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Journal of Nursology
Sevim ŞEN OLGAY1
Hediye ARSLAN ÖZKAN2
Begüm KIRIK2
Ceren ZEREN ERDEM2
1Acıbadem Mehmet Ali Aydınlar University,
Faculty of Health Sciences, Department of
Nursing, İstanbul, Türkiye.
2Yeditepe University, Faculty of Health
Sciences, Department of Nursing, İstanbul,
Türkiye.
Research Article Araştırma Makalesi
DOI: 10.17049/jnursology.1429829
Everything’ll be Fine Together! Peer Support in
the Pandemic: A Mixed Methods Study
Her Şey Birlikte Güzel Olacak! Pandemide Akran Desteği: Bir
Karma Yöntem Çalışması
ABSTRACT
Objective: This study aims to examine the effects of a peer support program implemented for Health
Sciences Faculty students who were isolated due to the COVID-19 pandemic on their levels of
loneliness, stigma, and anxiety.
Methods: The study was conducted using a mixed-methods design between September 2020 and
February 2022. The quantitative component included a sample of 66 students. Data were collected
before and after the peer support program using sociodemographic information form, the UCLA
Loneliness Scale, the Stigma Scale, and the Epidemic Anxiety Scale. Descriptive statistics and paired
sample t-tests were used for data analysis in group comparisons. In the qualitative component,
individual in-depth interviews were conducted with 11 students selected through purposive sampling
in a face-to-face setting. The qualitative data were analyzed using thematic analysis, with themes and
subthemes identified.
Results: The mean scores of the scales before and after the peer support program were, respectively,
15.18±2.57 and 14.56±2.48 for the UCLA Loneliness Scale, 38.69±11.00 and 35.66±11.47 for the
Stigma Scale, and 50.50±13.36 and 46.24±15.69 for the Epidemic Anxiety Scale. After the program,
there was a statistically significant decrease in the stigma and anxiety levels of the participants with
peer support. The study identified two main themes: "Experiences related to the isolation process"
and "Coping strategies during the isolation process."
Conclusion: It is recommended to develop global peer support education programs to support
students' well-being in disaster situations such as pandemics.
Keywords: Anxiety disorders, COVID-19, nursing students, social isolation
ÖZ
Amaç: Bu çalışma, COVID-19 pandemisi nedeniyle izolasyona alınan Sağlık Bilimleri Fakültesi
öğrencileri için uygulanan akran destek programının yalnızlık, damgalanma ve kaygı düzeyleri
üzerindeki etkilerini incelemeyi amaçlamaktadır.
Yöntemler: Araştırma, Eylül 2020 ile Şubat 2022 tarihleri arasında karma yöntem deseniyle
gerçekleştirilmiştir. Nicel bölümde örneklem 66 öğrenci ile oluşturulmuştur. Veriler, akran desteği
programı öncesi ve sonrası sosyodemografik bilgi formu, UCLA Yalnızlık Ölçeği, Stigma Ölçeği ve
Salgın Hastalık Kaygı Ölçeği ile toplanmıştır. Verilerin analizinde tanımlayıcı istatistikler ve gruplar
arası karşılaştırmalarda eşleştirilmiş örneklem t testi kullanılmıştır. Nitel bölümde ise yüz yüze
ortamda, amaçlı örneklem doğrultusunda 11 öğrenci ile bireysel derinlemesine görüşme
yapılmıştır. Nitel veriler tematik analiz ile analiz edilerek tema ve alt temalar oluşturulmuştur.
Bulgular: Ölçeklerin akran destek programı öncesi ve sonrası ortalama puanları sırasıyla UCLA
Yalnızlık Ölçeği için 15.18±2.57 ve 14.56±2.48, Stigma Ölçeği için 38.69±11.00 ve 35.66±11.47,
Salgın Hastalık Kaygı Ölçeği için ise 50.50±13.36 ve 46.24±15.69 olarak bulunmuştur. Program
sonrasında akran desteği alan katılımcıların damgalanma ve anksiyete düzeylerinde istatistiksel
olarak anlamlı bir azalma tespit edilmiştir. Çalışmada iki ana tema belirlenmiştir: "İzolasyon
sürecine ilişkin deneyimler" ve "İzolasyon sürecinde başa çıkma stratejileri."
