# Using a Learning Health System to Integrate Peer Support in Early Intervention Services for Psychosis in Quebec: Protocol for a Participatory, Mixed‐Methods Study (the PAIRPEP Project)

## TL;DR

This study outlines a protocol to integrate and evaluate peer support services in psychosis early intervention programs in Quebec using a learning health system.

## Contribution

The novel contribution is a co-designed, mixed-methods protocol to implement and assess peer support within a rapid learning health system in Quebec.

## Key findings

- The PAIRPEP project uses a participatory approach to implement peer support services across 12 early intervention clinics.
- Quantitative and qualitative data will be collected over three years to evaluate implementation and stakeholder impact.
- The study aims to foster real-time feedback and iterative improvements through integration with a rapid learning health system.

## Abstract

Since 2019, SARPEP (Système Apprenant Rapide pour les programmes de Premiers Épisodes Psychotiques), a rapid learning health system (RLHS) for Quebec's Early Intervention for Psychosis Services, operates to bridge the evidence‐practice gap across the province. Despite strong stakeholder support and government recommendations, peer support services remained poorly available. To address this gap, since 2023, the PAIRPEP project was co‐developed to support and evaluate the implementation of peer support and family peer support. This paper describes the co‐designed study protocol, embedded within this RLHS.

This participatory, mixed‐methods study aims to examine the implementation of the PAIRPEP intervention longitudinally over 3 years across 12 Early Intervention Services and its impact on multiple stakeholders. Informed by the Medical Research Council framework for complex interventions, the project includes a co‐designed (with multiple stakeholders) multimodal capacity‐building program with specific components developed to overcome barriers to integrating peer support and family peer support. Quantitative questionnaires are collected every 4 months from clinicians while youth and families can complete surveys at any convenient time, via QR codes available in clinics, through the RLHS electronic platform. Focus groups are conducted annually over 3 years with eight stakeholder groups. The analysis integrates findings using thematic synthesis and joint displays to assess convergence and divergence across methods and perspectives.

This protocol paper outlines the study's co‐design, procedures and anticipated contributions. Embedding large‐scale innovative intervention implementation (such as peer support) within an RLHS can foster real‐time feedback, iterative refinement and inform clinical practice and policies.