Towards an Effective Communication in the Care of Patients with Long Term Disease in Kenya via Cybernetic—A Systematic Review ()
1. Introduction
In this study, a preliminary literature review mounts its objectives and aids in honing it to focus. It is adopted for a comprehensive grasp of current literature. On the flip side, a systematic review of literature comes later after a clear understanding of this study’s purpose and reviews direct literature relevant to its goal. Undertaken preliminary literature studies of Kenyan context have brought to light the difficulties and obstacles experienced by patients who have chronic illnesses on account of a communication gap in their treatment plan. In particular a study by Raphael et al. (2016) [1] revealed that telephone conversations between practicing nurses and elderly patients with chronic illnesses frequently concentrate on managing the diseases in lieu of taking the patient’s perspective into account concurrently. A study by (Nooshin, 2014) [2] also showed that insufficient health literacy impedes the ability of healthcare providers and patients of chronic illnesses to communicate effectively. Also, the influence of language obstacles on successful communication in healthcare institutions is affirmed by Oberle et al. (2020) [3] as additional culprit. On the same note, Butto et al. (2020) [4] discovered that insufficient functional health literacy is a barrier to efficient doctor-patient communication among HIV/AIDS patients.
A detailed review of the preliminary literature posits that some of the difficulties faced by Kenyan patients can be settled via a good synergized communication plan. This plan interchanges communication among healthcare professionals, patients, caregivers and plays a significant role in patient recovery (Chaturvedi, Loiselle, & Chandra, 2009) [5] . A case in point is a study by Caren et al. (2020) [6] who investigated the communication experiences of caregivers and patients with cervical cancer, highlighting the therapeutic value of communication. Moreover, the prominence of intercommunication in the healthcare industry was highlighted by (Kourakos et al., 2017) [7] who claimed that better patient outcomes, compliance, and satisfaction result from good intercommunication between patients and healthcare providers. Similarly, (Raphael et al., 2016) [1] demonstrated the potential advantages of telephone-based treatments as a communication medium to influence patient behavior, enhance disease-specific health indicators amid practicing nurses and elderly patients with long-term diseases.
Thus far, we have seen a substantial focus of the preliminary literature on significance of efficient communication to turn around wretchedness faced by chronically sick patients in Kenya. Besides, Caren et al. (2020) [6] who looked at the communication experiences of patients with cervical cancer and caregivers, provided another typical example of a desperation experienced by patients thus calls for expeditious redress. Their results emphasized on the therapeutic benefit of dialogue in patients’ long-term illness rehabilitation. Another study by (Kourakos et al., 2017) [7] found that better patient outcomes, compliance, and satisfaction result from a coordinated communication among patients and healthcare providers.
Another preliminary literature review undertaken was a meta-analysis of a research study conducted in Kenya to identify determinants of Patient Satisfaction in Indigenous Cancer Palliative Care Services which recorded that Patient Satisfaction is positively associated with waiting time (AOR = 2.663, 95% CI = 1.235 - 5.743), provider attention (AOR = 3.698, 95% CI = 1.657 - 8.254), provider politeness (AOR = 6.774, 95% CI = 3.697 - 12.413) and provider social communication skills (AOR = 6.520, 95% CI = 3.642 - 11.673) hinting at the significance of Effective Communication in the care of Patients with long term Disease in Kenya. This study used a descriptive cross-sectional design among patients exiting in indigenous outlets using pretested, semi-structured questionnaires. Cross-sectional studies involve data collected at a defined time. They are often used to assess the prevalence of acute or chronic conditions, but cannot be used to answer questions about the causes of disease or the results of intervention. Indigenous health practitioner outlets were included and stand-alone clinics. The selected outlets were visited, consented and client exit interviews undertaken during the survey period. This study concluded that a good patient-provider interaction, provider social skills and service waiting time influence patient recovery satisfaction with indigenous palliative care (Cheboi, Nyawira, Ngolo, & Ng’ang’a, 2023) [8] .
Over and above, there is a reviewed preliminary literature on the World Bank that has categorized Kenya as a low-middle-income nation (World Bank Country and Lending Groups - World Bank Data Help Desk, n.d.) [9] . This categorization stems from many factors besides a shift in the population’s demographics, which comes with new health implications as an increase in chronic and fatal diseases like breast cancer (BC). For instance in 2017, Lukong et al. [10] conducted a study titled “Breast cancer in Africa: prevalence, treatment options, herbal medicines, and socioeconomic determinants.” This preliminary review indicated that the number of deaths related to breast cancer (BC) has increased significantly in lower-middle-income countries, where a growing trend toward urbanization and the adoption of Western lifestyle is on the rise. According to Lukong et al. (2017) [10] , these countries i.e. lower-middle-income nation, account for 70% of all breast cancer (BC) fatalities worldwide, and that a higher proportion of these deaths are thought to be related to inadequate communication. Furthermore, a 2016 study (Healthcare Miscommunication Cost $1.7 B—and Nearly 2000 Lives) [11] found that communication problems in the treatment of patient with long-term illness is congruent to medical malpractice claims and account for about 30% of mortality instances. In this instance, communication breakdowns were found in 37% of all high-severity injury cases. These preliminary literature findings provide eminence and the impetus to undertake this study. The outlined substance is significant having been demonstrated that effective intercommunication and improved healthcare outcomes in chronic and terminal conditions is like conjoined twins.
This study’s relevance lies in its contribution to understanding the ontological and epistemological basis of the communication problem in Kenyan patients with long-term diseases, as well as examining whether cybernetic electronic communication improves those outcomes further. The notion of ontology represents how Kenyans view the inefficiency of communication among chronic and terminal illness patients, whereas epistemology is their idea of how this problem should be investigated and resolved.
Multidisciplinary research of this caliber is essential for efficient communication and treatment outcome. In the Kenyan context, where death due to insufficient communication is widespread (Ndemo, 2020) [12] , it crystallizes localized ontological and epistemological underpinnings of a remediating model solution for effective communication in patients with long-term diseases who are confined to the agony of inefficient communication.
