What are the experiences of people living with multimorbidity in Malawi?

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

P1.2A.1

Presenter:

Edith F. Chikumbu

Co-authors:

Edith F. Chikumbu, Christopher Bunn, Stephen Kasenda, Albert Dube, Enita Phiri-Makwakwa, Bhautesh D. Jani, Modou Jobe, Sally Wyke, Janet Seeley, Amelia C. Crampin, Frances S. Mair.

Author institutions:

University of Glasgow, Malawi Epidemiology and Intervention Research Unit, London School of Hygiene and Tropical Medicine

Problem

Multimorbidity, the presence of two or more chronic health conditions, is an increasing global challenge. In parallel there has been growing interest in the concept of treatment burden (the work of managing chronic illness), and factors that affect a person’s capacity to manage any given level of treatment burden. Most of the conceptual work in this sphere has been undertaken in high income countries. The applicability of theories, such as Burden of Treatment Theory, to low or middle countries (LMICs) is unclear as we know very little about the experiences of people living with multimorbidity in LMICs. The aim of this study was to: a) explore experiences of people living with multimorbidity in Malawi including their experiences of burden of treatment and 2) examine the utility of Normalization Process Theory (NPT) and Burden of Treatment Theory (BOTT) for understanding these experiences.

Approach

Qualitative semi-structured interviews with 32 people in Malawi, located in urban and rural locations, who were living with multimorbidity; 16 males; 16 females. Data analysed thematically and then conceptualised through the lens of Normalisation Process Theory (NPT) which focuses on treatment burden concepts and Burden of Treatment Theory (BOTT) which addresses treatment burden and issues likely to affect capacity to self-manage effectively.

Findings

We discovered that identified burden of treatment and capacity factors mapped well to NPT and BOTT constructs. Issues highlighted included: sense-making work to gain an understanding of health conditions and living with multimorbidity; dealing with disruptions to family life and the work of engaging with family and community to gain support; navigating healthcare systems; coping with lack of continuity of care; operationalising self-management advice; negotiating medical advice; assessing treatments. However, we identified a key issue that is less evident in high income countries, that is the burden posed by lack of access to treatments and/or services. Poverty and inadequate healthcare provision also limited capacity to deal with treatment burden although supportive social and community networks were important facilitating factors.

Consequences

Improved access to health information/education would lessen treatment burden as would better resourced healthcare systems and enhanced standards of living. NPT and BOTT were shown to be useful for aiding conceptualisation of treatment burden issues in LMICs but we have demonstrated that ‘lack’ of access to treatments or services is an important additional burden which must be included when considering treatment burden in LMICs.

Submitted by:

Frances Mair

Funding acknowledgement:

This work was funded by the MRC Grant MR/T037849/1 and by the University of Glasgow’s GCRF Small Grants Fund, an initiative supported by an allocation of Global Challenges Research Fund from the Scottish Funding Council under agreement SFC/AN/10/2018. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.