Implementation of an innovative peer support program for undergraduate mental health

Objective: Our anonymous, text-based peer support program, DukeLine is uniquely poised to combine developmentally appropriate support with technology to increase accessibility of mental health support. We collected data to inform program feasibility and acceptability, and to explore putative mechanisms of treatment effect. 

Method: To assess the acceptability of DukeLine, we surveyed a sample of undergraduate students (n = 67) on the perceived acceptability of and future likelihood of using a peer support text line. For the subsequent pilot project, the service was directly advertised to a subset of Duke undergraduates (initially to 300 students and then to 2000 students). We collected usage data (basic user demographics, time of text, duration of conversation) and user experience data (satisfaction with service, likelihood to recommend to others) from students who interacted with our text-based support platform (n = 9). To assess feasibility, we collected self-reports from student coaches (n = 63) on their emotional exhaustion, sense of purpose, and general mental health every four weeks throughout training and provision of peer support. 

Results: Before DukeLine was launched, most students surveyed (78%) indicated that they would be at least somewhat likely to use the hypothetical peer support service and 88% percent of respondents said they would be at least somewhat likely to refer a friend. In the pilot from Fall 2020 to Spring 2022, students were most likely to seek support via DukeLine when off-campus and in the local Durham area. Overall, coaches responded to texters within 2 minutes (average response time = 72.76 seconds, SD = 74.63 seconds). The average conversation length was about 1 hour (Mean = 70.58 min, SD = 47.60 min). According to summaries written by the peer coaches, 38.81% of texters described an academic issue (e.g., stress about grades, conflict with professor, career stress), 43.28% sought support for a social issue (e.g., romantic relationship/dating, conflict with friends, identity concerns, loneliness), 43.28% reported mental or physical health concerns (e.g., depression, anxiety, eating concerns, issue with CAPS, pandemic stress), and 4.48% described a familial issue (e.g., conflict with parents, death of a family member).  A majority of the students who used DukeLine during the pilot (88.89%) indicated they would be Very or Extremely Likely to use DukeLine again. Finally, we found that peer coaches showed increased empathy, F (1,27) = 21.62, p < .01 and decreased emotional exhaustion, F (1,27) = 4.26, p = 0.49 over the course of one year of coaching. 

Conclusions: DukeLine met expected acceptability thresholds on all three fronts: students appear to be interested in using peer support, students who used peer support were satisfied with their experience, and coaches were satisfied with their experience in training and actively coaching. Our peer coaching program specifically addressed accessibility barriers by offering immediate support (via text) after typical business hours. Additionally, DukeLine coaches were able to address a variety of presenting concerns brought by texters and made referrals to additional services when appropriate. Our program maintained high retention of peer coaches throughout the pilot experiment, both within and across semesters. This retention is promising for future sustainability of this model. Overall, coaches trained and supervised under the DukeLine model successfully provided support to a pilot sample of students in a manner that is potentially sustainable in the long term.