Table 4 Themes defining HCP challenges in HTN and DM care

Negative reputation associated with HCPs

Some people fear our attitudes, they don’t want to come to the hospital. (Female, Nurse at Nakaseke Hospital, HCP 1)

They [patients] can fear the health workers […] the way you handle that patient can affect the patient to come back to the hospital. […] If we are friendly with the patients it will be ok. (Female, Nurse at Nakaseke Hospital, HCP 1)

When [patients] reach the hospital, we tell them “you have high levels” then they get worried. […] [We tell the patients] Once a diabetic is always a diabetic. So that worries also. It will take long to make one stabilize [to manage their condition]. (Female, Nurse at Nakaseke Hospital, HCP 8)

Some [patients] say some staffs are harsh. Some say, if you’re going to hospital, people might think they have HIV. So, most people fear hospitals. […] When a patient has taken drugs for 1 year then starts taking herbals, herbals fail, it [symptoms of DM] comes back, and someone [a HCP] could abuse her [the patient], “why weren’t you on diabetic drugs? Now you’re coming back?” such things. You shout at her. It doesn’t feel good. (Female, Pharmacist at Nakaseke Hospital, HCP 5)

Patients’ herbal medication use and hospital as the last resort

People believe in herbal so much even they may not come [to the hospital]. Person comes in too late and say that we’ve been using herbal. […] hospital is always the last solution. (Female, Nurse in Nakaseke Hospital, HCP 3)

Sometimes even those patients can take [traditional medicine] and sometimes they don’t come to the hospital. But at the end, they end up coming back here because they have tried that traditional herbs and it doesn’t work. (Female, Nurse at Nakaseke Hospital, HCP 1)

Especially those [patients] ones in the village, they are not educated very well. “I was thinking herbal drugs,” those are the stories they give us. […] They come in with their conditions worse. (Female, Nurse at Nakaseke Hospital, HCP 3)

Some [patients] don’t have enough drugs because at times they come here [hospital] and drugs are out of stock, [which is] another reason they feel that these herbals are better than tablets. (Female, Doctor at Nakaseke Hospital, HCP 7)

Challenges related to patient education on HTN and DM

We’ve not done enough of the counseling, because we don’t have the time […] Diabetes and hypertension needs time [in counseling] because, you need to talk about lifestyles. For both hypertension and diabetes, when we talk about weight reduction, it needs a lot of skills, it needs a lot of examples, needs a lot of talking. (Male, Doctor in Kasangombe, HCP 9)

If we have budget for some fuel and go to villages, you can health educate these people, you talk about symptoms of hypertension and diabetes, you can health educate the community. (Female, Nurse at Nakaseke Hospital, HCP 1)

We do our best to convince them [the patients] and tell them the complications [of medication non-adherence]. But it is a struggle to convince them to take their hypertensive drugs. If I take the blood pressure, [and I] say it is ok, they [patients] don’t take their drugs. (Female, Nurse at Nakaseke Hospital, HCP 3)

They [patients] are good at forgetting. They easily forget so we continue to health educate them. (Female, Nurse at Nakaseke Hospital, HCP 2)