Multiple long-term conditions (MLTCs)

Current research into MLTCs.

Overview

This project explores how socioeconomic deprivation impacts self-management of multiple long-term conditions (MLTCs). The first phase of this project was originally funded by the NIHR School for Primary Care Research (SPCR) and commenced on November 2021. The first phase comprised of systematic reviews and a large qualitative study with the population and their carers. The second phase comprises an additional qualitative study with primary care health care professionals and the development of a recommendations for MLTC care and started April 2024. The third phase includes the development of a digital toolkit to support self-management of MLTCs and started in June 2025. 

Principal Investigator: Dr Megan Armstrong 

Co-investigators: Professor Kate Walters (UCL); Professor Fiona Stevenson (UCL); Professor Carolyn Chew-Graham (University of Keele); Professor Jo Protheroe (University of Keele); Professor Caroline Mitchell (University of Keele); Professor Steph Taylor (QMUL); Dr Jamie Ross (QMUL); and Professor Nathan Davies (QMUL).

Background

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 experiencing socioeconomic deprivation 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 this population and the reasons why this is, or how it can be addressed, has seldom been explored.

Findings from phase one and two

Qualitative interviews with 18 health care professionals working in primary care within areas of deprivation have been conducted. The aim was to explore how MLTCs are currently managed within these areas and implementation barriers. The paper is currently being drafted for publication.

Tasmin Rookes

Overview

The team in CAPS are developing a self-management toolkit for people living with MLTCs experiencing socioeconomic deprivation to manage the symptoms related to their health conditions. Embedded within this project, is a post-doctoral fellowship building on the work conducted in Tasmin’s PhD, exploring the additional support needs of people with mild cognitive impairment (MCI) to engage with and benefit from the intervention. 

This project will include a systematic review, co-design workshops and a feasibility study:

Systematic Review

A mixed methods review exploring the impact MCI has on the management of MLTCs and the related symptoms.

Co-design Workshops

Once the initial prototype has been developed, two co-design workshops will be held with people experiencing socio-economic deprivation, living with MLTCs and experiencing subjective memory complaints. Adaptations from the guideline developed as part of Tasmin’s PhD will be explored to apply the relevant specific support needs for people with MCI to engage with and benefit from this intervention to ensure it is suitable for all. We will identify and rank the specific aspects of this intervention and how it can be further refined to support people with mild cognitive impairment to engage and benefit from it. These adaptations will be fed back to the toolkit development team and implemented into the toolkit design. 

Feasibility testing and qualitative interviews

An additional group of participants with MLTCs and their carers, who have MCI will be recruited to test the toolkit developed as part of the main project. Their involvement will follow the same design as the main study. Quantitative outcomes and digital engagement between those with healthy cognition for their age and those with MCI will be compared to explore any differences. All participants with MCI and/or carers who receive access to the toolkit will be invited to be interviewed about their experience of taking part, to understand any barriers and facilitators to engagement and perceived benefits related to cognition.