Abstract
In this article, we explore how older British Pakistani people experience multimorbidity (defined as the coexistence of two or more medical conditions) and engage with self-management within the context of their life histories and relationships. We conducted biographical narrative interviews in Urdu and/or English with 15 first-generation Pakistani migrants living with multimorbidity, at their homes in East London. Our analysis showed that the triadic construct of family, faith, and health was central to how participants made sense of their lives, constituting notions of “managing” in the context of multimorbidity. For Pakistani patients, the lived experience of health was inseparable from a situated context of family and faith. Our findings have implications for existing public health strategies of self-management, underpinned by neoliberal discourses that focus on individual responsibility and agency. Health care provision needs to better integrate the importance of relationships between family, faith, and health when developing services for these patients.
Highlights
It is both a great success and a significant challenge for global health care systems that people are living longer
The aging population is accompanied by a higher prevalence of long-term conditions (LTCs) and multimorbidity—defined as the coexistence of two or more medical conditions (Barnett et al, 2012)
Our findings consistently demonstrate that, for this older Pakistani population with multimorbidity, the emotional and practical work of living with multimorbidity was underpinned by the support of their networks; most frequently consisting of the immediate family
Summary
It is both a great success and a significant challenge for global health care systems that people are living longer. Multimorbidity places burden on affected individuals and the health care system and is associated with increased unplanned hospitalizations and impaired quality of life (Marengoni et al, 2011). Self-management is the “lifetime task” of managing an LTC and is made more complex in the context of multimorbidity (Holman & Lorig, 2004). Corbin and Strauss (1988) described three groups of tasks that contribute to the self-management of LTCs: medical or behavioral management (e.g., taking medication, following a special diet), maintaining and creating new behaviors or life roles, and the emotional management of living with LTCs. Supporters of self-management claim that it empowers people to take control of their health (McCorkle et al, 2011). Formal self-management programs such as the United Kingdom’s Expert Patient Program form part of a larger policy discourse directed at containing the escalating burden and cost of multimorbidity (Donaldson, 2003)
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