Playing with peers: Exploring peer support mechanisms of a type 2 diabetes-specific board game

Aim To explore specific mechanisms of a board game aiming to facilitate peer support among people with type 2 diabetes. Design Qualitative observational study including game tests in group-based diabetes education programs and focus groups exploring experiences among people with type 2 diabetes playing the game. Methods The game was tested with 77 people with type 2 diabetes in March-July 2019. Data from audio recordings of game tests and focus groups were analysed using interpretive description. Results Six mechanisms facilitated peer support among people with type 2 diabetes: 1) entering a safe space of normality created by emotional in-game mirroring; 2) mutual in-game acknowledgment of out-of-game efforts; 3) forming relationships through in-game humor; 4) health care professionals using game rules to support group dialogues of interest to people with type 2 diabetes; 5) being inspired by in-game exchange of tips and tricks; and 6) co-players guiding each other during the game. Peer support was inhibited by the mechanism of game rules obstructing group dialogues. Conclusion The board game effectively facilitated peer support through playfulness and humor and helped players form relationships. Additionally, the game established a framework for players to share and listen to each other9s diabetes-specific experiences, promoting a sense of normality and cohesiveness. This process depended on facilitating educators9 flexibility to balance the rules of the game with its aim of creating peer support.