Figure 3

Consider each tooth on each cog to represent a facet of context, mechanisms or outcomes. With all elements in place the outcome cog will turn at maximum pace. With teeth missing on any of the cogs each will still turn and influence the next but less efficiently. Without any part of the context, the triggering of all the mechanisms is less likely and, therefore, interventions to improve education and healthcare in multimorbidity are at risk of failure due to lack of attention to social processes and education.