Modeling Predictors of Health System Responsiveness among Chronic Care Centers in Tier Three Hospitals in Kenya

Abstract

This study sought to model predictors of health system responsiveness among diabetic and hypertensive patients in Kenyan primary hospitals. Responsiveness in the health system hinges on service provision and system demands, but there are noted deficiencies in Kenya prompting this study. The study explored how valuations, accountability, access, structural factors, organizational culture, and perceptions of justice impact responsiveness. This cross-sectional survey provided baseline data for an intervention study. From a sampling frame of 853 patients, 323 were sampled using the Fishers et al. formula. Of these, 308 questionnaires were completed: 130 from Gatundu, 98 from Uasin Gishu, and 80 from Kimilili Hospitals. Data was collected through structured questionnaires using a five-point Likert scale, after which scores were summed up and divided into favorable and unfavorable using the demarcation threshold formula. Only 38.3% of respondents reported favorable responsiveness. Three predictors; accountability, structural and organizational culture had majority in the unfavorable, while valuations, access, and justice had majority in the favorable category. Following conditional backward binomial logistic regression, the final model included four significant predictors of responsiveness; namely, structural, accountability, organizational culture, and justice perceptions. Using the Nagelkerke statistic, the model explained 15.7% variation in responsiveness. The model achieved a 79.5% success rate in predicting unfavorable responsiveness and a 46.6% success rate in predicting favorable responsiveness, with an overall correct prediction rate of 66.9%. The probability of experiencing favorable responsiveness given positive experiences in the predictors was 68.5%. In conclusion, responsiveness remains low. Critical predictors identified in this study serve as intervention targets for improving responsiveness. With 15.7% explained variation in responsiveness, there's room for further model enhancement. The study recommends managers to adopt a holistic, patient-centered care approach, and suggests implementation studies to validate the model across diverse contexts and identify additional predictive factors for responsiveness improvement.