Table 3 BIGPIC Re-evaluation changes

Monthly meeting time determined by clinician availability.

Participant availability may change based on agricultural season.

CHWs function as primary liaison with medical team to coordinate best meeting time before the end of each month.

Group education on NCDs at the time of group formation and before every monthly meeting.

There is low interest in group education.

Health education time is modified from didactic teaching to facilitated group discussions on self-management and problem solving.

CHWs receive training in group facilitation.

Maximum group size of ~ 30 participants.

Large groups may overburden clinicians.

Maximum group size is decreased to ~ 20 participants.

Village-based health screenings to recruit intervention participants.

Concern for disease stigma may preclude willingness to join groups

Renew efforts to increase community health and intervention awareness.

Remove AMPATH logo from clinician vehicles.

Clinician brings a toolkit of common medications for chronic disease management.

Availability of other commonly used medications (i.e., ibuprofen, antibiotics).

Toolkit of medications needed communicated to AMPATH pharmacy.

Community entry focused on local leadership.

Concerns regarding program sustainability.

Community entry and scale up includes multiple levels of leadership.

Given CDM program is well known, emphasize roll out is in partnership with the existing CDM program.

No seed money provided, but increased agribusiness and financial trainings.

Microfinance training during group enrollment, and CHW-led health education didactic sessions every month.

There is low income generation among community members, particularly elderly and those with low education levels.

Agribusiness and financial trainings are incorporated.

Health education time is modified as above.