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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.

Publication ,  Journal Article
Dong, R; Leung, C; Naert, MN; Naanyu, V; Kiptoo, P; Matelong, W; Matini, E; Orango, V; Bloomfield, GS; Edelman, D; Fuster, V; Manyara, S ...
Published in: PLoS One
2021

BACKGROUND: 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. 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. METHODS: Two 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. RESULTS: We 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. DISCUSSION: Our 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.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2021

Volume

16

Issue

6

Start / End Page

e0248496

Location

United States

Related Subject Headings

  • Stakeholder Participation
  • Social Stigma
  • Rural Population
  • Qualitative Research
  • Noncommunicable Diseases
  • Medical Assistance
  • Male
  • Kenya
  • Humans
  • Health Services Accessibility
 

Citation

APA
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MLA
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Dong, R., Leung, C., Naert, M. N., Naanyu, V., Kiptoo, P., Matelong, W., … Vedanthan, R. (2021). 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. PLoS One, 16(6), e0248496. https://doi.org/10.1371/journal.pone.0248496
Dong, Rae, Claudia Leung, Mackenzie N. Naert, Violet Naanyu, Peninah Kiptoo, Winnie Matelong, Esther Matini, et al. “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.PLoS One 16, no. 6 (2021): e0248496. https://doi.org/10.1371/journal.pone.0248496.
Dong R, Leung C, Naert MN, Naanyu V, Kiptoo P, Matelong W, Matini E, Orango V, Bloomfield GS, Edelman D, Fuster V, Manyara S, Menya D, Pastakia SD, Valente T, Kamano J, Horowitz CR, Vedanthan R. 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. PLoS One. 2021;16(6):e0248496.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2021

Volume

16

Issue

6

Start / End Page

e0248496

Location

United States

Related Subject Headings

  • Stakeholder Participation
  • Social Stigma
  • Rural Population
  • Qualitative Research
  • Noncommunicable Diseases
  • Medical Assistance
  • Male
  • Kenya
  • Humans
  • Health Services Accessibility