In this interdisciplinary study, a team of specialists and/or writers from other disciplines collaborate to address the 30% death rate in patients with chronic and terminal illnesses, attributed to inadequate communication (Healthcare Miscommunication Cost $1.7 B—and Nearly 2000 Lives) [11] . Theoretical frameworks, concepts, and approaches supporting ontological and epistemological aspects of effective patient-centered communication are examined by these experts/authors. This endeavor is likely to make a good contribution to the corpus of knowledge. This is since it adds to theoretical frameworks a study that might enhance patient care and identifies variables impacting successful communication. In order to create strong integrated communication deliverable solutions that are expected to enhance treatment results, this study integrates principles from the fields of communication, health, and information technology into a cybernetic framework.
The study explores strategies to address the communication gap among patients with long-term diseases in Kenya by focusing on healthy communication between healthcare professionals, patients, and caregivers. This is crucial for patient-centered care and may guide future research studies and practice. Furthermore the study examines patterns and trends in patient recovery post activation of the Effective Communication in the Medicare program.
A limitation of this study is that it doesn’t espouse meta-analysis in its methodology. Not conducting a meta-analysis of the literature, is a drawbacks. Limited synthesis of evidence in the literature material in this study might provide a qualitative overview of existing studies which is informative but lacks the quantitative synthesis that a meta-analysis offers. It’s difficult therefore to identify overall trends without aggregating and quantifying the across studies’ results. These might deny this study an opportunity to assess whether there is a consistent effect or if results are conflicting. However it was our view as experts that not conducting a meta-analysis wouldn’t have any significant impact on our finding as the study was phenomenological qualitative research, which looks in-depth at non-numerical data and uses interviews and observation notes. A phenomenological study explored on patients experience and attentions given to how this experience was influence by ineffective Communication as a phenomenon. Though at the initial stage of this study, we considered a meta-analysis review from a manuscript by (Cheboi, Nyawira, Ngolo, & Ng’ang’a, 2023) [8] but only for this preliminary literature review. This was useful as it helps mount objectives of the study from a wider perspective to sharpen the study focus. Failure to have an instance of a meta-analysis at the preliminary literature review, would have probably made it an uphill task to persuade our audience as to why we did not factor it as part of the actual Systematic Review of literature. This would have as well created an impression of biasness. It is therefore understood that we didn’t close out an essential design process for fun but since it was proven at a preliminary literature review that it would be insignificant for our study.
Another limitation is that some patients may communicate inaccurate information due to their old age that is synonymous to long term Disease and diminished or poor memory. This study assumes that reviewed literature are sufficiently succulent and similar in terms of participants, interventions and outcomes, in pooling of data. That is all necessary data is available for extraction and analysis. This implies that the distribution of effect sizes of reviewed material is normal. Also assumed is that included literature for review are of reasonable quality. Another assumption is that findings of this study can be generalized to a broader population or context. Lastly, it’s assumed in the study that the effects of interventions in reviewed literature are consistent over time and that the results of older studies are still applicable today.
The design and implementation of this study are described in the methodology section, where cybernetics is advocated in tandem to season and propel the necessary communication outcome in Kenyan patient care for long-term illnesses.
2. Methodology
The methodology is a procedure of the study represented by a flowchart of the study in Figure 1. The processes involved in carrying out this investigation are outlined in the study flowchart.
2.1. Selection of the Co-Authors/Experts from Their Disciplines of Expertise
Experts and co-authors were not chosen at random. An expert became an author automatically upon joining the project research. As a result, co-authors served as experts in the study and were admitted provided they possessed training in clinical psychology, computer science, health informatics, public health, or communication. Additionally, they had to have been prepared to commit time and resources as needed.
2.2. The Study Design
We employed search terms from important knowledge databases, such as Cochrane, PubMed, Scopus, Web of Science, Google Scholar, and Scopus, to direct the literature design approach in this study. To find pertinent studies published in the last 17 years, we combined subject headings and keywords. The search strategy was refined to ensure that only the most relevant and up-to-date literature was included.
2.3. The Search Terms
For this, search terms were used. For example, “Importance of communication in the care of patients with long term diseases in Kenya” OR “Communication and patient care for long term diseases in Kenya” OR “Effective communication and patient care for patients with long term diseases in Kenya” AND “Therapeutic communication and its relationship with chronic disease in Kenya” used were. Results were filtered to include only publications from the past 17 years. Filtration was via a systematic evaluation of all the publications that ultimately informed a sample size for the inclusion, exclusion criteria, and formulation. A systematic evaluation of publications was done by reading these journals in full to assess their eligibility. The PRISMA model fused in a systematic review provided a general logical review approach. Thus a manual review of all eligible publications occurred via a systematic evaluation and their results are summarized in Table 1.
2.4. Literature Population of the Study
The study considered all relevant literature, including titles, terms, summaries, and concepts about effective communication in the care of long-term disease patients in Kenya.
2.5. A Sampling of the Literature Journals
Non-probability sampling was also used instead of a probability sampling approach. A non-probability sampling method selects literature from a population using a subjective (non-random) process. This sampling method is an appropriate technique in this study as we were unable to practically and convincingly determine all possible pieces of literature that underpin the study’s title, concept, and summary as would be in the ideal case (random).
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Table 1. Outcome summary findings of a Systematic literature evaluation.
Thus in this study, not every literature sample from the population pool had an equal chance for an invitation to participate before being classified into included or excluded criterion. This is since certain terms, titles, concepts, and summaries were used to query selected databases for relevant literature and thus didn’t guarantee inclusivity for every literature material on other databases but ascribed to the same nature of the study.
Consequently, non-probability sampling permitted us to target literature journals on the subject matter but not all in the population pool. This is a natural phenomenon to have certain literature journals excluded from the study’s sampling despite the likelihood of qualifying inclusion criteria. In this study, the exclusion of certain literature journals is not necessarily that they were unsuccessful on inclusion criteria but that the technique in use is constrained. Thus the exclusion of additional literature materials despite the likelihood to qualify the study’s criterion, didn’t affect the validity of our results and conclusions as the nature of the study is largely qualitative, intuitive, and doesn’t involve any form of meta-analysis.
Since Non-probability sampling doesn’t require a complete survey frame, it was fast, easy, and inexpensive way to obtain data for literature review.
2.6. The Inclusion Criteria
1) Context: Low-resourced settings of a low and Low Middle Income Country (LMIC).
2) Intervention Design: The study intervention includes the embedding of effective communication in the care of patients with long-term Disease in Kenya to improve health outcome.
3) The outcome of reviewed papers must either impact positively or negatively on the quality outcome of patients with long-term diseases in Kenya.
4) Any publication journal on effective communication to improve the quality of health, care for patients with long-term disease in Kenya.
