Peer-Led Emotional CPR Program in Black, Indigenous, and People of Color Communities: Convergent Mixed Methods Study.

Background: Black, Indigenous, and people of color (BIPOC) experience disproportionately negative mental health outcomes, including rising suicide rates, and persistent barriers to culturally responsive care. Systemic racism, discrimination, and historical trauma contribute to mistrust of traditional mental health systems. Peer-led approaches that center lived experience and shared cultural identity may offer culturally responsive alternatives that foster emotional connection and trust. Objective: This study examined pretraining to posttraining changes in emotional well-being, empowerment, and interpersonal outcomes among BIPOC participants who completed Emotional CPR (Emotional Connection, Empowering, Revitalizing), a trauma-informed, peer-led mental health education program facilitated by BIPOC trainers. Methods: A convergent mixed methods pre-post design was used. Eighty-five BIPOC participants completed validated self-report measures immediately before and after a 12-hour web-based Emotional CPR training delivered over 3 consecutive days. Outcomes included loneliness, empowerment, flourishing, hope, active-empathic listening, mindfulness, social connectedness, and affect. Paired-samples 2-tailed t tests examined pre-post differences. Seventeen participants participated in 2 posttraining focus groups conducted through Zoom. Qualitative data were analyzed using thematic analysis informed by phenomenological principles. Quantitative and qualitative findings were integrated during interpretation. Results: Participants (N=85; mean age 41.9, SD 11.2 years; women: n=65, 76.5%) reported significant reductions in loneliness (P=.03; d=0.25) and significant increases in positive affect (P=.002; d=-0.37). Significant declines were observed in empowerment (P=.03; d=0.26), active-empathic listening (P=.02; d=0.26), flourishing (P=.02; d=0.27), and hope (P<.001; d=0.41). No significant changes were observed in social connectedness or mindfulness. Qualitative themes included empowerment through skill-building, emotional vulnerability, cultural trust and safety, challenges in sustaining confidence after training, and the application of skills in daily life. Participants described increased self-awareness and emotional openness, particularly within a culturally responsive training environment. Qualitative findings suggested that increased emotional awareness may have influenced posttraining self-assessments. Conclusions: Participation in BIPOC-facilitated Emotional CPR training was associated with short-term reductions in loneliness and increased positive affect, alongside modest declines in self-rated empowerment and hope. Qualitative findings suggest that increased emotional awareness and engagement with systemic stressors may temporarily influence self-perceived competence. Ongoing reinforcement, mentorship, and follow-up sessions may support sustained empowerment and emotional resilience in culturally responsive peer-led interventions.