‘ Bottom up ’ approach: A community-based intervention in fighting non-communicable diseases in urban informal settlements Kenya

Objective: The main objective of this study was to identify challenges faced by healthcare front-liners towards health promotion in the prevention and management of Non-Communicable Diseases (NCDs) amongst the urban 25 - 59-year olds living in urban informal settlements within Kamukunji, Nairobi County. Design: Using the design thinking methodology, this qualitative research aimed at exploring the use of an innovative communication strategy using community-based interventions as a new approach towards NCDs prevention and management. Setting: This study was carried out in two community units within California Ward, in Kamukunji Sub-county, one of the most populous sub-counties in Nairobi Participants: 7 CHVs, 6 Sub-county health officers and 3 Design Thinking practitioners were included in this study. Intervention: A ‘bottom-up approach’ of involving healthcare front-liners in communities in decision making about their health choices and what works best for them, is an unexplored area in health promotion programmes in Kenya. Towards this end, a co-design workshop conducted with the key stakeholders helped in framing and designing health promotion and communication messages that could have a major impact in the reduction of NCDs and related risk factors and increase health-seeking behaviour within the community. Results: The significance of the findings from this qualitative study identified major challenges which 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 limited health literacy levels amongst the community members. It was also observed that the current health promotion programmes used were designed and implemented by the National Government, who were not fully aware of the challenges faced at the grassroots. Conclusion: This paper argues that community engagement in designing health promotion programmes goes a long way in influencing healthbehaviour change among community members.