Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-18T04:15:37.941Z Has data issue: false hasContentIssue false
  • English
  • Français

Women living with multi-morbidity in the Greater Accra Region of Ghana: a qualitative study guided by the Cumulative Complexity Model

Published online by Cambridge University Press:  26 November 2018

Sara A. Morgan ,
Caroline Eyles ,
Paul J. Roderick ,
Philip B. Adongo  and
Allan G. Hill
Sara A. Morgan*
Affiliation:
Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
Caroline Eyles
Affiliation:
Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
Paul J. Roderick
Affiliation:
Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
Philip B. Adongo
Affiliation:
Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Ghana
Allan G. Hill
Affiliation:
Academic Unit of Social Statistics & Demography, Faculty of Social & Human Sciences, University of Southampton, Southampton, UK
*
*Corresponding author. Email: s.afshar@soton.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Defined as the co-occurrence of more than two chronic conditions, multi-morbidity has been described as a significant health care problem: a trend linked to a rise in non-communicable disease and an ageing population. Evidence on the experiences of living with multi-morbidity in middle-income countries (MICs) is limited. In high-income countries (HICs), multi-morbidity has a complex impact on health outcomes, including functional status, disability and quality of life, complexity of health care and burden of treatment. Previous evidence also shows that multi-morbidity is consistently higher amongst women. This study aimed to explore the perceptions and experiences of women living with multi-morbidity in the Greater Accra Region, Ghana: to understand the complexity of their health needs due to multi-morbidity, and to document how the health system has responded. Guided by the Cumulative Complexity Model, and using stratified purposive sampling, 20 in-depth interviews were conducted between May and September 2015 across three polyclinics in the Greater Accra Region. The data were analysed using the six phases of Thematic Analysis. Overall four themes emerged: 1) the influences on patients’ health experience; 2) seeking care and the responsiveness of the health care system; 3) how patients manage health care demands; and 4) outcomes due to health. Spirituality and the stigmatization caused by specific conditions, such as HIV, impacted their overall health experience. Women depended on the care and treatment provided through the health care system despite inconsistent coverage and a lack of choice thereof, although their experiences varied by chronic condition. Women depended on their family and community to offset the financial burden of treatment costs, which was exacerbated by having many conditions. The implications are that integrated health and social support, such as streamlining procedures and professional training on managing complexity, would benefit and reduce the burden of multi-morbidity experienced by women with multi-morbidity in Ghana.

