Comparison of Baseline and Follow-Up Data of a Comprehensive Patient Navigation Program at Kenyatta National Hospital in Nairobi, Kenya

November 2018 Vol 9, NO 11
Esther Munyoro, MD
Kenyatta National Hospital
Nairobi, Kenya
Grace Omulogoli, BSc, HSM
Kenyatta National Hospital
Nairobi, Kenya
Kristie McComb, MPH
Kenyatta National Hospital
Nairobi, Kenya
Erica Krisel, MPH
American Cancer Society,
Atlanta, GA

Background: Kenyatta National Hospital (KNH) is the only public hospital in Kenya delivering comprehensive cancer care and receives patients from throughout the country. With support from the American Cancer Society, KNH launched a new patient navigation program in June 2017, serving all new patients in the Cancer Treatment Centre (CTC). Prior to the start of the program, the navigation team conducted a baseline survey of 453 patients served in the CTC. In July and August 2018, the navigation team conducted a follow-up survey of 426 patients served.

Objectives: KNH conducted a baseline survey before the start of the navigation program to understand patients’ clinical, psychosocial, and physical barriers to care, and their suggestions for service improvement. After 1 year of program implementation, a follow-up survey was conducted to identify the extent to which barriers have been addressed. The survey had additional questions assessing patients’ experience with navigators.

Methods: Cross-sectional surveys were administered at baseline and 1 year after implementation using quantitative and qualitative methods. Specific inclusion/exclusion criteria were developed to recruit eligible participants using random sampling methods. A standardized questionnaire was used to collect sociodemographic information, disease and treatment information, and barriers to cancer treatment. Quantitative data were analyzed using descriptive analysis, and correlations were tested using chi-square tests and logistic regression. Thematic analysis was conducted on qualitative data.

Results: Baseline data showed that the majority of patients (66.7%) were not informed of the length of their treatment, and the most common reason for delaying treatment was not having money to pay for treatment. When asked about their satisfaction with the information and support provided at KNH, over 90% of patients had not received food or water, written materials to learn more about their disease, support group services, financial support, accommodations support, or transportation support. Over half of patients surveyed had not received directions to find their way around the hospital, education about their disease and/or treatment plan, information on needed clinical services, and information on managing their disease. Over 70% of patients were very satisfied with spiritual well-being support received at KNH. Year 1 follow-up survey data collection is completed, and analysis is ongoing.

Conclusion: In the first year of implementation, the KNH navigation team incorporated findings and suggestions from the baseline survey into the program. Anecdotal evidence and hospital satisfaction surveys demonstrate patient satisfaction in the CTC due to the navigation program. Given increased satisfaction and a decrease in complaints, KNH is interested in introducing patient navigation in other hospital departments. Additionally, the patient navigators have reported higher job satisfaction due to their ability to provide a level of support to patients that they were not able to offer before.


Bukowski A, Chávarri-Guerra Y, Goss PE. The potential role of patient navigation in low- and middle-income countries for patients with cancer. JAMA Oncol. 2016;2:994-995.
Cazap E, Magrath I, Kingham TP, Elzawawy A. Structural barriers to diagnosis and treatment of cancer in low- and middle-income countries: the urgent need for scaling up. J Clin Oncol. 2016;34:14-19.
Challinor JM, Galassi AL, Al-Ruzzieh MA, et al. Nursing’s potential to address the growing cancer burden in low- and middle-income countries. J Glob Oncol. 2016;2:154-163.

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