What's Changed?: A Scoping Review of Existing Frameworks, Models and Tools Used in Peer-Based Health Promotion

Peer-based health promotion (PBHP) is recognised for its ability to engage populations who are often excluded or underserved by traditional healthcare. Despite documented strengths, gaps exist in the evidence base regarding PBHP approaches and implementation. Accordingly, this scoping review aimed to explore the frameworks, models, and tools used for the planning, implementation, and evaluation of peer-based health promotion programs.

This scoping review followed methodological guidance for scoping articles provided by Arksey and O'Malley and Levac et al., and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched PubMed, Web of Science, ProQuest and Google Scholar using keywords. Included articles were published in English between January 2014 and October 2024 and described PBHP programs or interventions that provided guidance on at least one aspect of program planning, implementation, or evaluation. Consultation with stakeholders (n = 10) was undertaken to contextualise and validate the review findings.

A total of 64 articles were included in the final review. Six articles reported on the development of a conceptual model or framework, whilst 15 reported on the use of named frameworks. Most studies incorporated behavioural theory to inform program design and evaluation, with limited use of systematic planning and implementation elements. Eighteen articles reported systematic evaluation methods. Stakeholder consultation reinforced findings from the literature and provided additional practice-based insights into funding constraints, evaluation challenges, the need for flexible frameworks, authentic co-design, reciprocal benefits for peer workers, and workforce sustainability.

This review found diverse and often inconsistent application of intervention elements, including theories and models, as well as planning and evaluation frameworks. In addition, findings suggested that while health promotion principles are deeply embedded in peer-based practice, they are not always explicitly recognised as such. Results point to three actionable priorities: institutional advocacy to strengthen the infrastructure required for comprehensive PBHP program reporting; research to test strategies to address identified gaps in terminology and evaluation; and funding and commissioning organisations to invest in co-designed, peer-specific evaluation tools that capture the full scope of PBHP impact.