# Exploring stakeholder perceptions of peer support initiatives in the management of diabetes in low- and middle-income countries: An online survey study

## TL;DR

This study explores how stakeholders in low- and middle-income countries view peer support programs for managing type 2 diabetes, identifying key barriers and readiness factors.

## Contribution

The study provides new insights into stakeholder perceptions of peer support for diabetes in low- and middle-income countries.

## Key findings

- Most stakeholders were aware of peer support and some were actively involved in such initiatives.
- Limited resources and funding were the most commonly cited barriers to implementing peer support programs.
- Local leadership, resource allocation, and sustainability planning showed the highest perceived readiness for implementation.

## Abstract

Peer support is an effective strategy to promote self-management behaviors and improve well-being in those with cardiometabolic disease, including type 2 diabetes mellitus (T2DM). There is limited knowledge about stakeholder perceptions regarding peer support programs in low- and middle-income countries (LMICs). The study assessed stakeholders’ awareness and understanding of peer support initiatives for T2DM, and explored their perceived barriers and readiness for implementation. A cross-sectional, self-administered online survey with branching logic was distributed to stakeholders across macro- (health policy), meso (tertiary hospital), and micro (community) levels of LMIC healthcare systems from June 1 to December 15, 2023. Quantitative data were analyzed descriptively; qualitative data underwent thematic content analysis. A total of 69 respondents from 25 LMICs participated in the survey. Due to branching logic and response attrition, 53 surveys (77%) had complete responses. Most respondents were medical doctors (n = 35, 50.7%) and a large proportion worked in tertiary hospitals (n = 27, 39.1%). Thirty-nine respondents (56.5%) were aware of peer support; among the 38 respondents with complete data, 29 (76%) reported active involvement in T2DM peer support initiatives. Of 15 responses to open-ended questionnaires regarding barriers to T2DM peer support, 9 (60%) cited concerns about limited resources and lack of funding. Local leadership (mean ± standard deviation: 3.4 ± 1.2), resource allocation (2.7 ± 1.4), and sustainability planning (2.7 ± 1.4) showed the highest perceived readiness on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Stakeholders in LMICs demonstrate awareness and active involvement in T2DM peer support programs. While limited resources and funding remain significant barriers, local leadership, resource allocation, and sustainability planning showed the highest perceived readiness, indicating promising foundations for implementation. Strengthening these areas through targeted support could facilitate the expansion and sustainability of peer support initiatives in resource-constrained settings.