Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12882-020-1702-6
Title: Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators
Authors: Jafar, Tazeen Hasan
Ramakrishnan, Chandrika
John, Oommen
Tewari, Abha
Cobb, Benjamin
Legido-Quigley, Helena
Sungwon, Yoon 
Jha, Vivekanand
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
CKD
Barriers
Facilitators
Rural
Qualititative research
India
CHRONIC KIDNEY-DISEASE
BLOOD-PRESSURE CONTROL
STAGE RENAL-DISEASE
CARDIOVASCULAR RISK
GLYCEMIC CONTROL
OUTCOMES
INTERVENTIONS
GUIDELINES
MANAGEMENT
Issue Date: 29-Jan-2020
Publisher: BMC
Citation: Jafar, Tazeen Hasan, Ramakrishnan, Chandrika, John, Oommen, Tewari, Abha, Cobb, Benjamin, Legido-Quigley, Helena, Sungwon, Yoon, Jha, Vivekanand (2020-01-29). Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators. BMC NEPHROLOGY 21 (1). ScholarBank@NUS Repository. https://doi.org/10.1186/s12882-020-1702-6
Abstract: © 2020 The Author(s). Background: 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.
Source Title: BMC NEPHROLOGY
URI: https://scholarbank.nus.edu.sg/handle/10635/169630
ISSN: 14712369
DOI: 10.1186/s12882-020-1702-6
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