Table 4 Representative quotes for selected PRISM dimensions

Organizational perspective on the program

“Physicians did not buy into it; they did not participate in the program and some staff perceived the program as “additional workload”. Professional nurses ended up taking on responsibilities that had been assigned to physicians.” (Data collector, MHD1)

“I think that the MoH can continue [implementing the program], as it can help patients and prevent [hypertension] […]. Patients go back home and share their experiences with their relatives on how to prevent chronic diseases – diet, salt consumption, weight, exercise, many habits that should be avoided, like eating junk food. This is very important and should be sustained. The MoH should take it on as its own program” (Health district administrator, MHD3)

Fit between program and health district

Competition with other MoH primary care programs

“During the initial phase [of COVID-19], services for patients with chronic diseases were suspended, all at once we had 13 COVID cases, we were afraid.” -Professional nurse, HD3

“Remember that an auxiliary nurse is responsible for 22 other MoH programs, and now, with this pandemic it’s even worse.” (Professional nurse, health area administration for MHD 1 and 2)

Previous experience providing services for chronic diseases

“This isn’t a new program for us. Since 2011 we’ve been following-up with patients with chronic diseases, monthly or annually, as part of the Inclusive Health Model (Modelo Incluyente de Salud, MIS), which is supported by the Institute for Inclusive Health. […] Implementing this program has not been very hard for our district. This new program improved our approach to managing hypertension.” (Professional nurse, MHD1 administrator)

Program champions and strong leadership

“The health area administrator really supports the program and she has made sure that hypertensive medications are available, which motivates patients to participate in the program.” (Data collector, MHD2)

Implementation and sustainability infrastructure

Human resources

“Our main challenge to deliver this program is that we need more human resources.” (Health area nurse, MHD1 and 2)

“The program can be implemented as planned, but there needs to be a supervisory team from the MoH in charge of monitoring the program, supervising and training [healthcare providers].” (Research assistant, MHD3)

Essential equipment and hypertensive medications

“This program has been possible just because INCAP provided us with blood pressure monitors, weight balances…” (Professional nurse, health area administration for MHD 4 and 5)