DO JUSTICE PERCEPTIONS MODERATE RESPONSIVENESS VALUATIONS' EFFECT ON HEALTH SYSTEM RESPONSIVENESS? A CROSS-SECTIONAL SURVEY IN CHRONIC CARE CENTERS, TIER THREE HOSPITALS, KENYA

This study determined the moderation effect of justice perceptions on the association between responsiveness valuations and health system responsiveness within diabetic and hypertensive clinics in tier three hospitals in Kenya. Responsiveness, defined as meeting non-health improving expectations, is fundamental to a well-functioning health system. The study employed a cross-sectional descriptive survey conducted at Kimilili, Uasin Gishu and Gatundu hospitals among 308 respondents. Responsiveness domains included promptness, respect, communication, involvement, confidentiality, choice, cleanliness, social support access, and overall trust. Responsiveness valuations were rated in regard to client’s awareness of their rights, obligations, legitimacy of expectations and client voice. Justice perceptions were rated on the indicators of non-discrimination, fairness in costs, equity, protecting the vulnerable, the minority communities, and according equal opportunity to all. Data on all variables was collected through structured questionnaires using a five-point Likert scale, after which scores were summed up and divided into favorable and unfavorable using the demarcation threshold formula. Only 38.3% of respondents reported favorable responsiveness. The predictors valuations, and justice perceptions had majority in the favorable category. Justice perceptions were more positively rated compared to valuations. Bivariate analysis using binomial logistic regression showed significant main effects of justice perceptions(p=0.001), while the main effects of responsiveness valuations had no significant influence on responsiveness. The interaction effects of justice perceptions and responsiveness valuations had significant effect on health systems responsiveness. Therefore, we conclude favorable responsiveness was less likely than unfavorable outcomes. Justice perceptions significantly moderate the relationship between responsiveness valuations and health system responsiveness. Health policies should ensure fairness, equity, and transparency. Patient care must reflect justice perceptions and include real-time feedback to build trust and improve outcomes. Practitioners need training in client-centeredness and fairness. Ongoing audits and surveys will enhance health system responsiveness. KEYWORDS: Health System Responsiveness, moderation effects, Justice perceptions, responsiveness valuations, chronic conditions, Diabetes Mellitus, Hypertension, Kenya