چکیده (انگلیسی):

Background:Multimorbidity poses a major health burden worldwide yet most healthcare is still orientated towards
the management of single diseases. Literature on the experience of living with multimorbidity is accumulating but
has not yet been synthesised in a manner conducive to informing the design of self-management interventions for
this population. This study aimed to systematically review and synthesise findings from published, in-depth qualitative
studies about the experience of multimorbidity, witha view to identifying the components and motivation for
successful self-management in this population.
Methods:Systematic review of and meta-synthesis of qualitative studies that evaluated patient experience of
living with and/or self-managing mental and/or physical multimorbidity. MEDLINE, Embase, PsycINFO, CINAHL,
and ASSIA along with reference lists of existing reviews and content pages of non-indexed specialists comorbidity
journals were searched.
Results:Nineteen studies from 23 papers were included. A line of argument synthesis was articulated around three
third-order constructs: 1) Encounters with complexity; 2) Marshalling medicines, emotions, and resources; and 3)
Self-preservation and prevention. Our interpretation revealed how mental and physical multimorbidity is experienced
as moments of complexity rather than mere counts of illnesses. Successful self-management of physical symptoms was
contingent upon the tactical use of medicines, whilst emotional health was more commonly managed by engaging in
behavioural strategies, commonly with a social or spiritual component. Motivations for self-management were
underpinned by a sense of moral purpose to take responsibility for their health, but also by a desire to live a purposeful
life beyond an immediate context of multimorbidity.
Conclusions:Understanding how people experience the complexities of mental and physical multimorbidity may be
crucial to designing and delivering interventions to support successful self-management in this population.
Future self-management interventions should aim to support patients to exert responsibility and autonomy for
medical self-management and promoteagency and self-determination to lead purposeful lives via improved
access to appropriate social and psychological support.