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. xvi 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.