Sonuç: Pandemi gibi afet durumlarında öğrencilerin iyilik halini desteklemek için küresel akran
desteği eğitim programlarının geliştirilmesi önerilmektedir.
Anahtar Kelimeler: Anksiyete, COVID-19, hemşirelik öğrenciler, sosyal izolasyon
This article was presented as an oral
presentation at the 6th National 2nd
International Basic Nursing Care Congress
held in Istanbul between 15-17 September
2022.
Geliş Tarihi/Received
Revizyon Talebi/Revision
Requested
Son Revizyon/Last Revision
Kabul Tarihi/Accepted
Yayın Tarihi/Publication Date
01.02.2024
05.01.2025
09.01.2025
10.02.2025
14.03.2025
Sorumlu Yazar/Corresponding author:
Sevim Şen Olgay
E-mail: sevim.olgay@acibadem.edu.tr
Cite this article: Şen Olgay S, Özkan Arslan
H, Kırık B, Erdem CZ. Everything’ll be fine
together! Peer support in the pandemic: A
mixed methods study. J Nursology. doi:
10.17049/jnursology.1429829
Content of this journal is licensed under a Creative
Commons Attribution-Noncommercial 4.0
International License.
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Journal of Nursology
INTRODUCTION
Since the beginning of 2020, the COVID-19 disease has
been seen as a public health crisis, and increased levels of
stress, fear and anxiety have been observed in individuals
during the outbreak and the increasing number of cases.1
In the COVID-19 epidemic, social isolation has begun to be
applied by physically separating people from each other for
infection control. Social isolation causes a decrease in social
relations, individuals feel trapped and isolated, and
loneliness increases.2 In a study conducted to evaluate the
relationship between loneliness and psychological
resilience of 109 university students who experienced the
COVID-19 pandemic, it was found that students' anxiety
about the future and their dissatisfaction with death in
their family or close environment increased the feeling of
loneliness, and those who wanted to socialize away from
the feeling of loneliness.3 In a study conducted to evaluate
the anxiety levels and coping methods among nursing
students studying at a college in the Southern District of
Israel, it was determined that 13.1% of the students had
severe anxiety and 42.8% had a moderate anxiety
prevalence. In the same study, it was determined that
gender, lack of personal protective equipment and fear of
infection were associated with higher anxiety scores,
stronger flexibility and humor use were associated with
significantly lower anxiety levels, and mental disconnection
was associated with higher anxiety levels.4
Peer support programs are used as an effective method for
all age groups such as decline in academic achievement,
peer rejection, exclusion, bullying, loneliness, health
problems (epidemic or chronic diseases, genetic disorders),
habits (smoking, substance use, etc.), eating disorders,
cultural differences, stress, elderly parents, suicide and
work-related problems. In the COVID-19 pandemic, peer
support program applications, which are established after
the recovery of intensive care patients and social and
emotional support of health personnel, are included in the
literature.5,6 In the study conducted by Hope et al.7, was
revealed that peer support was provided during the
recovery process of intensive care patients, and it provided
the improvement of the recovery, helped the patients to
understand the health services better, and helped in the
management of their recovery expectation. At the same
time, when the literature was examined, no study was
found in which the effect on symptoms was determined by
providing peer support during the isolation process,
especially for university students studying in the field of
applied health. In this direction, the aim of the study is to
examine the effect of the peer support program applied to
the students of the Faculty of Health Sciences in the
isolation process due to COVID-19 on loneliness, stigma
and anxiety levels during the isolation.
AIM
This study aims to examine the effects of a peer support
program implemented for Health Sciences Faculty students
who were isolated due to the COVID-19 pandemic on their
levels of loneliness, stigma, and anxiety.
Research questions
• What are the levels of anxiety, stigma, and loneliness
among students in isolation due to COVID-19 before
participating in the peer support program?
• What are the levels of anxiety, stigma, and loneliness
among students in isolation due to COVID-19 after
participating in the peer support program?
• Is there a significant difference in the levels of anxiety,
stigma and loneliness in students who are isolated
after a peer support program?
• What are the experiences of students in isolation due
to COVID-19 regarding the peer support program?
