Supporting Peer Mentoring
More than 10,000 people in the UK are affected by cystic fibrosis (CF), which is the most common inherited long-term condition in the UK. Significant progress has been made in combating CF – life expectancy has improved from a median of 6 months in 1938 to nearly 50 years for babies born this decade. However, CF remains a life-shortening condition.
For CF survival to continue improving, the challenge over the next few years is to close the gap between what is known to benefit people with CF and what treatment people with CF actually receive. A clear example of the chasm between theory and practice is the actual utilisation of preventative nebulised treatments among people with CF. High nebuliser adherence in CF is associated with better health outcomes and lower treatment costs, but median adherence is only around 36% and there is currently no effective adherence intervention for people with CF.
The CFHealthHub (CFHH) is a national self-management programme which consists of a 19-centre randomised controlled trial (300 adults with CF in the control arm, 308 adults with CF receiving adherence intervention, 27 health professionals delivering the intervention) and a parallel process evaluation to determine the efficacy of a complex intervention to support treatment adherence; and a data observatory to embed routine use of adherence data and run efficient trials within cohort. Patient and public involvement (PPI) meetings during the pilot phase of CFHH have suggested that adding peer mentoring as a module within the CFHH platform could further enhance its ability to support adherence.
Peer mentoring is a process whereby an experienced individual encourages and helps a less experienced individual to develop his/her potential within a shared area of interest. It has been used to support treatment adherence in long-term conditions e.g. HIV-positive adults and type II diabetes. Peer mentors may be able to provide one-to-one support which is tailored to an individual’s needs. Peer role modelling may also inspire lasting behaviour change by empowering others to develop self-efficacy and resilience. The US CF Foundation has recently introduced a national peer-to-peer mentoring programme.
However, there remains uncertainty regarding the most suitable model to deliver peer mentoring; and the methods to identify subjects most likely to benefit from peer mentorship, select appropriate peer models, match peers with subjects, and train, support and retain peers. The number of people able and willing to act as peers may be small, and most many peer mentoring models are based on group sessions or individually administered but each peer has multiple mentees. Another advantage of training a small group of dedicated peers is the potential for delivery of adherence support with high fidelity, which is known to be a mediator of intervention outcome.
A potential parsimonious model to deliver peer mentoring in CF is for a dedicated group of peers to deal with online queries from multiple mentees. This also allows peers to provide support at a time convenient for them and avoids cross-infection in a condition whereby strict clinical segregation is required and most of its sufferers are young and may have work / education commitment. It is likely this model would be most efficient if a system exists to triage mentees according to their barriers or challenges they face in terms of using medications, then funneling mentees to the appropriate mentor. We call such a system the ‘diagnostic sieve’.
The over-arching aim of this study is to harness the collective expertise of adults with CF that are potentially suitable to provide peer mentoring support, adherence intervention providers in the CFHH RCT and health psychologist with expertise in behaviour change for the
• Production of a diagnostic sieve to match queries from potential mentees to appropriate peer mentors
• Production of a suite of potential strategies that can be adopted by peer mentors to support mentees