Family, faith and health: How do older Pakistanis living in East London self-manage multimorbidity?

Problem

Self-management is the ‘lifetime task’ of managing a long-term condition. It is made more complex in the context of multimorbidity. Formal self-management programmes form part of a larger policy discourse directed at containing the escalating burden of multimorbidity. Critics have raised concerns that the self-management discourse often fails to consider the socio-cultural and biographical concerns of some patients, and that self-management programmes can instead become an additional burden.

London’s South Asian population, including those of Pakistani origin experience higher prevalence of multimorbidity compared to other ethnicities. Urdu-speaking Pakistani patients form a significant ethnic group in London. Most existing research on self-management in this community focuses on single diseases and is centered on compliance with medical recommendations. The aims of this study were to explore how older Pakistani people experience multimorbidity and to illuminate how they ‘manage’ their selves and their health in the context of their daily lives.

Approach

This was a narrative interview study. 15 patients were recruited from GP practices in East London. The inclusion criteria were: people aged over 50 with multimorbidity, of Pakistani ethnicity who spoke Urdu or were Urdu & English speakers. Participants completed an in-depth narrative interview with a bilingual researcher at home. Interviews were conducted using the Biographical Narrative Interview Method, enabling the elicitation of a rich narrative of patients experiences of multimorbidity in the context of their life stories.

Findings

Our analysis showed that participants experienced, understood and articulated ‘multimorbidity’ with reference to family, faith and health. They understood their ‘self’ and their health to be affected by - and in turn, to affect - their relationship with family and with God, in a deeply connected recursive triadic interrelationship. The relationship between family and health was accounted for in two ways. Firstly, emotional family events, particularly deaths and losses, were frequently identified as being a cause of personal ill health. Secondly, family was seen as a source of emotional and practical support in managing ill health. Furthermore participants identified the importance of their Muslim faith in making sense of, and managing, their ill health. Beyond the central triad of family, faith and health lay a wider circle of concern, comprising the participants’ community to whom participants performed moral work to present themselves as good people and citizens.

Consequences

Our findings have implications for existing public health strategies of self-management, underpinned by neoliberal discourses that focus on individual responsibility and agency. Healthcare provision needs to better integrate the importance of relationships between family, faith and health when developing services for these patients.