Using qualitative study designs to understand treatment burden and capacity for self-care among patients with HIV/NCD multimorbidity in South Africa: A methods paper

Abstract

Background Low- and middle-income countries (LMICs), including South Africa, are currently experiencing multiple epidemics: HIV and the rising burden of non-communicable diseases (NCDs), leading to different patterns of multimorbidity (the occurrence of two or more chronic conditions) than experienced in high income settings. These adversely affect health outcomes, increase patients’ perceived burden of treatment, and impact the workload of self-management. This paper outlines the methods used in a qualitative study exploring burden of treatment among people living with HIV/NCD multimorbidity in South Africa. Methods We undertook a comparative qualitative study to examine the interaction between individuals’ treatment burden (self-management workload) and their capacity to take on this workload, using the dual lenses of Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) to aid conceptualisation of the data. We interviewed 30 people with multimorbidity and 16 carers in rural Eastern Cape and urban Cape Town between February-April 2021. Data was analysed through framework analysis. Findings This paper discusses the methodological procedures considered when conducting qualitative research among people with multimorbidity in low-income settings in South Africa. We highlight the decisions made when developing the research design, recruiting participants, and selecting field-sites. We also explore data analysis processes and reflect on the positionality of the research project and researchers. Conclusion This paper illustrates the decision-making processes conducting this qualitative research and may be helpful in informing future research aiming to qualitatively investigate treatment burden among patients in LMICs.

Multimorbidity in South Africa: Is the health system ready?

“…Comprehensive information on multimorbidity is needed for health-service delivery planning. While there is increasing focus on epidemiology, 20,21 and the experience of multimorbidity in South Africa 98,99 a better understanding of the epidemiology and patient experience of multimorbidity could also allow for interventions to be developed which allow for more effective and efficient treatment of patients. 10,100 Multimorbidity is a growing concern in South Africa and therefore requires action.…”

Mapping the evidence on integrated service delivery for non-communicable and infectious disease comorbidity in sub-Saharan Africa: protocol for a scoping review

“…11 12 Patients with such concurrent conditions must deal not only with physical and psychological impacts of each disease, but also multifaceted challenges such as reduced quality of life, stigma and discrimination, complex treatment regimens and higher healthcare costs. [13][14][15][16] However, in resource-limited settings, particularly in LMICs, patients will face unique challenges, dealing with the complexities of accessing fragmented healthcare services that are ill-equipped to meet their intertwined and longterm needs. 13 14 Sub-Saharan Africa (SSA) stands at the epicentre of this complex NCD-ID crisis.…”