Promoting chronic disease management in persons with complex social needs: A qualitative descriptive study

Area of Science:

• Health Equity
• Chronic Disease Management
• Social Determinants of Health

Background:

• Health inequity in chronic disease management disproportionately affects socially complex individuals.
• Existing programs often fail to meet the needs of socially complex patients, leading to poor outcomes and high healthcare utilization.
• Social complexity presents unique challenges in accessing and engaging with traditional healthcare services.

Purpose of the Study:

• To identify challenges in availability, accessibility, and acceptability of Chronic Disease Management Programs (CDMPs) for socially complex patients with Chronic Obstructive Pulmonary Disease (COPD).
• To understand how contextual and personal factors influence chronic disease self-management in this population.
• To evaluate the alignment of conventional CDMPs with the needs of socially complex patients.

Main Methods:

• Qualitative descriptive study utilizing a health equity lens.
• Data collection through interviews with patients and managers, and a focus group with providers.
• Thematic analysis of qualitative data using Braun and Clarke's approach.

Main Results:

• Poverty, disability, personal beliefs (shame, mistrust), and healthcare system barriers profoundly impact patients' ability to manage chronic disease.
• Traditional CDMPs inadequately address the critical needs of socially complex patients.
• Accessibility and acceptability issues significantly influence how these patients manage their chronic illness.

Conclusions:

• Individualistic self-management approaches in conventional CDMPs are misaligned with the circumstances of many socially complex patients.
• Current programs require adaptation to better serve individuals facing social complexity.
• Development and evaluation of innovative, guided care models are essential to enhance health and self-efficacy for this population.