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Cognitive Behavioural Therapy for Adherence and Depression in the Treatment of Patients on Highly Active Antiretroviral Treatment at Kenyatta National and Mbagathi Hospitals, Kenya
No full textDoctor of Philosophy in Clinical PsychologyDepression is the most common mental illness associated with Human Immunodeficiency Virus (HIV) and is a major predictor of poor adherence to antiretroviral treatment. Cognitive Behavioural Therapy for Adherence and Depression (CBT-AD) has been reported as a psychotherapy intervention that equips patients with skills to enhance medication adherence and reduce depression. This study investigated the effectiveness of CBT-AD among patients on Highly Active Antiretroviral Treatment at Kenyatta National Hospital and Mbagathi Hospital in Kenya. A quasi-experimental design was used, targeting HIV patients with poor adherence. The study was conducted between January 2025 and July 2025, involving 198 participants who were randomly assigned in equal numbers to control and experimental groups. CBT-AD was compared to standard care which was used on the control group as the experimental group was subjected to the intervention. In the course of the study, at mid line, 28.8% of the participants who had severe depression were referred for further treatment at baseline of the study. Beck’s Depression Inventory assessed depression levels while the Morisky Scale for Adherence was used to assess levels of adherence. Besides there was a researcher-administered questionnaire which contained one open ended question which was analyzed thematically to investigate the risk factors for adherence to Highly Active Antiretroviral Treatment. Descriptive and inferential statistics using SPSS version 25 with a statistical significance set at p< 0.05 generated results which were presented in tables and charts. Analyses were conducted for three time-frames: baseline, midline and end line. The findings showed high levels of BDI II depression score (M=25.9, SD=6.7) for experimental group and for the control group (M=24.5, SD=8). The experimental group (M=4.4, SD=1.5) had almost the same low levels of adherence like the control group (M=4.3, SD=1.5) at base line. Socio-demographic characteristics associated with both adherence and depression was not statistically significant. There was a negative correlation between adherence and low adherence to HAART. CBT-AD significantly improved both adherence and reduced depression symptoms among participants in the experimental group compared to the control group (p < 0.001). Adherence in the control group also improved unlike their depression levels. Challenges for adherence as reported verbatim by the participants included: intimate partner violence, alcohol consumption, forgetting, socio-economic reasons, lack of disclosure, level of education, side effects of the medication and pill burden among others. There was no significant relationship between these factors and adherence. These results indicated that CBT-AD is an effective intervention for enhancing adherence and reducing depression among people on HAART. The recommendations from the study included the need to enhance screening for depression and adherence during every visit among those on HAART and to adopt CBT-AD as standard care for improving adherence and reduce depression symptoms. Individualized interventions to be instituted to address patients’ unique challenges that compromise adherence to HAART.Daystar Universit
Examining The Use of Internal Communication in Enhancing Employee Relations in Select Public Relations Agencies in Nairobi Kenya
No full textMASTER OF ARTS in CommunicationThis study examined the role of internal communication in enhancing employee relations within public relations (PR) agencies in Nairobi, Kenya. Effective internal communication is increasingly recognized as a cornerstone of organizational success, as it fosters trust, teamwork, and alignment between employees and leadership. Despite its importance, many organizations face challenges in establishing clear, timely, and participatory communication systems. Guided by the Social Exchange Theory (SET), which emphasizes reciprocity and mutual benefit in organizational relationships, this study sought to assess the internal communication strategies employed by PR agencies in Nairobi, examine employees’ perceptions toward these strategies, and analyze the role of internal communication in shaping employee relations. The study adopted a descriptive research design, targeting employees from the top five PR agencies in Nairobi: Ogilvy Africa, Gina Din Group, Tell-Em PR, Apex Porter Novelli, and Silver Bullet PR. A structured questionnaire was administered to 250 employees, generating both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics such as frequencies and percentages, while qualitative responses were examined thematically to provide deeper insights into employee experiences. Key findings revealed that emails, meetings, and newsletters are the most commonly used communication channels, with weekly updates being the predominant frequency of managerial communication. While a majority of employees perceived communication strategies as sufficient, clear, and timely, a notable proportion expressed neutrality or disagreement, indicating gaps in consistency and inclusivity. Moreover, internal communication was found to significantly enhance employee relations by fostering collaboration (68%), inclusion (62%), trust (68%), and a sense of belonging (66%). However, areas such as conflict management and equitable participation showed room for improvement. The study concludes that effective internal communication is not only transactional but relational, serving as a form of organizational investment that elicits reciprocity in the form of employee trust, collaboration, and commitment. It recommends that PR agencies strengthen feedback mechanisms, ensure more consistent communication across departments, and adopt symmetrical communication models to bridge existing gaps. The findings contribute to both theory and practice by offering actionable insights for organizational leaders seeking to build stronger employee relations through internal communication.Daystar Universit
