Barriers and Facilitators to Screening for Kidney Disease Among Older Adults with Hypertension and Diabetes in Mbarara Southwestern Uganda: Healthcare Providers' Perspective

Judith Owokuhaisa; Catherine N Abaasa; Rose Muhindo; Pius Musinguzi; Godfrey Zari Rukundo

doi:10.2147/JMDH.S451533

Barriers and Facilitators to Screening for Kidney Disease Among Older Adults with Hypertension and Diabetes in Mbarara Southwestern Uganda: Healthcare Providers' Perspective

J Multidiscip Healthc. 2024 Feb 29:17:855-865. doi: 10.2147/JMDH.S451533. eCollection 2024.

Authors

Judith Owokuhaisa¹, Catherine N Abaasa², Rose Muhindo³, Pius Musinguzi⁴, Godfrey Zari Rukundo⁵

Affiliations

¹ Faculty of Medicine, Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara, Uganda.
² Faculty of Medicine, Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda.
³ Faculty of Medicine, Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
⁴ Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda.
⁵ Faculty of Medicine, Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.

Abstract

Background: Screening for kidney disease (KD) among high-risk patients (patients with hypertension or diabetes) allows early diagnosis, intervention and delayed progression of the disease. In low- and middle-income countries (LMIC), KD screening is still sub-optimal. This study explored the healthcare providers' perceived barriers and facilitators to KD screening among older adults with hypertension and diabetes in Mbarara southwestern Uganda.

Methods: This was a descriptive qualitative study among healthcare providers caring for older adults with diabetes mellitus and hypertension at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to develop themes of barriers and facilitators.

Results: We conducted 30 in-depth interviews among healthcare providers. Barriers to screening for kidney disease included patient related factors according to healthcare providers (financial hardships, poor health seeking behavior, limited knowledge and awareness), healthcare factors (work overload, ineffective patient healthcare provider communication) and system/policy related factors (lack of laboratory supplies, lack of guidelines and poor medical record keeping and documentation). With respect to facilitators, we found formation of peer support groups, effective team, and continuous medical education (CME).

Conclusion: Healthcare providers encounter substantial but modifiable barriers in screening older adults for KD. The identification of barriers and facilitators in timely KD detection gives us an outlook of the problem in Uganda and leads for proposals of action. Interventions that address these barriers and promote facilitators may improve the healthcare provider's effectiveness and capacity to care including screening for patients at risk of KD.

Keywords: adults; barriers; diabetes; facilitators; healthcare providers; hypertension; kidney disease; older; screening.

Grants and funding

The study was funded by first mile capacity building project, Faculty of Medicine, Mbarara University of science and Technology and partly by the US National Institutes of Health(NIH) under grant number D43TWO11632-01.