METHODS
Study design
In the research, mixed method design was used with the
data obtained from the questionnaires applied to the
participants. Quantitative data were obtained through
questionnaires, in line with the single-group pre-test / post-
test design, and information on students' loneliness,
stigma, anxiety level and peer support. Qualitative data
were analyzed by conducting individual in-depth interviews
in order to analyze student experiences after the program.
The isolation decision of the students was taken according
to the examination and PCR test results of the school
physician and nurse. The isolation period was
communicated to the researcher, who is a member of the
COVID-19 team, by message. Students who were given a
decision to be isolated, met the inclusion criteria and
volunteered to participate in the research were randomly
assigned to students who provided peer support in the
social communication group. Students who provided peer
support informed about the research, obtained consent
from students who volunteered to participate in the
research, and started the peer support program. During the
study, the isolation period of the students varied between
10-14 days. The participant was given peer support
throughout the quarantine from the first day of isolation.
Participants
In the quantitative part, students who were studying at a
foundation university health sciences faculty in Istanbul
between September 2020 and February 2022 and who had
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a positive COVID-19 PCR test or were admitted to the
infirmary due to contact and decided to isolate were
invited to participate in the study (N=124). The sample
consisted of 66 participants who met the inclusion criteria
and volunteered formed the sample of the study (53.2%).
After the quantitative data were collected, the participants
who wanted to participate in the qualitative research were
contacted and the data (n=11) were collected through
individual in-depth interviews. The results of the analysis
were reviewed with the participants to confirm that the
researcher understood the participants' intent and to
increase the reliability of the qualitative research process.
Peer support education program
A peer support training program has been established for
students who will provide peer support in order to gain the
necessary skills to cope with the isolation process by
communicating appropriately with the students who are in
contact / positive with COVID-19 during the pandemic
process. This program was created by researchers with a
PhD in Nursing Education and clinical experience in
infection control. The prepared program was examined by
two academicians and two clinicians. The content of the
program included topics such as the COVID-19 disease, its
treatment, infection control measures and prevention, the
algorithm applied by the Ministry of Health and the
university regarding the follow-up of students in isolation,
the psychological effects of the pandemic and coping
strategies, communication methods and peer support
rules. Lecture, video presentation, use of printed materials
such as brochures, flow charts, and question and answer
were used as teaching methods. The duration of the
training program is three days (total 9 hours (180 minutes
/ day). Ten students who are third year students of the
Department of Nursing, who took the Mental Health and
Diseases Nursing course and agreed to participate
voluntarily. Continuing the information and support after
the training for this purpose, a social communication group
consisting of researchers and peer support students was
formed.
Data collection
Quantitative Data
In the research, variables such as demographic
information, student characteristics, loneliness, stigma and
anxiety were evaluated by using questionnaires. These
variables were measured at the beginning and end of the
isolation in order to collect the quantitative data of the
study.
Demographic information and student characteristics were
evaluated with the information form created by the
researchers.8,9
Loneliness was measured with The University of California
Los Angeles (UCLA) Loneliness Scale (ULS-8) Short Form.
The Turkish adaptation of the scale was made by Doğan et
al.10 The scale consists of 8 items and is graded on a 4-point
Likert scale as "Not at all Appropriate", "Not Appropriate",
"Appropriate" and "Completely Appropriate". A high total
score on the scale is evaluated in a way that suggests
loneliness. The Cronbach alpha value of the scale is 0.72.10
The tendency to psychological stigma was measured by the
Stigma Scale developed by Yaman and Güngör11 in 2013.
The scale consists of 22 items and is graded in a five-point
Likert type as “I strongly disagree” and “I totally agree”. The
scale has four sub-dimensions as discrimination and
exclusion, labeling, psychological health, and prejudice.
There is no reverse scored item in the scale. The lowest
score that can be obtained from the scale is 22, and the
highest score is 110. It can be said that individuals with a
score below 55 on the scale have a low tendency to
stigmatize, and individuals with a higher score have a high
tendency to stigmatize. The Cronbach’s alpha value of the
scale is 0.84.11
Anxiety was measured with the Epidemic Anxiety Scale.
