Context: Burden of Treatment Theory (BOTT) proposes poorer outcomes when the work of managing illness (treatment burden) outweighs an individual's capacity. Treatment burden is greater for people experiencing multimorbidity, particularly when living in areas of high socioeconomic deprivation (SED), where factors that reduce capacity (e.g. car access) also cluster. It is likely community factors (e.g. local assets) can enhance, or diminish individual capacity, but how these factors interact is unclear. Objective Explore how individual and community factors influence self-management of multimorbidity in the context of high SED. Study Design: 30 Qualitative semi-structured interviews, analysed thematically. Setting/Population: Individuals with >3 chronic conditions from a community experiencing high SED. Intervention: N/A Outcome Measures: N/A Results: Four key themes: biographical disruption as a catalyst - many successfully implemented lifestyle changes, almost all triggered by a diagnosis, most would not have made changes otherwise; "being known": many described "being known" in the community, creating security. However, there was also stigma of "being known" from their area, experienced in multiple spheres, influencing experience of wider systems. "Fear of failure" where attempts to make changes failed, it often resulted in fatalism, linked to experience of wider stigma. For these participants it was easier to not change, even if less than ideal, than risk failing/being judged, again; Holistic care: people valued care where they were "seen as a person", but experience was often biomedically focused. Interviewees recognised wider structural issues in the health service inhibiting this type of care eg. lack of time. For some reduced agency, particularly unwillingness to challenge staff, were key issues. Conversely, where people felt empowered to make decisions, that adapted to their context/values, this was generally in the context of strong relationships with primary care providers. Conclusion Capacity factors are important but rarely acknowledged, or addressed, by practitioners or health systems. The influence of social stigma on access/treatment decisions needs considered in health system delivery. Future research should explore interventions to empower people, particularly those experiencing stigma in their wider community. The biographical disruption of an illness should also be viewed as an opportunity for health promotion messages. [ABSTRACT FROM AUTHOR]