Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment.
Multimorbidity (presence of ≥2 long term conditions (LTCs)) is a growing global health challenge, yet we know little about the experiences of those living with multimorbidity in low- and middle-income countries (LMICs). We therefore explore: 1) experiences of men and women living with multimorbidity...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0000139&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849469809552523264 |
|---|---|
| author | Edith F Chikumbu Christopher Bunn Stephen Kasenda Albert Dube Enita Phiri-Makwakwa Bhautesh D Jani Modu Jobe Sally Wyke Janet Seeley Amelia C Crampin Frances S Mair MAfricaEE Project |
| author_facet | Edith F Chikumbu Christopher Bunn Stephen Kasenda Albert Dube Enita Phiri-Makwakwa Bhautesh D Jani Modu Jobe Sally Wyke Janet Seeley Amelia C Crampin Frances S Mair MAfricaEE Project |
| author_sort | Edith F Chikumbu |
| collection | DOAJ |
| description | Multimorbidity (presence of ≥2 long term conditions (LTCs)) is a growing global health challenge, yet we know little about the experiences of those living with multimorbidity in low- and middle-income countries (LMICs). We therefore explore: 1) experiences of men and women living with multimorbidity in urban and rural 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 structuring analytical accounts of these experiences. We conducted in depth, semi-structured interviews with 32 people in rural (n = 16) and urban settings (n = 16); 16 males, 16 females; 15 under 50 years; and 17 over 50 years. Data were analysed thematically and then conceptualised through the lens of NPT and BOTT. Key elements of burden of treatment identified included: coming to terms with and gaining an understanding of life with multimorbidity; dealing with resulting disruptions to family life; the work of seeking family and community support; navigating healthcare systems; coping with lack of continuity of care; enacting self-management advice; negotiating medical advice; appraising treatments; and importantly, dealing with the burden of lack of treatments/services. Poverty and inadequate healthcare provision constrained capacity to deal with treatment burden while supportive social and community networks were important enabling features. Greater access to health information/education would lessen treatment burden as would better resourced healthcare systems and improved standards of living. Our work demonstrates the utility of NPT and BOTT for aiding conceptualisation of treatment burden issues in LMICs but our findings highlight that 'lack' of access to treatments or services is an important additional burden which must be integrated in accounts of treatment burden in LMICs. |
| format | Article |
| id | doaj-art-a5477a6cfa9943e184f1d9f71ab7eda7 |
| institution | Kabale University |
| issn | 2767-3375 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj-art-a5477a6cfa9943e184f1d9f71ab7eda72025-08-20T03:25:21ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752022-01-0123e000013910.1371/journal.pgph.0000139Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment.Edith F ChikumbuChristopher BunnStephen KasendaAlbert DubeEnita Phiri-MakwakwaBhautesh D JaniModu JobeSally WykeJanet SeeleyAmelia C CrampinFrances S MairMAfricaEE ProjectMultimorbidity (presence of ≥2 long term conditions (LTCs)) is a growing global health challenge, yet we know little about the experiences of those living with multimorbidity in low- and middle-income countries (LMICs). We therefore explore: 1) experiences of men and women living with multimorbidity in urban and rural 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 structuring analytical accounts of these experiences. We conducted in depth, semi-structured interviews with 32 people in rural (n = 16) and urban settings (n = 16); 16 males, 16 females; 15 under 50 years; and 17 over 50 years. Data were analysed thematically and then conceptualised through the lens of NPT and BOTT. Key elements of burden of treatment identified included: coming to terms with and gaining an understanding of life with multimorbidity; dealing with resulting disruptions to family life; the work of seeking family and community support; navigating healthcare systems; coping with lack of continuity of care; enacting self-management advice; negotiating medical advice; appraising treatments; and importantly, dealing with the burden of lack of treatments/services. Poverty and inadequate healthcare provision constrained capacity to deal with treatment burden while supportive social and community networks were important enabling features. Greater access to health information/education would lessen treatment burden as would better resourced healthcare systems and improved standards of living. Our work demonstrates the utility of NPT and BOTT for aiding conceptualisation of treatment burden issues in LMICs but our findings highlight that 'lack' of access to treatments or services is an important additional burden which must be integrated in accounts of treatment burden in LMICs.https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0000139&type=printable |
| spellingShingle | Edith F Chikumbu Christopher Bunn Stephen Kasenda Albert Dube Enita Phiri-Makwakwa Bhautesh D Jani Modu Jobe Sally Wyke Janet Seeley Amelia C Crampin Frances S Mair MAfricaEE Project Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment. PLOS Global Public Health |
| title | Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment. |
| title_full | Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment. |
| title_fullStr | Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment. |
| title_full_unstemmed | Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment. |
| title_short | Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment. |
| title_sort | experiences of multimorbidity in urban and rural malawi an interview study of burdens of treatment and lack of treatment |
| url | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0000139&type=printable |
| work_keys_str_mv | AT edithfchikumbu experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT christopherbunn experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT stephenkasenda experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT albertdube experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT enitaphirimakwakwa experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT bhauteshdjani experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT modujobe experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT sallywyke experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT janetseeley experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT ameliaccrampin experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT francessmair experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment AT mafricaeeproject experiencesofmultimorbidityinurbanandruralmalawianinterviewstudyofburdensoftreatmentandlackoftreatment |