Table 2 Barriers, opportunities, and interventions of a one-time target behavior: register in the policy system

Patients

Predisposing factors

1. Poor policy awareness

2. Insufficient health condition awareness, lack of knowledge on NCDs self-management

3. Low demand for policy utilization among some patients:

(1) Acceptable outpatient medication costs

(2) Used to purchase medications at pharmacies

(3) Used to purchase medications by other family members

1. Initiatively consultancy with VDs on policy usage among some well-informed patients

2. Perception of policy benefits among some patients:

(1) Reduce financial burden of self-medication

(2) Enhance medication adherence

1. Carefully designed picture-rich posters to promote policy

2. Supplement promotion through broadcast, we-chat groups, and one-on-one promotion

3. One-on-one registration encouragement based on theories of loss aversion and encouragement

4. Encourage patients to inform policy to other patients in the village

Reinforcing factors

N/A

Peer influence from registered patients

Enabling factors

Lack of mobilization from service providers

N/A

VDs

Predisposing factors

1. Poor awareness on policy details and registration procedures

2. Low educational capacity to comprehend the policy

3. Unwilling to add additional workload on policy promotion

4. Lack of supervisions by DHCs

5. Lack of motivation

1. Possess preliminary understandings of the policy

2. Possess a positive belief on policy of helping and reducing financial burden of patients

3. High general self-efficacy on policy promotion

1. Systematic training on village doctors combined with carefully drafted training manuals and minute cards for reminder

2. Financial incentives based on performance

3. Timely report the registration progress in the communication channel

4. Clear up obstacles in the registration process by streamlining the registration procedures in DHCs and capacity building in village clinics

Reinforcing factors

Lack of communication channels between VDs of different villages

1. Peer influence from initiative VDs

2. Gain positive reputation among patients

3. Gain knowledges on NCDs management

Enabling factors

1. Difficulties in social mobilization for patients, lack of policy promotion materials and language skills

2. Many elderly VDs are not capable of operating the registration system

3. Outdated hardware and software

City medical insurance bureau support hardware and software issues in primary healthcare institutions

DHCs

Predisposing factors

1. Poor awareness on policy details

2. Lack of incentives and performance evaluation on VDs for policy promotion

1. Possess an intention to assist government on policy promotion and implementation

2. Possess an intention to reduce financial burden for patients

1. Structured communication channel between VDs and DHCs

2. Supervision and performance evaluations on VDs

3. Streamlining registration procedures through a multi-departmental coordination

Reinforcing factors

Lack of communication channels with VDs

1. Better provide essential public health services for NCDs patients

2. Increase service volume

Enabling factors

1. Medical insurance staff will be overextended if large-scale registration takes place, due to high number of patients and complicated registration procedures

2. Lack of special funds for policy promotion

1. City health insurance bureau support policy promotion and implementation

2. Complicated registration process can be streamlined through coordination