Table 3 Barriers, opportunities, and interventions of a recurring target behavior: adopt policy to reimburse medical expenses

Patients

Predisposing factors

1. 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

2. Misunderstand the scope of the policy to only applying to village clinics, and chose to purchase at pharmacies due to more types of medications available

3. Lack of knowledges and belief to intake medications on time and in right amount:

(1) Forgetfulness

(2) Insufficient awareness of NCDs and comorbidities threats

1. High-level overall trust on VDs

2. Perceive benefits and convenience provided by policy

1. Carefully informing details of the policy to patients by VDs

2. Regular follow-up on health condition monitor, health education, and continuous reminders by VDs

3. Using calendar fliers and involving family reminders for self-management

Reinforcing factors

Lack of regular reminders on adopting the policy

1. Family support

2. Peer behavior demonstration from other patients

Enabling factors

May not be convenient to get medicines at designated medical institutions for some villages

N/A

VDs

Predisposing factors

1. Unwilling to add additional workload on large-scale patients management and follow-up

2. Medication compliance of patients is not regularly included in VD’s performance index

Possess a positive belief on policy of reducing financial burden and increasing medication adherence of patients

1. Regular follow-up on health condition monitor, health education, and continuous reminders by VDs, integrated to the regular quarterly follow-up under the essential public health services program

2. Financial incentives based on performance

3. Supervision and performance evaluation on VDs by DHCs

Reinforcing factors

Lack of supervisions from DHCs

1. Gain positive reputation among patients

2. Gain knowledges on NCDs management

Enabling factors

Lack of communications and tools to remind patients adopting policy due to heavy workload

Regular quarterly follow-up visits for NCDs patients have been well established under the essential public health services program

DHCs

Reinforcing factors

Lack of communication channels with VDs

1. Better provide essential public health services for NCDs patients

2. Increase service volume

Structured communication channel between VDs and DHCs