5) The reviewed Journals must have been about the Kenyan context.
6) The Journal reviewed must have been published from May 2006 through December 2023.
7) Selection of the co-authors/experts was on long as the experts was coming from public health medical, communication, information technology, computer science and clinical psychologist background and was willing to dedicate time and resource whenever called upon.
2.7. Exclusion Criteria
1) Any studies set that didn’t include Kenyan Context.
2) Any publication journal that didn’t meet the set inclusion criteria above.
2.8. Search Strategy to Identify Relevant Articles for Review
To identify relevant and adequate literature, we considered articles published from May 2006 through December 2023. This enabled us to acquire sufficient articles to review since the preliminary study indicated that effective communication in the care of patients with chronic disease is a new concept and is not commonly practiced in Kenya and sub-Saharan Africa. Thus, longer periods enabled us to cast our net wider in capturing past and present relevant publications.
To obtain significant concepts underpinning Effective Communication in the care of patients with long-term diseases, the study adopted a systematic review approach. A systematic review approaches uses a predefined protocol based on the PRISMA guidelines as shown below to systematically identify, appraise, and synthesize relevant studies’ information.
Based on the PRISMA model, six computerized databases including Cochrane, PubMed, Scopus, Web of Science, Google Scholar, and Scopus were searched for the systematic review. In the search, relevant concepts, synonyms, keywords, titles, and abstract terms relating to Effective Communication in the care of patients with long-term diseases in Kenya were queried.
The titles and summaries of the studies that were screened against the inclusion and exclusion criteria are detailed in Table 1.
2.9. Findings
2.9.1. Quality Appraisal Results
This is a process used to evaluate the reliability, validity, and relevance of the reviewed study. Findings from reviewed articles were extracting from high number of articles upon which 24,977,018 articles did not report a philosophical perspective or address substance of our research concept. Additionally, 17 articles were also expunge from the study having gone through further rigorous review. In synthesis these articles, the study adopted phenomenological approach to understand hidden idea in them and if were underpinning effective communication in the care of patients with long term diseases in Kenya. Non-probability sampling was used, for the reason that the review study was social research and the main objective was not to give an equal opportunity to the entire population of articles but to select the population samples of articles that recognizes the phenomenon under study (Vehovar et al., 2016) [13] . Snowball sampling was also adopted in the study to build up a sample through informants articles (Blaxter et al., 2010) [14] . Snowball sampling, is a non-probability sampling method commonly used when studying hard-to-reach or hidden populations. This method is particularly useful when the target population is small, difficult to identify, or has limited accessibility as was the case in our study as the study focused on Kenya alone. In snowball sampling, articles were initially selected based on the study’s criterion, as already known in the study. Once the initial articles were recruited, they were used to refer or “snowball” additional articles that fit the study criteria or connection. This process continued iteratively, with each article referring others that are related in the study’s requirements. Thus the search from computerized databases yielded a total of 24,977,052 papers (Figure 2) when restricted to English language. Out of the 24,977,052 papers that were generated, only 34 studies were
potentially relevant. Only 17 of the 34 potentially relevant studies met the inclusion criteria and were reviewed as shown in Table 1, whose findings are discussed in the following subsections.
2.9.2. Overview of Findings
In one of the reviewed article of the study established that Kenya is less likely than America to adopt communication for healthy recovery of a patient with long term diseases precisely HIV and lung cancer (Miller et al., 2007) [15] . The paper highlighted the drawbacks and impact of communication and support for individuals with stigmatized conditions as a result of HIV and lung cancer as per Kenyan context. The paper found out that Effective communication can help reduce stigma towards individuals with HIV and lung cancer. By promoting understanding, empathy, and education, communication can challenge misconceptions and stereotypes, leading to more supportive attitudes (Miller et al., 2007) [15] . Further synthesis of the article also noted that effective communication towards persons with HIV and lung cancer can reduce stigma, increase support, enhance treatment adherence, empower individuals, provide access to information and resources, promote emotional well-being, and contribute to education and awareness efforts(Miller et al., 2007) [15] .
Another reviewed manuscript examined the impact of a health communication campaign on compliance with mass drug administration (MDA) for schistosomiasis control in western Kenya and found out that the campaign improves awareness and compliance with MDA, leading to better treatment outcomes. It also highlighted the importance of involving community leaders and using multiple communication methods for effective health interventions. In this review, health communication campaign on schistosomiasis control in western Kenya was found to have a positive impact on compliance with mass drug administration (MDA) Onkanga M, et al. (unpublished data). The increase in the number of people who complied with treatment was largely attributed to the intensive mass media campaign that was implemented before the MDA Onkanga M, et al. (unpublished data). The campaign raised community awareness of the disease, the control programs, and the intervention, leading to behavior change and increased healthcare-seeking behaviors Onkanga M, et al. (unpublished data).
Another study by Wachira et al., 2014 [16] , was reviewed as well. The study was entitled “Physician communication behaviors from the perspective of adult HIV patients in Kenya”. According to this study, perceived physician communication behaviors are associated with HIV patient adherence to treatment. The detailed study noted that patients who observed higher physician communication behaviors were more likely to attend clinic appointments and adhere to medication. The study found out that patients who believed that their physicians were more communicative were more likely to attend clinic, less likely to miss appointments and take medication as prescribed (Haskard Zolnierek & DiMatteo, 2009) [17] . These findings illustrate the positive association between physician communication behaviors and patient adherence to treatment. This study underscore that effective physician communication is crucial in fostering patient engagement, understanding patient preferences, and addressing informational gaps, ultimately leading to improved adherence to HIV care (Haskard Zolnierek & DiMatteo, 2009) [17] . The study noted that physicians often have a poor understanding of patients’ preferences and may have a more directive communication style, which can hinder patient engagement (Strull, 1984) [18] . Thus, it is important for physicians to adopt a patient-centered communication approach that involves effective questioning, transmission of information, expression of empathy and concern, and active engagement with patients. This study also noted that patients’ perception of physician communication behaviors can as well be influenced by factors such as their trust in the physician, their relationship with the physician, and their health status. Overall, the overarching statement in that study is that effective physician communication is essential for promoting adherence to HIV care and improving patient outcomes (Wachira et al., 2014) [16] . The study used a cross-sectional design and was conducted between July and August 2011 in three adult HIV clinics at the Moi Teaching and Referral Hospital-Eldoret, Kenya. A convenient sample of 400 HIV-positive adult patients on combined antiretroviral therapy (cART) was surveyed during their routine medical visits. The study employed two instruments for data collection: a recruitment instrument and a main instrument. The recruitment instrument collected self-reported measures of specific patient characteristics such as gender, receiving HIV treatment, number of missed medical appointments, and frequency of missed cART medication. The main instrument included measures of socio-demographic characteristics, health status, healthcare system factors, and physician-patient relationship characteristics. Perceived physician communication behaviors were assessed using a scale consisting of 11 items, with higher scores indicating more communication behaviors. The study used SPSS-18 statistical package for data analysis, and a p-value of <0.05 was considered statistically significant (Wachira et al., 2014) [16] .
