How do older people with Multiple Long-Term Conditions engage with behaviour change interventions? A qualitative study
Problem
In England, the proportion of people living with multiple long-term health conditions (MLTCs) and frailty is increasing as its population ages. Both lead to higher costs for the health service and reduce quality of life for those affected. Often health services focus on individual LTCs, however approaches focussed on tailored goal setting across health and social domains to enable independence and better functioning may be a way of providing more holistic support. Conversely living with MLTCs could also lead to greater barriers to setting and achieving goals.
Approach
The aim of this study is to understand how living with MLTCs impacts engagement with and benefiting from a holistic behaviour change intervention targeted at older people, to inform future similar interventions. We carried out this study in the context of the process evaluation of the HomeHealth randomised controlled trial (n=388) evaluating a 6-month, person-centred intervention that seeks to empower people aged over 65 with mild frailty to make positive changes in their lives to maintain their independence. Participants are assisted by HomeHealth voluntary sector workers to choose goals and find ways to achieve and maintain these, using behaviour change techniques tailored to their circumstances. Using purposive sampling to maximise diversity in socioeconomic status, number and type of long-term health conditions (LTCs), demographics and intervention engagement, we are interviewing 35-45 participants and 7 HomeHealth workers in their home, over telephone, or virtually, depending upon their preference. Semi-structured interviews explore participants’ experiences of living with MLTCs or working with people with MLTCs and how these affect their motivation, goal choices, progress, maintenance, habit formation, and overall benefits. To date, 30 interviews have been conducted. Transcripts are being analysed using reflexive thematic analysis.
Findings
Preliminary findings suggest that while some older people view the health-related difficulties of older age fatalistically, symptoms associated with MLTCs such as physical pain, hearing loss, anxiety, and breathlessness, hinder goal progress and affect maintenance of positive behaviour changes. Bladder problems, gastrointestinal problems, mobility issues due to arthritis or neurological conditions, and breathing problems e.g. due to heart disease or emphysema limit access to public spaces, and consequently social interactions. Most participants interviewed viewed the intervention positively, and where failure to reach or maintain goals was mentioned, some blamed themselves for “not doing better” because of the limitations of their health.
Consequences
Understanding what changes and approaches are required to adapt behaviour change interventions such as HomeHealth to people living with MLTCs could improve how the services are delivered, maximise benefits to the individuals involved, and provide a helpful way to support people with MLTCs live life with dignity.