The validity and reliability study of the scale was carried out
by Sayar et al.12 in 2020. The scale consists of 18 items and
is graded as “Not at all suitable for me” and “Completely
appropriate for me” on a five-point Likert scale. The scale
has four sub-dimensions as epidemic, economic,
quarantine and social life. The highest score that can be
obtained from the entire scale is 90 and the lowest score is
18. In this direction, an increase in the total score of the
scale is considered as an increase in epidemic disease
anxiety. The Cronbach alpha value of the scale is 0.90.12
Qualitative Data
In order to collect qualitative data, after the peer support
program, the students were asked “…how did you feel?”,
“…….how did you cope?” and “……how did peer support
relationship” individual in-depth interviews with 10-item
open-ended questions were conducted. It was conducted
by researchers trained in how to conduct semi-structured
interviews. Individual in-depth interviews lasted
approximately 40 minutes. It was explained that their
requests regarding this interview (such as interrupting the
interview, stopping the video recording, ending the
interview) would be taken into account, and the
confidentiality of the names of the participants and the
data obtained would be ensured. The interviews were held
at mutually determined times.
Data analysis
Quantitative Analysis
Statistical analyzes were performed with SPSS 25. In the
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Journal of Nursology
evaluation of the data, descriptive statistical methods
(frequency-percentage, arithmetic mean, standard
deviation) and paired samples t test were used for
comparisons between groups. Values with P<0.05 at the
95% confidence interval in all analyzes were considered
statistically significant.
Qualitative Analysis
Data from individual in-depth interviews were recorded.
These records were transcribed by the researcher in the
computer environment. Thematic analysis was performed
to systematically group the interview data and themes
were created.8 Thematic analysis was conducted by three
experienced researchers who had conducted several
qualitative studies.
Ethical consideration
This study was approved by the Yeditepe University Non-
Interventional Clinical Research Ethics Committee (Date:
21.06.2021, Number: 202105042). Institutional permission
was obtained (14092020). In addition, the participants
were informed that participation in the research was
voluntary. The data was kept anonymous and used for
research purposes only.
RESULTS
The mean age of the students who provided peer support
was 22.60±0.69, 100% of them were female and were in
the third and fourth year of nursing. The mean age of the
students participating in the study was 21.39±1.47 years.
Among them, 92.4% were female, 33.3% were in the
second grade, and 48.5% were studying in the nursing
department. Additionally, 90.9% did not have a chronic
disease, 86.4% had a moderate economic status, and 60.6%
lived with their families. Furthermore, 18.2% had lost a
relative due to COVID-19, and 45.5% did not receive social
support outside their family (Table 1).
When examining the students' situation during the
isolation process, 65.2% tested positive for COVID-19.
During the isolation period, 89.4% lived at home, 50% did
not experience any disease-related symptoms, 27.2%
reported joint pain and weakness, 18.2% had a cough,
12.1% had a sore throat and nasal congestion, 6.1%
experienced a loss of smell and taste, 4.5% had a fever and
mouth sores, and only 3% reported symptoms such as a
headache (Table 2).
It was observed that 86.4% of the participants did not
receive medical support during the isolation process, 18.2%
felt anxious and hopeless, 77.3% did not experience any
Table 1. Distribution of students' sociodemographic
characteristics (n=66)
Sociodemographic Characteristics
n
%
Age (Mean ± SD)
21.39±1.47
Gender
Female
61
92.4
Male
5
7.6
Academic year
First Grade
14
21.2
Second Grade
22
33.3
Third Grade
18
27.3
Fourth Grade
12
18.2
Department
Nursing
32
48.5
Nutrition and Dietetics
16
24.2
Physical therapy and
rehabilitation
18
27.3
The state of having a
chronic illness
Yes
6
9.1
No
60
90.9
Economic state
Low
5
7.6
Middle
57
86.4
High
4
6.1
Residence
With family
40
60.6
Dormitory
7
10.6
Alone
8
12.1
With friend
11
16.7
The state of having a
chronic disease in the
person with whom share
the house
Yes
21
31.8
No
45
68.2
Losing a relative due to
COVID-19
Yes
12
18.2
No
54
81.8
Frequency of
communication with
family
Rarely
20
30.3
Often
28
42.4
Always
18
27.3
Existence of social
support outside the
family
Yes
36
54.5
No
30
45.5
SD;Standard deviation
significant problems during the isolation period, and 9.2%
faced priority issues related to symptom management and
fear of contagion (Table 2).
