Management of Chronic Comorbid Conditions Model: Context –Informed for Primary Health Care Settings in Kenya.

Abstract

Comorbidity of non communicable diseases, posses a new global challenge to health systems. Management of chronic conditions require a comprehensive care provision to both at risk and affected by the coexisting conditions. Management process has to be cognizant of cultural differences, attitude, beliefs and practices of the community, patients and health care providers. The objective of this study was to explore and analyze current approaches to management of chronic comorbid diabetes and hypertension among adults in selected Primary Health Care settings in Kenya and further develop context informed model to guide management of chronic comorbid conditions in primary care settings. The study adopted a constructivist, qualitative approach and a combination of focused ethnography and grounded theory research designs towards the development of context informed model. Ethnography design was to collect data: participant observation; structured interviews, document analysis and focus group discussion. The study used constant comparative method in the field to ensure rich data collection. The study sites comprised; seven health facilities and 40 informants who were purposively selected. Data was analyzed using Open, axial and selective coding as presented in Strauss and Corbin substantive model.

Management of chronic comorbid conditions model was developed and, which is presented as: concepts of the model; the context, political commitment; integrated health service delivery; guiding principles and expected outcomes. Several basic assumptions to management of chronic comorbid conditions emerged. The model adds new literature on the management of chronic comorbid conditions, particularly in Primary care settings, and in-corporates a devolved health system into quality health care service provision, leading to improved quality of life and informed patients.