Bridging gaps: a qualitative inquiry on improving paediatric rheumatology care among healthcare workers in Kenya

Abstract

Background Due to the paucity of paediatric rheumatologists in Kenya, it is paramount that we explore strategies to bridge clinical care gaps for paediatric rheumatology patients in order to promote early diagnosis, prompt referral, and optimal management. Purpose To identify proposed interventions which can improve the ability of non-specialist healthcare workers to care for paediatric rheumatology patients across Kenya. Methods We conducted 12 focus group discussions with clinical officers (community physician assistants), nurses, general practitioners and paediatricians across six regions in Kenya. Interviews were conducted, audio-recorded, transcribed verbatim, and analysed using MAXQDA 2022.2 software. Results A total of 68 individuals participated in the study; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and eight other healthcare workers. Proposed patient interventions included patient education and psychosocial support. Community interventions were outreach awareness campaigns, mobilising financial support for patients’ care, mobilising patients to access diagnostic and therapeutic interventions. Healthcare worker interventions include diagnostic, management, and referral guidelines, as well as research and educational interventions related to symptom identification, therapeutic strategies, and effective patient communication skills. In addition, it was highlighted that healthcare systems should be bolstered to improve insurance coverage and access to integrated multi-disciplinary clinical care. Conclusions Study participants were able to identify potential initiatives to improve paediatric rheumatology care in Kenya. Additional efforts are underway to design, implement and monitor the impact of some of these potential interventions,

Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study

“…Lack of understanding about disease, mechanism and prognosis may lead to misperception about the importance of ongoing clinic visits for disease control, and subsequent disease activity and damage [ 35 ]. In other places in sub-Saharan Africa, there is varied understanding of the severity and subtypes of pediatric rheumatic disease leading to frustration among providers, patients, and their families [ 36 ]. The limited knowledge of the diagnoses and management of chronic rheumatic diseases in general practitioners led to addressing the more urgent challenge of managing pain control rather than conclusively working towards diagnosis and treatment, resulting in delays and lack of a definitive diagnosis.…”