Community engagement to inform development of strategies to improve referral for hypertension: perspectives of patients, providers and local community members in western Kenya

BMC Health Services Research

Research Article

Josephine Andesia¹  Constantine Akwanalo¹  Hillary Koros¹  Benson Njuguna²  Gerald Bloomfield³  Jemima Kamano⁴  Sonak Pastakia⁵  Rajesh Vedanthan⁶  Tim Mercer⁷  Violet Naanyu⁸ 

[1] Academic Model Providing Access to Healthcare (AMPATH), Nairobi, Kenya;Department of Clinical Pharmacy & Practice, Moi Teaching and Referral Hospital, Nairobi, Kenya;Department of Medicine, Duke University School of Medicine &, Duke Global Health Institute, Durham, USA;Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Nairobi, Kenya;Department of Pharmacy Practice & Center for Health Equity & Innovation, Purdue University College of Pharmacy, West Lafayette, USA;Department of Population Health & Department of Medicine, New York University Grossman School of Medicine, New York, USA;Department of Population Health & Department of Medicine, University of Texas at Austin, Austin, USA;Department of Sociology Psychology and Anthropology, School of Arts and Social Sciences, Moi University, Nairobi, Kenya;

关键词: Hypertension;    Referral networks;    Barriers to care;    Health information technology;    Peer support;    LMIC;    Implementation research;   

DOI  :  10.1186/s12913-023-09847-0

 received in 2022-10-31, accepted in 2023-07-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHypertension is the leading cause of death and disability. Clinical care for patients with hypertension in Kenya leverages referral networks to provide basic and specialized healthcare services. However, referrals are characterized by non-adherence and delays in completion. An integrated health information technology (HIT) and peer-based support strategy to improve adherence to referrals and blood pressure control was proposed. A formative assessment gathered perspectives on barriers to referral completion and garnered thoughts on the proposed intervention.MethodsWe conducted a qualitative study in Kitale, Webuye, Kocholya, Turbo, Mosoriot and Burnt Forest areas of Western Kenya. We utilized the PRECEDE-PROCEED framework to understand the behavioral, environmental and ecological factors that would influence uptake and success of our intervention. We conducted four mabaraza (customary heterogenous community assemblies), eighteen key informant interviews, and twelve focus group discussions among clinicians, patients and community members. The data obtained was audio recorded alongside field note taking. Audio recordings were transcribed and translated for onward coding and thematic analysis using NVivo 12.ResultsSpecific supply-side and demand-side barriers influenced completion of referral for hypertension. Key demand-side barriers included lack of money for care and inadequate referral knowledge. On the supply-side, long distance to health facilities, low availability of services, unaffordable services, and poor referral management were reported. All participants felt that the proposed strategies could improve delivery of care and expressed much enthusiasm for them. Participants appreciated benefits of the peer component, saying it would motivate positive patient behavior, and provide health education, psychosocial support, and assistance in navigating care. The HIT component was seen as reducing paper work, easing communication between providers, and facilitating tracking of patient information. Participants also shared concerns that could influence implementation of the two strategies including consent, confidentiality, and reduction in patient-provider interaction.ConclusionsAppreciation of local realities and patients’ experiences is critical to development and implementation of sustainable strategies to improve effectiveness of hypertension referral networks. Incorporating concerns from patients, health care workers, and local leaders facilitates adaptation of interventions to respond to real needs. This approach is ethical and also allows research teams to harness benefits of participatory community-involved research.Trial registrationClinicaltrials.gov, NCT03543787, Registered June 1, 2018. https://clinicaltrials.gov/ct2/show/NCT03543787

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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