Experiences of multimorbidity in urban and rural Malawi

An interview study of burdens of treatment and lack of treatment

Bibliographic Data

ID5812129
AuthorsEdith Chikumbu (0000-0002-0956-3331, Malawi Epidemiology and Intervention Research Unit, corresponding author), Christopher Bunn (0000-0001-6604-1305, Malawi Epidemiology and Intervention Research Unit, corresponding author), Stephen Kasenda (0000-0001-9208-4122, Malawi Epidemiology and Intervention Research Unit, corresponding author), Albert Dube (0000-0002-6392-0475, Malawi Epidemiology and Intervention Research Unit, corresponding author), Enita Phiri (0000-0002-1970-146X, Malawi Epidemiology and Intervention Research Unit, corresponding author), Bhautesh Jani (0000-0001-7348-514X, University of Glasgow, corresponding author), Modou Jobe (0000-0001-5309-5611, MRC Unit the Gambia, corresponding author), Sally Wyke (0000-0002-7509-8247, University of Glasgow, corresponding author), Janet Seeley (0000-0002-0583-5272, London School of Hygiene & Tropical Medicine, corresponding author), Amelia C Crampin (0000-0002-1513-4330, University of Glasgow, corresponding author), Frances S Mair (0000-0001-9780-1135, University of Glasgow, corresponding author), on behalf of the MAfricaEE Project
EditorsMelanie Boeckmann (0000-0001-5909-5508)
Year2022
Volume2
Issue3
Pagese0000139-e0000139
Publication date2022-03-24
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PUBLISHER • US)
DOI10.1371/journal.pgph.0000139
PMID36962280
OpenAlexW4220965483
LanguageEN
Citations received18
References cited33

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

Chronic Disease Management Strategies · Health Systems, Economic Evaluations, Quality of Life · Healthcare Systems and Reforms

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