Self-management of multiple long-term conditions: A systematic review of the barriers and facilitators amongst people experiencing socioeconomic deprivation

• Published in: PloS one 2023-02, Vol.18 (2), p.e0282036-e0282036
• Main Authors: Woodward, Abi, Davies, Nathan, Walters, Kate, Nimmons, Danielle, Stevenson, Fiona, Protheroe, Joanne, Chew-Graham, Carolyn A, Armstrong, Megan
• Format: Article
• Language: English
• Subjects: Analysis; Data collection; Demographic aspects; Deprivation; Diabetes; Economic aspects; Financial management; Health care disparities; Health disparities; Health Personnel - psychology; Health risks; Humans; Literacy; Management; Medical personnel; Medicine and Health Sciences; Mental disorders; Mental Health; Methods; People and Places; Polypharmacy; Populations; Qualitative Research; Research and Analysis Methods; Self-care, Health; Self-Management; Social aspects; Social Sciences; Socioeconomic Factors; Socioeconomics; Systematic review; Well being
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0282036

Multiple long-term conditions are rising across all groups but people experiencing socioeconomic deprivation are found to have a higher prevalence. Self-management strategies are a vital part of healthcare for people with long-term conditions and effective strategies are associated with improved health outcomes in a variety of health conditions. The management of multiple long-term conditions are, however, less effective in people experiencing socioeconomic deprivation, leaving them more at risk of health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management on long-term conditions in those experiencing socioeconomic deprivation. MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions among socioeconomically disadvantaged populations. Data were coded and thematically synthesised using NVivo. From the search results, 79 relevant qualitative studies were identified after the full text screening and 11 studies were included in the final thematic synthesis. Three overarching analytical themes were identified alongside a set of sub-themes: (1) Challenges of having multiple long-term conditions; prioritisation of conditions, impact of multiple long-term conditions on mental health and wellbeing, polypharmacy, (2) Socioeconomic barriers to self-management; financial, health literacy, compounding impact of multiple long-term conditions and socioeconomic deprivation, (3) Facilitators of self-management in people experiencing socioeconomic deprivation; maintaining independence, 'meaningful' activities, support networks. Self-management of multiple long-term conditions is challenging for people experiencing socioeconomic deprivation due to barriers around financial constraints and health literacy, which can lead to poor mental health and wellbeing. To support targeted interventions, greater awareness is needed among health professionals of the barriers/challenges of self-management among these populations.