Healthcare providers’ perceptions of the HEARTS Clinical Pathway in Belize: barriers and facilitators

ABSTRACT Objective. To estimate the proportion of healthcare providers who perceived the HEARTS Clinical Pathway as easy to apply in routine practice and identify perceived barriers and facilitators influencing its use. Methods. A cross-sectional analytical study was conducted among HEARTS-trained healthcare providers in public primary health care facilities across Belize between 29 September and 3 October 2025. A structured questionnaire assessed training, leadership, resources, and pathway applicability. Quantitative data were analyzed descriptively and through exploratory logistic regression, while qualitative responses underwent thematic analysis. Results. A total of 227 healthcare providers from 22 public primary health care facilities participated. Overall, 23.8% (95% CI [18.7, 29.7]) perceived the HEARTS Clinical Pathway as easy to apply in routine practice. Leadership support (aOR = 6.47, p < 0.001) and resource availability (aOR = 2.93, p = 0.002) were independently associated with greater perceived pathway applicability. Commonly reported barriers included medication stock-outs, limited consultation time, and workflow complexity, while leadership engagement, teamwork, standardized protocols, and refresher training were identified as facilitators. Conclusions. Perceived applicability of the HEARTS Clinical Pathway was limited despite positive perceptions of training. Leadership support and resource availability were more strongly associated with pathway applicability than training alone. Strengthening governance, essential resources, and multidisciplinary support may facilitate broader adoption of HEARTS in Belize. Findings reflect implementation readiness rather than implementation fidelity or program effectiveness.