Influence of Access Factors On Uptake of Diagnostic Imaging by Oncology Patients in Nakuru, Bomet and Nandi Counties, Kenya

Abstract

Cancer, a non-communicable disease, poses a significant global and national health threat, with high demands for diagnosis and treatment. Late diagnosis has been a key factor contributing to high cancer mortality rates in Kenya. This study aimed to examine how access factors influence oncology patients' uptake of diagnostic imaging in Nakuru, Bomet and Nandi Counties, Kenya. Specific objectives focused on the influence of demographic factors, equipment acceptability, healthcare accessibility, scanning costs, imaging adequacy, and the overall uptake of diagnostic imaging. The study was grounded in the Health Belief Model and the Theory of Planned Behavior. A cross-sectional research design was employed, collecting data from 3 public hospitals in Nakuru, Bomet and Nandi Counties, Kenya. The primary respondents were 326 patients and 41 health workers. Semi-structured questionnaires were used to interview patients and a key informant interview guide was used to collect data among the healthcare workers. A pre-test was conducted at Texas Cancer Center in Nairobi County. Data analysis was performed using SPSS version 25, which processed descriptive statistics and binary logistic regression and qualitative data was analysed using themes. Key findings revealed that 25% of the patients were aged 41-50, and 22% were aged 61-70. Most (89%) were married, and 61% were male. Breast and colon cancers were the most common diagnoses (63%). Regarding equipment awareness, 76% of patients were familiar with CT and MRI scanners, while only 5% knew about PET scanners. Insurance usage was inconsistent, with 41% of patients using it twice, but many had to rely on fundraising or family contributions for other expenses. Conclusions indicated that most patients seeking cancer diagnostic imaging were middle-aged or older, married individuals. Many patients 208(76%) had some prior knowledge of CT and MRI scanners, though awareness of PET scanners was low. Long wait times of 3-6 months were common due to overbooked sessions. Despite most patients having SHA or private insurance, many still paid out-of-pocket for services. Inadequate imaging services on operational days caused significant delays for patients. The study recommends that the hospitals should allocate more funding to raise awareness particularly among young, unmarried individuals, to encourage early diagnostic imaging, especially for females. Regarding equipment acceptability, hospitals should develop policies that include pre-imaging training for patients. To improve accessibility, hospitals should seek donor support and corporate partnerships to acquire more imaging equipment. On scanning costs, there is a need for the county governments to enhance public awareness of SHA's benefits. Lastly, hospitals should ensure that imaging services remain operational consistently to serve more patients efficiently. This study underscores the need for improved access, awareness, and resource allocation in cancer diagnostic imaging to reduce late diagnosis and enhance patient outcomes in Kenya.