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Spiritual issues of people living and dying with advanced heart failure in Kenya: a qualitative serial interview study
  1. Kellen N Kimani1,
  2. Scott A Murray2,
  3. Liz Grant3
  1. 1School of Public Health, University of Nairobi, Nairobi, Kenya
  2. 2Primary Palliative Care Research Group, The Usher Institute, University of Edinburgh, Edinburgh, UK
  3. 3Global Health Academy, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Kellen N Kimani; K.N.Kimani{at}


Background Exploring patients' spiritual issues is vital for informing holistic care. The spiritual concerns of patients living and dying with advanced heart failure in sub-Saharan Africa remains unknown. Our aim was to describe spiritual issues in the context of the lived experiences of patients with heart failure in Kenya.

Methods We purposively recruited 18 patients admitted with advanced heart failure at a rural district hospital in Kenya. We conducted serial in-depth interviews with patients at 0, 3 and 6 months after recruitment. We conducted bereavement interviews with their carers. Interviews were recorded, transcribed into English and analysed using a thematic approach, assisted by Nvivo software package.

Results Patients expressed traditional and Christian spiritual beliefs in response to their illness. At diagnosis, some patients felt their illness had occurred because they had wronged God, while others felt betrayed by God. Some expressed comfort from God and optimism believing that God was in control and would heal their illness. During acute episodes patients questioned whether witchcraft or curses caused their illness. Younger patients experienced more spiritual distress. Although church fellowship generally offered spiritual and social support, some patients felt let down by the church which they perceived to favour those who offered more tithes.

Conclusions This is the first study to explore the spiritual issues of people living with advanced heart failure in Kenya. Understanding patients' spiritual concerns is important for developing evidence-based patient-centred holistic care to promote multidimensional well-being.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Handling editor Seye Abimbola

  • Contributors KNK, SAM and LG developed and designed this study. KNK was the primary researcher. KNK collected all the data and conducted initial data analysis. All authors contributed to data interpretation. KNK prepared the initial manuscript and all authors contributed to its final version.

  • Funding This study was supported by the University of Nairobi PhD training programme.

  • Competing interests None declared.

  • Ethics approval Ethics approval was granted by the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (P469/07/2014) and the Ethics Review Group at the University of Edinburgh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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