Managing diabetes and hypertension in western Kenya

The Primary Health Integrated Care for Chronic Conditions (PIC4C) pilot project was launched in 2018 to strengthen prevention and control of four non-communicable conditions at primary health care level in western Kenya. We conducted a qualitative study to explore the extent to which PIC4C integrated services supported people with hypertension and/or diabetes towards timely diagnosis and referral, treatment, follow-up and adherence, from the perspective of those receiving care. Semi-structured interviews were conducted with a purposively sampled patient cohort at two time points, with the intention of capturing changes over time (total (n) = 43, completion of both interviews (n) = 37). We extracted existing survey data to describe socio-demographic characteristics and analyzed qualitative data thematically. We identified two cross-cutting contextual factors, individual’s financial resources and their social situation, which shaped each stage of their interactions with PIC4C services. The PIC4C model successfully engaged people in accessing screening services to enable timely diagnosis and referred them to enter care. Free community level screening services and decentralization of care to lower level facilities reduced cost barriers for patients. However, retention in care and adherence to treatment were affected by the wider system context in which PIC4C was operating, including inconsistencies in medication availability and patients’ limited financial capacity. Individually tailored advice from health care workers to work around some of these challenges supported self-management strategies. Further development of the service should focus on supporting health care workers to adopt flexible, contextually responsive approaches in order to support patients facing economic and other constraints to engage in (self) care

Business · Chronic care · Decentralization · Family medicine · Focus group · Health care · Integrated care · Political science · Primary care · Qualitative property · Qualitative research · Referral · Chronic Disease Management Strategies · Diabetes Management and Education · Medicine · Nursing · Primary Care and Health Outcomes · Marketing

• ‘You can sleep hungry just to buy the medicine’

  Open Access•Ruth Willis, Daniel Mbuthia et al.•SSM - Qualitative Research in…•2025

  Añadir item

• Access to hypertension services and health-seeking experiences in rural Coastal Kenya

  Open Access•Robinson Oyando, Nancy Kagwanja et al.•PLOS Global Public Health•2025

  Añadir item

• The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement

  Open Access•Erik Von Elm, David G Altman et al.•PLoS Medicine•2007

  Añadir item

• Cumulative complexity

  Open Access•Nathan D Shippee, Nilay D Shah et al.•Journal of Clinical Epidemiology•2012

  Añadir item

• A Protocol on Using the RE-AIM Framework in the Process Evaluation of the Primary Health Integrated Care Project for Four Chronic Conditions in Kenya

  Open Access•Violet Naanyu, Hillary Koros et al.•Frontiers in Public Health•2022

  Añadir item

• Solving the problem of access to cardiovascular medicines

  Open Access•D N Tran, I Manji et al.•BMJ Global Health•2020

  Añadir item

• Patient experiences of diabetes and hypertension care during an evolving humanitarian crisis in Lebanon

  Open Access•Ruth Willis, Chaza Akik et al.•PLOS Global Public Health•2023

  Añadir item

• Understanding the treatment burden of people with chronic conditions in Kenya

  Open Access•Hillary Koros, Ellen Nolte et al.•PLOS Global Public Health•2023

  Añadir item

• It is like an umbrella covering you, yet it does not protect you from the rain”

  Open Access•Beryl Maritim, Adam D Koon et al.•International Journal for Equity…•2023

  Añadir item

• Evaluating the effectiveness of the National Health Insurance Fund in providing financial protection to households with hypertension and diabetes patients in Kenya

  Open Access•Robinson Oyando, Vincent Were et al.•International Journal for Equity…•2023

  Añadir item

• Development and validation of the Patient Experience with Treatment and Self-management (Pets)

  Open Access•David T Eton, Kathleen J Yost et al.•Quality of Life Research•2016

  Añadir item

• Using thematic analysis in psychology

  Open Access•Braun, Virginia Braun et al.•Qualitative Research in Psychology•2006

  Añadir item

• Experiences of multimorbidity in urban and rural Malawi

  Open Access•Edith Chikumbu, Christopher Bunn et al.•PLOS Global Public Health•2022

  Añadir item

• Chronic illness as biographical disruption

  Open Access•Michael Bury•Sociology of Health & Illness•1982

  Añadir item