Coping with multiple chronic conditions: a mixed methods study

Multiple chronic conditions (MCCs) pose a significant burden on individuals’ health and present challenges for healthcare providers and systems. How people cope with chronic conditions is an important factor that influences their health. However, little research has been undertaken in this area, especially in Asian populations. Informed by the transactional theory of stress and coping (TTSC), this research aimed to explore coping in people with MCCs in China, where the population is ageing faster than almost any other country in modern history. More specifically, the current research aims were to: (1) validate the Brief Coping Orientation to Problems Experienced (COPE) inventory among Chinese people with MCCs, (2) examine the relationship between coping strategies, illness perceptions, socio-demographic characteristics, MCC-related characteristics, and quality of life (QoL) among Chinese people with MCCs, (3) investigate the experiences of coping with MCCs in Chinese people, and (4) identify the cultural effects on coping among this population. This research was conducted in a university-affiliated hospital based in north Anhui, China, from December 2017 to October 2018 following Human Research Ethics Committee approval of the University of Newcastle, Australia and the participating hospital. An explanatory, sequential, mixed methods design with a three-phase approach was employed: Phase (1) a validation phase of the Brief COPE inventory administered in 290 participants; Phase (2) a quantitative cross-sectional survey involving 351 participants examining associations between coping strategies, illness perceptions, QoL, and socio-demographic and clinical characteristics; and Phase (3) a qualitative face-to-face, semi-structured interviews study undertaken among 14 participants to explore people’s experiences of coping with MCCs. Results from the quantitative and qualitative phases were integrated into the final analysis. The key findings were: 1. A psychometrically sound, Chinese version of the Brief COPE inventory with five sub-scales was developed. 2. Participants reported high illness concerns over MCCs, duration of MCCs, and control of MCCs. They prioritised their chronic conditions for management. 3. Most participants used positive adaptation to cope with their chronic conditions with both problem-focused and emotional-focused strategies. 4. Seeking alternative treatments, changing lifestyles, and coping at the family level and social level were critical coping strategies, which were influenced by the Chinese culture. 5. People with MCCs had impaired QoL in physical and mental domains compared to the general population in China. Rural participants reported worse QoL than their urban peers. 6. Older age, lower educational level, and more chronic conditions were significantly associated with worse QoL among people with MCCs. 7. Psychological distress was common in older adults with MCCs and might account for poorer QoL scores. 8. Greater concerns about perceived illness consequences and timelines were associated with worse QoL. Frequent use of coping by denial and disengagement was related to worse QoL. Strong faith about perceived treatment control was linked with improved QoL. These findings serve as a basis for further psychometric research on coping in the Chinese population, as well as a reference for cross-culture coping research. Perceptions and coping strategies found in this study, especially the coping taxonomy ascertained, play a unique role in explaining QoL among people with MCCs. This work echoed Lazarus’s theory, there was a strong link between coping and individuals’ health. The current research provided evidence to support clinical practice in people with MCCs. Coping-based interventions that foster positive coping and alter negative illness perceptions of MCCs should be implemented. Cultural impact is a key factor in healthcare delivery in different social contexts. More attention should be primarily addressed to those in rural areas, those with lower educational backgrounds, and those having a greater number of chronic conditions.