Twenty-seven participants were recruited across all six settings. The sample consisted of nine patients with multimorbidity, nine nurses, two physicians, four nutritionists, two physical therapists and one respiratory therapist. Participant characteristics are presented in Table 2. Interview length varied from 26 to 71 minutes and data saturation was reached after interviewing seven patients and 13 providers; two more patients and one of each type of provider (5) were interviewed with no new themes emerging.
Participants described 19 outcomes that we grouped according to the domain classification from our previous scoping review (21): Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. Thematic organization of domains and outcomes that have emerged from the qualitative description (in comparison with the preliminary framework) are presented in Table 3.
Health Management domain
Talking about their conditions and health behaviours helped patients by making them more aware of how they value their health and realize that their health is important to them.
“Confessions about alcohol consumption and smoking behaviours raised my awareness about the state of my health state [pause]. It made me aware that health was important for me.” (patient 1)
Knowledge was acquired concerning health-related behaviours, symptom management and long-term complications. A participant explained that he now knows how to adopt healthy eating behaviours using examples of plate size to demonstrate his understanding. Participants described knowledge acquisition as being newly mindful of the long-term complication of chronic diseases that prompted to better manage their health condition.
“I now have some tricks for doing physical activity without getting a “hypo” [hypoglycemia].” (patient 4)
Participants identified a new awareness of the power they had over their health and how it helped them regain control over it. In relation to power over health, a process of transfer of power over health decisions was described by participants.
“I have a healthcare team, but part of the power is mine, I want to take back the power over my life.” (patient 7).
Participants described feeling an increased capacity to self-manage their health and knowing when external assistance is necessary. Self-efficacy was further described as a patient’s initial success, producing a feeling of capacity. Being able to express, pursue and attain their own health goals was an important outcome for the participants.
“They are proud, it gives them so much self-confidence, to be able to have successes. It is wonderful, it gives them a feeling of capacity.” (provider 3)
Moreover, participants mentioned that goal attainment should be the principal outcome pursued by an intervention for patients with multimorbidity.
“Interviewer: Your objective was to not take medication? Participant: Yes, if I follow the recommendations for my eating habits, I should be able to obtain an acceptable cholesterol level.” (patient 9)
Participants described self-management of health conditions as an overarching result of other outcomes. Learning about their health conditions, complications and health-related behaviours were key components identified as helping patients act to manage their conditions.
“[…] they [patients] are going to better understand their diseases, and then feel responsible for their management.” (provider 12)
Physical Health domain
Physical health outcomes were described as an improvement in multiple physical manifestations of chronic conditions, including pain improvable by the multimorbidity intervention.
“I have less pain, better digestion, less diarrhea, less stomach pain.” (patient 7)
Increased energy levels to complete daily tasks and health-related behaviours were reported, helping patients to “get moving.” Participants added that improved disease management leads to an increase in available energy for daily tasks.
“It gives me fuel to start the day, it’s getting me moving.” (patient 7)
Weight loss and the ability to prevent further weight gain also constituted a relevant outcome described by participants. Regarding weight control, participants pointed out that a stable weight should also be considered significant for some patients.
“I have lost 15 pounds since July, and I am maintaining it.” (patient 5)
Functional Status domain
Overall physical health significantly influenced autonomy in daily activities. Participants further stated that health status improvement and pain control had an impact on patient autonomy in daily activities such as cooking, cleaning and getting dressed. It was described that the intervention helped patients understand the interlinked nature of their condition, indicating that improvements in health status increased their ability to complete daily tasks.
“They felt less limited, with fewer physical, psychological and physiological limitations that affected their daily living.” (provider 10)
Psychosocial Health domain
Participants reported that engaging in self-management reduced their anxiety. It was also identified that knowledge acquisition improved specific stressors and further acknowledged that transferring control of the health situation to patients was beneficial for patient anxiety.
“It helped me get moving and activate my brain, and that also calmed my anxiety.” (patient 7)
Well-being was described as a process of living with a positive mindset and accepting one’s health situation. Participants reported guilt reduction when they were told that they could make mistakes while engaging in their process of change.
“It helped me to live better, to better accept [pause] and live my life in relation with my health status.” (patient 1)
Health-related Behaviours domain
The physical activity outcome was described as new activities or changes in the type and duration of physical activities reported by patients.
“I have more energy and I want to get back into it [physical activity].” (patient 8)
Several outcomes were reported regarding patients’ eating behaviours including portion size, meal schedule, choice of food and the introduction of fruits and vegetables.
“But that’s it, it’s the quantity [of food] that I need to be aware of at home.” (patient 08)
“It’s about what is good to eat, choosing fish for example, and avoiding bad food, like high-fat food.” (patient 9)
Participants reported some improvement in smoking habits by cutting down from daily smoking to occasional smoking.
“My family physician told me several times that I needed to stop smoking and prescribed [nicotine] patches, but I was always relapsing, but the intervention was what I needed [to stop].” (patient 10)
A decrease in alcohol consumption was described as a change to non-alcoholic alternatives or fewer alcoholic beverages per day. Participants further explained that a reduction in alcohol consumption was linked to patient-centred objectives and readiness to change.
“Patients tell me: Since I’ve been drinking more water I have reduced my alcohol consumption.” (provider 3).
General Health domain
Reports of improved quality of life outcomes were described by participants as an overall effect of all factors influencing health. In terms of a general health outcome, participants also reported feeling healthier than before, saying that this had a positive influence on their overall mood. Participants described a life-changing experience brought by changing health habits and way of seeing health.
“With all the services, I would say that I have an 80% increase in quality of life […] you know, from having a place to be heard, get moral support and orientation.” (patient 7).
Health Services domain
Patients stated that their satisfaction with the health services received was closely related to a feeling of safety and an appropriate follow-up.
“I feel like I am in good hands, when I come here I feel like I’m going to get the answers that I rightfully deserve, I feel safe.” (patient 4).
Primary care physicians reported seeing patients less frequently because they were being followed up by an entire team of healthcare providers.
“I saw these patients less, I kind of lost sight of them because they went to improve their condition with other people [healthcare providers].” (provider 1)