The impact of multiple long-term conditions on engaging with and maintaining behaviour change in older people with mild frailty: a qualitative study

Managing multiple long-term conditions (MLTCs) is a growing priority for health and social care systems, as MLTCs often lead to frailty and reduced resilience to adverse health events. Behaviour change interventions for this population have shown limited effectiveness. We developed HomeHealth, a home-based behaviour change intervention for older adults with mild frailty and evaluated it in a randomised controlled trial in England. As part of the process evaluation, we conducted a qualitative sub-study to examine barriers and facilitators to engagement, approaches to goal setting, and strategies for tailoring future interventions. Forty-nine participants with MLTCs who received HomeHealth were interviewed, within 6-months of their final intervention session. Participants had an average age of 80.3 years, 65% female, 76% white British, and lived with an average of 5.1 health conditions (range 2–11). Data were thematically analysed. Three themes were developed: (1) prioritising symptoms over conditions; (2) coping with and adapting to symptoms; and (3) tailoring goal setting for MLTCs. Impacts were driven by cumulative symptom burden rather than diagnoses, with mobility-related impairment being the primary concern. Symptom-focused goal setting supported engagement, but symptom fluctuations hindered progress. Findings underscore the importance of person-centred approaches. Targeting goals around functional impairment and symptom management may improve engagement compared to condition-focused strategies. Supporting adaptive behaviours during symptom exacerbations and providing positive feedback on effort, rather than completion, could sustain motivation and promote long-term behaviour change.