Experiences of multimorbidity in urban and rural Malawi: an interview study of burdens of treatment and lack of treatment

Chikumbu, E. F. et al. (2022) Experiences of multimorbidity in urban and rural Malawi: an interview study of burdens of treatment and lack of treatment. PLoS Global Public Health, 2(3), e0000139. (doi: 10.1371/journal.pgph.0000139) (PMID:36962280) (PMCID:PMC10021162)

Abstract

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.

• Item Type: Articles
• Additional Information: 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.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wyke, Professor Sally and Jani, Dr Bhautesh and Bunn, Dr Christopher and Mair, Professor Frances and Crampin, Professor Mia

Creator Roles

Bunn, C.: Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Validation, Writing – original draft, Writing – review and editing
Jani, B. D.: Funding acquisition, Writing – review and editing
Wyke, S.: Formal analysis, Methodology, Writing – review and editing
Crampin, A. C.: Conceptualization, Data curation, Funding acquisition, Methodology, Project administration, Resources, Supervision, Writing – review and editing
Mair, F. S.: Conceptualization, Formal analysis, Methodology, Project administration, Supervision, Writing – original draft, Writing – review and editing

• Authors: Chikumbu, E. F., Bunn, C., Kasenda, S., Dube, A., Phiri-Makwakwa, E., Jani, B. D., Jobe, M., Wyke, S., Seeley, J., Crampin, A. C., and Mair, F. S.
• Subjects: H Social Sciences > H Social Sciences (General); R Medicine > R Medicine (General); R Medicine > RA Public aspects of medicine
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
• Journal Name: PLoS Global Public Health
• Publisher: Public Library of Science
• ISSN: 2767-3375
• ISSN (Online): 2767-3375
• Copyright Holders: Copyright © 2022 Chikumbu et al.
• First Published: First published in PLoS Global Public Health 2(3): e0000139
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
309238		Multimorbidity in Africa - Increasing Understanding of the Patient Experience and Epidemiology (MAfricaEE)	Frances Mair	Medical Research Council (MRC)	MC_PC_MR/T037849/1	HW - General Practice and Primary Care