Kasongo Bertin Mutabesha, Molima Christian Eboma Ndjangulu, Karemere Hermès, Makali Samuel Lwamushi, Mugisho Landry Chahihabwa, Mwembo Albert Tambwe, Bisimwa Ghislain Balaluka, Mukalay Abdon Mukalay Wa
Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.
School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
Glob Health Action. 2025 Dec;18(1):2555030. doi: 10.1080/16549716.2025.2555030. Epub 2025 Sep 4.
The WHO recommends the Person-Centred Care approach, based on the biopsychosocial (BPS) model with community participation, to streamline the management of chronic diseases in Primary Health Care (PHC) activities and reduce their growing burden, even in Africa. The Democratic Republic of Congo's (DRC) experience of community participation in implementing the BPS model for chronic diseases has been little explored.
To describe community ownership of the biopsychosocial model of chronic disease care in PHC facilities in South Kivu province, DRC.
A basic interpretive qualitative study was conducted in April 2024, in three health areas of the Katana health district, among beneficiaries of chronic disease interventions. Nine in-depth interviews were conducted with care providers and community representatives, followed by two focus groups with community health workers (CHWs) and a document review. An inductive-deductive content analysis was carried out using ATLAS.ti 24 software.
Based on the four main themes identified in the study, community ownership of the model depends on various factors (relational, organizational, and motivational/supportive). As perceptions, respondents recognized the model's application through partner support, meetings with community representatives and patient decision-making. Community involvement in the model was observed through participatory meetings, reinforced home visits, psycho-education, and club solidarity. Significant challenges included the lack of training for providers and CHWs, CHW's financial demotivation, poor dissemination of model, and patient poverty. Proposed strategies included a participatory stakeholder audit, capacity-building on the model, psychologist availability, and income-generating activities to motivate CHWs.
Community ownership of the BPS model is a vital pillar to support effective and resilient chronic disease management, rationalizing it in PHC for better health outcomes. Healthcare systems should consider these identified factors in the policy definition and rationalization process for these diseases by establishing effective coordination mechanisms.
世界卫生组织推荐以生物心理社会（BPS）模型为基础、社区参与的以人为本的照护方法，以优化初级卫生保健（PHC）活动中慢性病的管理，并减轻其日益加重的负担，即便在非洲也是如此。刚果民主共和国（DRC）在实施慢性病BPS模型方面社区参与的经验鲜有探讨。
描述刚果民主共和国南基伍省初级卫生保健机构中慢性病照护生物心理社会模型的社区自主性。
2024年4月，在卡塔纳健康区的三个卫生区域，针对慢性病干预措施的受益者开展了一项基础解释性定性研究。对医护人员和社区代表进行了9次深入访谈，随后与社区卫生工作者（CHW）进行了两次焦点小组讨论，并进行了文献回顾。使用ATLAS.ti 24软件进行归纳-演绎内容分析。
基于研究中确定的四个主要主题，该模型的社区自主性取决于各种因素（关系、组织和激励/支持）。在认知方面，受访者认可通过合作伙伴支持、与社区代表会面以及患者决策来应用该模型。通过参与性会议、强化家访、心理教育和俱乐部团结观察到社区对该模型的参与。重大挑战包括医护人员和社区卫生工作者缺乏培训、社区卫生工作者经济动力不足、模型传播不力以及患者贫困。建议的策略包括参与性利益相关者审计、该模型的能力建设、配备心理学家以及开展创收活动以激励社区卫生工作者。
BPS模型的社区自主性是支持有效且有韧性的慢性病管理的重要支柱，使其在初级卫生保健中合理化以实现更好的健康结果。医疗保健系统应在这些疾病的政策定义和合理化过程中，通过建立有效的协调机制来考虑这些已确定的因素。
