MESH Asthma Self-Care Pilot Study

Title:

Pilot study for evaluating the MESH (Managing illness by Empowerment of Self-care and Harmonisation of patient-practitioner agendas) self-care support intervention for patients with poorly controlled asthma.

Research Summary

The project involved conducting pilot/trial development work to inform the development of a full randomised controlled trial. The research strategy followed the MRC-recommended framework for design and evaluation of complex interventions.[1]

Completed: The first stages of intervention development and the specification of a model and theoretical basis and exploratory (pilot) trial work, followed by a definitive RCT. In the pilot work, the aims were to:-

a) obtain formative feedback about the feasibility and acceptability of the recruitment methods and measures intended for use in the trial (including process measures).

b) obtain formative feedback from asthma nurses to optimise the training and implementation of the intervention, and to specify the essential content and relevant competencies to be acquired, so that the intervention is replicable, and the quality of delivery is measurable.

Relevant research methods were semi-structured interviewing, qualitative analysis, and the use of descriptive statistics to provide essential trial planning data (e.g. prevalence of eligible patients, recruitment rates).

In the main trial, a cluster randomised controlled trial design was used. In parallel to this, the process model (a theoretical model of how the intervention.

1. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex interventions to improve health. British Medical Journal 2000; 321:694-696.

The MESH Intervention
© Peninsula Medical School (Primary Care), July 2007.

The MESH approach is a system for assessing a patient’s asthma situation and for developing an individually tailored self-care plan. This is done in partnership with the patient, and with attention to each individual’s specific motivations and barriers to change. MESH stands for ‘Managing illness by Empowerment of Self-care and Harmonisation of patient-practitioner agendas’.

The approach involves working individually with patients to explore their perspectives on having asthma and their existing self-care strategies. The approach includes an assessment of the patient’s understanding of the illness, motivations about self-care and any barriers to improving self-care. The asthma nurse’s medical perspective is also represented. The nurse guides the patient, if needed, towards a more complete/functional understanding of their asthma. The patient and nurse then work together, using a novel ‘situation-mapping’ approach to identify gaps in the patient’s self-care strategies and to make a plan to improve asthma control in the future. It is:-

a) a structured approach: MESH follows a structured interview pathway, with four stages of Assessment, Strategic analysis, Action Planning and Monitoring/Relapse Prevention.
b) a set of specialist skills/techniques: We are aiming to teach specific skills and consultation techniques for engaging and empowering or motivating patients and facilitating behaviour change. The other main skill is the use of semi-structured interviewing to bring out the patient’s viewpoint, whilst retaining a focus on the key issues.
c) targeted: The MESH approach takes considerably longer than a standard asthma review as it involves a more in-depth and individually-tailored assessment of the patient’s asthma situation. This may involve two or three hours of contact time per patient. However, despite the intensity and depth of the intervention, we think that it may be possible to save time and resources in the longer term for around 15 to 20% of asthma patients (those with a history of relatively poorly controlled asthma).

The MESH intervention was developed through a process of literature review and qualitative investigation (grounded theory study) of patient perspectives on asthma self-care.[2]

2. Greaves CJ. Psychosocial Influences on Self-Care and Health Outcomes in Adults with Asthma. PhD Thesis. University of Exeter, 2002.

Staff

Professor John Campbell - Professor of General Practice & Primary Care
Dr Colin Greaves - NIHR Senior Research Fellow
Professor Chris Griffiths: Queen Mary’s College London
Education for Health (Liz Bryant, Jane Leyshon, Dr Samantha Walker)

Location:

Peninsula Medical School (Primary Care)
Smeall Building, St Luke's Campus
Magdalen Road
Exeter
EX1 2LU

Tel: 01392 722751
Fax: 01392 432223