A qualitative socioecological exploration of community health promoters' barriers and facilitators in cardiovascular disease prevention in Kenya.

Background: Cardiovascular diseases (CVDs) remain a growing public health challenge in low- and middle-income countries, where there is an upsurge of risk factors. Community health promoters (CHPs) have the potential to play a crucial role in CVD prevention and care to underserved communities in Kenya. However, there are limited studies on their experiences, which are likely shaped by multilevel barriers and facilitators across the individual CHP, the community, relationships with primary health systems, and societal-level policies and structures. This study explored the barriers and facilitators shaping CHPs' experiences in mitigating CVD in Kenya. Methods: A qualitative descriptive study was conducted in the Lari sub-county of Kiambu. Data were collected using semi-structured interview guides with 15 purposively selected CHPs and 6 key informants, including supervisors and health facility incharges, guided by the principle of data saturation. Qualitative content analysis was employed, guided by a socio-ecological framework. Results: Findings revealed a complex interplay of barriers and facilitators across four themes: individual, relationship, community, and society. CHPs had a limited understanding of CVDs, revealing inadequate CVD training. Commitment and remuneration were enabling; however, CHPs faced limited financial support and a heavy workload. Community acceptance and leadership support enhanced outreaches, whereas poverty and resistance, rooted in cultural and religious beliefs, hindered uptake. Despite supervision and teamwork within the health system, staffing gaps and medication shortages persist. At the societal level, role recognition and functional referral structures legitimised the CHP efforts, though inadequate resources undermined sustainability. Conclusion: CHP's commitment, community acceptance, supportive leadership, supervision, role recognition, and functional referral structures enhanced CHP's motivation and service. However, limited CVD knowledge, inadequate training, financial difficulties, community poverty and resistance, staffing, medication and resource shortages impede their capacity to reduce CVD. Strengthening their role requires multilevel interventions, including structured training, adequate resourcing, and leveraging community trust, to sustain CVD prevention in Kenya and similar low-resource contexts.