Background: Ineffective referral networks in low- and middle-income countries hinders access to evidence-based therapies by hypertensive patients, leading to high cardiovascular mortality and morbidity. The STRENGTHS (Strengthening Referral Networks for Management of Hypertension Across Health Systems) study evaluates strategies to improve referral processes utilizing the International Association of Public Participation framework to engage stakeholders.

Objectives: This study sought to identify and engage key stakeholders involved in referral of patients in the Ministry of Health, western Kenya.

Methods: Key stakeholders involved in policy formulation, provision, or consumption of public health care service were mapped out and contacted by phone, letters, and emissaries to schedule meetings, explain research objectives, and obtain feedback.

Results: Key stakeholders identified were the Ministry of Health, the Academic Model Providing Access to Healthcare, health professionals, communities and their leadership, and patients. Engaging them resulted in permission to contact research in their areas of jurisdiction and enabled collaboration in updating care protocols with emphasis on timely and appropriate referrals.

Conclusions: Early stakeholder identification and engagement using the International Association of Public Participation model eased explanation of research objectives, building consensus, and shaping the interventions to improve the referral process.

• Strengthening the referral process for hypertension in low- and middle-income countries will improve access to evidence-based and guideline-based care, leading to reduced cardiovascular mortality and morbidity.
• Early identification of multiple stakeholders involved in hypertension care and the referral process hastens consensus-building on research objectives and shaping contextualized interventions.
• We used the International Association of Public Participation (IAP2) framework during the engagement process, due to its flexibility in allowing multiple contacts with stakeholders.