Dr Immaculate Nyaseba Marwa graduated with a PhD in Nursing.PhD Study Investigates Management of Comorbid Diabetes and Hypertension
The management of comorbid diabetes and hypertension conditions in primary health care (PHC) settings involves four core specific characteristics which need to be fulfilled for effective management of patients, a PhD in Nursing study revealed.
According to doctoral graduate, Dr Immaculate Nyaseba Marwa, the four characteristics are collaboration, culture-sensitivity, continuity and self-management.
Marwa’s thesis was titled: “A Focused Ethnographic Study of the Management of Comorbid Diabetes and Hypertension Among Adults in Primary Health Care Settings in Kenya”.
Supervised by Professor Ntombifikile Mtshali and Professor Gugu Mchunu of the Nursing Discipline, the study aimed to analyse the current management strategies available to comorbid diabetes and hypertension patients in selected PHC settings and further to develop a context-informed model for the management of comorbid conditions in primary care levels in Kenya.
Marwa said this group of patients formed a special set as usually either diabetes or hypertension occured as a single condition, but when they occurred together they complicated the general management, especially at primary care levels. ‘Paying special attention to these comorbid conditions results in improved management, continuity of care and improved quality of life,’ she said.
Her findings bring into practice a new model of managing comorbid chronic conditions which are on the rise among the elderly. ‘It also emphasises continuity of care which incorporates self-management skills. The findings also indicate that with effective leadership skills, chronic care services are bound to succeed. Centralisation and decentralisation of health systems create challenges for the whole process of chronic care,’ said Marwa.
The study findings also revealed that the action and interaction strategies were contextually influenced by strong governance and leadership, together with international initiatives and partnerships towards health systems for the management of chronic comorbid conditions.
Said Marwa: ‘The context of care is based on health policies, legal document strategies, clinical guidelines the international initiatives and partnerships which form the basis for healthcare delivery and management of comorbid conditions.’
The actions and interactions in the study were based on the political commitment to provide and support healthcare organisations with resources for chronic care both at the strategic and operational levels of management.
According to Marwa, the management of chronic comorbid conditions, especially in resource constrained communities and health systems, is based on the integration of healthcare service, while looking at the patients as the most important partner in healthcare.
‘Self-management allows a shift of health promotion and care to the patients and the community for sustainability and continuity along the disease process,’ said Marwa.
The study recommended collaboration between national and regional government should focus on implementation of the already existing policies and strategic plans at the contextual level where chronic care is crucial for effective management of chronic comorbid conditions in PHC settings.
Marwa emphasised team work and collaboration ensured improved quality of care, sustainable chronic care which is person-centred through the implementation and evaluation of the context-specific model to other divisions within the Kenyan health system.
The study also recommends health systems to consider integration and collaboration between traditional herbal medicine, the private sector and public health sector services, to allow for continuity across settings and providers.
Marwa is currently a Lecturer at the University of East Africa, Baraton, in Kenya. She hopes to run awareness and advocacy campaigns for people with comorbid chronic conditions, non-communicable conditions and also wants to start a community home-based care for patients with diabetes and hypertension not excluding other conditions.
Marwa is from a family of 12. Her mother died from diabetes in 2004 and her father is a retired pastor, ‘My siblings keep me going, believing in my abilities to venture into new worlds and fight it out.’
She is married to Gideon and they have a son, Charlton. ‘The two give me more reason to wake up and struggle to touch people’s lives.’
She loves teaching, and researching to find solutions to help people who need assistance in any way.’