Multimorbidity in the context of socioeconomic deprivation: a study protocol

Problem

In the UK, health inequalities continue to worsen and are especially stark in relation to multimorbidity, which is more common, and begins up to 15 years earlier, in communities experiencing socioeconomic deprivation. Treatment burden (the work done by patients to manage conditions) is increased in this context, and several individual factors that impact on patients’ capacity (such as health literacy, environment) to manage multimorbidity cluster in communities experiencing socioeconomic deprivation. Community is important; an individual’s capacity to manage multimorbidity may be enhanced, or diminished, by the community they live in. Yet the influence of community level factors (particularly at the level of the individual) in this context is poorly understood. Understanding these factors is critical if we are to design interventions and services that narrow rather than widen health inequalities. This project aims to explore, and quantify, the impact of factors influencing capacity to self-manage multimorbidity in the context of socio-economic deprivation, and how individual and community level factors interact to influence self-management decisions.

Approach

A mixed methods study consisting of three separate work packages.

Work Package 1: Meta-ethnography of patient experience of current multimorbidity interventions, and exploration of whether and how self-management, treatment burden, capacity and socio-economic deprivation feature.

Work Package 2: Using data from the West of Scotland Twenty-07 cohort a secondary quantitative analysis to build models for capacity (individual and community) and treatment burden and examine the associations between the models and mortality and hospital admissions.

Work Package 3: An ethnographic study to explore individual and community influences on patient capacity. Engagement with a range of community organisations and service users in one area experiencing high levels of socio-economic deprivation (in Scotland) will explore the interaction between individual and community influences on health. This work will also consider how the coronavirus, and lockdown, have impacted community resource and capacity.

Findings

This poster presents the protocol for this planned study. Work packages 1 and 2 are currently underway; efforts to progress work package 3 in the context of COVID-19 are on-going.

Consequences

We will gain an in-depth understanding of how individual and community level factors interact to influence patients’ ability to self-manage multimorbidity. Moreover, we will characterise how wider community beliefs and resources enhance, or limit, individual level capacity. We will synthesise participant experience of current multimorbidity interventions, and we will begin to quantify the impact of patient capacity and treatment burden on mortality and hospital admissions. Together these findings will permit the design of services and interventions that simultaneously enhance individual capacity, harness community assets and ultimately narrow, rather than widen, existing health inequalities.