Table 3. Explanatory Sequential Joint Display: A Summary of Quantitative and Qualitative Findings and Mixed Methods Meta-Inferences in an Evaluation of a Diabetes Self-Management Education and Support Intervention in Rural Guatemala, 2018–2020.

RE-AIM Dimension	Quantitative Findings	Qualitative Findings	Meta-Inferences
Reach	• 16% of participants were men, while approximately 50% of people with diabetes in the population were men • Participants had worse HbA1c and blood pressure compared with overall diabetes population	Barriers to enrollment of men: • Prioritization of work • Culture of machismo • DSMES not perceived as beneficial • Desire to received something of material value for time (also found for women)	Future DSMES interventions may have trouble reaching total diabetes population without • Prioritizing at-work men • Addressing the culture of machismo • Integrating education more clearly within the broader structures of clinical diabetes care
Effectiveness	Improvements in clinical and psychometric outcomes: • HbA1c, blood pressure • Diabetes knowledge, diabetes distress, self-care activities	Principal mechanisms that led to effectiveness: • Personalized nature of study visits • Cultural and linguistic acceptability • Family and community support	DSMES programs benefit from: • Patient-centered care • Family and community inclusion
Adoption	• Most (95%) participants were recruited from health centers or by Wuqu’ Kawoq staff and programs • All health facilities that were approached agreed to participate, although few patients were referred	• Intervention was only partially adopted by health centers • Pre-intervention trainings may help increase health facility involvement	• Public and private health facilities were willing to participate in the DSMES program • Minimal participation in settings without direct involvement of study staff • Special attention to integrating health facilities may be necessary
Implementation	Mean visit duration: • Home visits (71 min) • Telephone visits (41 min)	• More difficult to implement telephone visits than home visits • Overall high levels of patient satisfaction with telephone visits	Future interventions should carefully consider tradeoffs between at-home and telephone visits
Maintenance	Direct intervention costs were US$90.19 per participant	Both participants and health center staff expressed desire to continue the intervention	There is interest in sustaining DSMES from: • Patients • Health workers • Health facility leadership However, important financial and time constraints exist

Abbreviations: DSMES, diabetes self-management education and support; HbA_1c, glycated hemoglobin A_1c; RE-AIM, reach, effectiveness, adoption, implementation, and maintenance.