Contextual Antecedent Conditions in the Management of Chronic Comorbid Diabetes and Hypertension in Primary Health Care Settings in Kenya.

Abstract

Non- Communicable Diseases (NCDs) emerges as a global burden, despite the efforts being put in place by World Health Organization (WHO) and other health related organizations. There is evidence that people with diabetes type 2 usually have more than one co-existing chronic conditions often including, hypertension being the leading condition yet healthcare systems are inadequately prepared to manage chronic comorbid conditions such as diabetes and hypertension. This study explored the antecedent or causal conditions relevant to the management of chronic comorbid diabetes and hypertension in Nandi County rural settings. Qualitative focused ethnography was used to collect data within the community and grounded theory method used for data analysis using the paradigm model. Purposeful sampling was used to select informants based on experience and expertise related to management of comorbid diabetes and hypertension. Data was collected through triangulation of participant observation, interviews, focus group discussion and document analysis. Interviews were tape recorded and transcribed verbatim and a series of coding was conducted leading to emergence of categories and core phenomenon of study. Results showed that management of chronic comorbid diabetes and hypertension in primary health care commenced as a result of contextually relevant actions and interactions taken to supervise the situation. These include: low literacy level on comorbid diabetes and hypertension; preventable high hospital admission; delays in seeking medical help, high premature mortality cases, lack of default tracing system and poor control levels in comorbid diabetes and hypertension. It was observed that patients with comorbid diabetes and hypertension require comprehensive, long term and timely interventions to improve health outcome and quality of life.