Study limitations and future research
The first limitation of this study is that it was not an RCT, but a one-group pretest-posttest design. Therefore, we cannot rule out the possibility of other factors affecting the changes in outcomes. Second, the program facilitators received two days of training to conduct the program; however, most of them did not have professional qualifications (such as social work degrees). Therefore, they are not as well-trained in the successful use of group dynamics as those with professional education and training. Third, participants had multiple diagnoses. Peer-led groups are particularly useful in contexts in which people can relate to their peers. Therefore, this method may be less effective than one where participants have a single diagnosis. Fourth, we recognize that originally developed items may not have good validity or reliability. Since this pilot study does suggest the importance of communication and listening skills, future research needs to measure these constructs with psychometrically sound scales. Finally, diagnoses were self-reported rather than clinically assessed. Therefore, a valid diagnosis was not confirmed.For future research, we believe that the program needs to focus on unmarried participants and to make use of peer facilitators (including those who are currently married) and to enhance the training of facilitators as well as provide professional support in conducting the program.