Community ownership of biopsychosocial model of care: a qualitative study in the Katana health district, Democratic Republic of Congo.

BACKGROUND

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.

OBJECTIVE

To describe community ownership of the biopsychosocial model of chronic disease care in PHC facilities in South Kivu province, DRC.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.