Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya.

Rae Dong,Claudia Leung,Valentin Fuster,Tom Valente,David Edelman,Gerald S Bloomfield,Violet Naanyu,Mackenzie N Naert,Carol R Horowitz,Jemima Kamano,Peninah Kiptoo,Diana Menya,Simon Manyara,Esther Matini,Sonak D Pastakia,Rajesh Vedanthan,Winnie Matelong,Vitalis Orango,Nelly Oelke

doi:10.1371/journal.pone.0248496

Abstract

BackgroundNon-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known.MethodsTwo types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes.ResultsWe conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. In the context of poverty and previous experiences with the health system, participants described challenges to NCD care across three themes: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility. However, they also outlined windows of opportunity and facilitators of group medical visits and microfinance to address those challenges.DiscussionOur qualitative study revealed actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also described opportunities to address and mitigate the impact of these factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.

Highlights

Our qualitative study revealed actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for Non-communicable diseases (NCDs) care
Non-communicable diseases (NCDs) are the leading cause of mortality in the world, with 80% of this burden occurring in low- and middle-income countries (LMICs) [1]
Combining the group-based experience of MF with a group medical visit (GMV) is a novel approach to NCD care delivery that has the synergistic potential to improve health care access and quality, increase the strength of social networks among group members, and improve clinician-patient trust, in addition to other social determinants of health

Summary

Introduction

Non-communicable diseases (NCDs) are the leading cause of mortality in the world, with 80% of this burden occurring in low- and middle-income countries (LMICs) [1]. MF activities have been shown to reduce poverty and improve health outcomes [8] Another innovative care delivery approach is the group medical visit (GMV), which is a clinical encounter involving a group of patients, and has been shown to increase the efficiency of care delivery, quality of care, enhance social support, and encourage self-efficacy [9, 10]. Combining the group-based experience of MF with a GMV is a novel approach to NCD care delivery that has the synergistic potential to improve health care access and quality, increase the strength of social networks among group members, and improve clinician-patient trust, in addition to other social determinants of health. Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. The contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known

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