How do carers, patients and primary care professionals make sense of the work of managing multiple long-term conditions in the context of socioeconomic deprivation?

Aim: To examine how patients with MLTC, informal carers, and community healthcare professionals (HCPs) understand and explain each other’s roles in MLTC management in areas of socioeconomic deprivation.

Design: Qualitative interview study using a critical contextualist framework. Participants were recruited through general practices across multiple sites in England serving populations experiencing socioeconomic deprivation.

Methods: Semi-structured interviews with 58 participants: 28 patients with MLTC, 12 informal carers, and 18 community HCPs, analysed using thematic synthesis informed by a critical contextualist paradigm.

Results: Results are presented as three meta-themes: Management in the context of poverty; Roles and responsibilities; and Knowledge, expertise and decision-making. Participants in all three groups described poverty and system-level barriers as profoundly shaping MLTC management. Groups held conflicting understandings of roles and responsibilities within and outside consultations, and as a result responsibility for care coordination was often poorly defined between groups and insufficiently recognised. Patients and carers questioned whether professional expertise, grounded in formal biomedical knowledge, adequately accounted for their embodied understanding of living with multiple conditions. There was misalignment across groups about how decisions could be shared effectively.

Conclusions: Managing MLTC in deprived contexts requires better alignment on how decisions are made, formal support for carers’ distributed continuity work, and consultation practices that support triadic decision-making.

Patient or Public Contribution: Two PPIE members – one a patient with MLTC experiencing socioeconomic deprivation, one a carer in similar circumstances – contributed to all study stages, including recruitment, data collection, thematic synthesis, and critical review of the manuscript.