Abstract:
Background
Hypertension 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.
Methods
We 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 inuence uptake and success of our intervention. We conducted four
mabaraza, eighteen key informant interviews, and twelve focus group discussions among clinicians, patients
and community members. The data obtained was audio recorded alongside eld note taking. Audio recordings
were transcribed and translated for onward coding and thematic analysis using NVivo 12.
Results
Specic supply-side and demand-side barriers inuenced 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 benets 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 inuence
implementation of the two strategies including consent, condentiality, and reduction in patient-provider
interaction.
Conclusions
Appreciation 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 benets of participatory community-
involved research.