Crisis Communication Preparedness at The University of Nairobi: An Investigation of Practices and Perspectives of Key Stakeholders
No full textDOCTOR OF PHILOSOPHY in CommunicationCrisis events continue to threaten the stability, continuity, and reputation of organizations, including public universities in Kenya. While considerable attention has been directed toward managing crises during or after their occurrence, limited focus has been placed on preparedness, a vital yet overlooked dimension of crisis communication. The University of Nairobi (UoN), having undergone significant transformations within a competitive and dynamic environment, remains vulnerable to crises that have disrupted its image, operations, and stakeholder confidence. Undoubtedly, key stakeholders, such as senior managers, communication practitioners, and student leaders, play an instrumental role in shaping the institution's communication during periods of uncertainty. However, these groups have grappled with how best to coordinate and engage effectively, resulting in a communication gap with far-reaching implications on the institution's reputation and image. Against this backdrop, the purpose of this study was to investigate the crisis communication preparedness of key stakeholders at the University of Nairobi to improve its image. The study was guided by three research questions: (i) the crisis communication strategies employed by key stakeholders at the University of Nairobi (ii) how key stakeholders perceive their current level of preparedness to address crises that threaten the institutions' image, and (iii) the best crisis communication practices that can be recommended to inform a sustainable, and long-term framework for preparedness. Anchored on William Benoit's Image Restoration Theory (1997) and expanded by Timothy Coombs' Situational Crisis Communication Theory (2007), the study adopted a constructivist (interpretivist) research paradigm and employed a descriptive case study design. Purposive sampling was used to select participants comprising senior managers, communication practitioners, and student leaders, all of whom hold strategic and key decision-making roles at UoN. Data was collected through in-depth interviews and Focus Group Discussions (FGDs) to capture both individual insights and collective practices and perspectives of crisis communication preparedness. Findings revealed that although stakeholders recognized the importance of crisis communication, preparedness remained largely reactive, ad hoc, and poorly coordinated, with limited training and weak alignment between leadership and communication practitioners. Furthermore, while senior managers employed a mix of accommodative and defensive communication strategies during crises, the absence of a clear guiding framework undermined their timeliness and credibility. The study concluded that strategic crisis communication preparedness necessitates the convergence of proactive planning, continuous training, and scenario-based simulations that bring together senior leadership, communication practitioners, and student leaders. By identifying the existing gaps and proposing actionable recommendations, the study findings advance both theoretical and practical understandings of crisis communication preparedness in higher education. This underscores the urgent need for a sustainable crisis communication framework to safeguard the image of the University of Nairobi.Daystar Universit
Strategic Change Management Practices and Performance of Fintech Firms in Kenya
No full textMaster of Business Administration in Strategic ManagementThe Fintech industry plays an instrumental role in economic growth in the 21st century. However, the industry has experienced a decline in performance as a result of a diverse set of challenges including technological advancements, competition, regulatory compliance and lack of investments. Fintech’s in Africa experienced low growth rates of 42% and 36% in 2021 and 2022 while other regions had over 50% growth rates in this period. This has had an impact on their profitability, market share and their ability to satisfy customers. Implementing strategic change management practices allows Fintech firms to cope and adopt to inevitable changes and challenges in the environment enabling them to grow and remain competitive. Research on strategic change management practices affecting performance with a specific focus on the Fintech industry is limited. The purpose of this study was to determine the effect of strategic change management practices on performance of Fintech firms in Kenya. The objectives included to determine the specific strategic