Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers
Najma Siddiqi,
Meena Daivadanam,
J Jaime Miranda,
Trishul Siddharthan,
Gary Parker,
Gina Agarwal,
Naomi Levitt,
Pallab K Maulik,
Muralidhar M Kulkarni,
Gillian Sandra Gould,
Job F M van Boven,
Kirsten Bobrow,
M O Owolabi,
Joan B Soriano,
Erick Wan-Chun Huang,
Shahirose Sadrudin Premji,
Lijing Yan,
F Xavier Gómez-Olivé,
Bruce J Kirenga,
Rianne M J J van der Kleij,
Laura Loli-Dano,
Shane Norris,
Josefien van Olmen,
Antigona C Trofor
Affiliations
Najma Siddiqi
1 Department of Health Sciences, University of York, York, UK
Meena Daivadanam
9 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
J Jaime Miranda
CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
Trishul Siddharthan
1 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
Gary Parker
10 Institute for Global Health, University College London, London, UK
Gina Agarwal
Family Medicine, McMaster University, Hamilton, Ontario, Canada
Naomi Levitt
Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
Pallab K Maulik
Research, The George Institute for Global Health, New Delhi, India
Muralidhar M Kulkarni
1 Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
Gillian Sandra Gould
1 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
Job F M van Boven
Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
Kirsten Bobrow
Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
M O Owolabi
Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria
Objectives There is growing recognition around the importance of multimorbidity in low-income and middle-income country (LMIC) settings, and specifically the need for pragmatic intervention studies to reduce the risk of developing multimorbidity, and of mitigating the complications and progression of multimorbidity in LMICs. One of many challenges in completing such research has been the selection of appropriate outcomes measures. A 2018 Delphi exercise to develop a core-outcome set for multimorbidity research did not specifically address the challenges of multimorbidity in LMICs where the global burden is greatest, patterns of disease often differ and health systems are frequently fragmented. We, therefore, aimed to summarise and critically review outcome measures suitable for studies investigating mitigation of multimorbidity in LMIC settings.Setting LMIC.Participants People with multimorbidity.Outcome measures Identification of all outcome measures.Results We present a critical review of outcome measures across eight domains: mortality, quality of life, function, health economics, healthcare access and utilisation, treatment burden, measures of ‘Healthy Living’ and self-efficacy and social functioning.Conclusions Studies in multimorbidity are necessarily diverse and thus different outcome measures will be appropriate for different study designs. Presenting the diversity of outcome measures across domains should provide a useful summary for researchers, encourage the use of multiple domains in multimorbidity research, and provoke debate and progress in the field.
