Self-management support in people with multiple long-term conditions

• Research type

  Research Study

• Full title

  Self-management support in people with multiple long-term conditions in the post-COVID-19 era: a qualitative study

• IRAS ID

  324006

• Contact name

  Michelle Hadjiconstantinou

• Contact email

  mh333@leicester.ac.uk

• Sponsor organisation

  University of Leicester

• Clinicaltrials.gov Identifier

  https://doi.org/10.17605/OSF.IO/DGACR, Open Science Framework registration link

• Duration of Study in the UK

  1 years, 0 months, 1 days

• Research summary

  Multiple long-term conditions (MLTCs) are defined as the existence of two or more long-term conditions in a single individual. These conditions can include physical diseases, mental health conditions or infectious diseases. MLTCs are associated with a reduced life expectancy, a poorer quality of life and increased health service utilisation. Self-management can involve managing emotions, organising medications and setting goals, to reduce the burden of these conditions on individuals. Support from health care professionals can encourage and empower individuals to self-manage their conditions. However, people with MLTCs may experience additional difficulties with self-management, due to the number of symptoms which may impact their daily life and the need to organise multiple healthcare appointments across different services. The COVID-19 pandemic may have also caused new problems for the self-management of MLTCs.

  Previous research has mainly focused on self-management support of single conditions and healthcare guidelines tend to be focused on single conditions, with less focus on other conditions individuals may have. There is a need to explore self-management and experiences amongst people with MLTCs and HCPs to increase understanding of MLTCs and self-management support. The impact of COVID-19 on self-management and the delivery of self-management support amongst people with MLTCs needs to be explored.

  The populations of interest are people with MLTCs and health care professionals who support people with MLTCs. This qualitative study will use either interviews or focus groups to explore their experiences and perceptions of MLTCs and self-management support. This study will also explore how these experiences have changed throughout the COVID-19 pandemic.
  
  These cohorts will be recruited across the University Hospitals of Leicester NHS Trust and primary care, with additional recruitment via social media, posters, email lists and training events.

  This PhD is funded by the NIHR Applied Research Collaboration East Midlands.
  Lay summary of study results: Who carried out the research?
  • This study was carried out by a PhD student, with support from academic supervisors, at the University of Leicester.

  Why was this study needed?
  • More people are living with two or more health conditions, and this can lead to unwanted health outcomes, including poor quality of life and mental health.
  • Previously, most research has focused on managing one condition at a time. Prior to this research, we knew little about the current experiences and needs of people living with two or more health conditions. This information is important to improve healthcare and support for people managing two or more health conditions.
  • This is one of the first studies to explore what it is really like for people managing several long-term health conditions, and what healthcare professionals think about supporting them.

  What was the study about?
  • This study looked at what it is like to live with and manage two or more long-term health conditions (multiple long-term conditions), from the point of view of individuals and healthcare professionals.

  How was the study done?
  • Remote interviews using the telephone or using video call (Microsoft Teams)

  When did the study take place?
  • From November 2023 until February 2025.

  Who participated in the study?
  • 22 adults (18+) living with two or more health conditions o On average, each person had 5 conditions o Common conditions included high blood pressure, diabetes and anxiety o Equal numbers of men and women participated in the interviews o 9 people were aged under 65, and 13 were over 65 • 19 healthcare professionals o Including GPs, nurses, pharmacists, physiotherapists, physiologists, dietitians and social prescribers

  What did the study find out?
  Five key themes came out of the interviews:
  1. Informed and activated “patients”: Individuals want to understand their health to help manage their conditions. This information may be provided by healthcare professionals or through individuals’ own research and experience.
  2. Person-centred and holistic care: Support should consider the whole person, not just individual conditions. This means that support needs to be personalised based on individual needs, priorities and preferences. Wider factors, such as finances, social issues and cultural norms, need to be considered when support self-management 3. Stigma: people sometimes feel judged, ashamed or guilty for having multiple health conditions. This may have negative impacts on their health and ability to self-manage.
  4. Safe spaces: It is important that individuals have trusted environments to discuss their health, such as with family, friends and workplaces. This provides a supportive network to help manage multiple conditions.
  5. Complexity: Managing multiple conditions is very complicated, like putting together a puzzle. People with multiple conditions may have:
  o Difficulties with their mental health
  o High number of symptoms
  o Many medications
  o Other barriers to self-management, such as social or economic barriers These findings show that managing multiple conditions is challenging and influenced by many different factors.

  What were the important conclusions from this study?
  • Managing long-term conditions should be a joint effort between individuals and healthcare professionals • Support should be personalised, based on each person’s needs, priorities, and situation • Wider factors, such as finances, support networks and culture, should be considered to effectively support people with multiple health conditions • Support should move away from focusing on disease-specific areas, such as blood sugar levels or blood pressure. Support should focus on non-disease specific areas, such as diet, physical activity, mental health and improving confidence.

  How has this study helped individuals, healthcare professionals and researchers?
  • This study has contributed to important and new knowledge which will help support people to self-manage multiple long-term conditions • People with multiple long-term conditions need access to information, personalised care and supportive networks to enable them to self-manage effectively • Focusing on non-disease specific areas of health and making sure that all support is personalised based on individual needs is important for effective self-management support • These findings may feed into the development of future self-management support interventions for people living with multiple long-term conditions. These interventions may have the potential to improve health outcomes for these individuals.

  Are there any recommendations for wider healthcare services?
  To improve self-management support, healthcare should be more joined-up and person-centred. This could include:
  • Regular meetings between different types of healthcare professionals to coordinate care • Better sharing of patient information using electronic health records • A “one-stop shop” approach – where one appointment covers all health conditions, instead of many separate ones

• REC name

  East Midlands - Leicester Central Research Ethics Committee

• REC reference

  23/EM/0173

• Date of REC Opinion

  11 Aug 2023

• REC opinion

  Further Information Favourable Opinion