Describing Working Alliance Longitudinally in a Peer Support Intervention for Adolescents and Young Adults with Chronic Illness

Peer support is one theoretically grounded and developmentally informed approach to support the unique psychosocial challenges faced by adolescents and young adults (AYAs) living with childhood onset chronic conditions (COCCs). Working alliance is presented as one well-established construct to understand the underlying mechanisms of peer support in this population. This exploratory study sought to describe the working alliance trajectory in a peer support intervention for AYAs with a COCC.

The present study was a substudy of a randomized controlled trial examining the efficacy of a one-to-one telephone-based peer coaching intervention for AYAs with a COCC designed to promote self-management and patient activation. The present study aimed to describe the working alliance trajectory from the perspective of the AYA over the first four coaching sessions and to examine AYA, peer coach, and dyadic characteristics (gender, age, race, COCC category) that influence the working alliance trajectory. This study also utilized qualitative analyses to describe core aspects of the AYA-peer coach relationship over time. AYAs completed a self-report measure to assess their perceived working alliance following the first four peer coaching sessions. For 32 AYA-peer coach dyads, linear random coefficient regression models for longitudinal data were conducted to describe the trajectory of overall working alliance across the first four coaching sessions. AYAs perceived a strong working alliance in the first peer coaching session, which was maintained across three subsequent sessions. There were no significant differences in working alliance trajectory across AYA, peer coach, and dyadic characteristics. Although not significantly significant, a trend emerged in which AYAs and peer coaches with the same COCC had a decrease in working alliance over time, while AYAs and peer coaches with a different COCC had an increase in working alliance over time. Qualitative findings revealed themes describing peer coach skills consistent with the working alliance construct (warmth/empathy/genuineness, alignment with AYA’s goals) as well as the ability to integrate similar experiences to build a trusting relationship and provide support, which may be unique to the peer relationship. Findings from the present study serve as a foundation for future efforts to capture the underlying mechanisms of peer support for AYAs with a COCC, which can inform the design of research and clinical programming that effectively leverage peer support to promote outcomes.