Published in PLOS One on 2025-11-20, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original study title: Exploring factors contributing to patient decision-making in the care journey to elective hernia care in Kenya
Original authors: Helen W Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A Blatnik, JoAnna Hunter-Squires, Ivan Seno Saruni, Lovenish Bains
Source: PLOS One • DOI 10.1371/journal.pone.0337430
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Capacity for elective general surgical care is an important reflection of a health system’s ability to meet a population’s surgical needs and is currently known to be inadequate in many low- and middle-income countries. Patient agency is a key, understudied factor which shapes how and when patients ultimately decide to engage with formal care. Understanding factors which influence patient care seeking activity can have important implications for how current and future health systems may be utilized. This study aims to explore how patients approach the navigation and triage of their elective hernia condition within the Kenyan surgical care system.
We conducted a qualitative study of 38 convenience-sampled patients diagnosed with an elective hernia condition at a tertiary referral hospital in Kenya between November 2023 and March 2024. We utilized Braun and Clarke’s six-step model of thematic analysis to generate key themes across the phases of care seeking, reaching and receiving as modeled in the Three Delays Framework.
We identified three main cross-cutting themes including (1) the flow of power from patients to providers, and vice versa, take the form of consent or knowledge, respectively; (2) trust is a limited currency required for patients to engage with formal care; and (3) internal and external contextual factors remain the foundation for patient-provider care activities. We incorporated these themes together in a framework which illustrates the cyclical nature by which each factor feeds back on the others, ultimately affecting patient care.
Fluctuating flows of patient power and trust interacts with existing infrastructural context to influence the ability of a health system to generate care. Recognizing the interaction of these key factors may have important bearing on the successful implementation of any larger systemic efforts or policies to improve access to elective surgical care.
Introduction
Elective general surgical care has a fragile and often leaky pipeline, a phenomenon highlighted following the COVID-19 pandemic when an estimated 82% of elective surgeries for benign conditions were canceled or postponed globally [1,2]. Elective surgical capacity can reflect a health system’s ability to meet the surgical needs of its population in a timely fashion, particularly given that managing surgical needs in an elective manner avoids emergent surgeries which are known to be associated with worsened patient outcomes. Initiatives like National Surgical, Obstetric and Anesthesia Plans (NSOAPs) or the Global Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care (G4 Alliance) 11 Best Practice Recommendations on the optimal organization of surgical services seek to integrate operative care into broader country-level health systems strengthening plans [3,4]. While these system-level approaches are critical for coordinating the expansion of access to elective surgical care, a gap remains in considering how patients may interact with these well-laid plans.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Helen W Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A Blatnik, JoAnna Hunter-Squires, Ivan Seno Saruni, Lovenish Bains. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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