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Developing an intervention prototype to support people with multimorbidity in addressing social care needs: What factors should be considered?

Holt, S. Z.; Smith, L.; Santer, M.; Davis, F.; Farmer, A.; Simpson, G.; Nwokedi, C.; Dambha-Miller, H.; Morrison, L.

2025-10-09 primary care research
10.1101/2025.10.08.25336767 medRxiv
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BackgroundPeople living with multimorbidity often face complex social care needs that significantly affect their health and wellbeing. Despite growing recognition of the importance of addressing these needs in primary care, practical and systemic barriers, such as time constraints, unclear professional roles, and fragmented service pathways, limit effective support. MethodsUsing the Person-Based Approach, we developed a dual-component intervention: (1) a brief screening tool for primary care professionals (PCPs) to identify patients with potential social care needs, and (2) a patient-facing self-navigation tool to help individuals recognise, prioritise, and plan responses to their needs. Sixteen patients and fifteen PCPs participated in think-aloud interviews. Data were analysed using a Table of Changes to inform real-time optimisation. ResultsParticipants appreciated the autonomy-supportive, personalised tone of the self-navigation tool and its journey-based framing. Managing expectations was essential to avoid misinterpretation, and acknowledging prior negative healthcare experiences helped build trust. PCPs valued the screening tools brevity and practicality but raised concerns about role clarity and integration into workflows. Both groups highlighted the importance of accessibility, digital inclusion, and the burden of multimorbidity. ConclusionFindings informed a practical checklist for future intervention design, including: (1) prioritising control and choice, (2) setting clear expectations, (3) minimising burden, (4) acknowledging past experiences, (5) clarifying roles, and (6) embedding tools within existing systems. This study offers actionable insights into person-centred intervention development and highlights the need for further evaluation to assess effectiveness and scalability in improving outcomes and system efficiency.

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