Ubuntu as a mediator in coping with multimorbidity treatment burden in a disadvantaged rural and urban setting in South Africa

Nonzuzo Mbokazi; Myrna van Pinxteren; Katherine Murphy; Frances S Mair; Carl R May; Naomi S Levitt

doi:10.1016/j.socscimed.2023.116190

Ubuntu as a mediator in coping with multimorbidity treatment burden in a disadvantaged rural and urban setting in South Africa

Soc Sci Med. 2023 Oct:334:116190. doi: 10.1016/j.socscimed.2023.116190. Epub 2023 Aug 28.

Authors

Nonzuzo Mbokazi¹, Myrna van Pinxteren², Katherine Murphy¹, Frances S Mair³, Carl R May⁴, Naomi S Levitt¹

Affiliations

¹ Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa.
² Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa. Electronic address: Myrna.vanpinxteren@uct.ac.za.
³ Institute of Health and Well-Being, University of Glasgow, Scotland, UK.
⁴ Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, NIHR North Thames Applied Research Collaboration, UK.

PMID: 37659263
DOI: 10.1016/j.socscimed.2023.116190

Abstract

Background: People living with multimorbidity in economically precarious circumstances in low- and middle-income countries (LMICs) experience a high workload trying to meet self-management demands. However, in countries such as South Africa, the availability of social networks and support structures may improve patient capacity, especially when networks are governed by cultural patterns linked to the Pan-African philosophy of Ubuntu, which promotes solidarity through humanness and human dignity. We explore the mediating role Ubuntu plays in people's ability to self-manage HIV/NCD multimorbidity in underprivileged settings in urban and rural South Africa.

Methods: We conducted semi-structured interviews with 30 patients living with HIV/NCD multimorbidity between February-April 2022. Patients attended public health clinics in Gugulethu, Cape Town and Bulungula, Eastern Cape. We analysed interviews using framework analysis, using the Cumulative Complexity Model (CuCoM) and Burden of Treatment Theory (BoTT) as frameworks through which to conceptualise the data.

Results: Despite facing economic hardship, people with multimorbidity in South Africa were able to cope with their workload. They actively used and mobilized family relations and external networks that supported them financially, practically, and emotionally, allowing them to better self-manage their chronic conditions. Embedded in their everyday life, patients, often unconsciously, embraced Ubuntu and its core values, including togetherness, solidarity, and receiving Imbeko (respect) from health workers. This enabled participants to share their treatment workload and increase self-management capacity.

Conclusion: Ubuntu is an important mediator for people living with multimorbidity in South Africa, as it allows them to navigate their treatment workload and increase their social capital and structural resilience, which is key to self-management capacity. Incorporating Ubuntu and linked African support theories into current treatment burden models will enable better understandings of patients' collective support and can inform the development of context-specific social health interventions that fit the needs of people living with chronic conditions in African settings.

Keywords: Africa; HIV; Multimorbidity; Non-communicable diseases; Social support.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological
HIV Infections* / epidemiology
HIV Infections* / therapy
Humans
Multimorbidity
Noncommunicable Diseases*
South Africa / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding