Facilitation Strategies and Challenges in the Management of Chronic Comorbid Conditions (Diabetes and Hypertension) in Kenya.

Abstract

Management of chronic conditions requires a comprehensive care provision to both at risk and affected. Comorbidity of non- communicable diseases pose a new global challenge to health systems, particularly those in resource limited settings. The effort towards provision of health for all to meet global goal of universal health coverage and the big four government agenda requires an in-depth comprehension of broad structural and general conditions which may challenge and facilitate the management of chronic comorbid conditions within the health care settings. The purpose of this paper is to describe facilitation strategies and challenges in the management of chronic comorbid conditions (Diabetes and Hypertension) in primary health care settings in Kenya. The study adopted a constructivist, qualitative approach and a combination of focused ethnography and grounded theory research designs. Ethnography design was used during data collection utilizing the following triangulated data collection methods: participant observation; structured interviews, document analysis and focus group discussion. Study used constant comparative method in the field to ensure rich data collection. The study sites comprised; seven health care facilities and 40 informants (patients, care providers and administrators) who were purposively selected in Nandi County, Kenya. Data was analyzed using Open, axial and selective coding as presented in Strauss and Corbin substantive model. The study results were affected by Family involvement in care, government commitment to fund health resources, accessibility to chronic care services, community participation and involvement, and preparedness for self-management. Limited knowledge on comorbid conditions, belief systems, cost implications, and provider-patient perceived factors. Results of this study were also important forms the basis for strategic planning towards improving chronic care and improving the quality of life for people living with multiple comorbid chronic conditions.