Management of Chronic Comorbid Conditions Model: Context –Informed for Primary Health Care Settings in Kenya

Abstract

Comorbidity of non-communicable diseases, poses a new global challenge to health systems. Management of chronic conditions requires comprehensive care provision to those at risk and affected. The management process has to be cognizant of the cultural differences, attitude, beliefs and practices of the community, patients and health care providers. This study explored and analyzed current approaches to management of chronic comorbid diabetes and hypertension among adults in selected primary health care settings in Kenya and developed context informed model to guide management of chronic comorbid conditions in primary care settings. The study adopted a constructivist, qualitative approach and a combination of focused ethnography and grounded theory research designs towards development of context informed model. Ethnography design was used in data collection through participant observation; structured interviews, document analysis and focus group discussion. The study used constant comparative method in the field to ensure rich data collection. Study sites comprised; seven health care facilities in Nandi county, Kenya and 40 informants. Data was analyzed using the three phases Open, axial and selective coding as presented in Strauss and Corbin substantive model. We developed a model for management of chronic comorbid conditions presented as: concepts of the model; the context, political commitment; integrated health service delivery; guiding principles and expected outcomes. Several basic assumptions in management of chronic comorbid conditions also emerged. This model is a new addition to management of chronic comorbid conditions, particularly in primary care settings, and further in-corporates a devolved health care service provision, aimed at achieving quality of life and informed patients. Comorbidity of non-communicable diseases, poses a new global challenge to health systems. Management of chronic conditions requires comprehensive care provision to those at risk and affected. The management process has to be cognizant of the cultural differences, attitude, beliefs and practices of the community, patients and health care providers. This study explored and analyzed current approaches to management of chronic comorbid diabetes and hypertension among adults in selected primary health care settings in Kenya and developed context informed model to guide management of chronic comorbid conditions in primary care settings. The study adopted a constructivist, qualitative approach and a combination of focused ethnography and grounded theory research designs towards development of context informed model. Ethnography design was used in data collection through participant observation; structured interviews, document analysis and focus group discussion. The study used constant comparative method in the field to ensure rich data collection. Study sites comprised; seven health care facilities in Nandi county, Kenya and 40 informants. Data was analyzed using the three phases Open, axial and selective coding as presented in Strauss and Corbin substantive model. We developed a model for management of chronic comorbid conditions presented as: concepts of the model; the context, political commitment; integrated health service delivery; guiding principles and expected outcomes. Several basic assumptions in management of chronic comorbid conditions also emerged. This model is a new addition to management of chronic comorbid conditions, particularly in primary care settings, and further in-corporates a devolved health care service provision, aimed at achieving quality of life and informed patients.