The mean score of the students on the UCLA Loneliness
Scale was 15.18±2.57 before the peer support program and
14.56±2.48 after the program. There was no statistically
significant difference between the UCLA Loneliness Scale
scores measured before and after the program (t=1.882;
P=.064) (Table 3).
Before the peer support program, the students' total score
on the Stigma Scale was 38.69±11.00. The sub-dimensions
were as follows: discrimination and exclusion 7.18±2.89,
labeling 9.33±3.50, psychological health 8.43±3.35, and
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Table 2. The situation of students in the isolation
process (n=66)
Interview form
n
%
Reason for
isolation
COVID-19 positive
43
65.2
Contacted
23
34.8
Place of
residence
during isolation
Home
59
89.4
Dormitory
7
10.6
Presence of
symptoms
during isolation
Joint pain and fatigue*
18
27.2
Cough*
12
18.2
Sore throat and nasal congestion*
8
12.1
Loss of smell and taste*
4
6.1
Fever and mouth sore*
3
4.5
Headache*
2
3
No symptoms experienced
33
50
Status of
receiving
medical
support
Yes
9
13.6
No
57
86.4
Mood during
isolation
Comfortable
27
40.9
Anxious-hopeless
12
18.2
Tired
27
40.9
Problems in the
isolation
Symptom management*
6
9.2
Quarantine period and fear of
contagion*
6
9.2
No problem occurred
51
77.3
* More than one option ticked
prejudice 13.74±4.01. After the program, the students'
total score on the Stigma Scale was 35.66±11.47, with the
following sub-dimensions: discrimination and exclusion
7.12±2.36, labeling 8.80±3.83, psychological health
7.62±3.18, and prejudice 12.12±3.95. A statistically
significant difference was found in the total Stigma Scale
score (t=2.009; P=.049) and the sub-dimension of prejudice
(t=3.464; P=.001) between the measurements taken before
and after the program (Table 3).
Before the peer support program, the mean total score on
the Epidemic Anxiety Scale was 50.50±13.36, with the
following sub-dimensions: epidemic 15.74±5.61, economic
5.22±1.89, quarantine 13.19±3.92, and social life
16.33±4.86. After the program, the mean total score on the
Epidemic Anxiety Scale was 46.24±15.69, and the sub-
dimensions were as follows: epidemic 13.31±6.57,
economic 5.50±2.38, quarantine 12.31±4.97, and social life
15.10±5.16. A statistically significant difference was found
in the Epidemic Anxiety Scale (t=2.837; P=.006), and the
sub-dimensions of epidemic (t=4.344; P<.001) and social
life (t=2.107; P=.039) measurements taken before and after
the program (Table 3).
In the qualitative part, two main themes and six sub-
themes were formed as a result of the content analysis of
Table 3. Comparison of the loneliness, stigma and
epidemic anxiety scale mean scores of students before
and after the peer support program (n=66)
Measurements
Before the
Peer Support
Program
(Mean±SD)
After the
Peer Support
Program
(Mean±SD)
Test
value
P**
UCLA Loneliness
Scale
15.18±2.57
14.56±2.48
1.882*
.064
Stigma Scale
38.69±11.00
35.66±11.47
2.009*
.049**
Discrimination and
exclusion
7.18±2.89
7.12±2.36
.133*
.894
Labeling
9.33±3.50
8.80±3.83
1.117*
.268
Psychological
health
8.43±3.35
7.62±3.18
1.989*
.051
Prejudice
13.74±4.01
12.12±3.95
3.464*
.001**
Epidemic Anxiety
Scale
50.50±13.36
46.24±15.69
2.837*
.006**
Epidemic
15.74±5.61
13.31±6.57
4.344*
<.001**
Economic
5.22±1.89
5.50±2.38
-.991*
.325
Quarantine
13.19±3.92
12.31±4.97
1.475*
.145
Social life
16.33±4.86
15.10±5.16
2.107*
.039**
*Paired samples t test **P<.05, SD; Standard deviation
the individual in-depth interviews with the students. The
first main theme, "Experiences Related to the Isolation
Process", was examined under three sub-themes:
"Experiences with COVID-19", "Psychological Experiences",
and "Experiences Related to the Educational Process". The
second main theme, "Coping Strategies During the
Isolation Process", was examined under three sub-themes:
"Social Support", "Family Support", and "Peer Support"
(Table 4).
