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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This workshop on which this research was based was funded by the National Institute of Health and Care Research [Multilink Consortium, grant ref. NIHR201708, and the NIHR Leicester Biomedical Research Centre (BRC)], The Wellcome Trust [Multimorbidity and Knowledge Architectures: An Interdisciplinary Global Health Collaboration, grant ref. 222177] and the Department of Respiratory Sciences, University of Leicester, UK, supported by the British Academy and Global Challenges Research Fund [grant ref. GCRFNGR5\1242]. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Due to the collaborative research design employed, in which the participants were researchers (and vice versa) and with all co-authoring the manuscript, formal ethical review was not required for this research. The concept-building workshop on which the article is based was subject to the safeguarding mechanisms of the host organisation (Malawi-Liverpool-Wellcome Trust), which included anonymous reporting procedures. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes A detailed account of workshop proceedings, ratified by all participants, has been published in Wellcome Open [] The original rapporteur notes and other sources materials have not been made available as these would reveal the input of specific contributors, all of whom are named co-authors of the article.