Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

Justin Dixon; Ben Morton; Misheck J. Nkhata; Alan Silman; Ibrahim G. Simiyu; Stephen A. Spencer; Myrna Van Pinxteren; Christopher Bunn; Claire Calderwood; Clare I. R. Chandler; Edith Chikumbu; Amelia C. Crampin; John R. Hurst; Modou Jobe; Andre Pascal Kengne; Naomi S. Levitt; Mosa Moshabela; Mayowa Owolabi; Nasheeta Peer; Nozgechi Phiri; Sally J. Singh; Tsaone Tamuhla; Mandikudza Tembo; Nicki Tiffin; Eve Worrall; Nateiya M. Yongolo; Gift T. Banda; Fanuel Bickton; Abbi-Monique Mamani Bilungula; Edna Bosire; Marlen S. Chawani; Beatrice Chinoko; Mphatso Chisala; Jonathan Chiwanda; Sarah Drew; Lindsay Farrant; Rashida A. Ferrand; Mtisunge Gondwe; Celia L. Gregson; Richard Harding; Dan Kajungu; Stephen Kasenda; Winceslaus Katagira; Duncan Kwaitana; Emily Mendenhall; Adwoa Bemah Boamah Mensah; Modai Mnenula; Lovemore Mupaza; Maud Mwakasungula; Wisdom Nakanga; Chiratidzo Ndhlovu; Kennedy Nkhoma; Owen Nkoka; Edwina Addo Opare-Lokko; Jacob Phulusa; Alison Price; Jamie Rylance; Charity Salima; Sangwani Salimu; Joachim Sturmberg; Elizabeth Vale; Felix Limbani; Andre F. S. Amaral

doi:10.1371/journal.pgph.0003434

Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

Justin Dixon, Ben Morton, Misheck J. Nkhata, Alan Silman, Ibrahim G. Simiyu, Stephen A. Spencer, Myrna Van Pinxteren, Christopher Bunn, Claire Calderwood, Clare I. R. Chandler, Edith Chikumbu, Amelia C. Crampin, John R. Hurst, Modou Jobe, Andre Pascal Kengne, Naomi S. Levitt, Mosa Moshabela, Mayowa Owolabi, Nasheeta Peer, Nozgechi PhiriSally J. Singh, Tsaone Tamuhla, Mandikudza Tembo, Nicki Tiffin, Eve Worrall, Nateiya M. Yongolo, Gift T. Banda, Fanuel Bickton, Abbi-Monique Mamani Bilungula, Edna Bosire, Marlen S. Chawani, Beatrice Chinoko, Mphatso Chisala, Jonathan Chiwanda, Sarah Drew, Lindsay Farrant, Rashida A. Ferrand, Mtisunge Gondwe, Celia L. Gregson, Richard Harding, Dan Kajungu, Stephen Kasenda, Winceslaus Katagira, Duncan Kwaitana, Emily Mendenhall, Adwoa Bemah Boamah Mensah, Modai Mnenula, Lovemore Mupaza, Maud Mwakasungula, Wisdom Nakanga, Chiratidzo Ndhlovu, Kennedy Nkhoma, Owen Nkoka, Edwina Addo Opare-Lokko, Jacob Phulusa, Alison Price, Jamie Rylance, Charity Salima, Sangwani Salimu, Joachim Sturmberg, Elizabeth Vale, Felix Limbani, Andre F. S. Amaral (Editor)

Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation

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Abstract

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.

Original language	English
Article number	e0003434
Journal	PLOS Global Public Health
Volume	4
Issue number	7
Early online date	30 Jul 2024
DOIs	https://doi.org/10.1371/journal.pgph.0003434
Publication status	Published - 30 Jul 2024

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Dixon, J., Morton, B., Nkhata, M. J., Silman, A., Simiyu, I. G., Spencer, S. A., Van Pinxteren, M., Bunn, C., Calderwood, C., Chandler, C. I. R., Chikumbu, E., Crampin, A. C., Hurst, J. R., Jobe, M., Kengne, A. P., Levitt, N. S., Moshabela, M., Owolabi, M., Peer, N., ... Amaral, A. F. S. (Ed.) (2024). Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model. PLOS Global Public Health, 4(7), Article e0003434. https://doi.org/10.1371/journal.pgph.0003434

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title = "Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model",

