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International journal of professional Practice (IJPP)

Permanent URI for this collectionhttp://41.89.31.6:4000/handle/123456789/515

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Author: search.filters.author.Mapesa, JobEnd date: 2025

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    Clinical and Socio-Demographic Predictors of Psychosocial Distress in Women with Breast Cancer in Nairobi, Kenya
    (International Journal of Professional Practice (IJPP), 2023) Muriithi, Wanjiru; Kaaria, Zipporah; Mapesa, Job
    Research shows that 25%–50% of breast cancer patients worldwide experience distress, with Africa reporting 71% and Kenya 34-50% distress cases. This study investigated clinical and socio- demographic predictors of breast cancer patients' psychosocial distress. Poor quality of life outcomes, reduced adherence to treatment, and inferior clinical and psychosocial functioning are all associated with psychosocial distress. This study adopted an exploratory, sequential cross- sectional design. The study targeted 763, 18–70-year-old female breast cancer patients. Breast cancer patients, nurses, lay navigator, and oncologists were enlisted through opportunity sampling technique for collection of both the qualitative and the quantitative data. Interviews, focus group discussions, and questionnaires were used to collect data. Using a total score of >11, with NCCN cut-off mark of >4 for clinically significant distress; and >7 for severe distress, psychosocial distress was screened using distress thermometer and problem checklist. Notably, income and stage of diagnosis emerged as significant predictors of psychosocial distress, clinical anxiety, and depression. Income predicted severe distress (OR = 5.5, p = 0.001), anxiety (OR = 2.8, p = 0.004), depression (OR = 4.7, p = 0.001), and early diagnosis had an inverse relationship with distress (OR = 0.3, p = 0.006) and depression (OR = 0.5, p = 0.049). Still, testimonials showed that young women had more emotional distress, while elderly women had more physiological distress. Marriage provided two insurance policies. The study emphasises understanding of emotional and psychological distress factors, identifying patients who need extra help, and using psychotherapy and social interventions to alleviate suffering, enhance resilience, and improve treatment outcomes
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    Determinants of Demand for Community Differentiated Service Delivery among People Living with HIV in Kakamega County
    (International Journal of Professional Practice (IJPP), 2023) Owiti, Winnie Sarah; Njoroge, Kezia; Mapesa, Job
    Community differentiated service delivery model (CDSD) is community level health system strengthening intervention that addresses barriers to accessing health services. Increased number of stable people living with human immunodeficiency virus (PLHIV) has prompted more emphasis to promoting CDSD model utilization as a significant policy to improve health outcomes and meet the international commitment to make health services accessible. However, key health systems policy makers have put more emphasis on improving physical access rather than its patterns of utilization. This study seeks to understand demand for CDSD model and its determinants among PLHIV in order to device appropriate strategies that will encourage better utilization. The objectives were to assess CDSD model of choice, and factors that determine its demand among PLHIV. A quantitative design was conducted in Kakamega County, Kenya. Systematic random sampling was used to select 402 participants from facilities with high number of stable patients. A pretested interview schedule, and structured questionnaire was used to collect data using an open data kit app. Non parametric test was used to determine determinants for demand for CDSD model. A total of 402 (depicting a response rate of 100%) participants took part in the study. The tests revealed 66 % (264) of participants prefers the family model, 25 % (100) community anti-retroviral treatment groups, 8% (30) community drug distribution points, and 2% (8) community pharmacies. Determinants of demand were awareness 76% (307), acceptability 44% (176), service availability 78% (314), and service cost 78% (315). The findings indicate that the model of choice is the family model. Determinants for demand that affect utilization of the model include awareness, service availability and cost of the services. Policy makers in the ministry of health need to use these key determinants of demand to estimate its impact on health service delivery and health outcomes.
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    Role of County Health Governance in Implementation of Social Insurance National Scheme in Selected Counties in Kenya
    (Kenya Methodist University, 2019) Mwangi, Eunice M.; Mapesa, Job; Wairia, Samuel K.
    Health care financing (HCF) is one of the building blocks of a health system. Kenya envisions to have Universal Health Coverage (UHC) by 2022. To achieve this, the National Hospital Insurance Fund (NHIF) was identified as a vehicle towards the realization of UHC. NHIF collects revenue, pools risks, and purchases health services for its members. NHIF uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study aimed to establish the role of County Health Governance in implementation of the NHIF national scheme. Specifically, the study sought information on NHIF’s communication with the County Health Management Team (CHMT), CHMT knowledge of NHIF national scheme guidelines, suitability of county health facility Infrastructure , adequacy of NHIF capitation funds, NHIF accountability and how they all influence provision of NHIF primary care health services. This was a cross sectional research. All 120 County and Sub-County Health Management Team members were purposively sampled from Nakuru and Nyandarua Counties, a 96% (115) response rate was achieved. Results showed that, 64(56%) of respondent said NHIF was accountable to the population, 73(63%) said the county health facility infrastructure was adequate and 67(58%) said there were guidelines directing implementation of NHIF PCHS. However, 66(57%) said patients were not accessing NHIF primary care health services, 70(61%) said capitation funds were not adequate and 59(51%) said communication from NHIF to them was inadequate. Chi square results indicated that all variables, NHIF communication χ² = 5.364, p < 0.05, availability of guidelines χ² = 10.447, p < 0.05, suitability of county health facility infrastructure χ² = 13.199, p < 0.001, adequacy of NHIF capitation funds χ² = 6.956, p < 0.05 and NHIF accountability χ² = 10.982, p < 0.05 were scientifically significant and influenced implementation of the national scheme outpatient services. The study concludes that there is minimal participation of the CHMT in NHIF decision making and this hinders successful implementation of the NHIF National scheme. The study recommends that 1) NHIF improves communication with the CHMT members, so as to involve them in the implementation of NHIF national scheme, 2) NHIF to raise awareness of the strategic purchasing function in order to promote a shared understanding which will enrich knowledge of the roles and responsibilities of all the players including the County and National governments, NHIF, Citizens and providers.