Understanding needs and solutions to promote healthy ageing and reduce multimorbidity in Rwanda: a protocol paper for a mixed methods, stepwise research study

Introduction Ageing is often accompanied by chronic
diseases, multimorbidity and frailty, increasing the need
for clinical and social care to support healthy ageing and
manage these conditions. We are currently in the UN
Decade of Ageing, and there is a growing focus on the
need to prevent or delay some of these conditions through
the ‘Healthy Ageing’ initiative of the WHO. However,
there are limited data available to inform prioritisation of
interventions, particularly for countries in sub-Saharan
Africa.
Methods and analysis This study will use a mixedmethods, stepwise approach to identify the current
needs for older people in Rwanda, health system
capacity and possible solutions to unmet need. First,
we will conduct a household survey in the City of Kigali
(predominantly urban) and Northern Province Burera
district (predominantly rural) to determine the burden of
multimorbidity, frailty, access to care, and experiences
and responsiveness of care in older people. This work
will be supplemented by secondary analysis of data from
the Rwandan STEPwise approach to non-communicable
disease risk factor surveillance (STEPs) survey of 2021.
Second, we will conduct a health facility readiness
assessment and healthcare provider survey to assess
health system capacity and gaps to deliver effective
primary care to older people in Rwanda. Third, to capture
the voices of older people, we will explore the quality
of healthcare as experienced by them using in-depth
interviews. Fourth, we will synthesise data using mixed
methods to understand barriers to access to quality
of care among people of older ages based on a Three
Delays framework (seeking, reaching and receiving
quality healthcare). Finally, the project will culminate in a
stakeholder workshop to ensure results are contextually
appropriate and disseminated, and gaps identified are
prioritised to design novel interventions to promote healthy
ageing in Rwanda and the region.
Ethics and dissemination The study has received ethics
approval from the Rwanda National Ethics Committee,
Northwestern University, USA, and the University of
Birmingham, UK. This study will deliver impactful research by using multiple methodologies and working with
in-country partners to develop a deep knowledge and
understanding of healthcare systems experienced by
older people in Rwanda. It will also provide a framework
for sustainable healthy ageing research and policy
engagement to benefit older adults living in Rwanda and
inform similar work in low- and middle-income countries
during this Decade of Healthy Ageing and beyond.