By Joyce Chimbi
Nairobi, Kenya: With the rise in chronic disease burden, patients are increasingly seeking relief through both conventional and traditional healthcare options. Scientists say there is an urgent need to explore what determines a patient’s satisfaction with the chosen healthcare path and that such critical information may be the key to tweaking of healthcare systems and services.
Patient satisfaction is an important goal of the health system’s responsiveness as it significantly influences the quality of care. Such studies have been conducted within the formal healthcare pathway and few within the indigenous pathway. This is in spite of a large population of Kenyans, over 70 percent, rely on indigenous medicine as their primary source of health services
A multi-disciplinary team of scientists from the National Museums of Kenya (NMK), University of Nairobi (UoN), Kenya Medical Research Institute (KEMRI), and Ministry of Culture and Social Services with funding from the National Research Fund (NRF) conducted a study assessing whether there are Indigenous regimens available locally that have the potential to improve the quality and longevity of life for cancer patients, as well as documenting clients’ treatment-seeking behaviors and treatment suitability.
Led by Solomon K. Cheboi (PhD), the team made of Dr(s) Kiprop Lagat (Culture), Staline Kibet (UoN), Peris Kariuki, and Paul Musili (NMK), and Joseph Mutai (KEMRI) successfully lifted the lid on the factors of patient satisfaction in the context of indigenous palliative care in Kenya. Others were Daisy N. Nyawira, Philamon Nyamanga, Peter M. Ngolo, and Wanjiru S. Ng’ang’a all from NMK.
The scientists define patient satisfaction as ‘a measure of how content a patient is with the health service received from their health care provider’ and that it is an important measure of health-care quality. The scientists allude that patient satisfaction “can therefore be used to detect challenges and identify client characteristics that appear to influence the quality of services well as for successful management and improvement of service.”
The scientists indicated that in Kenya, “about 800,000 individuals are in need of palliative care every year resulting mostly from cancer, cerebrovascular diseases, dementia, and respiratory diseases yet only 1.8 percent access these services. The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their caregivers who are facing problems associated with life-threatening illness, preventing and alleviating physical, psycho-social or spiritual suffering.”
Access to patient-centered and appropriate palliative care services remains a key priority in Kenya. Towards this goal, a descriptive cross-sectional study was conducted among cancer patients exiting Indigenous care outlets located in 12 towns across Kenya using a structured modular questionnaire.
Over 443 patients were interviewed. The study found that whereas conventional palliative care is limited, “indigenous point of care otherwise known as traditional medicine provides a hub for multifaceted palliative care in Kenya.
Kenyans of all ethnicities frequent these places, with the majority being Kalenjin 188 or 43.4 percent, Luhya 91 or 21 percent, Kikuyu 65 or 15 percent, Kamba 30 or 6.9 percent, and Gusii 18 or 4.2 percent. An indigenous outlet is a service point that offers any service, or product, aiming to maintain, promote, prevent, and or improve physical, psychological, and mental well-being.
There are five types of outlets: mobile services at 25 percent, basic stationary outlets at 40 percent, stationary outlets with patient records at 31 percent, stationary outlets with inpatient and outpatient services, and stationary outlets with inpatient and outpatient services with laboratory at 2 percent. The bulk of practitioners come from the Ameru/Aembu at 8.2 percent, Luo at 10.3 percent, Kalenjin at 15 percent, Agikuyu at 23.3 percent, and Abaluyia at 17.0 percent ethnic groups.
Regardless of cultural variety, cancer is typically referred to as a fatal and terminal condition, according to the survey. In the Luo community, cancer is known as “Dhola/Adhola,” while the Abagusii community calls it “Omuaga.” The Kamba community refers to it as “Kivivya/Muvivya,” the Abaluyia community as “Ingwasi,” and the Teso community as “Shokhoro.”
The Ameru/Aembu community uses the term “Mkoje,” the Mijikenda community refers to it as “karonda cha rika,” and the Maasai community as “enayiengi.” The Marakwet/Turgen/Keiyo communities use the terms “siryan/seryan” or “lubaniat,” while the Agikuyu community calls it “ironda cia ndiira.” This diverse range of names reflects the shared indigenous palliative care aims and practices surrounding cancer.
This phenomenon may be explained by the magnitude of cancer in Kenya as the National Cancer Registry Data for 2021/2022 showed that a total of 42,116 new cancer cases are recorded annually and, at least 27,092 cancer deaths every year, and the numbers are projected to increase.
Regions most affected by cancer are central and eastern and, counties with the highest cancer cases are Kiambu, Nakuru and Nairobi. Estimates further show that two out of three people diagnosed with cancer will succumb to the disease, largely due to late diagnosis. Only 23 percent of cancer patients access the cancer management services they need underpinning the significance of expanding health services and research.
The study found that demographic variables including patient’s education level, ethnicity, means of transport, and period of illness have a major impact on patient satisfaction scores and by extension perceived quality of care.
For instance, those “who walked to Indigenous outlets were two times as likely to have overall service satisfaction than those who used a vehicle. Traveling without “straining may play a stabilizing role on the patient rating of satisfaction.”
The period of illness had an implication on satisfaction as one year and 5 years of being unwell had a 34 percent and 37 percent chance of being satisfied than those who had been sick for over 7 years.
The study findings further suggested that “Indigenous providers were polite and friendly. Providers empathized, communicated well, and provided ample opportunity and time to relate and answer questions.”
Importantly, the researchers found that most Indigenous services were pro bono or paid in kind, which may explain the satisfaction with the cost of service revealed by the study. The perceived results of the visit may alternatively explain this satisfaction results.
For example, out of the 443 patients interviewed, 76 percent reported improvement after undergoing the THP regimen, with 78.2 percent experiencing ease in various activities such as eating, swallowing, drinking, talking, standing, and walking. Eleven percent were able to resume conjugal roles, farming, and office work. Additionally, 6.9 percent saw their wounds heal, tumors dry up, and pain subside, while 4 percent were able to urinate without pain.
Mental and psychological healing was also reported by 50.3 percent of participants, with 54.1 percent feeling healthier, happier, and stronger. Furthermore, 38.5 percent reported fewer worries, 4.6 percent regained hope and confidence, and 2.8 percent mentioned an improvement in family togetherness.
The majority of patients, 57.3 percent, expressed satisfaction with the indigenous palliative care services, with factors such as waiting time, provider attention, politeness, and social communication skills being positively associated with satisfaction.
In conclusion, the study’s findings highlighted the influence of personal attributes in patient satisfaction scores. As such, provider social skills, responsiveness, courteousness and empathy, politeness, communication, and connectedness are important characteristics to patient satisfaction score.
Recommending the integration of “these attributes into training and health education programs for providers who care for patients with a life-threatening illness is paramount. Layout, cleanliness, and availed privacy were important outlet-related factors for patient satisfaction and were significantly associated with overall service satisfaction.”
Further citing that the research implication to theory, practice, or policy is that their “paper contributes to the orientation of Indigenous cancer palliative care in Kenya and provides scientific evidence for providers and policymakers to improve service and outlet setting.”
Furthermore, policymakers and providers may use the evidence to redesign and improve their service to include integration of Indigenous palliative services with other disciplines of care, in alignment with standard medical practice.