DISCUSSION
This study aimed to examine the effects of the peer support
program applied to students in isolation due to COVID-19
on their loneliness, stigma and anxiety levels. The findings
showed that the peer support program reduced the stigma
and anxiety levels of the students, they received support
during the illness-related processes in isolation due to
COVID-19, and improved their coping attitudes and skills in
this process. In addition, the peer support program
increased their satisfaction with the education process. The
results are discussed under two main themes.
Experiences with the isolation process
In the literature, the signs and symptoms that occur in the
long term due to COVID-19; fatigue13,14, shortness of
breath15, chest pain14, joint and muscle pain16, insomnia17.
In the study, it was determined that most of the students
were isolated due to COVID-19 positive, they lived at home
during the isolation period, they did not experience any
symptoms related to the disease, and those who did
generally experienced joint pain and fatigue.
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Table 4. Analysis of individual in-depth interviews after the peer support program of the students (n=11)
Themes
Subthemes
Example of description
Experiences related to the isolation process
Experiences with
COVID-19
“…..Since I have never faced such an event before, it felt like a very difficult and never-ending process. We never went out as a family because we were
very scared when it first came out. We got caught though. My brother and I have been through a lot. Our fever was high for 3 days and the bone pains got
worse. We tried not to use any other medication other than painkillers. Later, it infected our parents as well. It was very difficult to go through such an
illness as a family and to see my family in this way.” (Participant 6)
“.....Two days after me, my mother and brother also tested positive. It was very sad and difficult to see my family suffer. I blamed myself for their
suffering.” (Participant 9)
Psychological
experiences
“…..Even though I was in contact, I had to stay at home. So I felt left out and alone. I was very happy when the isolation was over.” (Participant 2)
“….. At the end of the process, I was very afraid that people would react when I returned.” (Participant 5)
“…..We went to our nursing internships during the covid period, and at the end, it was canceled when the cases increased. In this process, my friends were
staying away from me because they were afraid of me because I was working at the hospital. I was trying to isolate myself so that if it got into me, it
wouldn't infect my family. This made me very sad. During the period when Covid 19 was positive, staying at home for 2 weeks was very depressing. I missed
walking outside, and sometimes I was crying with anger. It was a process where I was very worn out psychologically.” (Participant 6)
“…..My positivity period coincided with my full intern internship. Since I have been in contact with many patients, I wonder if I infected my patients, the
fear made me very sad.” (Participant 9)
Experiences related to
the educational
process
“…..I was very worried about how we will take the exams, how this process will go.” (Participant 1)
“…..Because I was positive, I would not be able to attend the classes, I was afraid of being behind and incomplete in the subjects and not being successful in
the exams. I was very worried about the prolongation of this process and not knowing when I would turn negative.” (Participant 7)
Coping strategies during the isolation process
Social support
“…..My friends were with me during this process and they reduced my anxiety level.” (Participant 3)
“….. Our social life has been severely restricted. I think the addiction to social media has increased even more. Because people had to provide
communication and interaction in this way. I also tried to keep in touch with my friends and relatives over the phone on social media as much as possible.”
