Multimorbidity and its effect on perceived burden, capacity and the ability to self-manage in a low-income rural primary care population: A qualitative study

Abstract

Introduction Multimorbidity is increasing in prevalence, especially in low-income settings. Despite this, chronic conditions are often managed in isolation, potentially leading to burden-capacity imbalance and reduced treatment adherence. We aimed to explore, in a low-income population with common comorbidities, how the specific demands of multimorbidity affect burden and capacity as defined by the Cumulative Complexity Model. Materials and methods Qualitative interviews with thirteen rural community health centre patients in Victoria, Australia. Participants were aged between 47–72 years and reported 3–10 chronic conditions. We asked about perceived capacity and burden in managing health. The Theory of Patient Capacity was used to analyse capacity and Normalisation Process Theory to analyse burden. All data specifically associated with the experience of multimorbidity was extracted from each burden and capacity domain. Results The capacity domains of biography, resource mobilisation and work realisation were important in relation to multimorbidity. Conditions causing functional impairment (e.g. chronic pain, depression) interacted with physical, psychological and financial capacity, leading to biographical disruption and an inability to realise treatment and life work. Despite this, few people had a treatment plan for these conditions. Participants reported that multimorbidity affected all burden domains. Coherence and appraisal were especially challenging due to condition interactions, with clinicians providing little guidance. Discussion The capacity and burden deficits highlighted by participants were not associated with any specific diagnosis, but were due to condition interactions, coupled with the lack of health provider support to navigate interactions. Physical, psychological and financial capacities were inseparable, but rarely addressed or understood holistically. Understanding and managing condition and treatment interactions was a key burden task for patients but was often difficult, isolating and overwhelming. This suggests that clinicians should become more aware of linkages between conditions, and include generic, synergistic or cross-disciplinary approaches, to build capacity, reduce burden and encourage integrated chronic condition management.

Self-management of multiple long-term conditions: A systematic review of the barriers and facilitators amongst people experiencing socioeconomic deprivation

“…All of the studies used one-to-one interviews as the data collection method with one study [ 20 ] conducting two interviews with each participant. Five of the studies [ 20 , 21 , 24 , 28 , 29 ] conducted interviews in participants’ own homes, five were conducted in a room at a community, healthcare/clinic setting [ 23 , 25 – 27 , 30 ] and one study did not specify a location [ 22 ]. The participant characteristics from the studies reviewed are presented in Table 1 .…”

“…Two studies [ 23 , 29 ] describe how participants prioritised the management of certain conditions over others. In an Australian-based study [ 23 ], two participants were said to rate depression as their most important condition while another prioritised obesity because of its impact on their mental health.…”

“…Two studies [ 23 , 29 ] describe how participants prioritised the management of certain conditions over others. In an Australian-based study [ 23 ], two participants were said to rate depression as their most important condition while another prioritised obesity because of its impact on their mental health. Symptoms of depression and mental health problems were recognised as a catalyst for worsening other health conditions and impacted broadly on self-management practices:…”

“……it’d be so much easier if I just had one health problem I could work on and not have multiple problems… I got really bad a few months ago… I just stopped taking everything… I went into a really deep depression and couldn’t be bothered doing a thing . (p.9) [ 23 ]…”

“…The co-existence between physical and mental health, and the impact upon self-management was discussed in seven studies [ 21 , 23 , 25 – 28 , 30 ]:…”