abstract = "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.",

author = "Justin Dixon and Ben Morton and Nkhata, {Misheck J.} and Alan Silman and Simiyu, {Ibrahim G.} and Spencer, {Stephen A.} and {Van Pinxteren}, Myrna and Christopher Bunn and Claire Calderwood and Chandler, {Clare I. R.} and Edith Chikumbu and Crampin, {Amelia C.} and Hurst, {John R.} and Modou Jobe and Kengne, {Andre Pascal} and Levitt, {Naomi S.} and Mosa Moshabela and Mayowa Owolabi and Nasheeta Peer and Nozgechi Phiri and Singh, {Sally J.} and Tsaone Tamuhla and Mandikudza Tembo and Nicki Tiffin and Eve Worrall and Yongolo, {Nateiya M.} and Banda, {Gift T.} and Fanuel Bickton and Bilungula, {Abbi-Monique Mamani} and Edna Bosire and Chawani, {Marlen S.} and Beatrice Chinoko and Mphatso Chisala and Jonathan Chiwanda and Sarah Drew and Lindsay Farrant and Ferrand, {Rashida A.} and Mtisunge Gondwe and Gregson, {Celia L.} and Richard Harding and Dan Kajungu and Stephen Kasenda and Winceslaus Katagira and Duncan Kwaitana and Emily Mendenhall and Mensah, {Adwoa Bemah Boamah} and Modai Mnenula and Lovemore Mupaza and Maud Mwakasungula and Wisdom Nakanga and Chiratidzo Ndhlovu and Kennedy Nkhoma and Owen Nkoka and Opare-Lokko, {Edwina Addo} and Jacob Phulusa and Alison Price and Jamie Rylance and Charity Salima and Sangwani Salimu and Joachim Sturmberg and Elizabeth Vale and Felix Limbani and Amaral, {Andre F. S.}",

note = "Publisher Copyright: Copyright: {\textcopyright} 2024 Dixon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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Dixon, J, Morton, B, Nkhata, MJ, Silman, A, Simiyu, IG, Spencer, SA, Van Pinxteren, M, Bunn, C, Calderwood, C, Chandler, CIR, Chikumbu, E, Crampin, AC, Hurst, JR, Jobe, M, Kengne, AP, Levitt, NS, Moshabela, M, Owolabi, M, Peer, N, Phiri, N, Singh, SJ, Tamuhla, T, Tembo, M, Tiffin, N, Worrall, E, Yongolo, NM, Banda, GT, Bickton, F, Bilungula, A-MM, Bosire, E, Chawani, MS, Chinoko, B, Chisala, M, Chiwanda, J, Drew, S, Farrant, L, Ferrand, RA, Gondwe, M, Gregson, CL, Harding, R, Kajungu, D, Kasenda, S, Katagira, W, Kwaitana, D, Mendenhall, E, Mensah, ABB, Mnenula, M, Mupaza, L, Mwakasungula, M, Nakanga, W, Ndhlovu, C, Nkhoma, K, Nkoka, O, Opare-Lokko, EA, Phulusa, J, Price, A, Rylance, J, Salima, C, Salimu, S, Sturmberg, J, Vale, E, Limbani, F & Amaral, AFS (ed.) 2024, 'Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model', PLOS Global Public Health, vol. 4, no. 7, e0003434. https://doi.org/10.1371/journal.pgph.0003434

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T1 - Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

AU - Dixon, Justin

AU - Morton, Ben

AU - Nkhata, Misheck J.

AU - Silman, Alan

AU - Simiyu, Ibrahim G.

AU - Spencer, Stephen A.

AU - Van Pinxteren, Myrna

AU - Bunn, Christopher

AU - Calderwood, Claire

AU - Chandler, Clare I. R.

AU - Chikumbu, Edith

AU - Crampin, Amelia C.

AU - Hurst, John R.

AU - Jobe, Modou

AU - Kengne, Andre Pascal

AU - Levitt, Naomi S.

AU - Moshabela, Mosa

AU - Owolabi, Mayowa

AU - Peer, Nasheeta

AU - Phiri, Nozgechi

AU - Singh, Sally J.

AU - Tamuhla, Tsaone

AU - Tembo, Mandikudza

AU - Tiffin, Nicki

AU - Worrall, Eve

AU - Yongolo, Nateiya M.

AU - Banda, Gift T.

AU - Bickton, Fanuel

AU - Bilungula, Abbi-Monique Mamani

AU - Bosire, Edna

AU - Chawani, Marlen S.

AU - Chinoko, Beatrice

AU - Chisala, Mphatso

AU - Chiwanda, Jonathan

AU - Drew, Sarah

AU - Farrant, Lindsay

AU - Ferrand, Rashida A.

AU - Gondwe, Mtisunge

AU - Gregson, Celia L.

AU - Harding, Richard

AU - Kajungu, Dan

AU - Kasenda, Stephen

AU - Katagira, Winceslaus

AU - Kwaitana, Duncan

AU - Mendenhall, Emily

AU - Mensah, Adwoa Bemah Boamah

AU - Mnenula, Modai

AU - Mupaza, Lovemore

AU - Mwakasungula, Maud

AU - Nakanga, Wisdom

AU - Ndhlovu, Chiratidzo

AU - Nkhoma, Kennedy

AU - Nkoka, Owen

AU - Opare-Lokko, Edwina Addo

AU - Phulusa, Jacob

AU - Price, Alison

AU - Rylance, Jamie

AU - Salima, Charity

AU - Salimu, Sangwani

AU - Sturmberg, Joachim

AU - Vale, Elizabeth

AU - Limbani, Felix

A2 - Amaral, Andre F. S.

N1 - Publisher Copyright: Copyright: © 2024 Dixon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2024/7/30

Y1 - 2024/7/30

N2 - 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.

AB - 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.

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JO - PLOS Global Public Health

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M1 - e0003434

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Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

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