Abstract
Background: There has been a rapid increase in morbidity and mortality arising from non-communicable diseases (NCDs). The Academic Model Providing Access to Healthcare (AMPATH) program has established a chronic disease management program in collaboration with the Ministry of Health (MoH) in Kenya at over 150 health facilities in western Kenya. The primary health integrated care for chronic (PIC4C) disease project seeks to deliver preventive, promotive, and curative care for diabetes, hypertension, cervical and breast cancers at the primary health care level. We apply the RE-AIM framework to conduct a process evaluation of the integrated PIC4C model. This paper describes the protocol we are using in the PIC4C process evaluation planning and activities.Methods and Analysis: This evaluation utilizes clinic reports as well as primary data collected in two waves. Using mixed methods (secondary data, observation, semi-structured interviews, and focus group discussions), the process evaluation assesses the reach, effectiveness, adoption, implementation and maintenance of the PIC4C model in Busia and Trans Nzoia Kenya. The evaluation captures the PIC4C process, experiences of implementers and users, and the wishes of those using the PIC4C services. We will analyse our data across the RE-AIM dimensions using descriptive statistics and two-sample t-test to compare the mean scores for baseline and end line. Qualitative data will be analyzed thematically.Discussion: The process evaluation of the PIC4C model in Kenya allows implementers and users to reflect and question its implementation, uptake and maintenance. Our experiences thus far suggest practicable strategies to facilitate primary health care can benefit extensively from deliberate process evaluation of the programs undertaken. Furthermore, integrating the RE-AIM framework in the process evaluation of health programs is valuable due to its pragmatic and reporting usefulness.
Highlights
Sub-Saharan Africa is home to 11% of the world’s population yet it accounts for the largest proportion of the global chronic disease burden [1]
This paper describes the use of the REAIM framework to evaluate the PIC4C integrated chronic care model for hypertension, diabetes, cervical and breast cancers within primary health care setting in Busia and Trans Nzoia counties of western Kenya
The following changes will be expected among patients: a drop of 10 systolic blood pressure (SBP) or 5 diastolic blood pressure (DBP); % of diabetes mellitus (DM) patients getting to
Summary
Sub-Saharan Africa is home to 11% of the world’s population yet it accounts for the largest proportion of the global chronic disease burden [1]. High healthcare expenses and reduced productivity associated with chronic diseases continue to impose huge strain on households and developing economies in low and middleincome countries, slowing economic and social development [3]. This underscores the need for well-designed chronic disease management interventions to improve service delivery and improve health outcomes [4, 5]. Innovative integrated care primary care models have been designed and piloted based on existing evidence for early diagnosis and management of chronic diseases yielding better health outcomes [7, 8]. This paper describes the protocol we are using in the PIC4C process evaluation planning and activities
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