Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
School of Medicine, Keele University, Staffordshire, United Kingdom.
PLoS One. 2023 Feb 21;18(2):e0282036. doi: 10.1371/journal.pone.0282036. eCollection 2023.
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.
多种长期疾病在所有人群中都呈上升趋势，但经济社会地位较低的人群患病比例更高。自我管理策略是长期疾病患者医疗保健的重要组成部分，有效的策略与各种健康状况下改善健康结果相关。然而，在经济社会地位较低的人群中，多种长期疾病的管理效果较差，使他们面临更大的健康不平等风险。本综述旨在确定并综合有关经济社会地位较低人群自我管理多种长期疾病的障碍和促进因素的定性证据。
在 MEDLINE、EMBASE、AMED、PsycINFO 和 CINAHL Plus 中搜索有关经济社会地位较低人群多种长期疾病自我管理的定性研究。使用 NVivo 对数据进行编码和主题综合。
经过全文筛选，从搜索结果中确定了 79 项相关的定性研究，最终纳入了 11 项研究进行主题综合分析。确定了三个总体分析主题和一组子主题：（1）多种长期疾病的挑战；疾病的优先排序、多种长期疾病对心理健康和幸福感的影响、多种药物治疗，（2）自我管理的社会经济障碍；经济限制、健康素养、多种长期疾病和经济社会地位下降的复合影响，（3）经济社会地位较低人群自我管理的促进因素；保持独立性、“有意义”的活动、支持网络。
由于经济限制和健康素养方面的障碍，经济社会地位较低的人群自我管理多种长期疾病具有挑战性，这可能导致心理健康和幸福感较差。为了支持有针对性的干预措施，健康专业人员需要更多地了解这些人群自我管理的障碍/挑战。
