“You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use

Abstract Background Increasingly, substance use and homelessness services have peer workers, those with lived or living experience of substance use and homelessness, who provide support to those experiencing similar challenges. While research regarding the effectiveness of such peer workers in helpi...

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Main Authors: Hannah Carver, Joanna Astrid Miler, Jessica Greenhalgh, Bernie Pauly, Nicola Ring, Hazel Booth, Josh Dumbrell, Tessa Parkes
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Public Health
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Online Access:https://doi.org/10.1186/s12889-025-23006-6
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author Hannah Carver
Joanna Astrid Miler
Jessica Greenhalgh
Bernie Pauly
Nicola Ring
Hazel Booth
Josh Dumbrell
Tessa Parkes
author_facet Hannah Carver
Joanna Astrid Miler
Jessica Greenhalgh
Bernie Pauly
Nicola Ring
Hazel Booth
Josh Dumbrell
Tessa Parkes
author_sort Hannah Carver
collection DOAJ
description Abstract Background Increasingly, substance use and homelessness services have peer workers, those with lived or living experience of substance use and homelessness, who provide support to those experiencing similar challenges. While research regarding the effectiveness of such peer workers in helping others achieve better outcomes is growing, little is known about their experiences in this role. Methods A systematic review and qualitative evidence synthesis was conducted to better understand the experiences of peer workers who have lived/living experience of substance use and homelessness who are providing support to those experiencing similar challenges within substance use and homelessness settings. Nine electronic databases were searched for primary qualitative research published from 1990. Studies meeting the inclusion criteria were quality assessed using the Critical Appraisal Skills Programme checklist. Data from included studies were extracted, entered into NVivo, and analysed using a thematic synthesis approach. Results Nine studies were identified, published from 2006 from three countries with 272 participants. Three themes were identified: peer workers’ reflections on the key components of their role; peer work as enabling individual growth and recovery; and destabilising challenges peer worker growth and recovery.. Peer workers described many essential qualities, and their lived experience was valued as a way of enabling deeper trust and empathy with the people they supported. Strong relationships with other peer workers were described as important. Many benefits to the peer workers were described, including positive life changes and increased responsibility. Challenges were also identified, with professional boundaries causing particular tensions. Conclusions This qualitative evidence synthesis provides unique insight into the experiences of peer workers who are working at the intersection of homelessness and substance use. Their experiences highlight the real benefits that peer workers have, whilst working in challenging situations in often precarious contracts. Such insights can inform the employment of peer workers. Those employing peer workers should prioritise clear job descriptions encompassing specific peer qualities, training and education opportunities, and peer-to-peer, professional, and organisational support.
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spelling doaj-art-fedfce081a904c218cb4efe56a5d90422025-08-20T03:53:14ZengBMCBMC Public Health1471-24582025-05-0125112510.1186/s12889-025-23006-6“You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance useHannah Carver0Joanna Astrid Miler1Jessica Greenhalgh2Bernie Pauly3Nicola Ring4Hazel Booth5Josh Dumbrell6Tessa Parkes7Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of StirlingSchool of Applied Sciences, Edinburgh Napier UniversitySalvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of StirlingCanadian Institute for Substance Use Research, University of VictoriaSchool of Health and Social Care, Edinburgh Napier UniversitySchool of Health Sciences, University of DundeeSalvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of StirlingSalvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of StirlingAbstract Background Increasingly, substance use and homelessness services have peer workers, those with lived or living experience of substance use and homelessness, who provide support to those experiencing similar challenges. While research regarding the effectiveness of such peer workers in helping others achieve better outcomes is growing, little is known about their experiences in this role. Methods A systematic review and qualitative evidence synthesis was conducted to better understand the experiences of peer workers who have lived/living experience of substance use and homelessness who are providing support to those experiencing similar challenges within substance use and homelessness settings. Nine electronic databases were searched for primary qualitative research published from 1990. Studies meeting the inclusion criteria were quality assessed using the Critical Appraisal Skills Programme checklist. Data from included studies were extracted, entered into NVivo, and analysed using a thematic synthesis approach. Results Nine studies were identified, published from 2006 from three countries with 272 participants. Three themes were identified: peer workers’ reflections on the key components of their role; peer work as enabling individual growth and recovery; and destabilising challenges peer worker growth and recovery.. Peer workers described many essential qualities, and their lived experience was valued as a way of enabling deeper trust and empathy with the people they supported. Strong relationships with other peer workers were described as important. Many benefits to the peer workers were described, including positive life changes and increased responsibility. Challenges were also identified, with professional boundaries causing particular tensions. Conclusions This qualitative evidence synthesis provides unique insight into the experiences of peer workers who are working at the intersection of homelessness and substance use. Their experiences highlight the real benefits that peer workers have, whilst working in challenging situations in often precarious contracts. Such insights can inform the employment of peer workers. Those employing peer workers should prioritise clear job descriptions encompassing specific peer qualities, training and education opportunities, and peer-to-peer, professional, and organisational support.https://doi.org/10.1186/s12889-025-23006-6Substance useHomelessnessPeer workersPeer supportQualitativeQualitative evidence synthesis
spellingShingle Hannah Carver
Joanna Astrid Miler
Jessica Greenhalgh
Bernie Pauly
Nicola Ring
Hazel Booth
Josh Dumbrell
Tessa Parkes
“You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use
BMC Public Health
Substance use
Homelessness
Peer workers
Peer support
Qualitative
Qualitative evidence synthesis
title “You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use
title_full “You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use
title_fullStr “You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use
title_full_unstemmed “You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use
title_short “You are helping from the heart not just from the head”: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use
title_sort you are helping from the heart not just from the head a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use
topic Substance use
Homelessness
Peer workers
Peer support
Qualitative
Qualitative evidence synthesis
url https://doi.org/10.1186/s12889-025-23006-6
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