are entitled to In this case, health and well-being.

l What people can do What they are endowed with, in terms of HL.

l What people can get How people can use their interactive and critical HL to improve their health and well-being.

Surrounding this set are the broader social and material conditions that individuals must deal with when trying to achieve health and well-being. In theory, peer support aims to improve HL with the aim of increasing agency–the ability to interact with the surrounding material and social conditions to get what one is entitled to in terms of health.

At present, the capabilities approach is not a fully developed theory–it has been described as a model or a partial theory.104_{We felt that it was important to use this model as a device for examining whether or}

not peer support could promote capability, particularly in relation to dealing with conditions that create health inequalities.

Identify need for programme Develop strategies for recruiting PS Develop training materials and approach to delivering Provide training Situate PS in community with appropriate support Understanding of community needs Appropriate strategies for recruitment Relevant materials that address learning needs Acquire KPS to recruit and support participants Ability to deliver effective intervention

A capabilities template (Figure 13) was used to explore potential relationships. In the template, context is defined as the broader political, policy and social environment, and social conditions surrounding the programme.

Political and policy aspects include national drivers for focusing on health improvement, and political attitudes towards those drivers, which can be manifested as the amount of system support.

The presence of existing social networks within a community, and the amount of social isolation versus cohesiveness and trust may also interact with the programme. Finally, the design of the programme in the sense that it either enables or restricts a responsive and opportunistic approach to needs–may either work with aspiration and peer support or dilute effectiveness.

The endowments of participants at baseline, in terms of what they‘bring to the table’interact with the context and the peer support. This gives rise to mechanisms–psychological, social, cognitive and other processes–that either incline people to consider their health situation or render them unready to deal with it. This template was applied to the programmes and discussed with members of our Advisory Network. Several interesting insights arose from this process.

Aspirations In the programmes, aspirations were often reflected as the opinions or views of the

researchers and sponsor organisations rather than reflecting a process through which people were helped to identify what they would like to do. The Advisory Network, in contrast, unanimously focused on establishing a facilitating relationship through which people were engaged in reflecting on what they would like to be able to manage.

Attributes Physiological and psychological abilities in some of the programmes had already been defined before the intervention was developed. In contrast, the Advisory Network thought that finding out what people were currently capable of doing was part of the peer-support process.

Context What exists around us

• Political and policy environment • System support

• Social network • Responsiveness

Peer support provided • Emotional support • Information support • Affirmational support • Instrumental support

Mechanisms

Beliefs, reactions, motivations, attitudes toward

• Peer support • Health condition • Health behaviour change

Capability set: improvement in functioning over intermediate and long term

• Health literacy: functional; critical; interactive; ability to access, understand, interpret information; judge its relevance; make informed decisions about how to improve

• Agency: individual or collective ability to act on and achieve what I/we would like to be capable of What we ‘bring to the table’

• Personal attributes: physiological, psychosocial

• Aspirations: what we would like to be able to do; ‘ought’ to be able to do

Social networks The relevance of social networks was largely ignored in the programme literature, whereas the Advisory Network practitioners explained how they routinely spent time finding out if people were connected.

Type of peer support When the programme literature focused on providing informational support as a key component, which was often provided early in the peer/participant encounter, Advisory Network practitioners described many scenarios in which information was offered at a later stage, after aspirations had been identified and when people were ready for it. The conceptual analysis that we used to initially define peer support stated that‘the literature clearly demonstrated that peer support primarily occurs without the provision of instrumental support’.1_{Our Advisory Network, however, agreed that instrumental}

support was essential when working with marginalised and vulnerable groups.

The findings from the Advisory Network discussions of capability were summarised as user-friendly documents and diagrams, and fed back to members for further discussion. This produced a list of components that are present in peer support (Box 4). The components illustrate the importance of establishing connections first, describing a situation in which personal information relevant to the encounter is shared. This places the relationship on an‘equal footing’from the start, laying the foundation for participatory parity.

The principle of homophily is emphasised in the programme literature, but the Advisory Network stated clearly that skills in making connections and establishing relationships were equally as important as similar characteristics, and, in some cases, relationships could be developed based on an interest in differences between supporter and supported.