Table 4

Summary of key themes and sample quotes from qualitative data collected across all HealthRise sites

HealthRise thematic area components and contexts	Sample thematic quotes
Global and cross-cutting
Innovation in programme design within and across sites	‘E-clinics give the same care as hospitals and time is saved’—Administrator, India
Impact of social determinants of health on NCD risk, onset and treatment	‘Many of the diagnoses we were seeing were directly related to social determinants of health, particularly healthy food access and access to affordable and culturally appropriate clinical care.’—Administrator, US
Role of front-line health workers in bridging geographic, linguistic and cultural divides	‘All health-related programmes that were given the ASHA workers, there have been advantages due to it.’—Clinic provider, India
Importance of care coordination to provide more efficient and effective care	‘Before the programme, there was not much communication with the doctors and the nurses. Our work is usually with people from the community only. The HealthRise programme has helped us in increasing our communication with officials at the clinic…Our rapport with doctors and nurses has improved.’—CHW, India
Improved patient empowerment through increased knowledge of NCD management
Importance of strong health systems with basic infrastructure, staffing, and supplies to support effective community-based programmes	‘As you can see, we got here at the clinic at 6am but here we are still waiting for assistance.’—Patient, South Africa
Brazil
Improved provider experience from reorganised patient flows, new training opportunities, increased availability of tests, implementation of a clinical decision support system, and introduction of tablets	‘I think the EMR resulted in a better way of communicating about the patient…any professional can now access the information stored in there’—Frontline health worker
Demand for additional technical trainings and multidisciplinary engagement	‘A more intense multidisciplinary approach…I missed that a lot. A psychologist, a nutritionist…so that we could discuss the cases together.’—Frontline health worker
Barriers to disease management from local food culture and health system constraints	‘I really like eating rice, but we can’t. But I eat it anyway.’—Patient
India
High level of basic awareness of diabetes and hypertension symptoms and risk factors	‘You feel it—sleepy, dizzy, irritable, can't control yourself.’—Patient
High exposure to and awareness of HealthRise interventions, except patient support groups	‘From MAMTA for the past 2 years they are coming continuously in our village. They give us information and also tell us precautions about what to do. They do medical check-ups also every month after the health centre was made. Have given us cards as well.’—Patient
Positive patient and provider experiences with CHWs	‘Initially people think, 'what do they know, they are just freshly appointed ASHAs,' but they bring people to us, mobilise people; people do listen to them.’—Clinic-based provider
Ongoing challenges for NCD management and access to care related to health system constraints (eg, medicine stock outs), competing priorities (eg, family, work and social obligations) and modern lifestyles	‘Life is too fast paced, people pay more attention to electronics, social media and not nutrition and exercise.’—Patient
South Africa
Positive views of introducing community-based NCD care and outreach services alongside requests for further expanding community services and health education initiatives	‘Outside the facility, we have adherence club where chronic patients are being taught about exercises and adherence in the community. Then we have collection points where patients fetch their medication, the collection point are at scheduled halls or education institutions. That has helped us…because we take the medication to the people.’—Frontline health worker
Some underlying tensions in patient–provider relationships related to long wait times and lack of trust (from patients' perspective) and reluctance to make necessary changes to diet and exercise (from providers' perspective)	‘It’s not good and it’s also not bad, it’s in between. There are some patients who understanding our working conditions that maybe we have shortage of medication at that particular time and maybe we are busy because this is the only clinic in the community, but there are some patients who do not understand, they would say that we are slow or do not care about the patients.’—Facility manager
Role for traditional medicine alongside more formal health sector	‘If one doesn’t have cash, he can’t get to the hospital. We then use the services of prophets and traditional healers.’—Patient
Ongoing barriers and constraints to care, including physical accessibility to facilities, medicine stock-outs and staff shortages	‘(Facilities) need to employ more staff and equipment, increase the resources needed and focus on each and every chronic condition….our government is trying but it is not enough.’—Frontline health worker
USA
Programme strengths from the opportunity for global learning and introduction of home-based providers	‘The global aspect is quite unique…utilising similar strategies in different countries with very different health systems but with a similar population focus and similar workforce approaches…. I'm not aware of other projects that have attempted that across a set of different jurisdictions and landscapes.’—Policymaker
Programme challenges from the lack of experience with home-based providers and issues with patient data accessibility among care team members (ie, electronic medical record system incompatibility)	‘We've learnt that a lot of the hurdle we have to get past is educating other healthcare providers on what we do…what is a CP and how can we be part of their team and help to better serve their patients…the ones who do now understand our role…they are our champions, they get so excited…we definitely see resistance in the beginning.’—Community paramedic
Perceived improvements regarding clinical interactions and patient well-being	‘The home visits contributed to more rational use of clinic time…and improved care on my end. From listening to CHWs, I have a better understanding of what's going on in people's lives.’—Clinic-based provider

CHW, community health worker; NCD, non-communicable disease.