1Academic Unit of Primary Care and Population Sciences,University of Southampton,Southampton General Hospital, Southampton,UK.
2Department of Social and Behavioural Sciences, School of Public Health,University of Ghana,Ghana.
J Biosoc Sci. 2019 Jul;51(4):562-577. doi: 10.1017/S0021932018000342. Epub 2018 Nov 26.
Defined as the co-occurrence of more than two chronic conditions, multi-morbidity has been described as a significant health care problem: a trend linked to a rise in non-communicable disease and an ageing population. Evidence on the experiences of living with multi-morbidity in middle-income countries (MICs) is limited. In high-income countries (HICs), multi-morbidity has a complex impact on health outcomes, including functional status, disability and quality of life, complexity of health care and burden of treatment. Previous evidence also shows that multi-morbidity is consistently higher amongst women. This study aimed to explore the perceptions and experiences of women living with multi-morbidity in the Greater Accra Region, Ghana: to understand the complexity of their health needs due to multi-morbidity, and to document how the health system has responded. Guided by the Cumulative Complexity Model, and using stratified purposive sampling, 20 in-depth interviews were conducted between May and September 2015 across three polyclinics in the Greater Accra Region. The data were analysed using the six phases of Thematic Analysis. Overall four themes emerged: 1) the influences on patients' health experience; 2) seeking care and the responsiveness of the health care system; 3) how patients manage health care demands; and 4) outcomes due to health. Spirituality and the stigmatization caused by specific conditions, such as HIV, impacted their overall health experience. Women depended on the care and treatment provided through the health care system despite inconsistent coverage and a lack of choice thereof, although their experiences varied by chronic condition. Women depended on their family and community to offset the financial burden of treatment costs, which was exacerbated by having many conditions. The implications are that integrated health and social support, such as streamlining procedures and professional training on managing complexity, would benefit and reduce the burden of multi-morbidity experienced by women with multi-morbidity in Ghana.
定义为两种以上慢性疾病的同时存在，多重疾病已被描述为一个重大的医疗保健问题：这种趋势与非传染性疾病的增加和人口老龄化有关。关于中低收入国家（MICs）多重疾病患者生活经历的证据有限。在高收入国家（HICs），多重疾病对健康结果有复杂的影响，包括功能状态、残疾和生活质量、医疗保健的复杂性以及治疗负担。以前的证据还表明，多重疾病在女性中更为普遍。本研究旨在探索加纳大阿克拉地区患有多重疾病的女性对其的认知和体验：了解她们因多重疾病而导致的健康需求的复杂性，并记录卫生系统的反应。本研究以累积复杂性模型为指导，采用分层目的抽样法，于 2015 年 5 月至 9 月在大阿克拉地区的三个综合诊所进行了 20 次深入访谈。使用主题分析的六个阶段对数据进行分析。总体上出现了四个主题：1）对患者健康体验的影响；2）寻求医疗照顾和卫生保健系统的反应性；3）患者如何管理医疗保健需求；4）健康导致的结果。精神信仰和特定疾病（如 HIV）引起的污名化影响了他们的整体健康体验。尽管覆盖范围不一致且缺乏选择，女性仍然依赖卫生保健系统提供的护理和治疗，尽管她们的体验因慢性疾病而异。女性依赖家庭和社区来减轻治疗费用的经济负担，而多种疾病的存在则加剧了这种负担。这意味着综合的健康和社会支持，如简化程序和管理复杂性的专业培训，将使加纳患有多重疾病的女性受益，并减轻她们所经历的多重疾病的负担。
