Mbokazi Nonzuzo, van Pinxteren Myrna, Murphy Katherine, Mair Frances S, May Carl R, Levitt Naomi S
Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa.
Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa.
Soc Sci Med. 2023 Oct;334:116190. doi: 10.1016/j.socscimed.2023.116190. Epub 2023 Aug 28.
People living with multimorbidity in economically precarious circumstances in low- and middle-income countries (LMICs) experience a high workload trying to meet self-management demands. However, in countries such as South Africa, the availability of social networks and support structures may improve patient capacity, especially when networks are governed by cultural patterns linked to the Pan-African philosophy of Ubuntu, which promotes solidarity through humanness and human dignity. We explore the mediating role Ubuntu plays in people's ability to self-manage HIV/NCD multimorbidity in underprivileged settings in urban and rural South Africa.
We conducted semi-structured interviews with 30 patients living with HIV/NCD multimorbidity between February-April 2022. Patients attended public health clinics in Gugulethu, Cape Town and Bulungula, Eastern Cape. We analysed interviews using framework analysis, using the Cumulative Complexity Model (CuCoM) and Burden of Treatment Theory (BoTT) as frameworks through which to conceptualise the data.
Despite facing economic hardship, people with multimorbidity in South Africa were able to cope with their workload. They actively used and mobilized family relations and external networks that supported them financially, practically, and emotionally, allowing them to better self-manage their chronic conditions. Embedded in their everyday life, patients, often unconsciously, embraced Ubuntu and its core values, including togetherness, solidarity, and receiving Imbeko (respect) from health workers. This enabled participants to share their treatment workload and increase self-management capacity.
Ubuntu is an important mediator for people living with multimorbidity in South Africa, as it allows them to navigate their treatment workload and increase their social capital and structural resilience, which is key to self-management capacity. Incorporating Ubuntu and linked African support theories into current treatment burden models will enable better understandings of patients' collective support and can inform the development of context-specific social health interventions that fit the needs of people living with chronic conditions in African settings.
在低收入和中等收入国家（LMICs），处于经济不稳定状况下的患有多种疾病的人群在努力满足自我管理需求时面临着繁重的工作量。然而，在南非等国家，社会网络和支持结构的存在可能会提高患者的能力，特别是当这些网络受与泛非乌班图哲学相关的文化模式支配时，乌班图哲学通过人性和人的尊严促进团结。我们探讨了乌班图在南非城乡贫困环境中人们自我管理艾滋病毒/非传染性疾病合并症能力方面所起的中介作用。
2022年2月至4月期间，我们对30名患有艾滋病毒/非传染性疾病合并症的患者进行了半结构式访谈。患者前往开普敦古古莱图和东开普省布隆古拉的公共卫生诊所就诊。我们使用框架分析法对访谈进行分析，将累积复杂性模型（CuCoM）和治疗负担理论（BoTT）作为概念化数据的框架。
尽管面临经济困难，南非患有多种疾病的人仍能够应对其工作量。他们积极利用并动员在经济、实际和情感上支持他们的家庭关系和外部网络，从而能够更好地自我管理其慢性病。患者在日常生活中常常不自觉地接受乌班图及其核心价值观，包括团结、互助以及从医护人员那里获得“因贝科”（尊重）。这使参与者能够分担他们的治疗工作量并提高自我管理能力。
乌班图对于南非患有多种疾病的人来说是一个重要的中介因素，因为它使他们能够应对治疗工作量，并增加其社会资本和结构适应力，而这是自我管理能力的关键。将乌班图及相关的非洲支持理论纳入当前的治疗负担模型，将有助于更好地理解患者的集体支持，并为制定符合非洲背景下慢性病患者需求的因地制宜的社会健康干预措施提供参考。
