Abstract:
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.
