We randomised 100 participants to either training (n = 50) or wait-list control (n = 50). Participants completed baseline assessments (30th May–3rd of June) and 1-week post-randomisation assessments (12–16th June 2020) during a lockdown period in the UK (with face-to-face teaching suspended from 20 March to 15 June 2020). Recruitment and retention rates are displayed in Fig. 1. All training group participants attended all training sessions, with the exception of one participant who missed one session. There were no dropouts in the 1-week assessment; however, one participant was lost to follow-up and others missed one or two follow-up questionnaires.
Baseline demographic characteristics are displayed in Table 1. Across both groups, most participants were aged 16 or 17 years (> 90%), self-identified as female (> 80%), and lived in England (> 80%). Both groups were ethnically diverse (< 50% White British), with similar levels of family affluence.
Results from the ANCOVAs comparing training and wait-list groups on each primary and secondary outcome 1 week post randomisation, controlling for corresponding baseline score, gender and age are detailed in Table 2.
Ability to provide support
There was no difference between the training and the wait-list groups on motivation to provide support to others (F1,95 = 2.60, p = 0.110). However, there was a significant effect of training on perceived support-giving skills (F1,95 = 15.83, p < 0.0001, ηp2 = 0.14) and how often participants provided support to others (F1,95 = 13.99, p < 0.0001, ηp2 = 0.13). Self-reported compassion towards others was also significantly greater among those who received training, compared to wait-list controls, both in relation to engaging with others and perceived ability to take action (F1,95 = 12.03, p = 0.001, ηp2 = 0.11 and F1,95 = 23.21, p < 0.0001, ηp2 = 0.20, respectively). The training group also reported feeling significantly more connected to their peers than wait-list controls (F1,95 = 19.48, p < 0.0001, ηp2 = 0.17). With the exception of motivation, effect sizes across indicators of ability to provide support to others ranged from medium to large.
Mental wellbeing and emotional symptoms
We also found evidence of an effect of training on self-reported mental wellbeing and emotional symptoms. Those who received training reported significantly better mental wellbeing and significantly lower negative emotional symptoms compared to the wait-list, with large- and medium-effect sizes, respectively (F1,95 = 62.51, p < 0.0001, ηp2 = 0.40, F1,95 = 8.26, p = 0.005, ηp2 = 0.08).
Agency (self-efficacy and civic engagement)
Relative to the wait-list group, the training group reported significantly greater self-efficacy, with a medium-effect size (F1,95 = 7.91, p = 0.006, ηp2 = 0.08). Compared to wait-list controls, the training group also reported more positive civic attitudes and greater perceived ability to engage in civic behaviours, each with a large-effect size (F1,95 = 25.82, p < 0.0001, ηp2 = 0.21 and F1,95 = 20.86, p < 0.0001, ηp2 = 0.18, respectively).
Training group follow-up
Participants most frequently reported helping close others: all training participants reported helping friends at least once over the follow-up period; 88% (n = 44) helped family members; 80% (n = 40) helped other peers and 38% (n = 19) helped young people they did not know. Figure 2 displays self-reported motivation to provide support to others, perceived support-giving skills and how often participants provided support to others at each assessment point among the training group. Repeated measures ANOVAs indicated perceived support-giving skills and how often participants provided support differed significantly across assessment points (F2.65, 129.88 = 6.13, p = 0.001; F2.82, 138.08 = 10.39, p < 0.001), and both increased from baseline to 4 weeks post randomisation (p = 0.018 and p = 0.006, respectively), although motivation at 4 weeks did not significantly differ from baseline (p = 0.49). The training group’s connectedness to their peers also differed across assessments (F4, 196 = 8.41, p < 0.0001), and participants reported feeling significantly more connected to their peers at 4 weeks compared to baseline (p = 0.001).
Across the three open-ended questions, three main clusters emerged from participants’ responses: supporting and connecting with peers, empowerment and civic engagement, and self-care. Figure 3 provides a summary of the results; additional quotes and frequencies are provided in Table S3.
Perceived impact of training
Increased ability to support and connect with peers was the main impact of the training. In particular, three-quarters of participants indicated that the training increased their ability and confidence in supporting others. For instance, Holly (all names are pseudonyms) expressed that the training made her “feel more prepared to help my friends and peers when they need me.” Two-fifths indicated that the training helped them build stronger relationships. For Paige, the training made her more “present within my friendships and relationships.”
About a third mentioned that the training made them feel empowered and more confident in themselves (“it made me see that I am more powerful and I can really make a change”; Rebecca), and had renewed aspirations to help the community (“I'm hoping to help my community increase the number of diverse Peer Supporters”, Charlotte). Equally frequent were references to increased self-awareness and self-care (“It has made me … more aware and more capable to deal with my own emotions and problems”; Stephanie).
Negative impacts of the training were rarely mentioned; only three participants indicated the training caused some fatigue (“made me tired due to lots of socialising and concentrating”; Kirsty), but no further negative experiences or harms were reported.
Use of peer support skills
All participants reported at least one instance of using the skills to emotionally support others. Many young people described situational challenges peers faced, including lockdown, exam stress and family conflict (e.g., “I helped a friend who was struggling with being isolated in COVID-19 lockdown and just had a few conversations with them”; Georgia). Participants also reported specific emotional difficulties among their peers, and often mentioned techniques used to help others cope. Laura, for instance, supported a friend who “was having a panic attack and I tried to help her to calm down by suggesting that she did things which would distract her, I was referring to the emergency action plan which is something I learnt on the course.” Lastly, participants described using active listening skills; Jade, for example reported that “when having meaningful conversations I remembered to use a gentle tone and the mirroring technique.”
Two-fifths mentioned how their skills had been useful in helping the community and communicating around civic responsibilities. For example, Chloe reported that she used the skills “to help to educate others about the importance of understanding and fighting for the rights of those less privileged.” In addition, about a third mentioned using the skills for self-care and setting personal boundaries. Anna reported that “rather than shooting into panic mode, I reasoned with myself to think logically rather than emotionally, which had helped me calm down”.
Intention to use the skills
All but one participant reported planning to use their new skills in the future, both immediately after the course (100%) and at the last follow-up (98%). The vast majority described plans to use the skills to support others (e.g., “I will try and help more of my peers even after all of this COVID-19 stuff has died down”; Georgina). Roughly half mentioned aspirations to improve their relationships and communication skills (e.g., “I plan to use some of the techniques like mirroring to help build stronger rapport with people”; Paul).
Many participants also reported a motivation to advocate for mental health and plans to contribute to community wellbeing. Paige reported she hoped to “set up a student organisation in my school, aiming to empower and educate younger students — with a focus on battling misogyny and sexual assault.” Participants also planned to continue to focus on self-care; for example, Samantha planned to “balance what I want to do and my own mental health.” Finally, an additional code identified in this section related to academic or professional aspirations, mentioned by about a fifth of participants. Alexandra, for instance, reported that “I hope to be a doctor so these skills will be extremely useful.”