Table 3.

Themes defining patient challenges in HTN and DM care

Lack of knowledge of HTN and DM

They are not communicable like HIV […] You can’t prevent hypertension or diabetes. (HTN and DM, Female, Kasangombe, P4) I don’t know. No [I can’t even speculate the cause], because I never used to take sugar, indeed I was so perplexed when I was told that I am diabetic. I couldn’t understand […] I didn’t have any pain, or anything that would prompt me to go to the hospital, I was just there feeling nothing. (DM only, Male, Nakaseke sub-county, P10) If someone shares about HIV what about diabetes, I wouldn’t hide it even from a woman because she cannot contract diabetes, diabetes is not communicable. (DM only, Male, Nakaseke town council, P9) Yes [diet has many roles in managing diabetes]. It helps because there are times when I get blurred vision when I delay eating food, and when you eat and take medication too it is well for you. Food moves with the drugs it helps to transport blood. (DM only, Male, Nakaseke town council, P9) You might have palpitations and also get worried of children’s school fees, then you find increased blood sugar level but you are on drugs. So the doctor asks, “are you taking your medication?” “Yes doctor I do take,” “what are you worried about” and you come to realize that there is something distressing you. (HTN and DM, Female, Nakaseke sub-county, P6) You hear them speak of what shouldn’t be eaten but we have not yet gotten a teaching about how to conduct our lives. (DM only, Female, Kasangombe, P11)

Lay sources of HTN and DM information

Yes, [I feel comfortable sharing with family members and neighbors] because somebody might advise and recommend you to a better medication or to traditional medicines. (HTN only, Female, Nakaseke Sub-county, P15) I hear food with starch should not be eaten like cassava. [I get this information] from our colleagues. (DM only, Female, Kasangombe, P11) Why wouldn’t I share with them [friends and neighbors]? [I share with them because] maybe they could give me some advice. (HTN only, Female, Kasangombe, P23) My friend [advises me on hypertension]. They [my friends] also have hypertension. (HTN only, Female, Nakaseke town council, P12) There is no problem [sharing with neighbors about the condition] because I explain to many of my friends, and relatives who say that they get heat in the body, sweating, thirst because I also get these symptoms. I tell them to reduce on taking sugar, reduce on eating fatty foods. (DM only, Male, Nakaseke sub-county, P10) I feel comfortable. Because I want to help them be more aware of hypertension. I try to tell them to avoid getting worried when they get a similar problem because worrying precedes hypertension. (HTN only, Female, Kasangombe, P20)

Patient trust in HCPs vs lack of involvement in the medical decision-making processes

Their [the prescribed drugs] names! They [the doctors] just give me the drugs, I don’t know the names. I am just given the drugs. (HTN and DM, Female, Kasangombe, P4) I know them [the drugs], they are dispensed to me. […]do I know how to read your English [to name the drugs]? (HTN and DM, Female, Nakaseke town council, P1) I am not a doctor, unless I bring you the prescription book but I don’t know the drugs. (HTN and DM, Female, Kasangombe, P5) Sometimes we find that the drugs are finished, and we are told to go and buy from places were the drugs are, at times you don’t have money and you have to first work to make the money then go and buy the drugs. (DM only, Female, Kasangombe, P11) When I take it, I feel like throwing up, I feel disgusted in my heart. [when this happens,] I first take some break. I take a break for about 2 days such that these that I have taken descend down (DM only, Female, Kasangombe, P11) I buy [drugs], they are not there at the hospital that is the problem. […] The government has not endeavored to know that diabetes exists it the country and that it affects people, I thought that I was the first to ever get this disease and I almost became hopeless but I realized that we were about 680 patients […] but there are those who die without ever going to the hospital. (DM only, Male, Nakaseke sub-county, P10) “We are in a good relationship with the doctors, because they comfort us and teach us what we need to do to live.” (DM only, Male, Nakaseke sub-county, P8) “It is doctors [I trust to give information on HTN and DM]. We get our blood sugar level measured […] and if it has increased then I resume taking drugs. Sometimes I take drugs, sometimes I don’t, so you take one tablet once a day for hypertension and for diabetes one tablet in the morning and one in the evening.” (HTN and DM, Female, Nakaseke town council, P3) That [information on any diseases] comes from a doctor and nobody can diagnose a disease it is only a doctor who can do that [provide information]. (DM only, Male, Nakaseke sub-county, P8) “Many times, the person to trust [on HTN and DM information] is the one who also has the disease. The second is the health worker. Not the traditional herbalists, but the real professional health worker because they are well trained.” (HTN and DM, Female, Nakaseke sub-county, P18)

Inability to access medication due to financial constraints

“I was told to started on drugs, and to regularly come to [the hospital to] pick up the drugs. However sometimes I go there and the drugs are not available. I also don’t have money. Then I keep quiet with nothing to do.” (HTN only, Female, Nakaseke town council, P17) The only problem is when there are no drugs in the hospital. When the drugs are finished, it is you who has to look for them to survive. (DM only, Male, Nakaseke sub-county, P9) Problem is lack of money to buy capsules to take. Even to get the drugs from Nakaseke is far and, boda boda [motorcycle] are also expensive. When there are no free drugs in hospitals, all you get is Panadol. (HTN only, Female, Nakaseke sub-county, P16) You have to take your prescription. [It is easy to get drugs] If it is available [in the hospital] but right now I need money to buy the drugs. (HTN only, Female, Kasangombe, P23) I had not encountered any [difficulties] yet because we have been getting the government drugs and even when there are only a few, at least they divide and everyone gets a little and we are informed to come back [to the hospital] when that is finished. We get to pick more drugs if the stocks are refilled. (HTN and DM, Female, Nakaseke sub-county, P7)