Patient reported barriers and facilitators of chronic kidney disease care in Sub-Saharan Africa: a mixed methods systematic review using the COM-B model.

BACKGROUND: In Sub-Saharan Africa (SSA), the prevalence of chronic kidney disease (CKD) is on the rise. Treatment for CKD in SSA is characterized by delayed initiation, early discontinuation, inadequate duration of therapy, and suboptimal follow-up. To our level of understanding, evidence on the barriers and facilitators of CKD care in SSA has not been comprehensively reported and is the focus of this mixed methods systematic review. METHODS: This convergent integrated Joanna Briggs Institute (JBI) methodology for mixed systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Six databases were utilized and included Medline, Ovid, Cumulative Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, and Scopus for studies. Peer-reviewed articles published in the English language between 2000 and July 30, 2024, were included. Qualitative, quantitative, or mixed-method studies that reported health care, treatment barriers, and facilitators among patients with CKD residing in SSA were included. Two independent reviewers screened, appraised, and extracted data from included studies using a standardized JBI SUMARI data extraction form. A deductive data analysis approach was used to match the findings to the six components of the COM-B (capability, opportunity, motivation) behavioral change model. RESULTS: The review identified 10,627 records, 155 of which were found to be eligible for full-text screening, and 28 of these articles met the inclusion criteria. The review included 15 quantitative and 13 qualitative studies with a total of 2,178 participants with ages ranging from 18 to 86 years. Fatigue and comorbidities were commonly discussed under capability barriers. Economic constraints, unavailability of drugs, care facility inaccessibility, and distance were commonly explained under opportunity barriers. Depression and uncertainty of the future were commonly discussed motivational barriers, whereas social support and a positive attitude towards CKD care were key facilitators of CKD care. CONCLUSION: We used a theory-informed approach to synthesize barriers and facilitators of CKD care and then mapped the identified barriers to behavioral change wheel interventions using the Taxonomy of Behavioral Change Technique. Education, training, enablement, environmental restructuring, and persuasion were commonly mapped to identify barriers. Further research is recommended to identify contextually appropriate interventions to address barriers and capitalize on facilitators.