UCL Queen Square Institute of Neurology


Megan Armstrong

Summary of the project:

Overview - The project explores how socioeconomic status impacts on self-management of long-term conditions (multi-morbidity) and how self-management can be improved. The study comprises of two systematic reviews and a large qualitative study.

The project is funded for 18 months by the NIHR School for Primary Care Research (SPCR) and commenced on 1st November 2021.

Problem - Long-term health conditions are one of the biggest challenges to health care with 70% of all health and social care funding going to people with long-term health conditions, including 50% of primary care appointments. People from the lowest socioeconomic status groups have a 60% higher prevalence of having a long-term health condition, a 30% increase in severity of the condition and are twice as likely to have multiple long-term conditions compared with those from the higher socioeconomic groups. There is evidence that self-management interventions have reduced effectiveness in people from low socioeconomic groups and the reasons why this is, or how it can be addressed, has seldom been explored.

Systematic Reviews

One review looks at the views and experiences of people experiencing social and economic deprivation and who are managing more than one long-term health condition. The other view looks at studies that have tried to improve the way these people manage their conditions.  We will assess how well the research was conducted and therefore how reliable the findings are. These reviews will provide us with a summary of all the current evidence on this topic.

Qualitative Study

The qualitative study builds on the findings from the systematic review by speaking with people who are currently experiencing social and economic deprivation, and who have multiple long-term health conditions. As part of this we will also be speaking to people’s care givers. The research team will ask participants about what makes managing their health conditions harder or easier. Researchers will explore how education, income, access to information, their expectations, Covid-19 and attitudes to health and government policies might impact self-management in this group. This will help identify factors so self-management support and resources are more inclusive for disadvantaged people and to help them manage their health conditions.

Approach to qualitative study:

The research team will conduct semi-structured one-to-one interviews with between 35-50 people and their care givers. Interviews will be carried out face-to-face or virtual, depending on COVID-19 restrictions). Those eligible are people with multi-morbidity who live in areas of high deprivation (bottom 30% as categorised by the Index of Multiple Deprivation), and who identify as being from a low socioeconomic group. Recruitment is expected to begin in Spring 2022 following ethical approval.​​​​​​​