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Table 5 Main and sub-themes of field testing of the developed HEI

From: Process of adaptation, development and assessment of acceptability of a health educational intervention to improve referral uptake by people with diabetes in Sri Lanka

Main Domain Theme Sub-theme Example Quotation
1) Comprehension and readability 1.1) Intelligibility of the leaflet and video Understanding of diabetes lead to blindness and eye check-up prevent sight loss “Diabetes can cause a huge damage to the eyes. It can lead to blindness. We can spend little time and get our eyes checked and prevent this damage.” [HE_S22_64yrs_F]
   Difficulties in reading the leaflet by some PwDM “I like the video because I can see it clearly. To read the leaflet I have to put some effort. It was bit of a hard work for me.” [HE_S03_65yrs_F]
  1.2) Difficulty in interpreting figures and medical images Difficulty in understanding of the fundus images (in page number 03-leaflet). “I could understand most of the things; However, I could not get the message from the pictures in the 2nd or the 3rd page. I cannot understand what is explained here.” [HE_M14_51yrs_M]
  1.3) Level of simplicity and cultural appropriateness of the language style Not preferring different colloquial languages in Tamil “This is Jaffna Tamil. It is difficult to follow the video.” [HE_M17 _65yrs_F]
2)Actionability 2.1) Ability to extract key messages of referral uptake Understanding importance of follow-up as a key message “I think the more serious message I captured from the video is that the ‘right follow up’ is very important to protect the sight’. Old lady’s story was interesting for me.” [HE_S21_58yrs_M]
   Understanding of Facilities are available at XX hospital. “XX hospital is more capable of providing the latest treatments. We should get the maximum benefits out of it as diabetic patients.” [HE_S11_62yrs_M]
3) Mode of Delivery 3.1) Preference over delivery at the medical clinic Preference of delivering and effective use of waiting time at the medical clinic. “It is good to get the details like this at the Room 26 (medical clinic). After giving the leaflet I had enough time to read it, till I get my turn. I was sitting more than one hour.” [HE_T06_51yrs_M]
  3.2) Usability and willingness to share the HE material Level of sharing resources “My husband comes home late after work. He is tired after working and I am reluctant to discuss about my diseases when he is back home.” [HE_S27_50yrs_F]
  3.3) Overall high social acceptability and attractiveness of the HEI High acceptance of the delivered leaflet and video. “I prefer both leaflet and video, but for more common use, leaflet would be better. It is easy to carry inside my bag.” [HE_S06_71yrs_F]