change management practices adopted by Fintech firms, to examine the level of performance and to assess the effect of strategic change management practices on the performance of Fintech firms in Kenya. The study was underpinned by the Burke-Litwin change model, Kotter’s 8 step model, Balanced scorecard and Institutional Theory. The study adopted a descriptive and explanatory research design. The target population of this study was the 35 Fintech firms in the payment’s services segment and involved 105 respondents categorized into top, middle and lower-level managers. Census was used in this study as the target population is small. Data was collected using structured questionnaires which had undergone pretesting. The data collected was analyzed using frequency, mean and standard deviation as well as multiple linear regression and correlation analysis. The data was presented in the form of tables. The findings emphasize the significant role of strategic change management practices leadership, communication, and stakeholder engagement in enhancing performance within Kenya's Fintech industry. With an R² of 0.605, the regression model demonstrates that these practices collectively explain 60.5% of the variance in performance. Stakeholder engagement emerged as the strongest predictor, followed by leadership and communication. Correlation analysis revealed strong positive relationships between these practices and performance. The mean scores for leadership, communication and stakeholder engagement underscore the perceived effectiveness of these practices by respondents. Recommendations focus on strengthening leadership through targeted training, enhancing communication channels for clarity and alignment, and fostering stakeholder engagement through inclusivity and collaborationDaystar Universit
Socio-Demographic Correlates of Burnout Syndrome amongst Community Health Promoters: A Case of Ruiru Sub County, Kiambu County, Kenya
No full textMASTER OF ARTS in Counseling & PsychologyBurnout syndrome has emerged as a major occupational health concern, particularly among frontline workers such as Community Health Promoters (CHPs), who play an important role in bridging the gap between health systems and communities. Previous research has shown that primary health workers experience emotional exhaustion, depersonalization and reduced personal accomplishment which affects service delivery and personal well-being. Few studies in Kenya have examined the socio-demographic correlates of burnout among CHPs particularly at the sub-county level, resulting in a large information vacuum that this study aimed to solve. The purpose of this study was to gain deeper insights into the socio-demographic dynamics influencing burnout among CHPs in Ruiru Sub-County, Kiambu County, Kenya, and to identify mechanisms for its reduction. The study's specific objective was to analyze the socio-demographic characteristics of burnout among CHPs in Ruiru Sub County, to establish the relationship between socio-demographic factors and burnout among CHPs, and to investigate the coping methods used by CHPs to minimize burnout. The study is based on the Conservation of Resources (COR), Job Demand-Resource (JD-R) and Perceived Organization Support Theories (POS). The COR hypothesis emphasizes how people try to acquire, preserve, and defend resources, with burnout occurring when these resources are endangered or exhausted. The JD-R theory adds to this by emphasizing the relationship between high job demands and inadequate resources, which frequently results in stress and burnout. The POS theory states that when employees perceive strong organizational support, they are motivated. These theories, taken together, provided a solid theoretical platform for investigating how socio-demographic characteristics such as age, gender, education, marital status, and years of service influence CHP burnout. The conceptual framework that underpins this study posits that socio-demographic factors operate as independent variables impacting burnout (the dependent variable), whereas coping methods act as intervening factors that can either reduce or worsen it. Target population was 192 CHPs, while the sample size comprised of 65 CHPs. The study employed a correlational research design. Quantitative data collected using researcher-structured questionnaires and the Maslach Burnout Inventory (MBI), were analyzed using SPSS utilizing descriptive and inferential statistics. Ethical considerations were duly observed. Findings indicated that burnout among CHPs was generally low, although a few experienced moderate emotional exhaustions, depersonalization, and reduced personal accomplishment. Specifically, 61.5% reported low emotional exhaustion, 70.8% low depersonalization, and 61.5% low reduced personal accomplishment. No significant relationships were found between socio-demographic variables gender (p > 0.05), education level (p = 0.521), marital status (p = 0.397), and years of experience (p = 0.313) and burnout levels, though slight, statistically insignificant variations were observed. However, the results showed a moderate positive and statistically significant relationship with age (p = 0.005). Coping strategies such as maintaining work-life balance and social support were key in mitigating burnout. The study concluded that burnout among CHPs is low and is influenced more by work-related and organizational factors than by demographic characteristics and recommended strengthening wellness programs, psychosocial support, and equitable workload distribution to promote CHP well-being and performanceDaystar Universit
