Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators
Authors
Tazeen Jafar
Program in Health Services & Systems Research, Duke NUS Medical School, Singapore, 169857 Singapore
Chandrika Ramakrishnan
Program in Health Services & Systems Research, Duke NUS Medical School, Singapore, 169857 Singapore
Oommen John
The George Institute for Global Health, University of New South Wales, New Delhi, India
Abha Tewari
The George Institute for Global Health, University of New South Wales, New Delhi, India
Benjamin Cobb
Duke Global Health Institute, Duke University, Durham, NC USA
Helena Legido-Quigley
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
Yoon Sungwon
Program in Health Services & Systems Research, Duke NUS Medical School, Singapore, 169857 Singapore
Vivekanand Jha
The George Institute for Global Health, University of New South Wales, New Delhi, India
Keywords:
CKD, Barriers, Facilitators, Rural, Qualititative research, India
Abstract
Despite the high and rising burden of chronic kidney disease (CKD) in South Asia, factors that influence access to CKD care at the community level have not been studied previously, especially in the rural areas. We conducted a mixed methods study and interviewed key stakeholders to explore the views and experiences of key stakeholders, and identify barriers and potential facilitators that influence access to CKD care at the primary care level in rural India.
Methods
A total of 21 stakeholders participated in the study. We conducted 15 in-depth interviews on a purposive sample of stakeholders (CKD patients, healthcare providers and health planners) and one focus group discussion with 6 community health workers. The interviews were audio-recorded and transcribed verbatim. We employed the Lévesque’s framework for access to care to base interview guides and structure the initial codes. By inductive and deductive approaches, thematic analysis was undertaken using QSR NVivo version 11.
Results
The major patient-level barriers to CKD care as reported by the most patients and healthcare providers was poor knowledge and awareness of CKD. Health system-level barriers included shortages of skilled healthcare professionals and medicines, fragmented referrals pathways to the specialists at the hospitals with inadequate follow up care. Many patients and healthcare providers, when asked about areas for improving access to CKD care, reported educational initiatives to increase awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a systems-level approach to care coordination including task shifting by engaging community health workers in CKD care, as potential facilitators.
Conclusions
We identified several barriers to access CKD care at the primary care level in rural India that need urgent attention. Targeted CKD screening programs and CKD specific educational initiatives may improve awareness of CKD. Additionally, primary care infrastructure needs to be strengthened for CKD care, ensuring trained staff, availability of essential diagnostics and medications, and creating efficient referral pathways for quality CKD care.
Keywords: CKD, Barriers, Facilitators, Rural, Qualititative research, India
Author Biography
Tazeen Jafar, Program in Health Services & Systems Research, Duke NUS Medical School, Singapore, 169857 Singapore
Duke Global Health Institute, Duke University, Durham, NC USA
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