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Table 3 Acceptability of a community CVD programme among CHWs and community members based on the Theoretical Framework of Acceptability (TFA) framework

From: Acceptability of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda: a qualitative study

TFA construct / themeSub-themeSummary codes
CHWCommunity
EthicalityProgramme fits community value system• Belief in seeking healthcare from facilities.
• Interest in remaining healthy.
• No contradiction with religious or political views.
• Similar approaches have been employed
• No contradiction with religious, political or cultural views.
• Intervention elements such as education and counseling are acceptable
Affective attitudeWillingness to engage in intervention• Participation in similar community based programmes.
• Community health services delivery is our role.
• Appointed and trusted by the community members.
• High perceived disease burden
• High need for CVD services
• Opportunity to widen scope of work.
• High perceived CVD burden.
• Interest in screening and treatment services.
• Opportunity to know CVD status.
• Difficult to access care at health facilities.
Conditions for intervention participation• Well trained to carry out assigned tasks.
• Obtain all costs related to intervention delivery.
• Regular refresher trainings.
• Honesty in terms of services.
• Well trained and motivated CHWs
• Early information about planned events.
• Continuous involvement in project activities.
• Honesty in terms of services.
Appropriateness of intervention delivery strategies (group gatherings and house to house visits)Group gatherings
• Has high reach to community members.
• Varrying confidence in conducting group sensitizations.
House to house visits
• Flexible timing.
• Quality time with community members.
• Reach the underserved.
• Appropriate with high reach among community members.
House to house visits
• Reach the underserved.
Intervention coherenceUnderstanding of intervention• Training in CVD prevention and control.
• CHWs educating community members.
• Assess lifestyle risk factors and provide advice.
• Encourage screening for risk factors.
• Offer treatment to community members.
• CVD prevention programme.
• Promotion of healthy lifestyles.
• CHWs trained to sensitise community.
• Community members mobilising others.
BurdenReaching communities• Transportation, big areas of coverage, meals and equipment
• Being exemplary
• Carrying heavy screening equipment.
 
Mobilising communities• High interest of in financial gains
• Resistant groups like youths
• Uncooperative community members
• Uncommon lifestyle choices
• Fatigue due to repetitive information.
• Unavailability at homes
• Low and inconsistent turn up
• Unavailability at homes
• Unwillingness to change
• Unreceptivity to CHWs
• Other duties and responsibilities
Community health work related challenges• Inadequate training for proposed roles.
• Transport and weather challenges.
• Low motivation and incentives.
• Inadequate tools and materials.
• Negative community attitudes towards CHWs.
• CHWs not being exemplary.
Health system barriers• Unprepared health workers.
• Lack of required equipment and drugs.
• Poor relationship with health workers.
• Low belief in health system.
• Lack of transport to distant health facilities.
• Lack of medicines at health facilities.
• Lack of screening equipment.
• Absence of health workers at facilities.
• Low belief in health system.
Opportunity costsReduced time for other activities• Reduced time for attending to farmlands, domestic work, socializing and travelling away.• Reduced time for income generating activities and tending to farms.
Benefits to communities• Access to treatment.
• Healthy members contributing to their communities.
• Savings due to prevention of CVDs.
• Knowing CVD status.
• Obtaining treatment and screening for CVDs.
• Knowing CVD status early.
• Healthy community members.
• Knowledge on CVDs and risk factors.
Benefits to CHWs• Information to keep healthy and better manage CVDs.
• Community members acknowledging CHW expertise.
• Fame and earning community trust.
 
Self-efficacyConfidence to deliver intervention or change behaviour• Previous experience in community programmes.
• Anticipated adequate training.
• Positive and eager community for information.
• Increased and empowerment to contribute to behavior change
• Information sharing among community members.
Perceived effectivenessIntervention is effective• Timely and consistent information key to reduce unhealthy behaviours
• CHWs serving as examples
Measures to increase effectiveness• Utilise community resources (community, religious and cultural leaders and community radio / loudspeakers)
• Increase functionality of the health system
• Involve external persons in intervention delivery
• Provide information education and communication materials such as leaflets in the local language.
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