In the systematic literature review, another study examined the stigma faced by rural Kenyan families affected by sickle cell disease. The study revealed that mothers of children with sickle cell disorder are particularly vulnerable to stigmatization within their families, often being blamed for the condition. The findings emphasize the importance of effective communication and sickle cell disorder (SCD management in addressing stigma and discrimination, as well as the need for broader social programs targeting gender and economic inequalities (Marsh et al., 2011) [18] . The analysis of this study noted that blaming mothers for sickle cell disorder (SCD) has several implications for emotional distress, economic costs, and limitations on their lives and choices. For instance blaming mothers for SCD can lead to significant emotional distress. This blaming can create a sense of guilt and shame for mothers, who may feel responsible for their children’s suffering (Marsh et al., 2011) [19] . This emotional distress can have a negative impact on their mental health and overall well-being. The reviewed manuscript pointed out that Mothers of children with SCD may face economic challenges due to the limitations imposed by the disorder. This study found out that mothers often experienced a loss of independent livelihoods and had limited options in coping with their children chronic condition which can result into financial strain and increased economic costs for the family exacerbating challenges of providing adequate care and support for their children in an emergent nation. The study also shows that blaming mothers for SCD can also limit their lives and choices in terms of protecting their own and their children’s livelihoods for instance, mothers may face difficulties in seeking employment or pursuing education due to the demands of caring for a child with SCD. Additionally, mothers may not have the option to leave their children with their husbands or other family members, as there may be concerns about the ability of others to care for the children adequately (Marsh et al., 2011) [19] . The study recommends health and research policies to address these issues targeting underlying gender and economic inequalities in this kind of a set up and fronting effective communication as a solution. The study documents that effective communication can play a crucial role in addressing the stigma faced by families affected by sickle cell disorder (SCD) in rural Kenya. The study suggest that by improving communication and providing accurate information about the genetic nature of SCD, misconceptions and blame can be addressed, reducing the stigma faced by mothers and families. The study advices that effective communication can promote understanding and empathy among community members. The study counseled that by raising awareness through effective communication on SCD and its impact, community members can develop a better understanding of the challenges faced by affected families and that understanding can help reduce stigmatizing attitudes, behaviors and foster a more supportive and inclusive environment (Marsh et al., 2011) [19] . The study concluded that effective communication is a crucial solution to address the stigma faced by families affected by SCD in rural Kenya. This is due to the provision of accurate information, promoting understanding, empathy besides connecting families with communicative support services. This can play a significant role in reducing blame, discrimination, the limitations imposed on the lives and choices of affected mothers and families. In that review, qualitative research methods were utilized in rural Kenya for conducting the study. In-depth interviews were conducted with 13 families affected by sickle cell disorder (SCD) and 12 staff members of a local biomedical research program. The selection of participants was purposive, aiming to maximize diversity in socioeconomic and educational status, religion, severity of illness burden, and religion among families. Purposive sampling refers to a group of non-probability sampling techniques in which units are selected because they have characteristics that are needed in the sample. In other words, units are selected “on purpose” in purposive sampling. The interviews were recorded, transcribed, and analyzed using the constant comparative method for family interviews and a thematic framework approach for staff data (Marsh et al., 2011) [19] . The analysis of data from approximately 28.5 hours of recordings of family narratives involved line-by-line coding, progressive categorization, and the development of analysis charts for comparison of emerging categories across participants. The analysis of perceptions of SCD inheritance and impacts on family relations also drew on data from the staff interviews, using a thematic framework method combining deductive assessment within the themes generated by the family narratives and an inductive search for new emerging issues relevant to these themes. The study obtained scientific and ethical approval from the institutional review committee and national scientific and ethical review committees in Nairobi (Marsh et al., 2011) [19] .
Another manuscript that we reviewed having meet the requirement of an Effective Communication in the care of Patients with long term Disease in Kenya was a descriptive observational study (Mohamoud & Mash, 2022) [20] that evaluated the quality of communication in consultations by general practitioners (GPs) in Nairobi, Kenya. The study found that while GPs demonstrate skills in gathering information, making diagnoses, and suggesting management, there are areas for improvement in terms of patient-centered care and communication skills. The paper suggests that further training in communication skills, particularly in delivering person-centered consultations, would benefit GPs in Nairobi Kenya. Additionally, deploying family physicians to the primary care setting could enhance the overall quality of service delivery. The study identified both strengths and weaknesses in the communication skills of general practitioners (GPs) in Nairobi, Kenya. Strengths that were identified for example were that GPs demonstrated skills in gathering information, explaining the diagnosis, and suggesting appropriate management (Louw et al., 2020) [21] . Though their weaknesses were that GPs did not make an appropriate introduction, explore the context or patients’ perspectives, allow shared decision making, or provided adequate safety netting. Their consultations were brief and had a biomedical approach, lacking skills in whole-person medicine (Mohamoud & Mash, 2022) [20] . Furthermore, GPs lacked training in effective communication skills, particularly in delivering person-centred consultations and that the quality of communication was negatively impacted by the young and inexperienced GPs, who dealt with low-to-moderate complexity and mostly acute problems. On account of that, synthesized study recommended for further training and expertise in communication skills for GPs in Nairobi, Kenya, to deliver high-quality primary care among patients with chronic conditions (Louw et al., 2020) [21] . The study utilized a descriptive observational cross-sectional design for its methodology. A cross-sectional study is a type of research design where data is collected from many different manuscripts at a single point in time. In cross-sectional research, variables are observed without influencing them. This study took place in 13 primary care clinics attached to a tertiary hospital in Nairobi, Kenya, owned and operated by the private healthcare organization. All 25 GPs working in these facilities were invited to contribute one audio recording of a consultation (Louw et al., 2020) [21] . The consultations were recorded using a discrete micro recorder, and basic demographic data related to each GP was collected (Louw et al., 2020) [21] . The audio recordings were assessed using the Stellenbosch University Observation Tool (SUOT), which evaluated 16 communication skills (Louw et al., 2020) [21] . The Statistical Package for Social Sciences (SPSS) was used to analyze the data (Mohamoud & Mash, 2022) [20] .