Change Management Strategies and Project Implementation in Kenya: A Case of Kenya Investment Authority
No full textMaster of Business Administration in Strategic Management and Project ManagementDespite the essential role that the Kenya Investment Authority (KenInvest) has played in fostering economic growth in Kenya, it has demonstrated a relative show in project implementation over the past five years due to several factors which included inadequate revenue from investments, insufficient developed strategies to manage changes, inefficient business redesign as well as poor integration process. Therefore, this study sought to determine the effect of change management strategies on project implementation in the Kenya Investment Authority (KenInvest). It was guided by three objectives namely, examine the effect of organizational structure on project implementation, assess the effect of process redesign on project implementation, and establish the effect of organizational innovation on project implementation at KenInvest. The study was underpinned by Lewin Three-step Change Theory, Institutional Theory and Lewin Three-step Change Theory. The study adopted descriptive research. The population of the study was all the employees of KenInvest, who were 303 employees from various departments of KenInvest. Therefore, the study targeted all the 91 managers and supervisors who had been employed at KenInvest for over three years. This study carried out a census approach, where all the 91 directors, senior managers and supervisors were studied. This study therefore used stratified random sampling to select the population based on management and supervisors. The study used a semi-structured questionnaire to collect primary data. The study conducted a census whereby all the 91 respondents were considered. The pretesting was at the Kenya Revenue Authority (KRA), whose 10% was represented by 9 staff members of KRA. Content and face to face tested the validity of the instrument, to determine its effectiveness. The reliability to determine the internal consistency adopted Cronbach's Alpha coefficient which was 0.764. The study analysed both descriptive and inferential statistics using SPSS version 26.0. Pearson Moment Product Correlation and multiple regression analysis were performed. The study considered voluntary participation, safety and rights were not infringed upon. No identification of the respondents as well as confidentiality was considered. The study found that organizational innovation had a strongly positive and statistically significant relationship (r=.773, p=.000) with project implementation at KenInvest. Also, the study established that organizational structure was ineffective and statistically non-significant predictor (r=-0.009, p=0.885). The study recommended that priority be given to clarity in roles and responsibilities, regular reviews of the organizational structure, allocation of enough resources towards innovation. Also, promote communication flow and decision-making processes, continuous training programs to equip employees with relevant skills for better innovation and new workflows and processes.Daystar Universit
An Investigation of The Psychosocial Effect of Children's Rapid Reintegration from Charitable Children's Institutions during The Covid-19 Pandemic in Nairobi, Kenya
No full textMASTER OF ARTS in Child DevelopmentThe COVID-19 pandemic forced the quick and unplanned reintegration of children from Charitable Children's Institutions (CCIs) into family-based care. This emergency action skipped important steps like preparation, assessment, and psychosocial support, essential for a smooth, child-centered transition. As a result, vulnerable children faced higher risks of anxiety, depression, and social disruption. This situation revealed a significant gap in understanding the psychosocial impacts of crisis-driven deinstitutionalization within the African context. The main goal of this study was to investigate the psychosocial effects of swiftly reintegrating children from CCIs during the COVID-19 pandemic in Nairobi County, Kenya. The study was based on Erikson’s Psychosocial Theory, which explains how relational stability affects developmental stages, and Attachment Theory, which highlights the importance of secure caregiving bonds for emotional resilience. The investigation used a descriptive survey design with a mixed-methods approach, focusing on Nairobi County's Kivuli Center and Ndugu Mdogo Rescue Center. The target population included 160 respondents, such as 130 children, 10 caregivers, and 20 family members identified from the CCIs’ Reintegration Report (2020-2021). Data collection utilized standardized structured questionnaires, including the validated Strengths and Difficulties Questionnaire (SDQ), to acquire quantitative data on emotional and behavioral issues. This was complemented by customized interview guides for caregivers and family members to obtain qualitative insights. Data analysis incorporated descriptive statistics (frequencies, percentages, means) and inferential statistics for quantitative data, whereas qualitative data was subjected to thematic analysis. Significant findings showed that rapid, unsupported reintegration was linked to higher psychosocial distress. Quantitative analysis found that 65% of the children scored in the 'High' or 'Very High' range on the Strengths and Difficulties Questionnaire (SDQ) subscales for emotional symptoms and hyperactivity, surpassing standard thresholds. Specifically, 72% displayed clinically significant emotional difficulties, and 55% reported notable peer relationship problems after reintegration. The qualitative data supported this, emphasizing key challenges such as difficulty in establishing stable family bonds, ongoing feelings of isolation, and limited access to crucial follow-up support services, which ultimately harm children’s psychosocial health. The study urges the urgent creation of resilient, crisis-proof protocols and thorough post-reintegration support systems to protect children’s mental health during emergencies.Daystar Universit
