Dixon Justin, Morton Ben, Nkhata Misheck J, Silman Alan, Simiyu Ibrahim G, Spencer Stephen A, Van Pinxteren Myrna, Bunn Christopher, Calderwood Claire, Chandler Clare I R, Chikumbu Edith, Crampin Amelia C, Hurst John R, Jobe Modou, Kengne Andre Pascal, Levitt Naomi S, Moshabela Mosa, Owolabi Mayowa, Peer Nasheeta, Phiri Nozgechi, Singh Sally J, Tamuhla Tsaone, Tembo Mandikudza, Tiffin Nicki, Worrall Eve, Yongolo Nateiya M, Banda Gift T, Bickton Fanuel, Bilungula Abbi-Monique Mamani, Bosire Edna, Chawani Marlen S, Chinoko Beatrice, Chisala Mphatso, Chiwanda Jonathan, Drew Sarah, Farrant Lindsay, Ferrand Rashida A, Gondwe Mtisunge, Gregson Celia L, Harding Richard, Kajungu Dan, Kasenda Stephen, Katagira Winceslaus, Kwaitana Duncan, Mendenhall Emily, Mensah Adwoa Bemah Boamah, Mnenula Modai, Mupaza Lovemore, Mwakasungula Maud, Nakanga Wisdom, Ndhlovu Chiratidzo, Nkhoma Kennedy, Nkoka Owen, Opare-Lokko Edwina Addo, Phulusa Jacob, Price Alison, Rylance Jamie, Salima Charity, Salimu Sangwani, Sturmberg Joachim, Vale Elizabeth, Limbani Felix
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2024 Jul 30;4(7):e0003434. doi: 10.1371/journal.pgph.0003434. eCollection 2024.
Multimorbidity is an emerging challenge for health systems globally. It is commonly defined as the co-occurrence of two or more chronic conditions in one person, but its meaning remains a lively area of academic debate, and the utility of the concept beyond high-income settings is uncertain. This article presents the findings from an interdisciplinary research initiative that drew together 60 academic and applied partners working in 10 African countries to answer the questions: how useful is the concept of multimorbidity within Africa? Can the concept be adapted to context to optimise its transformative potentials? During a three-day concept-building workshop, we investigated how the definition of multimorbidity was understood across diverse disciplinary and regional perspectives, evaluated the utility and limitations of existing concepts and definitions, and considered how to build a more context-sensitive, cross-cutting description of multimorbidity. This iterative process was guided by the principles of grounded theory and involved focus- and whole-group discussions during the workshop, thematic coding of workshop discussions, and further post-workshop development and refinement. Three thematic domains emerged from workshop discussions: the current focus of multimorbidity on constituent diseases; the potential for revised concepts to centre the priorities, needs, and social context of people living with multimorbidity (PLWMM); and the need for revised concepts to respond to varied conceptual priorities amongst stakeholders. These themes fed into the development of an expanded conceptual model that centres the catastrophic impacts multimorbidity can have for PLWMM, families and support structures, service providers, and health systems.
多重疾病是全球卫生系统面临的一个新挑战。它通常被定义为一个人同时患有两种或更多的慢性病，但它的含义仍是学术辩论的一个活跃领域，而且在高收入环境之外该概念的实用性尚不确定。本文介绍了一项跨学科研究计划的结果，该计划汇集了在10个非洲国家工作的60个学术和应用领域的合作伙伴，以回答以下问题：多重疾病的概念在非洲有多大用处？这个概念能否因地制宜以优化其变革潜力？在为期三天的概念构建研讨会上，我们研究了从不同学科和地区角度如何理解多重疾病的定义，评估了现有概念和定义的实用性及局限性，并思考如何构建一个更贴合实际情况、具有交叉性的多重疾病描述。这个迭代过程以扎根理论原则为指导，在研讨会上进行了重点讨论和全体讨论，对研讨会讨论内容进行了主题编码，并在会后进一步开展和完善。研讨会讨论产生了三个主题领域：多重疾病目前对构成疾病的关注；修订后的概念以多重疾病患者的优先事项、需求和社会背景为核心的潜力；以及修订后的概念应对利益相关者不同概念优先事项的必要性。这些主题推动了一个扩展概念模型的发展，该模型以多重疾病对多重疾病患者、家庭和支持结构、服务提供者及卫生系统可能产生的灾难性影响为核心。