This review also examined a manuscript on providers’ perceptions of communication and women’s autonomy during childbirth in sub-counties of Migori, Kenya (Afulani et al., 2020) [22] . According to the manuscript, poor communication and lack of respect for women’s autonomy during childbirth can adversely affect women, including negative birth experiences, reduced trust in healthcare providers, decreased satisfaction with care, increased risk of medical interventions (such as episiotomies, cesarean sections), adverse maternal and neonatal decision-making outcomes that could result in adverse infant outcomes (Afulani et al., 2020) [22] . The reviewer noted that while health providers recognize the importance of communication and autonomy, there are instances of poor communication and lack of respect for women’s sovereignty. The study stressed on the need to address these factors to improve communication and autonomy of women during childbirth. The study mounted a mixed-methods design, combining quantitative and qualitative data collection and analysis. The 49 clinical and non-clinical providers working in maternity units across all sub-counties of Migori, Kenya were interviewed. The interviews were conducted using a questionnaire with both closed and open-ended questions, and the data was analyzed using descriptive statistics and thematic analysis (Afulani et al., 2020) [22] .
The systematic literature review also inspected an article on Socio-cultural contexts of end-of-life conversations and decisions for bereaved family cancer caregivers entitled “Socio-cultural contexts of end-of-life conversations and decisions: bereaved family cancer caregivers’ retrospective co-constructions” by (Githaiga & Swartz, 2017) [23] . This article scrutinized the content and contexts of end-of-life conversations and decisions among bereaved women family cancer caregivers in Nairobi, Kenya. The article found that family dynamics plays part in influencing the nature of conversations and decisions thus their role is often critical in palliative care despite being ill-prepared to deal with end-of-life issues. The article concluded that palliative psychosocial interventions should equip family caregivers with end-of-life care skills in resource-limited settings as Kenya being an emerging economy. This study demonstrated the transitional nature of family caregiver roles, with caregiving being a shared role particularly in the terminal phase. The study suggested that interventions should focus on providing support and guidance to family caregivers in navigating the unknown end-of-life terrain and making difficult decisions. The review noted that when family caregivers are not equipped with necessary tools as communication skills for end-of-life care, there are potential adversaries that may increase as emotional distress and burden if they are for instance unable to effectively communicate with their loved ones about end-of-life issues which can lead to guilt, anxiety, and uncertainty. The study reverberates that family caregivers may struggle to understand their loved ones’ wishes and preferences for end-of-life care which can lead to misunderstandings and conflicts within the family. The study recognized that inadequate effective communication skills can lead to lack of coordination and collaboration between family caregivers and healthcare professionals. This can result in a lower quality of care for the patient, as important information may not be effectively communicated (Githaiga & Swartz, 2017) [23] . The methodology used in this study was an Interpretative Phenomenological Analysis (IPA). An IPA technique is an approach which focuses on in-depth investigation of people’s significant life experiences and the meanings they ascribe to those experiences (Githaiga & Swartz, 2017) [23] . The study adopted also the focus group discussions (FGDs) for its primary data collection which were conducted in small groups, with an average duration of 2 hours per group. The discussions were held in English and audio recorded with participants’ consent (Githaiga & Swartz, 2017) [23] . The data analysis involved several readings of each focus group transcript, with observations and comments written down alongside the numbered meaning units. The analysis process included a thematic scrutiny across the four focus groups, identifying points of convergence and divergence (Githaiga & Swartz, 2017) [23] .
Another article that we examined in the Systematic review study was on the potential of schoolchildren as a health change agents in rural western Kenya. The analysis of the article upheld that schoolchildren are able to improve their knowledge, practice related to health issues, as well as influence their peers and guardians. The review reported that schoolchildren can teach and influence adults, challenging the assumption that children are passive individuals in society health issues (Onyango-Ouma et al., 2005) [24] . Detailed synthesis of the manuscript established that children were able to bring about positive changes such as cutting grass and clearing footpaths, faster than adults. Although the total number of latrines in the area remained low, children were able to motivate their parents to build latrines (Onyango-Ouma et al., 2005) [24] . The intervention of Health communication in the study, registered increased knowledge levels among children, parents, and teachers. The intervention involved teaching activities and health communication, targeting children, parents, and teachers. Scrutiny of this manuscript showed that teachers facilitated the activities, addressing the concerns and fears of the health communicators (HCs) or schoolchildren. The method of the study involved a prospective, quasi-experimental design to compares groups with different circumstances or treatments and find cause-and-effect links. The study used questionnaire surveys to assess knowledge levels among the study’s population. The surveys were conducted at baseline (T1), 4 months into the intervention (T2), and 14 months later (T3). The surveys included both open-ended and closed-ended questions and covered topics related to malaria, diarrhea, and hygiene. The data collected from the surveys were coded and entered into a computer for analysis. Largely, the study utilized a combination of surveys, observations, and interviews to assess knowledge levels and evaluate the impact of the health communication intervention. In a nutshell, the study demonstrated that children can learn health messages/communication and pass them on to others, making them effective health change agents in their communities (Onyango-Ouma et al., 2005) [24] .