Effects of Social Media on Adolescent's Self Esteem and Body Image: A Case Study of Mtoto News Association, Nairobi, Kenya
No full textMaster of Arts in Child DevelopmentThe increasing prevalence of social media use among adolescents raised concerns about its potential impact on their self-esteem and body image. Adolescents are at a critical stage of identity formation and are particularly susceptible to external influences, making it crucial to understand how social media shapes their perceptions of themselves and their bodies. This study investigated the effects of social media on male and female adolescents' self-esteem and body image, focusing on the Mtoto News Association in Kenya. The study addressed the gap in research by examining the prevalence of different idealized body types and the specific relationships between social media, self-esteem, body image, and demographic characteristics among adolescents aged 10 to 19 years old in the context of the Mtoto News Association. The study employed two theories: the social comparison theory to understand how adolescents compare themselves to those they perceive as better than themselves, and Erik Erikson's Psychosocial Development Theory, specifically the fifth stage, to address adolescents' development. The study utilized a descriptive research design and collected primary data using a combination of standardized questionnaires for adolescents and interview guides for staff members. The target population comprised 769 adolescents and 16 staff members, from which 224 adolescents (85.2% response rate) were selected using stratified random sampling across three age categories (10–13 years, 14–16 years, and 17–19 years), and all 16 staff members (100% response rate) participated. Data were analyzed using SPSS version 23, applying descriptive statistics and chi-square analyses. Ethical standards, including informed consent, anonymity, and confidentiality, were strictly observed. The results showed that moderate body types demonstrated the highest prevalence as ideals, with 183 (81.7%) respondents selecting these figures, while thin body types showed lower prevalence at 41 (18.3%) respondents, and overweight body types demonstrated zero prevalence (0%). Regarding self-esteem, 145 (64.7%) respondents reported moderate self-esteem, 66 (29.5%) reported high self-esteem, and only 13 (5.8%) reported low self-esteem. For body image dissatisfaction, 191 (85.3%) respondents experienced moderate dissatisfaction, 26 (11.6%) experienced low dissatisfaction, and only 7 (3.1%) experienced high dissatisfaction. Chi-square analyses revealed that all demographic characteristics significantly intervened in the relationships between social media use and both self-esteem and body image (p = 0.000), with educational level showing the strongest intervening effect (χ² = 456.865 for self-esteem; χ² = 356.056 for body image), followed by family economic status (χ² = 267.064 for self-esteem; χ² = 274.923 for body image) and age category (χ² = 312.732 for self-esteem; χ² = 273.359 for body image. The study concluded that while social media significantly affected adolescents' self-esteem and body image, protective factors within the organizational environment effectively moderated these influences. It is recommended that organizations implement comprehensive media literacy programs, develop interventions tailored to vulnerable demographic groups, strengthen supportive environments that promote positive self-concepts, and advocate for policies addressing platform-specific risks while leveraging the positive potential of social media in adolescent development.Daystar Universit
Examining The Influence of the Funzo Programme Communication Strategies on Teenage Mothers’ Perceptions of Maternal Health in Kibra
No full textMaster of Arts in Development CommunicationTeenage pregnancy remains a persistent public health challenge in Kenya, particularly in informal settlements such as Kibra, where access to maternal health information and services is limited. The Funzo Programme, a community-based initiative, employs communication strategies to improve reproductive and maternal health outcomes among teenage mothers. This study examined the influence of Funzo’s communication strategies on teenage mothers’ perceptions of maternal health in Kibra. Guided by the Health Belief Model (HBM), which explains how perceptions of susceptibility, severity, benefits, and barriers shape health behaviour. The study’s objectives were: to assess the relationship between exposure to the Funzo programme communication strategies and teenage mothers’ awareness and understanding of maternal health services in