title: Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study.
abstract: OBJECTIVE
  We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members' thoughts regarding high impact solutions to expand access to essential emergency services.
  
  
  METHODS
  We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach.
  
  
  METHODS
  Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation.
  
  
  RESULTS
  Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care-a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene.
  
  
  CONCLUSIONS
  Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region.
authors.affiliation: Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
authors.forename: Morgan C
authors.initials: MC
authors.lastname: Broccoli
authors.affiliation: Department of Emergency Medicine, University of Maryland, Baltimore, Maryland, USA.
authors.forename: Emilie J B
authors.initials: EJ
authors.lastname: Calvello
authors.affiliation: University of Maryland, School of Medicine, Baltimore, Maryland, USA.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Skog
authors.affiliation: Accident and Emergency Department, The Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wachira
authors.affiliation: Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Wallis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D017144:Focus Groups; D006282:Health Personnel / Q000193:education; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010465:Perception; D036301:Qualitative Research; D012111:Residence Characteristics; D012424:Rural Population; D055815:Young Adult
keywords: ACCIDENT & EMERGENCY MEDICINE