The systematic literature study assessed critically a realist review article which focused on mHealth text and voice communication to monitor people with chronic diseases in low-resource settings. The article was a review of other studies on the use of mobile health (mHealth) interventions to monitor chronic diseases in low-resource settings such as an emerging economy. A realist review is a theory-driven approach for reviewing the literature with the aim of producing one or more theories to explain particular phenomena. This study found that mHealth interventions can be effective for improving patient care and health outcomes when based on existing frameworks and theory (Anstey Watkins et al., 2018) [25] . The manuscript presented specific studies that used text message interventions, the effectiveness of mobile health interventions in improving patient outcomes, mechanisms of change in mHealth interventions, and the limitations in low-and middle-income countries. The study noted that the common components in mobile health interventions for monitoring chronic diseases in low-resource settings are: Reminders, Patient observation of health state, Provision of support communication among others. For the reminders, the intervention included prompts to patients about appointments, medication compliance, or other important health-related tasks. In patient observation of health state, the intervention encouraged patient to monitor their own health state, such as tracking their symptoms, medication side effects, or physiological measures like blood pressure. As for Provision of support communication an interventions facilitated two-way communication between the patient and health worker, allowing patients to seek support, ask questions, or receive guidance and would be done through text messages or voice calls. The review noted that text message interventions have shown positive impacts on health outcomes for patients with HIV, hypertension, and other chronic diseases. For example a systematic review on text message interventions for HIV and other chronic diseases found that text mediations improved adherence to antiretroviral therapy, viral suppression, and retention in care for HIV patients (Mehra et al., 2021) [26] . Also a randomized controlled trial in South Africa found that text message interventions for hypertension led to improved medication adherence and increased proportion of days covered for blood pressure lowering medication (Bobrow et al., 2016) [27] . In other chronic diseases, text interventions are also shown improved health outcomes. A point in case is a systematic review that established text message interventions improved medication adherence and health outcomes for patients with diabetes, asthma, and cardiovascular diseases (Adunlin et al., 2018) [28] . These findings suggest that text message interventions can be a valuable tool in improving health outcomes for patients with chronic diseases, including HIV and hypertension. The methodology used for the review was a combination of a realist review and a systematic search for empirical studies. The realist review approach was used to make sense of heterogeneous evidence about complex interventions applied in diverse contexts, while the systematic search was conducted to identify relevant empirical studies. The review included searching for systematic reviews, extracting examples of how interventions worked from included papers, mapping these examples onto a realist Context-Mechanism-Outcome configuration (CMOc), and developing a summary of how the interventions were intended to work according to the study authors. Data extraction was conducted from the included studies, including research design, participant sample, setting, outcome measures, intervention description and components, intervention effect, and authors’ program theory (Anstey Watkins et al., 2018) [25] .
In addition, the systematic literature study reviewed a manuscript on successes and challenges of speech language therapy service provision in Western Kenya based on three case studies (Staley et al., 2021) [29] . The manuscript presented the challenges and successes of speech language therapy services in Western Kenya. It emphasizes the need for communication-related services in sub-Saharan Africa and proposes alternative models of service provision for instance a framework for responsive global engagement in speech language therapy, collaboration and sustainable relationships in under-resourced communities. The review identified some challenges faced in provision of speech language therapy services in sub-Saharan Africa such as a significant shortage of trained speech language therapists contributing to limited availability of services and adequate care to individuals with communication disabilities (Staley et al., 2021) [29] . The emerging profession of speech language therapy lacks adequate structures and support systems. Furthermore, Sub-Saharan Africa is home to a diverse range of cultures and languages thus providing speech language therapy services that are culturally and linguistically appropriate can be challenging. The review noted also that many of the services currently offered in sub-Saharan Africa are influenced by minority world cultural ideals and may perpetuate structural racism and language socialization. The study recommended that for a revise the service models to better meet the needs of individuals in African contexts. The study noted that the challenges in providing speech language therapy services in sub-Saharan Africa are multifaceted and require collaborative efforts to address the gaps in service provision and support the development of culturally and linguistically appropriate care. The study stated that effective communication can facilitate collaboration, cultural sensitivity, awareness, training, advocacy, and policy development, ultimately helping to address the challenges faced in providing speech language therapy services in sub-Saharan Africa (Staley et al., 2021) [29] . For example effective communication between different stakeholders, such as speech language therapists, healthcare providers, educators, and community members, can foster collaboration and partnerships. By sharing knowledge, resources, and expertise, these stakeholders can work together to address the challenges and develop sustainable solutions. Also effective communication allows for a better understanding of the cultural and linguistic diversity in sub-Saharan Africa. By actively listening and engaging in culturally sensitive communication, speech language therapists can tailor their services to meet the specific needs and preferences of individuals with communication disabilities (Staley et al., 2021) [29] . The study method was the examination of three clinical case studies from Western Kenya based on a conceptual framework.
The systematic literature review also surveyed a manuscript advancing that Higher Clinician-Patient Communication Is Associated with Greater Satisfaction with HIV Care (Wachira et al., 2021) [30] . The paper examines the relationship between clinician-patient communication skills and patient satisfaction with HIV care in Kenya. It emphasizes the importance of effective communication and patient-centered care in improving patient outcomes and satisfaction. It suggests that promoting good communication skills and provider-patient interactions may be key to enhancing patient satisfaction with HIV services. The study disclosed that effective communication plays a crucial role in patient satisfaction with HIV care. It showed that patients who perceive their clinicians as having good communication skills are more likely to report satisfaction with care. Provider-patient communication (PPC) skills, such as clear and empathetic communication, facilitate better provider-patient relationship dynamics and empower patients with knowledge about their health (Wachira et al., 2021) [30] . When patients feel that their clinicians have good communication skills, they are more likely to feel satisfied with the care they receive. This relationship between communication and satisfaction has been observed in high-income countries, but its characterization in resource-limited settings with a high HIV burden is still limited (Wachira et al., 2021) [30] . Therefore, promoting good PPC skills is essential for improving patient satisfaction with HIV care (Wachira et al., 2021) [30] . The researchers employed a quantitative research method, such as surveys/questionnaires, to assess patient satisfaction with HIV care and the role of effective communication. These surveys measured patient perceptions of communication skills, such as clarity, empathy, and information provision by healthcare providers. The study population consisted of adult patients living with HIV who are receiving HIV care at healthcare facilities. Eligibility criteria included factors such as being on a first-line antiretroviral therapy regimen and having an elevated viral load. Data collection instruments were developed and some adapted from validated measures of provider-patient communication (PPC) skills. These instruments assessed various aspects of communication, including verbal and non-verbal communication, active listening, and information sharing, and shared decision-making. Data was analyze the data using statistical methods such as correlation analysis, regression analysis, and structural equation modeling to examine the relationship between effective communication and patient satisfaction with HIV care. In addition, confounding factors such as sociodemographic characteristics, medication self-efficacy, and knowledge of HIV and treatment were controlled (Wachira et al., 2021) [30] .