(Participant 6)
Family support
“…..My family was also COVID positive. We got through this process well by keeping in touch with each other.” (Participant 3)
“…..I think I am lucky. My family was with me during my illness. They did their best to make me not feel alone psychologically. We caught a tighter bond
because we are all at home all the time. If I had lived alone, I'm sure I would have gotten through this process more difficult. Basically, I had very little
energy in activities such as cooking and cleaning. But since my family was with me, I did not have much difficulty.” (Participant 6)
Peer support
“…..We didn't just talk about the disease, we also discussed lessons, exams, study methods. My peer counselor told me about study methods, and it helped
me calm down.” (Participant 1)
“…..My peer counselor made me feel like I wasn't alone by asking about my daily situation. It relieved my concerns about school and internship
absenteeism. It made me feel better.” (Participant 3)
“…..My peer counselor often asked me how I was doing. She constantly questioned how I was feeling and whether I needed anything. Apart from that, we
talked about my general lifestyle, my psychological state, how I was affected not only by the disease but also by other events in life. She also gave advice on
study methods. It was very good for me to talk, to be in communication, to feel that I don't care. I was very satisfied.” (Participant 6)
“…..I was able to get rid of some of my worries thanks to the support of my peer counselor. The fact that my counselor gave examples from his experiences
made me realize that I am not the only one who has experienced this situation and I did not feel alone.” (Participant 7)
"…..The support I received at that time was very productive for me. Because we were put in isolation for the first time, and we did not know how the
process would work. My peer counselor called me every day and explained the process and helped me to overcome this process in the easiest way. Of
course, he is also a student. I won't forget your help with the lesson." (Participant 8)
“…..It felt good to have friends looking for me and asking me to distract me from these sick thoughts for a bit.” (Participant 9)
7
Journal of Nursology
In related studies, it has been stated that many people are
afraid of contracting the disease of COVID-19. It has been
observed that this fear is related to being infected or
infecting others.18 Cervin et al.19 in his study with young
people without anxiety disorders and psychiatric disorders,
it was stated that those who are afraid of getting sick think
that they may constantly be contagious, and as a result,
they often go to the doctor or use their own medication. It
has also been reported that the fear of COVID-19 negatively
affects individuals' stress levels and life satisfaction, and
that the fear of contamination can adversely impact daily
life by triggering obsessive-compulsive symptoms.20 In the
study, it was seen that the participants had the most
primary problems related to symptom management and
fear of contagion, and they received peer support on these
issues.
Coping strategies during the isolation
Mandatory isolation measures brought by the COVID-19
pandemic can lead to difficulties in socialization, peer
communication and establishing meaningful relationships,
which are very important in early adulthood according to
personality development theories. Peer support programs
are seen as a basic healing service for people with mental
health problems worldwide, especially during the
pandemic period, especially in problems such as loneliness,
stigma and anxiety and can be applied as a patient-
centered approach in some primary care settings.21
Loneliness, which is a negative subjective experience that
occurs when an individual perceives that social
relationships and interactions are inadequate, emerges as
a potential consequence of the mandatory state-imposed
quarantine to limit the spread of COVID-19.22 In the COVID-
19 pandemic, loneliness is higher among young people
compared to older adults.23 In the literature, it has been
stated that at least 38-50% of young people between the
ages of 18-24 experience high levels of loneliness during
mandatory quarantine22 and that women are more likely to
experience loneliness than men.24 In addition, it has been
shown that the feeling of loneliness is higher among
university students, especially after the mandatory
quarantine measures applied during the pandemic.24 The
research showed that peer support had no effect on the
loneliness level of the participants. It can be thought that
this situation is since most of the students live with their
family or friend, and the feeling of loneliness is less. As a
matter of fact, the loneliness levels of the students were
found to be below the average before and after the
program.
Another problem brought by the COVID-19 pandemic is the
stigma applied to individuals who are sick or suspicious.
Stigma causes anxiety, fear, lowers self-esteem and impairs
the quality of life of stigmatized people.25 It is observed that
individuals quarantined at home often experience negative
emotions such as anxiety and depression, avoidance of
seeking medical help, and social phobia due to feelings of
guilt towards family members or other people. It has been
stated that peer support programs used to prevent the
spread of attitudes and behaviors related to stigma were
provided especially through social media during the COVID-
19 pandemic, but they were not sufficient.26 Tasdelen et
al.27, it was reported that support from friends and family
members is effective in coping with depression, stress, and
anxiety. The findings of our study are in parallel with the
literature and show that the peer support program reduces
stigma and prejudice. Peer support is thought to be an
effective model for developing strategies to cope with
negative emotions and being a role model.
It is known that physical distance and isolation measures
and restrictions applied due to the COVID-19 pandemic
significantly threaten the mental health of individuals.28
This leads to consequences such as stress, anxiety and
alienation from peers among people.29 In a study
conducted in the USA, it was stated that the anxiety and
worry that increased in the first stage of the epidemic
increased three times more in the later stages of the
epidemic compared to the previous period.30 In another
similar study in the literature, it was revealed that the level
of anxiety about the COVID-19 pandemic was high.31
Therefore, the management of the anxiety caused by the
isolation measures taken during the pandemic period has
an important place. The American Psychological
Association stated that anxiety can be reduced by creating
a sense of normalcy and this can be achieved through social
networks.32 The literature states that peer support
functions as a social network and contributes to
improvements in self-esteem, anxiety, depression, stress,
burnout, loneliness, and overall mental health.33 The
results of our study showed that peer support reduces
anxiety about epidemic diseases in the COVID-19
pandemic. Especially after peer support, a statistically
significant difference was found in the epidemic and social
life measurements, which are sub-dimensions of the
epidemic anxiety scale.
