Demographic information QUAL1.

BackgroundThe integration of Peer Support Workers (PSWs) in mental health settings may encounter resistance due to the attitudes of Mental Health Workers (MHWs). At the same time, PSWs may initiate changes in the attitudes, as well as in the larger institutional culture. This paper addresses the question of which changes happen and how they occur.MethodsThis work is part of the ImpPeer-Psy5 study, funded by the German Innovation Fund, which examines the nationwide implementation of PSWs in health insurance-funded mental health care. Data were derived from two qualitative sub-studies: QUAL1encompassed 57 problem-centered interviews conducted with PSWs, MHWs working together with PSWs, and service users; QUAL2 consisted of one focus group and five interviews only with MHWs. Qualitative data were analyzed using a modified thematic analysis adapted to a collaborative research approach.ResultsThe main findings included that working with PSWs makes MHWs better integrate lived experience insights into their caregiving, pay more attention to life contexts, advance towards a more appreciative language, use diagnostic categories more flexibly, and show more openness towards their own affectedness. These changes are reported to be mediated by the simple presence of PSWs, their “role model” function for other staff, or more direct forms of feedback and critique.ConclusionOverall, staff attitudes changed as a result of reflexive processes induced by their interactions with PSWs. This poses a dilemma as changes in MHWs and larger institutions are expected to occur prior to the implementation of peer support work to facilitate their integration. Further research is needed to evaluate whether and how staff training can facilitate the implementation of PSWs by targeting MHWs’ attitudes.

研究背景：在精神卫生服务场景中引入同伴支持工作者（Peer Support Workers, PSWs）可能会因精神卫生工作者（Mental Health Workers, MHWs）的态度而遭遇阻力。与此同时，PSWs亦可能推动相关态度乃至整体机构文化发生变革。本研究旨在厘清具体发生了哪些变革，以及这些变革的发生路径。

研究方法：本研究隶属于德国创新基金资助的ImpPeer-Psy5项目，该项目旨在调研PSWs在医保覆盖的精神卫生服务中的全国性推广情况。研究数据来自两项质性子研究：QUAL1包含57场问题导向访谈，访谈对象涵盖PSWs、协同开展工作的MHWs以及服务使用者；QUAL2则包含1场焦点小组访谈与5场仅面向MHWs的访谈。质性数据的分析采用了适配协同研究框架的改良版主题分析法。

研究结果：核心研究结果显示，与PSWs协作可促使MHWs更好地将亲身经历的体悟融入照护工作，更关注服务对象的生活处境，逐步转向更具包容性的沟通语言，更灵活地使用诊断分类，并更愿意直面自身所受的影响。据报告，这类变革可通过PSWs的在场、其作为其他工作人员的"role model"功能，或是更直接的反馈与批评形式得以介导。

研究结论：总体而言，工作人员的态度因与PSWs互动引发的反思性过程而发生改变。这带来了一处两难困境：为助力PSWs的顺利整合，本应在同伴支持工作推行前先推动MHWs与整体机构的态度变革，而实际的变革却产生于与PSWs的互动过程中。未来仍需开展进一步研究，以评估针对MHWs态度的工作人员培训能否以及如何助力PSWs的推广实施。