Table 2

Characteristics of studies included in the review

Study numberStudyCountryMethod for data collectionParticipants and sample size for interviews/FGDsResearch question and analysisSetting/context of study—healthcare services and utilisation
Asian region
1 31 South IndiaIn-depth interviewsPatients with DM n=16Constraints faced by patients in managing care for diabetes, thematic analysisGovernment health centres’ free care and private fee-for-service facilities. Urban area.
2 29 South IndiaObservations,
semistructured interviews
Specialist and non-specialist doctors, pharmacists and laboratory technician n=19Organisation of a local health system for chronic care,
thematic analysis
Mixed health system-health centres, clinics and hospitals in an urban slum area
3 40 IndiaSemistructured interviewsPatients with a diagnosis of DM, HTN, TB n=7, FGDs with TB n=12, diabetes n=18 and HTN n=27Patient experiences in diagnostic services,
thematic analysis
Pluralistic healthcare services—public PHCs providing free OP care and many private providers
4 32 BangladeshIn-depth interviewsPatients with a diagnosis of DM n=23Patient experiences of care for DM, thematic analysisDiabetes Association of Bangladesh (BADAS) provides specialist clinics and tertiary-level specialist hospitals.
5 59 VietnamIn-depth interview and FGDsHealth staff, patients with NCDs and relevant stakeholders at 20 centresCommune health stations capacity for NCDs,
content analysis
A national strategy to have 90% of health facilities at the primary healthcare level with essential medical products and technology
6 26 MongoliaIn-depth interviews,
Practice doctors and practice directors at PHCs treating HTN n=10Factors influencing primary care providers’ role delineation in guideline implementation, thematic analysisState-funded Family Health Centres provide universal access to healthcare for individuals, families and communities.
7 44 MongoliaSemistructured interviews, FGDsNurses n=20,
practice doctor n=10 and practice managers n=10
Implementation of guidelines at primary care,
thematic analysis using theoretical domains framework
Family health centres’ private entities funded by the government. Services free of charge for citizens. Ministry publishes clinical guidelines for HTN and DM.
8 45 CambodiaIn-depth interviewsPatients with a diagnosis of DM and/or HTN n=28Patient experiences in care for DM and HTN, grounded theoryPublic chronic disease clinics at provincial and district hospitals. Also, private providers.
9 33 MalaysiaIn-depth interviewsPatients with HTN n=25Patient experiences of chronic care and self-management,
thematic analysis
Chronic disease primary health centres run by the government
10 41 MalaysiaDocument review and semistructured interviewsPatients with a diagnosis of HTN n=37 and health providers n=24Barriers and facilitators for hypertension management,
thematic analysis
Ministry of Health guidelines, staff training in screening and HTN management, traditional complementary medicine widespread
African region
11 28 TunisiaParticipant observation, semistructured interviews, FGDPatients n=12
Paramedical staff n=4
Clinicians public sector n=10
Observations n=50 centres
Barriers and facilitators of care in the management of DM,
content analysis
Ministry of Health—programme for management of HTN and DM in primary care.
Public and private health sectors coexist.
12 34 TunisiaSemistructured interviewsPatients with DM or HTN n=24Patient experiences of chronic care, thematic analysisGovernment-run primary health centres
13 60 South AfricaIn-depth narrative interviews and surveyWomen with self -reported DM/HTN n=12Facilitators and inhibitors of healthcare utilisation for DM and HTN, thematic analysisHealthcare system historically inequitable due to a racially fragmented public healthcare approach. Underutilisation of services.
14 35 South AfricaIn-depth interviewsPatients with DM/HTN n=22Patient experiences of chronic care and self-management,
framework analysis using self-determination theory
National Department of Health patient-centred model of chronic care and free primary healthcare
15 42 South AfricaIn-depth interviewsPatients with DM n=31 and healthcare providers n=23Reasons for missed appointments at PHC, thematic analysisChronic Dispensing Unit at PHC>75% dependent on the public sector for medicines
16 30 South AfricaFGDsPatients with DM and providers n=10–12Barriers and facilitators of chronic care, thematic analysisPrimary care community health workers and traditional healers provide services.
17 36 KenyaFGDs and in-depth interviewsPatients with DM or HTN n=179 and 4 FGDs n=242Factors influencing linkage to HTN care, thematic analysisClinics of AMPATH and Kenya government, optimising referral and retention in care
18 46 South AfricaIn-depth interviewsWomen with DM n=27Patient experiences with chronic care, thematic analysisPublic and private healthcare delivery with low utilisation of healthcare due to systemic inequalities
19 37 ZambiaIn-depth interviewsHealthcare providers n=20 in 46 clinicsAssess care delivery at centres enrolled in an intervention study,
thematic analysis
Better Health Outcomes through Mentoring and Assessment, 5-year trial of improved clinical service delivery in rural government clinics.
20 27 NigeriaSemistructured interviewsPhysicians, nurses, pharmacy staff, laboratory staff, administrative staff of health centres treating HTN n=39Factors that inhibit or facilitate high-quality care,
framework analysis using the tailored implementation for chronic disease framework
State Health Insurance clinics—a voluntary community-based health insurance programme supports quality improvement, provides new equipment, organisational support and staff training.
South American region
21 25 MexicoIn-depth interviewsPHC personnel including physicians, nurses and directors n=105Patient experiences in HTN management and control,
framework analysis
Casalud—comprehensive NCD care model based on the use of patient-centred technologies implemented through a public–private partnership
22 39 San José, Costa Rica, MexicoFGDsPatients with DM and/or HTN at urban public health centres n=70 in 12 FGDsPatient perception of barriers and facilitators to self-managementSecretary of Health programme of healthcare for all, Costa Rica—a comprehensive healthcare system
23 38 ColombiaIn-depth interviews,
Patients with HTN n=26,
patients n=6 and family members n=4
Patient experiences in management and control of HTN,
thematic analysis
The mandatory mixed contributory scheme covers salaries of retired and subsidised health insurance regime for the poor.
24 43 BrazilIn-depth interviewsPhysicians, nurses, ANMs, community health agents and other staff at PHC n=38Care provided by health professionals from a perspective of country policy,
framework analysis
Brazilian Health Department uses the chronic care model as the main reference for the construction of the Modelo de Atenção às Condições Crônicas Healthcare Networks.
  • AMPATH, Academic Model Providing Access to Healthcare Partnership; ANM, Auxillary Nirse Midwife; DM, diabetes mellitus type 2; FGD, focus group discussion; HTN, hypertension; NCDs, non-communicable diseases; OP, Out Patient; PHC, primary health centre; TB, Tuberculosis.