“Peer with a P versus a p”: A mixed-methods study of peer support training, service delivery, and supervision across global contexts

Peer support services in which people with lived experience provide non-clinical, mutualistic support are effective in improving health outcomes for people with serious mental health challenges. Despite its demonstrated effectiveness, there is limited research on peer supporters' experiences with training, service delivery, and supervision across diverse global contexts. This explanatory mixed methods study explored these perspectives through a survey (N = 101), key informant interviews (N = 13), and focus group discussions (N = 14). Quantitative data from the survey was summarized descriptively, and qualitative data were analyzed using thematic content analysis. Participants reported high use of peer-specific competencies including sharing lived experience (89.1%), collaboration and care (81.2%), and communication (78.2%). Themes emerging from qualitative data emphasized role clarity, collaboration with non-peers, accessible training, and peer supervision. Challenges identified included stigma, inequitable compensation, limited career pathways, and inconsistent training quality. Many participants preferred peer-led or co-supervision models. In contexts without formalized peer support infrastructures, grassroots and faith-based organizations played a critical role in delivering peer support services. These findings highlight common foundations and context-specific nuances necessary for strengthening peer support across contexts, including standardized training competencies, sustainable and inclusive training, equitable compensation, and peer supervision models.