The peer-professional interface in a community-based, breast feeding peer-support project.
OBJECTIVE: to explore key elements of the peer-professional interface within one breast feeding peer-support project. DESIGN: a descriptive, qualitative study design. Data were generated through focus-group discussions with volunteer peer supporters and health professionals. SETTING: the Breastfriends scheme was a community-based, peer-support project located in Doncaster, a town in the North of England. PARTICIPANTS: all of the volunteer peer supporters who were involved in the scheme at the time of data collection (n=7). In addition, a convenience sample of health professionals (community midwives and health visitors [n=9]) was also generated. ANALYSIS: thematic analysis of the data was undertaken. Two key themes that have relevance to understanding the peer-professional interface were derived: benefits of working together, and constraints on enabling working relationships. FINDINGS: benefits associated with participating in the breast feeding peer-support scheme were highlighted by volunteers and health professionals. Volunteers experienced enhanced social support and increased self-esteem and personal development. Health professionals benefited from being able to 'spread the load' of breast feeding support. Some health professionals were also able to learn from volunteers' specialist experiential and cultural knowledge. Health professionals were concerned about volunteers transgressing (poorly defined) boundaries. Both volunteers and health professionals described gate-keeping activities and surveillance behaviours practised by health professionals in an effort to control aspects of volunteers' access to, and work with, breast feeding women. DISCUSSION: as a cohort of peer supporters develops, members may derive benefits from their participation that extend beyond those predicted and planned for in the project. They may also exert a proactive influence upon the evolution of the peer-support project and upon the relationships between volunteers and health professionals. However, midwives and health professionals may also seek to exert influence over the work of peer supporters, preferring the volunteers to work for, rather than with, them as health professionals. It is at the peer-professional interface that any disjuncture between the project ideal and the reality of the group may be most evident and most problematic. CONCLUSION AND IMPLICATIONS FOR PRACTICE: in order to reduce tension at the peer-professional interface, and optimise relationships between volunteers and health professionals, an ongoing process of development involving volunteers and health professionals is essential. Such a process would need to proactively identify and diffuse professionals' concerns while addressing both volunteers' vulnerabilities and their potential for semi-autonomous development within and beyond the context of the peer-support scheme.