Supporting self-management: intervention design for those with musculoskeletal conditions in the context of health literacy

Problem

Musculoskeletal (MSK) conditions are common and can have a significant impact on individuals and society. Many MSK problems are managed predominantly in primary care, and in the UK, these account for 14% of all general practice (GP) consultations. Evidence shows that 43-61% of the English population have low health literacy (HL) and those individuals have a significantly higher prevalence of osteoarthritis. Furthermore, patients with low HL and MSK conditions are more likely to have a poor prognosis, with more persistent and disabling pain, compared to those with adequate HL. Supported self-management can be effective yet it appears that current interventions are not meeting the needs of all patients. Identifying the components of innovative interventions designed to address this gap is complex. The EASIER study has drawn on a number of methods to identify and reach consensus on intervention components suitable for individuals with MSK conditions and varying levels of HL.

Approach

This is a mixed-methods concurrent-sequential study design consisting of four work packages (WPs). Findings from WP1 (secondary analysis of existing data to identify potential components for intervention(s)), WP2 (evidence synthesis of existing interventions) and WP3 (the views of community members and professionals) were synthesised and evidence tables produced. A stakeholder group meeting is planned where a Nominal Group Technique (NGT) will be employed to discuss the evidence tables and reach consensus on which intervention components are most suitable to form the basis of an evidence-based logic model for supported self-management intervention(s) (WP4). The stakeholder group meeting will consist of a multi-disciplinary group of health care professionals (HCPs) and third-sector workers (n=8-10), who have the expertise or special interest in HL and experience in dealing with a range of individuals with MSK conditions.

Findings

The data from the WPs will be synthesized coherently and concisely such that they are accessible and understandable as tables of evidence. The NGT will enable diverse HCPs and third sector workers to reach consensus on the components of interventions and allow for the generation of a logic model for supported self-management interventions.

Consequences

Developing interventions that are acceptable to all users is essential to improving patient outcomes. Strategies that enable conversations amongst key stakeholders at the design stage is critical to identifying and developing robust research. The key output of the EASIER study will be the development of an evidence-based logic model for self-management intervention(s) that will be taken forward for testing in subsequent work.