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

Abstract

Background Multiple long-term conditions are rising across all groups but people experiencing socioeconomic deprivation are found to have a higher prevalence. Self-management strategies are a vital part of healthcare for people with long-term conditions and effective strategies are associated with improved health outcomes in a variety of health conditions. The management of multiple long-term conditions are, however, less effective in people experiencing socioeconomic deprivation, leaving them more at risk of health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management on long-term conditions in those experiencing socioeconomic deprivation. Methods MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions among socioeconomically disadvantaged populations. Data were coded and thematically synthesised using NVivo. Findings From the search results, 79 relevant qualitative studies were identified after the full text screening and 11 studies were included in the final thematic synthesis. Three overarching analytical themes were identified alongside a set of sub-themes: (1) Challenges of having multiple long-term conditions; prioritisation of conditions, impact of multiple long-term conditions on mental health and wellbeing, polypharmacy, (2) Socioeconomic barriers to self-management; financial, health literacy, compounding impact of multiple long-term conditions and socioeconomic deprivation, (3) Facilitators of self-management in people experiencing socioeconomic deprivation; maintaining independence, ‘meaningful’ activities, support networks. Discussion Self-management of multiple long-term conditions is challenging for people experiencing socioeconomic deprivation due to barriers around financial constraints and health literacy, which can lead to poor mental health and wellbeing. To support targeted interventions, greater awareness is needed among health professionals of the barriers/challenges of self-management among these populations.

A qualitative exploration of the barriers and facilitators to self‐managing multiple long‐term conditions amongst people experiencing socioeconomic deprivation

“…Health literacy refers to a person's ability to access, understand and use information to make decisions about their health 27 . Low health literacy results in challenges around making informed decisions about health and has the potential to reinforce existing health inequalities 6 . Low health literacy was evident amongst participants, alongside low financial literacy; the latter being a life skill highly related to the well‐being of individuals and crucial to financial inclusion 8,28 .…”

“…16 A systematic review conducted by the authors found that aspects in people's lives that can facilitate self-management include; opportunities to maintain independence, being in paid employment, receiving informal support from family and peer networks, engaging in physical activity and eating a healthy diet. 6 In a further systematic review focused on self-management interventions tailored for people experiencing socioeconomic deprivation, the trials on MLTCs showed promise in improving outcomes but have not been adopted into practice, suggesting implementation barriers. 17 The most effective tailoring of self-management interventions included adaptions for low literacy, the involvement of community health workers or peer leaders, providing helpful materials if needed and financial incentives.…”

“…17 There is however limited evidence from UKbased studies on the impact of socioeconomic deprivation on selfmanagement. 6 More research is needed to better understand individual deprivation, including the way in which individuals manage the intersecting components surrounding their MLTCs, self-management and challenges associated with socioeconomic deprivation. 6,17,18 The aim of this paper is to explore the barriers and facilitators to self-managing MLTCs, among people who experience socioeconomic deprivation.…”

“…3 The burden of MLTCs in England is increasing, and persistent inequalities due to MLTCs are found to be worse in working-age adults and for those with complex MLTCs (e.g., four or more longterm conditions). 4 People who experience socioeconomic deprivation face inequalities in health due to a range of interrelated characteristics that lead to a lack of resources and opportunities, 5,6 including low or limited social capital. The concept of 'social capital' broadly refers to the resources and benefits that individuals and groups gain from their social networks, relationships and interactions.…”

“…The most effective tailoring of self‐management interventions included adaptions for low literacy, the involvement of community health workers or peer leaders, providing helpful materials if needed and financial incentives 17 . There is however limited evidence from UK‐based studies on the impact of socioeconomic deprivation on self‐management 6 . More research is needed to better understand individual deprivation, including the way in which individuals manage the intersecting components surrounding their MLTCs, self‐management and challenges associated with socioeconomic deprivation 6,17,18 …”