Table 2.

Key insights for improvement from community health workers’ focus groups.

Categories	Quotes	Interpretation
Practical short-term needs	“Patients say they need to take too many pills, but we feel like the medication doses are just too low.” “Trainings to learn about hypertension could be taught a bit more slowly.” “Questions in the app seem to repeat. These repetitions make using the app quite slow.”	Highlights tension between algorithm dosing and actual pill burden. Suggests either needing a clearer CHWa-facing explanation of dosing rationale or adjusting pill dosages. Indicates that training pace may be a barrier to effective adoption. Emphasizes the importance of longitudinal training models. Reveals app workflow inefficiencies. Suggests shortening survey questions to shorten visit length and improve patient and CHW satisfaction.
Larger structural concerns	“For us working here, is there going to be more compensation?” “It is often hard because in our culture we are not used to asking women how many times they urinate; this is not normal for us Indigenous people.” “It may be common for women in other countries to drink [alcohol] often, but here in Guatemala they don’t tend to, and if you ask them, they get offended.”	Signals a potential retention and motivation issue. This challenge is a common barrier to long-term CHW program implementation, where compensation is often limited due to financial constraints. Suggests shifting financial priority toward workers. Demonstrates a cultural mismatch between standardized clinical questions and local norms. Indicates the necessity of culturally adapted questions, although many times it is difficult to align, since changes or omissions may affect the validity and reliability of clinical trial outcome measures.
Program benefits	“The program benefits many people in our communities since receiving care is often hard to get, but they can with the program.” “Our educational flip book helps make patients aware, specifically the objectives of the program and causes of hypertension.” “The patients look for us because they trust us. They know we can help them and that we are here for them.”	Emphasizes the importance of improved access to care, reinforcing program value and motivation. Identifies educational material as key for facilitating patient engagement and understanding. Highlights trust as a central mechanism through which CHWs enable hypertension management.

^aCHW: community health worker.