Bottom-Up Design Approach: A Community-Led Intervention In Fighting Lifestyle Diseases Within Urban Informal Settlements In Nairobi, Kenya
Abstract
Health communication programmes in Kenya have mainly used a ‘top-down
approach’ in designing health promotion strategies to be used within communities.
This approach has not been sustainable in promoting healthier lifestyles that would
potentially stave off Non-Communicable Diseases (NCDs) in these settings. A
‘bottom-up approach’ of involving communities in decision making about their
health choices and what works best for them, is an unexplored area in health
promotion programmes in Kenya. A ‘bottom-up approach’ engages people at the
grassroots levels in joint campaigns, causing a behaviour change within their
settings and thus influencing an incremental change towards their intended goals.
The rising burden of NCDs is of particular concern in urban informal settlements
in Kenya, partly because of lack of awareness and inadequate access to preventive
services. This qualitative formative research explored the use of the ‘bottom-up
approach’ as an intervention towards NCDs prevention and management through
the engagement of community members. The main objective of this research was
to co-design a population-led communication strategy with Community Health
Volunteers (CHVs) and relevant health stakeholders that could be used in the
prevention and management of NCDs amongst the urban 25-59 year olds living in
informal settlements in Kamukunji, Nairobi County.
Using the design thinking methodology that is user-focused, a bottom-up approach
was employed by the researcher in engaging relevant health stakeholders in the
design process of health promotion programmes. Towards this end, in-depth
interviews, open-ended questionnaires, community dialogues, focus group
discussions and a co-design workshop were used for data collection from 15 CHVs,
50 Community Members and 6 Sub-county health officials from Kamukunji Subcounty,
Nairobi, where this research was conducted.
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Findings revealed major challenges faced by the sub-county health officials and
CHVs towards health promotion and awareness of NCDs in their community.
These included irrelevant and poor health information, education and
communication (IEC) material, poor health education and training methods and
tools, socio-cultural barriers as well as varied health literacy levels amongst the
community members of Kamukunji sub-county. It was observed that the current
health promotion programmes used within the community were designed and
implemented by the County Government, who were not fully aware of the
challenges faced at the grassroots. The key stakeholders involved in this research
ratified the need to employ a user-centred approach in designing health promotion
programmes towards disease prevention and management.
This research designed a health communication strategy that can frame targetspecific
health promotion programmes with the end-user in mind. Key benefits of
this user-centered research emphasized the importance of co-design in planning
health promotion programmes. Co-design of health programmes presents a great
opportunity to engage the critical mass of people who are in the communities to
adopt appropriate behaviour for health promotion and diseases prevention, as well
as appropriate health-seeking behaviour. This in turn would reduce the health-care
difficulties in health facilities, which are already struggling to meet demand, and
as such give health facilities a chance to be more efficient and effective in health
service provision.
KEYWORDS: Bottom-Up Approach, Co-design, Community Health Volunteers,
Health Communication, Health Promotion, Nairobi, Lifestyle Diseases, Kenya,
Urban Informal Settlements.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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