An analysis of the application of the MESH intervention in asthma
Background: Asthma control is currently suboptimal for many individuals with asthma. A number of systematic reviews show that interventions are effective for improving asthma self-care in adults. However, the processes underpinning successful interventions remain unclear. A qualitative process evaluation of a small scale intervention targeting asthma self-care (the Managing Illness by Empowerment of Self-care and Harmonisation of Patient and Practitioner agenda) MESH intervention) was undertaken as part of my PhD. The analysis revealed three intra-patient processes (illness understanding, affective response to asthma and motivation) and two consultation processes (active patient involvement and individual tailoring) that were associated with change in self-reported asthma self-care behaviour. However, intervention deliverers (nurses) did not always deliver the intervention as intended.
Aim: To explore nurses’ experiences of delivering the MESH intervention and, in particular, to identify challenges associated with their ability to deliver it as intended.
Design : In-depth qualitative interviews and transcripts of consultations between nurses and patients were analysed using thematic analysis.
Participants : Nine nurses with experience in the delivery of asthma care.
Setting : Primary care practices in the South West of England.
Results: The themes arising from the analysis were (i) experiences of training (ii) perceived usefulness of techniques and approaches (iii) patient motivation and (iv) implementing the MESH in clinical practice
Conclusion: This research has identified specific issues relating to nurses’ understanding, motivations and abilities to deliver the MESH intervention. This has important implications for both future health psychology research and clinical practice. With regard to the future development of randomised trials of the MESH intervention, the process of nurse recruitment and training could be adjusted in light of these findings. This will prevent unnecessarily wasting resources and patients’ time, and increase the likely take up and effectiveness of the intervention. Further research is needed to develop theory underpinning nurses’ use of research in clinical practice.
Denford, S. An analysis of the application of the MESH intervention in asthma. (Thesis). University of the West of England. Retrieved from https://uwe-repository.worktribe.com/output/812650
Professional Doctorate in Health Psychology_Sarah Denford_Sept14.pdf