CO-ACTION: Personalised social and self-management support for better living with multiple long-term conditions in the community.

Background: The prevalence of multiple long-term conditions/multimorbidity (MLTC-M) is rising. Current care primarily focuses on individual conditions, acute symptoms, and medication reviews, neglecting broader needs like mobility, functioning, social isolation, mental health, and well-being, leading to fragmentation of care. Access to joined up health, social care and voluntary support services is limited. This results in a high incidence of unplanned hospital admissions, lack of personalised attention and higher costs. Aims and Objectives: To enhance health and well-being by adopting a bio-psychosocial approach, we are designing, evaluating, and implementing a personalised multisectoral intervention called CO-ACTION. It will focus on commonly experienced problems associated with MLTC-M, moving away from a narrow condition specific focus. The programme will involve people living with MLTC-M through five Work Packages (WPs) detailed below: WP1: Engaging Underserved MLTC-M Groups Participatory co-production methods and capacity building to engage underserved MLTC-M groups (low income, ethnic minorities and non-English speaking groups) will be undertaken. It will build relationships through peer support meetings, trust-building, facilitation, dialogue, listening, and non-judgmental engagement. Focus groups, interviews, and surveys will be used based on community preferences. WP2: Identifying High-Impact MLTC-M Groups and Designing the Intervention Medical records will be analysed to identify high-impact MLTC-M groups, and a risk prediction model will be developed using regression analysis/economic analyses. A systematic literature review will inform intervention characteristics and outcome measures for our MLTC-M target groups. The CO-ACTION intervention will be designed through iterative stakeholder co-creation workshops with our MLTC-M target group. WP3: Evaluating the CO-ACTION Intervention The intervention will be evaluated in a multi-centre 1:1 randomized pragmatic controlled trial involving 500 people with MLTC-M and carers across three sites (Southampton, Plymouth, and Manchester/Leeds). An embedded cost-effectiveness and qualitative process evaluation will be conducted. The intervention is likely to include: Personalised needs assessment to develop a shared understanding and identify the biggest problems affecting wellbeing for patients/carers. Priority-based support, providing a single point of contact and facilitating access to health, social, voluntary resources (multi-sectoral) through face-to-face and/or online/telephone support. Wellbeing, quality of life, unplanned hospital admissions and costs will be assessed at baseline, 6 and 12 months later. WP4: Implementation Strategies and Evaluation Normalisation Process Theory will be utilised to develop a logic model for adoption. Stakeholders will be involved in integration workshops, and the intervention will be tested in six diverse case study test sites. Implementation will be evaluated through mixed methods triangulation of sources and interviews, observations, questionnaires and health economic analyses. WP5: Anticipated Impact and Dissemination Dissemination, communication, and exploitation activities will target stakeholders through open access articles, community activities, conferences, and creative strategies. The impact of the CO-ACTION programme includes increased research participation of MLTC-M patients, improved well-being, enhanced visibility of the third sector in health, social care, and policy, optimized community support, MLTC-M researcher capacity building, and improved cost-effective care pathways for MLTC-M management. Timelines for Delivery: Over 54 months, MLTC-M patients, carers, and stakeholders will be involved in designing (0-18 months), evaluating (10-48 months), implementing and disseminating (32-54 months) the CO-ACTION intervention.