Patient capacity and constraints in managing multimorbidity: a qualitative study in primary care settings in Kerala, India

BACKGROUND: Multimorbidity, the coexistence of multiple chronic conditions, poses significant challenges to patients, particularly in low- and middle-income countries (LMICs) like India. Limited research has been done to understand the patient treatment burden and capacity from India, which is essential to design and implement effective interventions for managing multimorbidity. We explored the barriers and facilitators to patient capacity for managing multimorbidity in primary care settings in Kerala, India. METHODS: We conducted a qualitative study using semi-structured interviews with patients diagnosed with two or more chronic conditions (n = 42) seeking care in primary care settings in Kerala. Data were analysed thematically using two conceptual frameworks of treatment burden and patient capacity: Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) as theoretical lenses. FINDINGS: Our findings show that the complexity of conditions, financial constraints, and cultural practices were barriers to patient capacity. Facilitators that contributed to patient capacity were social support, accessible healthcare, and a positive attitude towards health. Primary care services provide selective care for patients with multimorbidity, leading to treatment burdens outweighing patient capacity. Financial constraints further impacted participants' ability to access out-of-pocket medications. CONCLUSION: This study highlights how the complexity of multimorbidity and financial constraints in primary care settings in Kerala influences patient capacity. Understanding how treatment burden and patient capacity influence patients in India and similar LMIC settings will enable the design of interventions that enhance patient capacity and reduce treatment burden within the cultural and health system context.