Kibra;to examine how Funzo’s communication strategies influenced teenage mothers’ perceived susceptibility to maternal health risks; to determine the extent to which the Funzo’s communication strategies shaped teenage mothers’ perceived benefits of seeking maternal healthcare services and to identify the key communication-related barriers within the Funzo intervention that hindered teenage mothers’ health-seeking behaviour in Kibra. The study adopted a convergent mixed methods design and used both simple random sampling and purposive sampling. The target population comprised teenage mothers in Kibra and the sample size comprised of 75 teenage mothers, 2 CFK staff and 2 Community Health Workers with data collected through structured questionnaires and key informant interviews. Quantitative data was analyzed using descriptive statistics and inferential statistics with the aid of SPSS version 22, while qualitative data was analyzed thematically using ATLAS.ti. The findings revealed that Funzo’s communication strategies significantly enhanced awareness of maternal health services, with interpersonal and community-based approaches proving most effective. Teenage mothers reported an increased perception of susceptibility to maternal health risks and recognized the benefits of attending clinics and delivering in health facilities. However, challenges such as limited comprehension, cultural stigma, and low access to digital information persisted, constraining consistent health-seeking behaviour. The study concludes that Funzo’s participatory communication strategies positively influenced teenage mothers’ perceptions of maternal health, but that behavioural change remains moderated by social and structural barriers. It recommends strengthening comprehension-based communication, integrating digital and multimedia platforms, and promoting culturally sensitive approaches to improve adolescent maternal health outcomes in informal settlements like Kibra.Daystar Universit
Evaluation of the Efficacy of Education Policies on Truancy in Secondary Schools in Narok North Sub-County
No full textMaster of Education in Leadership and Policy StudiesSubtleties of policy implementation and its effectiveness in ensuring regular school attendance remain unexplored for further policy reviews. Mitigation of truancy and student absenteeism remains the sine qua non in ensuring better academic outcomes and educated communities. This study evaluated efficacy of education policies on truancy in secondary schools in Narok North Sub-County. The objectives of the study were to assess policy implementation in schools, evaluate policy awareness and enforcement impact, evaluate effectiveness of education policies on truancy and identify better practices and recommendations based on their effectiveness. This study utilized the social control theory as anchor theoretical framework developed by Travis Hirschi (1969) who alludes that conformity to societal norms is maintained through social bonds including attachment to others, commitment to conventional goals, involvement in activities, and belief in the legitimacy of social rules and regulations. Mixed methods design with quantitative and qualitative insights were gathered through document analysis, survey questionnaires, interviews and focus groups. The study targeted a population of 3,245 participants (8 school administrators, 168 teachers, 8 parents, 3,061 students and one policy enforcement officer at the subcounty education office) in eight secondary schools in Narok north sub-county of Narok County. A sample size of 340 was used in the study constituted by eight school administrators, eight parent representatives purposely sampled. Simple random sampling technique was employed in sampling a total of 48 teachers proportionately distributed in the 8 schools. A total of 276 students were sampled through simple random sampling technique distributed proportionately across the 8 schools and across the three forms (strata). Findings revealed both quantitative and qualitative perspectives on the effectiveness of education policies with an indication of a high level of awareness of school policies amongst students (at 74%). Truancy was revealed to be persistent at 31% with family responsibilities and domestic issues (48%) and lack interest in schooling (37%) being the leading causes of school absenteeism. Parental & community involvement in schooling activities (66%) and guidance & counselling (61%) were perceived to be the most effective policies that ensured school retention. Education policies were generally perceived to have a significant impact in ensuring school attendance (at 63%). Snags in community involvement (59%) Inadequate resources for consistent policy implementation (41%) were cited to be the greatest undoing towards effective policy implementation in schools with glares in findings revealing themes of corporal punishment in schools and child abuse through cheap labor in the farms within the schools’ catchment areas. The study recommends the department of basic education to mandate regular monitoring and annual audits of the policies established to ensure school attendance, revamp Guidance & counselling and parental & community involvement in school and ensure a supportive school climate & wellbeing. Further studies could explore the role of digital technologies in truancy monitoring or assess teacher perceptions of truancy policy implementation challenges.Daystar Universit