The systematic literature review unmasked another research study on the experiences of patients living and dying with heart failure in Kenya (Kimani et al., 2018) [31] . The study focused on the physical, psychological, spiritual, and financial distress patient’s experience, as well as the information/communication needs they do not receive from healthcare providers. The study suggested that a holistic approach, such as palliative care, could improve the quality of life for these patients. The article also emphasized on the need for further research to integrate palliative care into the management of heart failure in Kenya and Sub-Saharan Africa. Effective communication was stressed in the article as an integral part of palliative care for the management of heart failure in Kenya and Sub-Saharan Africa (Kimani et al., 2018) [31] . The study records that a palliative care is multidimensional care aimed at reducing suffering and improving quality of life of a patient. It’s an appropriate holistic approach for addressing patient’s needs. The review also noted that there are significant barriers to effective communication and information exchange such as poor prognostication of heart failure, patients’ fear of retaliation for asking questions, and care that overlooks psychological, social, and spiritual needs. The study records that Improving communication with health professionals and providing timely information to patients are essential for enhancing symptom management and patients’ quality of life such as providing information at the time of diagnosis and during acute crises when symptoms become unfamiliar and unresponsive to treatment. The reviewed study recommended that as non-communicable diseases, including heart failure, continue to rise in Sub-Saharan Africa, it is crucial to address the communication and information needs of patients to ensure effective management and improve outcomes (Kimani et al., 2018) [31] . The study utilized a longitudinal qualitative study design using serial in-depth interviews to explore the experiences of patients living with advanced heart failure in Kenya for methodology. Qualitative longitudinal research (QLR) comprises qualitative studies, with repeated data collection, that focus on the temporality (e.g., time and change) of a phenomenon. The use of QLR is increasing in health research since many topics within health involve change (e.g., progressive illness, rehabilitation). The researchers conducted face-to-face interviews with patients at three-month intervals for up to six months, with the timing of interviews being flexible based on the patients’ health status or occurrence of events such as hospital admissions. The interviews took place in hospital wards or at the patients’ homes and lasted between 25 and 125 minutes. All interviews were audio recorded and transcribed into English. A topic guide was used to direct the interviews and explore patients’ physical, social, spiritual experiences, as well as their experiences with care. The researchers also conducted monthly phone calls with patients to record any changes in their condition and to plan subsequent interviews. The data analysis was done following Braun and Clark’s multi-staged approach to thematic analysis. Thematic analysis is a method for identifying, analyzing, and reporting patterns (themes) within data (Braun & Clarke, 2006) [32] . The transcripts were read repeatedly to familiarize the researchers with the data, and codes were identified and arranged into themes and sub-themes. Regular multidisciplinary team meetings were held to review emerging codes, themes, and data saturation. The Nvivo qualitative data analysis computer software package was used to manage the data, document systematically and individually (Kimani et al., 2018) [31] .
A manuscript about Functional Health Literacy and Doctor-Patient Communication from Experiences of HIV/AIDS Patients in Homa Bay County, Kenya (Butto et al., 2020) [33] also qualified for a systematic review. This manuscript examined the association between functional health literacy and doctor-patient communication among HIV/AIDS patients in Homa Bay County, Kenya. The majority of respondents had inadequate functional health literacy levels, which significantly influenced doctor-patient communication. Finding of the study was that functional health literacy needs to be improved to enhance interaction and improve health outcomes. The study noted that Effective communication plays a crucial role in improving functional health literacy and enhancing doctor-patient interaction as it helps patients better understand their health concerns. When doctors explain medical information in a way that is easy to understand then patients with limited health literacy are more likely to comprehend and retain the information (Butto et al., 2020) [33] . This improves their overall health literacy and enables them to actively participate in their own healthcare decisions and management. Secondly, the effective communication guarantees patients clear instructions about taking care of their health problems. When doctors provide easy-to-understand instructions, patients are more likely to adhere to treatment plans, engage in self-care practices, leading to better health outcomes (Butto et al., 2020) [33] . The review of the manuscript discovered also that effective communication helps doctors to listen carefully to their patients. Thus when doctors actively listen to patients, they gather important information about their health problems, leading to accurate diagnoses and appropriate treatment plans which enhances the quality of care and patient satisfaction. The review uncovered also that effective communication helps to establish trust and rapport between doctors and patients. This is since when doctors communicate in a respectful and empathetic manner, patients feel more comfortable discussing their health concerns and asking questions. This would eventually promote open and honest communication that is essential for effective healthcare delivery (Butto et al., 2020) [33] . The methodology used in this manuscript was a cross-sectional hospital-based survey conducted among 362 HIV/AIDS patients receiving care at the eight sub-county hospitals of Homa Bay County in Kenya. Data was collected using a self-administered structured questionnaire. Cronbach’s alpha and confirmatory factor analysis tests were used to ascertain the reliability and validity of the study instruments. Logistic regression analysis was used to measure the association between functional health literacy and doctor-patient communication (Butto et al., 2020) [33] .
Finally, the systematic review concluded the scrutiny of manuscripts by a paper on language of cancer diagnosis and implications for cancer management in Kenya by (Githaiga & Swartz, 2017) [34] and captioned “You have a swelling’: The language of cancer diagnosis and implications for cancer management in Kenya”. This article examined the impact of language barriers on cancer diagnosis and management in the Kenyan healthcare system. It reiterates the challenges that are faced by patients and caregivers who may not understand medical terminology, leading to inadequate understanding of the diagnosis and compromised care. The article suggests the need to reassess the assumption that English and Swahili are sufficient for communication in healthcare settings in Kenya and calls for further research on language needs and interpreter training (Githaiga & Swartz, 2017) [34] . The article recommended use of effective communication in addressing challenges faced by patients and caregivers who may not understand medical terminology, leading to inadequate understanding of diagnosis and care. This is since Effective communication is capable of bridging the language barrier between healthcare professionals, patients or caregivers who may not speak the same language. Language barriers can hinder understanding of medical terminology and instructions, making it difficult for patients and caregivers to fully comprehend the diagnosis and the recommended interventions. Synthesized article endorsed utilization of professional interpreters and healthcare professionals to ensure that accurate information is conveyed and understood by all parties. The study observed that by effective communication that uses plain language and non-verbal clues enhances understanding. The study also asked Healthcare professionals to simplify complex medical terms and explanations that to that which is easily comprehensible to patients and caregivers (Meuter et al., 2015) [35] . Additionally, non-verbal clues such as visual aids, diagrams, and gestures were also recommended to supplement and enhance understanding of verbal communication. The study noted that effective communication is edified by active listening and empathy on the part of healthcare professionals. Actively listening to patients, caregivers and healthcare professionals can enable better understanding of their concerns, fears and questions, before addressing them aptly. The article stated that empathy can help create a supportive and trusting environment in turn where patients and caregivers feel comfortable asking questions and clarification (Meuter et al., 2015) [35] .
