Table 5 Quotes representing the most salient considerations for health equity and sustainability
Representative quotes | Meta inferences | |
|---|---|---|
Health equity considerations | Equitable implementation of future hypertensive programs would require: •Designing strategies to reach and follow-up men working in agriculture •Addressing language preferences and limited literacy •Addressing structural factors: gender roles, poverty, unemployment, community engagement •Enhancing implementation and sustainability infrastructure for hypertensive programs within municipal health districts (e.g., equipment, human resources, transportation) •Enhancing the public health response to emerging diseases (e.g., COVID-19) Most participants identified sources of health inequities at the participant- and health facility-levels | “Some female participants required husband authorization to enroll in the program. Some were not authorized and did not enroll in the program” – Data collector, MHD1 “It is easier to work with patients who have a relative who is willing to help them, if they know how to read and write, and if they live closer to the health services. Patients without family support may not receive hypertensive medications” -Data collector, MHD2 |
Sustainability considerations | Sustainable implementation of future hypertensive programs would require: • Enhancing the fit of health districts by including programs for chronic diseases within primary care settings and ensuring understanding of intervention benefits prior to implementation • Training leadership to design program adaptations in response to contextual changes (e.g., COVID-19) • Strengthening communication and collaboration among primary care teams • Ensuring essential implementation and sustainability infrastructure within health districts • Ensuring essential infrastructure to respond to emerging diseases (COVID-19) Most participants expressed interest in sustaining the program beyond the study period. | “It is possible to continue delivering the program in the new COVID-19 reality. First of all, we need HTN medications. Second, we need training to provide health coaching sessions – we already have that, and we need to strengthen it. Third, we need to continue delivering health coaching sessions, but now as part of patient clubs.” – Health area nurse, MHD3 |