Table 2.

Themes and quotes that emerged from formative interviews about the hypertension program in primary care clinics

Domains and themes	Quotes
I. System (outer setting)
Ia. Improve quality of care by providing reports to measure performance	“Yes, ah, like for immunization, every month, after giving the report, we have a general meeting for only those who report those things so that you’ll know, so that you’ll know how far you are doing. We are even given categories. And I will like to take opportunity to tell you that this clinic is under grade one for the past ten years, in terms of our report.”
II. Inputs (intervention and individuals)
IIa. Ensure reliable drug supply and blood pressure measurement equipment are available at the point of care	“Also drugs are free. Test is even free. So they will always come back. They will always; even they by themselves ma, will even go and _ cos I remember the first case we had of TB here, that was first treated here, he went and brought about five people.” “Drug Revolving Fund. What happen is that, government gives fund for [medicines].”
IIb. Create an information system to inform case management in the healthcare setting and the community for more efficient and effective practice	“Everyday, there is data that we do send. The patient that we have, we have register that we write, this is the patient we see. In fact, every month, every department gives their records, data.”
IIc. Increase workforce capacity to deliver high-quality team-based care Enable and empower healthcare workers to participate in team-based care through training and education	“If it is still going higher as we said, then we will do the treatment though depend on whom is on the seat. [inaudible] their doctors. We don’t treat, the doctors does [sic] the work. But if doctor is not on seat, then anyone of us, if it is the nurse or the CHEW that is available, then we go ahead and do the treatment.” “We are very confident if there is good training. They must be training so that everybody knows what is expected of him.”
III. Service delivery (outer setting, inner setting, and processes)
IIIa. Create a system of person-centered, timely hypertension services which are financially and geographically accessible	“Of course, because somebody having malaria will prefer to go, you collect two paracetamols, collect ehh…you know, just few vitamins, they will mix it with antibiotics, and then they will just take and then they find out that they are okay. So they will prefer to go to such places, hundred naira or two hundred naira you go there. But by the time they are now coming here, you want to check BP, you want to check weight, you want to open card, and all those protocols, they see it as this is a delay. So, that thing can stop them from coming.”
IIIb. Conduct community engagement, proactive population outreach, and engage families to increase program uptake	“In community work, we have what we call mobilizers, we have town announcers, they go to inform them on some important issues if we need them to be here. And mostly, they encourage them to have the, what is it called, the digital BP apparatus, which they can use on their own without even struggling to come here. And we have to get some of their relatives, that can read and can understand better to help us through them to bring them to us or to even call us if need be. So those are the things we do.”
IIIc. Implement guideline-based hypertension services at a community level which are delivered with fidelity by motivated healthcare workers with respect and trust Train healthcare worker to improve patient-provider communication	“It’s useful because once the drugs, you put the drugs there, which means, any other person that comes, should follow the same pattern. So that there will be uniformity in the treatment of hypertension.” “Just like in HIV, we have standing order.” “When I was told that I have high blood pressure, I was told to take care of myself, I should always be happy, I should not be sad in my life, because this illness even if you are taking your medicines but you don’t have peace in your home, you won’t get better. They said it’s treatment is living in peace, and also I should take care of myself and also take my medicines.” “Well, they didn’t. Right there and then, I was told that I have hypertension, but they didn’t explain anything to me.”
IIId. Educate and equip healthcare workers to deliver person-centered and coordinated primary healthcare, including hypertension services	“Hundred percent because we can see they are coming up very well. Like the patients of TB, they can confidently come here and we’ll give them all the confidentiality they need; like the HIV, we make sure we take care of the confidential aspect of it. We make sure we give them the drugs that they need; we give them the counseling, all the advice that they need to be able to make a positive impact on them, and even to pro, to progress even in the program itself.”