The COVID-19 pandemic has also deeply impacted
students' educational processes and psychosocial well-
being, with increased levels of anxiety and stress due to
isolation and uncertainty.34 In this context, the peer
support program implemented has reduced students'
levels of stigma and anxiety, and positively influenced their
satisfaction with the educational process. Findings in the
literature indicate that peer support enhances motivation
in learning processes and supports academic success,
8
Journal of Nursology
which aligns with the results of this study.35 Within the
program, the guidance and support provided by peer
counselors have alleviated students' concerns about
lessons, exams, and study methods, enabling them to work
in a more organized and motivated manner. This has
contributed to an improvement in both their psychological
well-being and educational satisfaction. The multifaceted
benefits of peer support highlight its role as an essential
tool in promoting more effective student participation in
education during crisis periods such as the pandemic.
These findings emphasize the importance of integrating
social support interventions into educational programs and
provide effective strategies for similar situations in the
future.
Limitations
The fact that the research was conducted during the
COVID-19 period, which is a specific time period, limits the
comparability of the results with the results in different
periods due to the variability of the conditions during the
pandemic period. Another limitation of the study is that the
sample size is limited and that it is based on data from only
one institution. This indicates that the findings may be
specific to students at this institution and may limit their
generalizability. Studies conducted in different educational
institutions and different disciplines may reveal different
results.
Research findings show that students who are taken into
isolation have the most problems in coping with the
disease; revealed that stigma and anxiety decreased with
the peer support program and provided support in the
treatment and education processes. It is important to
implement support tools to help mitigate the harmful
effects of the fight against the COVID-19 pandemic and
maintain student well-being. In this context, it is
recommended to use the peer support program as a valid
and reliable model when there is a crisis period affecting
large masses.
Ethics Committee Approval: Ethics committee approval was
obtained from Yeditepe University Ethics Committee (Date:
21.06.2021, Number: 202105042)
Informed Consent: Written informed consent was obtained from
the students.
Peer-review: Externally peer-reviewed.
Author Contributions: Concept - SŞO, HAÖ, BK, CZE; Design- SŞO,
HAÖ, BK, CZE; Supervision- SŞO, HAÖ; Resources- BK, CZE; Data
Collection and/or Processing- SŞO, BK, CZE; Analysis and/or
Interpretation- SŞO, HAÖ, BK, CZE; Literature Search- SŞO, BK, CZE;
Writing Manuscript- SŞO, BK, CZE; Critical Review- SŞO, HAÖ.
Conflict of Interest: The authors have no conflicts of interest to
declare.
Financial Disclosure: The authors declared that this study has
received no financial support.
Etik Komite Onayı: Etik kurul onayı Yeditepe Üniversitesi Yerel Etik
Kurulu’ndan (Tarih: 21.06.2021, Sayı: 202105042) alınmıştır.
Bilgilendirilmiş Onam: Öğrecilerden yazılı bilgilendirilmiş onay
alındı.
Hakem Değerlendirmesi: Dış bağımsız.
Yazar Katkıları: Fikir- SŞO, HAÖ, BK, CZE,; Tasarım- SŞO, HAÖ, BK,
CZE; Denetleme- SŞO, HAÖ; Kaynaklar- BK, CZE ; Veri Toplanması
ve/veya İşlemesi- SŞO, BK, CZE; Analiz ve/ veya Yorum- SŞO, HAÖ,
BK, CZE; Literatür Taraması- SŞO, BK, CZE; Yazıyı Yazan- SŞO, BK,
CZE; Eleştirel İnceleme- - SŞO, HAÖ.
Çıkar Çatışması: Yazarlar, çıkar çatışması olmadığını beyan etmiştir.
Finansal Destek: Yazarlar, bu çalışma için finansal destek almadığını
beyan etmiştir.
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