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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

Author

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

Abstract

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.

Suggested Citation

  • Rae Dong & Claudia Leung & Mackenzie N Naert & Violet Naanyu & Peninah Kiptoo & Winnie Matelong & Esther Matini & Vitalis Orango & Gerald S Bloomfield & David Edelman & Valentin Fuster & Simon Manyara, 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-commun," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-11, June.
    • Handle: RePEc:plo:pone00:0248496
    DOI: 10.1371/journal.pone.0248496
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    References listed on IDEAS

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    1. Sima Berendes & Peter Heywood & Sandy Oliver & Paul Garner, 2011. "Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies," PLOS Medicine, Public Library of Science, vol. 8(4), pages 1-10, April.
    2. Paul Gertler & David I. Levine & Enrico Moretti, 2009. "Do microfinance programs help families insure consumption against illness?," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 257-273, March.
    3. Gutiérrez, Miguel, 2009. "Las microfinanzas: el sistema financiero en Guatemala," Financiamiento para el Desarrollo 5189, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL).
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