Table 4 Perceived benefits and concerns: Peer based and health information technology intervention in the STRENGTHS study
Peer based support | Illustrative excerpt | |
|---|---|---|
Benefitsa,b | Health education though peers | “With peer support, it is easier to educate people on the danger signs… when they are taught on the dangers, they tend to listen…” (KII, Clinician, Kocholya) |
Motivation for positive patient behavior | “We are being told most of the time to reduce salt, but we don’t do it. If you get a peer telling you, ‘I reduced salt and this is what happened,’ if you explain that to someone who is adding salt secretly, they will stop, because they will see your pressure is stable because you did it” (FGD, Patient, Mosoriot) | |
Follow up and reduced defaulter rates | “It will help to reduce the number of defaulters in the village.” (Baraza, Kocholya) | |
Psychosocial support | “I think it will be of help in terms of adherence and also just the psychosocial support because they will interact with more people who have hypertension and they will feel they are not alone” (FGD, Clinical Staff, Kitale) | |
Peers understand their lived experiences | “You use the person who really knows where the shoes pinches, so for example, if you use somebody who is hypertensive to address hypertensive clients, they will listen, ‘There is somebody who can understand us.’” (KII, Records, Webuye) | |
Assistance in navigating the health facility | “If maybe you are referred…he will explain to you… You won’t go there like someone blind because he will have already told you which office you will go to. [Upon arrival], you will find another one who will direct you at the referral and so there will be communication from one dispensary to the referral hospital.” (FGD, Patient, Turbo) | |
Patient advocate | “Other people come and pass you because they are known by the medical workers. So, he will be like your advocate.” (FGD, Patient, Kitale) | |
Reminder on clinic appointments | I think there is benefit, let’s say a woman forgets the clinic date. If there’s someone who will remind them—like two days to the clinic date, it will be very important (FGD, Patient, Mosoriot) | |
Concernsa,b | Confidentiality | “My worry is that I will be sharing health information about the condition of my body with someone that maybe comes from my location. Am concerned that he might be tempted to go and discuss with other community members how my body is weak or so” (FGD, Patient, Turbo) |
Health information technology | ||
Benefitsb | Easier communication between providers | “They also feel good because things like [laboratory] results, you can just get in the computer, rather than sending them again to the laboratory.” (FGD, Clinicians, Kocholya) |
Well-organized tracking of patient information | “Mostly now days we use the tablets and most of the information is easily traced…When am referring a patient, the other person can receive a message informing them to expect a client referred on that particular day. Also during follow up, you can get information that, this client that you saw, these are the recommendations, or this is what we have done to this patient, yeah, without even seeing that particular patient. Or if there are [laboratory] results, you get them electronically within a short period…” (FGD, Clinicians, Kocholya) | |
Reduced paper work | “You will carry a lot of information—that needed the whole of this building—within one small gadget and that information can be transferred to another point easily than getting a whole truck to transfer files of those clients.” (FGD, Clinician, Webuye) | |
Concerns | Sensitivity of HIT content and confidentialitya,b | “This is the secret—they don’t want the type of disease revealed…You know everybody has concerns about his disease getting known—he wants it to be a secret.” (Baraza, Burnt Forest) |
Patient consenta | “One concern, a patient will say like, ‘You are making my disease be known to other people.’ Now maybe the person didn’t want other people to know about their conditions. So maybe that could be a challenge which may arise.” (KII, CO, Burnt) | |
Reduced patient-clinician interactiona,b | “You come there and the clinician on the tablet all the time. You know, there is something called doctor-patient relationship…You are supposed to earn your patient’s confidence, if you are just on a machine and that reduces your interaction with the patient, that doesn’t seem to work very well…” (KII, Clinician, Webuye) | |