Table 4. Environmental barriers/facilitators to clinic attendance and medication adherence organized according to the domains of the Andersen’s behavioral model of health services use.

ABMHSU domain	Barrier/facilitator	Selected patient quotes
System factors	Specialized care	“… specialists should be increased because they better attend to patients when they are many.”–M, A, C2
	Drug stock	“… sometimes, they (patients) cannot access medications, or they can only get one drug at the hospital pharmacy.”–H, C2
		“Medications are often not available [at the hospital pharmacy], so they have to buy these medications at other pharmacies.”–H, C3
	Social services	"Social welfare officers evaluate the patient’s economic condition and provide an exemption certificate to help patients who cannot afford to pay for their treatment."–H, C2
		". . . they have exempt payment for all chronic diseases, so we do not pay for our treatments, including medications."–M, A, C3
Clinic factors	Clinic appointments	"The services from the clinic are time-consuming, and I still have other responsibilities to do."–M, NA, C2
	Service fragmentation	"At the clinic, there are many procedures that a patient has to go through before getting treatment."–M, NA, C2
	Clinic location	“I was referred to this health facility. . . It is very far [approximately 150 kilometers from the participant’s home].”–F, A, C1
	Peer support	"Patients who attend the clinic and who adhere to their medications can be used to educate other patients."–H, C1
	Quality of care	"We do receive good services, and doctors are available. If you come here, you receive good treatment on time."–F, A, C1
Provider factors	Patient-provider interaction	“. . . sometimes healthcare workers use harsh language/or are rude, so to avoid quarreling with them, I quit attending the clinic. . .”–M, NA, C2

M–male patient, F–female patient, A–Attending clinic, NA–Not attending clinic, C–outpatient clinic at (1: consultant hospital, 2: regional hospital, 3: district hospital), H–healthcare worker.