PHD-Depatment of Family Medicine community Health and Epidemiology
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Item Effectiveness of short message service support on adherence to chemotherapy treatment among patients attending cancer treatment in Kenya(Kenyatta University, 2024-11) Mchidi, Nebert K.Cancer is a chronic debilitating disease. At some point in cancer survivorship, chemotherapy is used, and the patient is expected to adhere to treatment to improve survival and quality of life. Adherence is the extent to which a patient follows the doctor’s prescriptive advice. Adherence to chemotherapy offers patients prolonged survival and improved quality of life. Adherence rates for chronic illnesses are sub-optimal and clinical practitioners recognize this as a public health threat which, unaddressed, will hinder the realization of universal health coverage. In Kenya, there is a dearth of data on the rate of chemotherapy treatment adherence. Further, strategies to improve adherence to cancer treatment in Kenya are untested or unavailable. This multisite, mixed methods cluster randomized trial evaluated the effectiveness of mobile phone SMS Support on chemotherapy treatment adherence among adult cancer patients in Kenya. Quantitative data was collected using questionnaires while qualitative data was collected using audio recordings of Key Informants. Ethical approvals were obtained from Kenyatta University Ethics Review Committee and various Hospital Ethics Review Boards. The study permit was obtained from the National Commission for Science, Technology, and Innovation (NACOSTI). Data was analyzed using Statistical Package for Social Sciences (SPSS) to get descriptive statistics. The student’s t-test was used to determine the significance of adherence differences between study arms. The adjusted chi-squared test was used to assess the significance of the difference between associations, while the generalized linear mixed model was used to determine the predictive odds of factors that influence adherence to chemotherapy treatment. The study found the mean adherence to be 83%. There was a significant difference between treatment arms in relation to adherence to chemotherapy treatment, with participants in the intervention arm having a higher mean adherence difference, M = 3.913, 95% CI 2.632-5.193, t (402) = 6.006, p = <0.001), with Cohen’s d = 0.60. Although gender was not significant in explaining the adherence difference between arms (χ²dd= 0.151, df=1, p=2.064), there were more women in the perfect adherence group than males. Participants who experienced perfect adherence were activated in care (χ²dd=21.174, p=< 0.001), were satisfied with SMS support (χ²dd= 7.620, df=1, p=0 .006), were in the intervention arm (χ²dd= 22.942, df=1, p= <0 .001) and had trust in the care provider (χ²dd =10.591 p= <0.001). SMS Support was not significant in the multivariate analysis but had an estimated effect size of 0.958 (z=1.424, p= 0.154, CI= 0.242-3.781), indicating that the mean adherence of a participant in the intervention arm was 1.42 standard deviations above the mean adherence in the control arm after adjusting for fixed effects in the model. The study recommends that the Ministry of Health (MoH) should design chemotherapy treatment programs that target male cancer survivors. The designers of chemotherapy treatment centers should ensure that cancer patient’s privacy and trust in the health care provider is maintained, identify, and meet unmet care needs and satisfy cancer patient’s care needs. MoH should develop guidelines on the adoption of mHealth solutions specific to chemotherapy treatment adherence