Interdisciplinary perspectives on multimorbidity in Africa: developing an expanded conceptual model

Multimorbidity is an emerging challenge for healthcare systems globally. It is commonly defined as the co-occurrence of two or more chronic conditions in one person, but the suitability and utility of this concept beyond high-income settings is uncertain. This article presents the findings from an interdisciplinary research initiative that drew together 60 academic and applied partners working in 10 African countries to critically consider existing concepts and definitions of multimorbidity, to evaluate their utility and limitations, and to co-develop an context-sensitive, interdisciplinary conceptual framing. This iterative process was guided by the principles of grounded theory and involved focus- and whole-group discussions during a three-day concept-building workshop, thematic coding of workshop discussions, and further post-workshop iterative development and refinement. The three main thematic domains that emerged from workshop discussions were: the disease-centricity of current concepts and definitions; the need to foreground what matters to people living with multimorbidity (PLWMM), families, and other stakeholders; and the need for conceptual breadth and flexibility to accommodate the contributions of multiple disciplinary perspectives and heterogeneity within and between different African countries. These themes fed into the development of an expanded conceptual model that centres the catastrophic impacts multimorbidity often has for PLWMM, their families and support structures, for service providers, and for resource-constrained healthcare systems.