Keywords

Multi-morbidityGhanaCumulative Complexity Model
Type
Research Article
Information
Journal of Biosocial Science , Volume 51 , Issue 4 , July 2019 , pp. 562 - 577
Copyright
© Cambridge University Press, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Afshar, S, Roderick, PJ, Kowal, P, Dimitrov, BD and Hill, AG (2015) Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys. BMC Public Health 15, 776.Google Scholar
Barnett, K, Mercer, SW, Norbury, N, Watt, G, Wyke, S and Guthrie, B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet 380.Google Scholar
Bower, P, Macdonald, W, Harkness, E, Gask, L, Kendrick, T and Valderas, JM (2011) Multimorbidity, service organization and clinical decision making in primary care: a qualitative study. Journal of Family Practice 28, 579–587.Google Scholar
Braune, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.Google Scholar
Brittain, K, Perry, S and Williams, K (2001) Triggers that prompt people with urinary symptoms to seek help. British Journal of Nursing 10, 74–76, 78, 80 passim.Google Scholar
Bryman, A (2012) Interviewing in qualitative research. In Bryman A (ed.) Social Research Methods. Oxford University Press, Oxford.Google Scholar
Danso-Appiah, A, Stolk, WA, Bosompem, KM, Otchere, J, Looman, CW, Habbema, JD and De Vlas, SJ (2010) Health seeking behaviour and utilization of health facilities for schistosomiasis-related symptoms in Ghana. PLoS Neglected Tropical Diseases 4, e867.Google Scholar
de-Graft Aikins, A (2003) Living with diabetes in rural and urban Ghana: a critical social psychological examination of illness action and scope for intervention. Journal of Health Psychology 8(5), 557–572.Google Scholar
de-Graft Aikins, A (2005) Healer shopping in Africa: new evidence from rural–urban qualitative study of Ghanaian diabetes experiences. BMJ 331, 737.Google Scholar
de-Graft Aikins, A, Unwin, N, Agyemang, C, Allotey, P, Campbell, C and Arhinful, D (2010) Tackling Africa’s chronic disease burden: from the local to the global. Globalization and Health 6, 5.Google Scholar
Dixon, J, Tenkorang, EY and Luginaah, I (2011) Ghana’s National Health Insurance Scheme: helping the poor or leaving them behind? Environment and Central Planning: Government and Policy 29, 1102–1115.Google Scholar
Duguay, C, Gallagher, F and Fortin, M (2014) The experience of adults with multimorbidity: a qualitative study. Journal of Comorbidity 4, 11.Google Scholar
Elliott, RA, Ross-Degnan, D, Adams, AS, Safran, DG and Soumerai, SB (2007) Strategies for coping in a complex world: adherence behavior among older adults with chronic illness. Journal of General Internal Medicine 22, 805–810.Google Scholar
Fortin, M, Stewart, M, Poitras, ME, Almirall, J and Maddocks, H (2012) A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Annuals of Family Medicine 10, 142–151.Google Scholar
Ganle, JK, Fitzpatrick, R, Otupiri, E and Parker, M (2016) Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana. International Journal of Health Planning and Management 31, e235–e253.Google Scholar
Gill, A, Kuluski, K, Jaakkimainen, L, Naganathan, G, Upshur, R and Wodchis, WP (2014) “Where do we go from here?” Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians. Healthcare Policy 9, 73–89.Google Scholar
Guba, EG and Lincoln, YS (eds) (1994) Competing Paradigms in Qualitative Research. Sage Publications, London.Google Scholar
Hansen, H, Phontsch, N, Van Den Bussche, H, Scherer, M and Schafer, I (2015) Reasons for disagreement regarding illnesses between older patients with multimorbidity and their GPs – a qualitative study. BMC Family Practice 16, 1–12.Google Scholar
Holzemer, WL, Uys, L, Makoae, L, Stewart, A, Phetlhu, R, Dlamini, PS et al. (2007) A conceptual model of HIV/AIDS stigma from five African countries. Journal of Advanced Nursing 58, 541–551.Google Scholar
Loffler, C, Kaduszkiewicz, H, Stolzenbach, CO, Streich, W, Fuchs, A, Van Den Bussche, H et al. (2012) Coping with multimorbidity in old age – a qualitative study. BMC Family Practice 13, 1–8.Google Scholar
Luijks, HD, Loeffen, MJW, Lagro-Janssen, AL, Weel, C, Lucassen, PL and Schermer, TR (2012) GPs’ considerations in multimorbidity management: a qualitative study. British Journal of General Practice 62, e503–e510.Google Scholar
McKeown, T and Record, RG (1962) Reasons for the decline in mortality in England and Wales during the nineteenth century. Journal of Population Studies 16, 94–122.Google Scholar
Mills, A, Ataguba, JE, Borghi, J, Garshong, B, Makawia, S, Mtei, G et al. (2012) Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage The Lancet 380, 126–133.Google Scholar
National Health Insurance Authority, (2013) National Health Insurance Authority Annual Report. Accra, Ghana.Google Scholar
Nimako, BA, Baiden, F, Sackey, SO and Binka, F (2013) Multimorbidity and chronic diseases among adult patients presenting to an inner-city clinic in Ghana. Globalisation and Health 9, 61.Google Scholar
Patton, MQ (2001) Qualitative Evaluation and Research Methods. Sage Publications, Newbury Park, CA.Google Scholar
Ritchie, J, Lewis, J, Nicholls, CM and Ormston, R (eds) (2014) Qualitative Research Practice: A Guide for Social Science Students And Researchers. Sage Publications, London, UK.Google Scholar
Seeman, TE and Crimmins, E (2001) Social environment effects on health and aging. Annals of the New York Academy of Sciences 954, 88–117.Google Scholar
Shippee, ND, Shah, ND, May, CR, Mair, FS and Montori, VM (2012) Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. Journal of Clinical Epidemiology 65(10), 1041–1051.Google Scholar
Smith, LK, Pope, C and Botha, JL (2005) Patients’ help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 366, 825–831.Google Scholar
St Sauver, JL, Boyd, CM, Grossardt, BR, Bobo, WV, Rutten, LJF, Roger, VL et al. (2015) Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open 5, e006413Google Scholar
Ulasi, CI, Preko, PO, Baidoo, JA, Bayard, B, Ehiri, JE, Jolly, CM and Jolly, PE (2009) HIV/AIDS-related stigma in Kumasi, Ghana. Health & Place 15(1), 255–262.Google Scholar
Valderas, JM, Starfield, B, Sibbald, B, Salisbury, C and Roland, M (2009) Defining comorbidity: implications for understanding health and health services. Annals of Family Medicine 7, 357–363.Google Scholar
Wang, H, Wang, JJ, Wong, SYS, Wong, MS, Jian, F, Wang, PI et al. (2014) Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China. BMC Medicine 12, 188Google Scholar
Warshaw, G (2006) Introduction: advances and challenges in care of older people with chronic illness. Generations 3, 5–10.Google Scholar
World Bank (2017) National Accounts Data and OECD National Accounts Data Files. URL: https://data.worldbank.org/indicator/NY.GDP.MKTP.CD (accessed 15th September 2017).Google Scholar