Public Perceptions of Multiple Long-Term Conditions: An Analysis of Mass Observation Accounts

The growing number of people living with two or more long-term conditions presents challenges to medicine and society. While the terminology of 'multiple long-term conditions' (MLTC) or 'multimorbidity' has increasingly been adopted in research, policy and clinical practice, how the public responds to 'MLTC' remains underexplored. Given the important implications for research inclusion and intervention uptake, we aimed to address this gap by investigating public perceptions of MLTC.

Mass Observation Project respondents were invited to share their views on MLTC. We collated the five words that respondents were asked to provide when hearing the term 'multiple long-term health conditions' and compared the responses of people with and without MLTC. We then reviewed each full written account and identified categories describing the different ways in which the respondents referred to MLTC.

Of 141 valid responses, 76 (53.9%) were written by people living with MLTC, two thirds of whom (67.1%) were aged 60 or over. Regardless of MLTC status, respondents predominantly associated MLTC with challenging embodied experiences such as pain and debilitation. We identified four types of response to 'MLTC': adopting, overlooking, resisting and rejecting. Around half the respondents (51.8%) adopted the construct, with 11.3% resisting or rejecting it due to concerns about its utility, incongruence with personal experience, or medicalisation of human experiences of illness.

MLTC were predominantly associated with challenging embodied experiences, and the construct was not adopted by all respondents. Researchers, clinicians and policymakers should carefully consider how to describe the construct of MLTC in public-facing materials to optimise research inclusion and intervention uptake.

Co-author VB was a public co-investigator within the ADMISSION Research Collaborative. VB was involved from the outset of this project, contributing to the directive design, data interpretation workshops, critical review of the draft manuscript and approval of the final version. Findings from the study have also been discussed with the ADMISSION Patient Advisory Group, a diverse group of patients and carers with lived experience of MLTC who provided advice to ADMISSION Research Collaborative researchers at regular intervals throughout the lifetime of the funding.