Understanding peer support: a qualitative interview study of doctors one year after seeking support.

BACKGROUND: Doctors' health is of importance for the quality and development of health care and to doctors themselves. As doctors are hesitant to seek medical treatment, peer support services, with an alleged lower threshold for seeking help, is provided in many countries. Peer support services may be the first place to which doctors turn when they search for support and advice relating to their own health and private or professional well-being. This paper explores how doctors perceive the peer support service and how it can meet their needs. MATERIALS AND METHODS: Twelve doctors were interviewed a year after attending a peer support service which is accessible to all doctors in Norway. The qualitative, semi-structured interviews took place by on-line video meetings or over the phone (due to the COVID-19 pandemic) during 2020 and were audiotaped. Analysis was data-driven, and systematic text condensation was used as strategy for the qualitative analysis. The empirical material was further interpreted with the use of theories of organizational culture by Edgar Schein. RESULTS: The doctors sought peer support due to a range of different needs including both occupational and personal challenges. They attended peer support to engage in dialogue with a fellow doctor outside of the workplace, some were in search of a combination of dialogue and mental health care. The doctors wanted peer support to have a different quality from that of a regular doctor/patient appointment. The doctors expressed they needed and got psychological safety and an open conversation in a flexible and informal setting. Some of these qualities are related to the formal structure of the service, whereas others are based on the way the service is practised. CONCLUSIONS: Peer support seems to provide psychological safety through its flexible, informal, and confidential characteristics. The service thus offers doctors in need of support a valued and suitable space that is clearly distinct from a doctor/patient relationship. The doctors' needs are met to a high extent by the peer-support service, through such conditions that the doctors experience as beneficial.

Why do doctors seek peer support? A qualitative interview study.

OBJECTIVES: To understand how doctors reflect on when and why they seek help from an organised peer-support service. DESIGN: Data were collected through audiotaped, qualitative, semi-structured interviews. The interviews were analysed with systematic text condensation. SETTING: A peer-support service accessible to all doctors in Norway. PARTICIPANTS: Thirteen doctors were interviewed after attending a counselling service in fall 2018. They were selected to represent variation in gender, demographics, and medical specialty. Doctors were excluded if the interview could not be held within 10 days after they had accessed peer support. RESULTS: The doctors' perspectives and experiences of when and why they seek support and their expectations of the help they would receive are presented, and barriers to and facilitators of seeking support are discussed. Three categories of help-seeking behaviour were identified: (1) 'Concerned-looking for advice' describing help seeking in a strenuous situation with need for guidance; (2) 'Fear of not coping any longer' describing help seeking when struggling due to unreasonable stress and/or conflict in their lives; and (3) 'Looking for a way back or out' describing help seeking when out of work. Expectations to the help they would receive varied widely. Motivations for seeking help had more to do with factors enabling or restricting help-seeking than with the severity of symptoms. CONCLUSIONS: Many different situations lead doctors to seek peer support, and they have various expectations of the service as well as diverse needs, motivations and constraints to seeking peer support. Further research is warranted to investigate the impact of peer support and how to tailor the service to best suit doctors' specific needs.

Managing Animal Welfare in Food Governance in Norway and Sweden: Challenges in Implementation and Coordination.

A key issue in food governance and public administration is achieving coordinated implementation of policies. This study addressed this issue by systematically comparing the governance of animal welfare in Norway and Sweden, using published papers, reports, and legal and other public information, combined with survey and interview data generated in a larger research project (ANIWEL). Governing animal welfare includes a number of issues that are relevant across different sectors and policy areas, such as ethical aspects, choice of legal tools, compliance mechanisms and achieving uniform control. Based on the challenges identified in coordinating animal welfare in Norway and Sweden, relevant organisational preconditions for achieving uniform and consistent compliance were assessed. The results showed that Sweden's organisation may need more horizontal coordination, since its animal welfare management is divided between multiple organisational units (Swedish Board of Agriculture, National Food Agency and 21 regional County Administration Boards). Coordination in Norway is managed solely by the governmental agency Norwegian Food Safety Authority (NFSA), which has the full responsibility for inspection and control of food safety, animal health, plant health, as well as animal welfare. Thus, Norway has better preconditions than Sweden for achieving uniformity in animal welfare administration. However, in Norway, the safeguards for the rule of law might be an issue, due to NFSA acting as de facto "inspector", "prosecutor" and "judge".

The implementation of European Union (EU) rules on cross-border care: moving towards convergence?

This article studies the implementation of the European Union (EU)'s Patients' Rights Directive in Germany and Norway. The objective of the Directive was to allow EU member states to have a say in the regulatory work, ensure predictability and uniformity in the application of EU rules on cross-border care, and enhance a move towards EU harmonisation in this area. So far, the implementation processes in Norway and Germany have mixed results regarding the likelihood of achieving uniformity and harmonisation. Although the Directive has had convergent effects on certain areas of cross-border care, such as setting up National Contact Points and providing patients with the basic right to treatment abroad, implementation also shows divergent patterns. In both countries, adapting to EU rules has strengthened patients' rights to choose freely among health-service providers in a wider European health-service market. However, due to legal discretion and country-specific institutions within which the new rules are applied, divergent patterns prevail.

Peer counselling for doctors in Norway: A qualitative study of the relationship between support and surveillance.

RATIONALE: Peer support can entail collegial responsibility for counselling and support as well as reactions to academic or ethical failure. These considerations can be complementary, but also conflicting. OBJECTIVE: This article focuses on how the peer support programme in Norway addresses these considerations. METHODS: Focus group interviews held with Norwegian peer counsellors from August 2011 to June 2012 were analysed by a stepwise deductive-inductive method. RESULTS: Based on organisational theory, two "ideal types" of counsellors were identified from the data, and these were then used to reanalyse the text. We found that the organisational framework is associated with the peer counsellors' role conception and thereby the relationship between the counsellor and the help-seeking doctor. The relationship between informal frameworks like collegiality, confidence and discretion, and more formalized incentive-driven frameworks, appear to influence the accessibility to peer support, the mandate to provide relevant help and the understanding of what peer support represents. CONCLUSION: The study showed the need for a continuous awareness of a balance between the informal and the more formalized elements in the framework for peer support. This is of importance for how the service can contribute to better health among doctors and to secure quality and safety in the treatment of patients. The analysis can also be used to demonstrate the consequences of how the peer support program is designed - such as the degree of formalisation and the balance between "hard" and "soft" ways to regulate the interaction between peer counsellors and doctors - for the ability to achieve the stated objectives of the service.