Table 1 Reported barriers and facilitators of patients’ self-management organized in the stages of change framework

Pre-contemplation

• Does not accept the diagnosis or hopes it will go away.

• Inclusive, horizontal communication.

I haven’t suffered from it, but it appears that I am going to suffer from high blood pressure, when they take me in to check my blood pressure, yes it is high… (Chiapas, Female)

• Lack of information about the disease.

• The primary health care institution is accessible (frequency of appointments, timing, publicly-funded).

“I battled a long time with my husband about hypertension, and so we argued about him taking his pills, and he said “-ay! What for? if we all have to die from something…” (San José, CR, Female)

• Does not feel any symptoms.

• Vertical communication between the provider and the patient.

• Poor eating habits and limited funds for healthy food.

Contemplation

• Previous negative family health care experiences with hypertension or diabetes.

• Previous positive relative’s care experience with hypertension or diabetes.

The doctor tells us that we should take care of ourselves, what we should do, she gives us appointments and she helps us. (Chiapas, Mexico Female)

• Difficulties negotiating between work, family, and health care commitments.

• Guidance from the primary care provider that allows patients to express how they feel about their disease.

Preparation

• Negative perception of healthy food as being expensive or does not fill you up.

• Feeling of urgency to begin to take care of oneself.

Having “sugar” is sad, I have high blood pressure, I have a warning, now it is up to me. (Chiapas, Mexico, Female)

• Difficulty adhering to treatment (lack of medicines, lack of or infrequent follow-up).

• Community educational sessions.

• Green spaces are not accessible.

• Family support.

Action

• Difficulty losing weight.

• Accessibility of the medical care system.

Now I love myself, I am going to stick to my diet, and my medications, I have to lose 8 kilograms. (Chiapas, Mexico, Female)

• Medication stock-outs.

• Humane, compassionate care is encouraging.

• Difficulty controlling what food to eat/compulsive eating.

• Organized walking groups.

• Additional health conditions.

• Not seeing progress/not having a record of change.

• Taking care of other family members.

Maintenance

• Difficulty keeping track of multiple medications.

• High self esteem, self efficacy.

Yes, every three months my doctor sees me in the clinic, weighs me, tells me you take this and that and gives me a prescription, it keeps me in control. (San José, Costa Rica, Male)

• Health care appointment becomes routine without new information or educational processes.

• Strict health center attendance is a requirement for national insurance.

• Staying calm and limiting stress.