3. Discussion and Recommendation
Despite numerous instances of failed patients care with long-term disease in Kenya attributed to ineffective communication, the study did come across a research study on this subject. The review aimed to provide valuable insights into the importance of effective communication in improving patient care and outcomes in Kenya. While the availability of research specifically focused on effective communication in the care of patients with long-term diseases in Kenya is limited, the existing literature from other countries highlights the importance of this topic. The findings emphasize the need for healthcare providers in Kenya to prioritize and improve their communication skills to enhance patient care and outcomes. A review of evidence revealed a devastating instance where mothers of children with sickle cell disorder are stigmatized in their families and blamed for the condition of their newborns. Due to the lack of evidence from the findings that male patriarchy was culpable for blaming mothers of sickle cell disorder (SCD) children, these and other findings formed fertile ground for staging an effective communication targeted at this setting (Marsh et al., 2011) [19] . Therefore, in our view, a lack of effective communication could have been a root cause of the affliction that innocent mothers and their newborns experienced with sickle cell disease. It was not just this study that informed our position, but also other reviewed studies. For instance it was discovered in one of these studies that schoolchildren could teach and influence adults, dispelling the myth that women and children are passive members of society when it comes to health issues (Onyango-Ouma et al., 2005) [24] . In this case, male patriarchy was revealed not to be absolutely responsible for extreme negative cultural practices, to the point of blaming and stigmatizing mothers and their newborns for sickle cell disease (SCD). Secondly, we were influenced by the study (Staley et al. 2021) [29] on the successes and challenges of speech language therapy service provision in Western Kenya. This study found no evidence that male patriarchy contributed to the challenges faced by speech language therapy providers in Western Kenya. Though this study showed sufficient evidence that cultural and linguistic diversity in sub-Saharan Africa can be better understood through effective communication (Staley et al., 2021) [29] . The study noted, for instance, that effective communication among different stakeholders, such as speech language therapists, healthcare providers, educators, and community members, can enhance collaboration, partnerships, and a better understanding of sub-Saharan Africa’s cultural diversity and linguistic diversity. A third study upon which our view was anchored is by (Wachira et al., 2021) [30] which suggested that higher clinician-patient communication is associated with greater satisfaction with HIV care. The study’s results suggested that patients who perceive their clinicians to have good communication skills are more likely to be satisfied with their treatment (Wachira et al., 2021) [30] . In high-income countries, the relationship between communication and patient satisfaction is well established. However, its characterization in resource-limited settings such as Kenya with a high HIV burden has not been well characterized. It’s for these reasons that we recommended the promotion of Provider-patient communication (PPC) skills to improve patient satisfaction with HIV care (Wachira et al., 2021) [30] . A fourth reviewed study by Kimani et al., (2018) [31] witnessed similar trends. This study’s title was “the experiences of patients living and dying with heart failure in Kenya”. These trends were also true for the fifth study whose author was (Butto et al., 2020) [33] . Butto et al., (2020) [33] study’s was entitled “Functional Health Literacy and Doctor-Patient Communication from Experiences of HIV/AIDS Patients in Homa Bay County, Kenya”. The sixth study upheld our views also as observed by the earlier authors. This study was authored by Githaiga & Swartz, (2017) [34] and entitled “The language of cancer diagnosis and implications for cancer management in Kenya you have a swelling”. It advocated for the use of Effective communication in addressing challenges faced by patients and caregivers who may not understand medical terminology, leading to inadequate understanding of diagnosis and care. This was so, since Effective communication was capable of bridging the language barrier between healthcare professionals, patients or caregivers who couldn’t speak the same language thus hindered understanding of medical terminology and instructions, making it difficult for patients and caregivers to fully comprehend the diagnosis and the recommended interventions. The successful stories witnessed in these (six) studies demonstrate sufficiently that when effective communication is embraced by all subjects then the outcome of the task undertaken is likely to favorable as effective communication is at the center stage.
Our second view from findings is that to ensure a truly effective communication at the center of care to patient with long term disease, then adoption and integration of Cybernetics is supreme. This submission triangulates our initial view that endorsed the use of effective communication for improving patient care and outcomes in Kenya. Refraction in our view has been shaped by an observation in another study that focused on mHealth text and voice communication to monitor people with chronic diseases (Anstey Watkins et al., 2018) [25] . This study promoted the adoption of a computer application with fixed modules or add-ons to facilitate effective communication in low-resource settings so that chronic disease patients can be monitored effectively (Anstey Watkins et al., 2018) [25] . This study recount that effective monitoring can be achieved if the computer is fixed with modules or add-ons to provide reminders, patient observation of health status, support, and communication for people with chronic diseases (Anstey Watkins et al., 2018) [25] . For instance, this study discovered that text message interventions for HIV and other chronic diseases in a computer application that fastened add-ons was able to improve adherence to antiretroviral therapy, viral suppression, and retention in care for HIV patients (Mehra et al., 2021) [26] . It’s for this reason that we held the view that a truly effective communication that enables centric care for patients with a long term disease in Kenya is by the integration of Cybernetics. The view to adopt Cybernetics in this study was aimed at unlocking a truly effective Communication in the care of Patients with long term Disease in Kenya. Cybernetics is the study of communication in human and machine and has been an area of research for a while. Cybernetics combined concepts from information theory, feedback control systems (both biological and machine) and electronic computers (Marinescu, 2017) [36] thus recommended to revolutionize communication in the care of Patients with long term Disease in Kenya.
Acknowledgements
Our special thanks to Prof. Laban P. Ayiro, vice Chancellor of Daystar University (Nairobi Kenya), who was instrumental in providing us with training, especially in mixed methods research. We would like to thank Prof. Egara Kabaji as well for his advice on writing skills for a manuscript. It is with great gratitude that we extend our appreciation to the Daystar University and fraternity for their general support while undertaking this study.
My special thanks go to my spouse, Lenah Chepkorir Oyuech, for her unwavering support in the face of her medical procedures as well as my absence throughout this study.