A Qualitative Exploration of Facilitators and Barriers to Control of Hypertension and Type 2 Diabetes Mellitus in Rural Nagpur, Central India

Abstract Background: Hypertension (HTN) and type 2 diabetes mellitus (T2DM) are increasingly prevalent in rural India, yet disease control remains suboptimal due to a confluence of socio-cultural, behavioral, and systemic challenges. Understanding community-perceived facilitators and barriers is essential for improving chronic disease management in these settings. Materials and Methods: An exploratory qualitative study was conducted in the catchment area of the Primary Health Centre (PHC) Bela, Nagpur district, Maharashtra. Free listing and pile sorting exercises were conducted with 30 purposively selected participants, including controlled/uncontrolled patients and healthcare providers. Items mentioned were analyzed using Smith’s Salience Index (cut-off ≥ 0.1), followed by two-dimensional scaling and hierarchical clustering to identify thematic groupings, which were then applied to organize findings within capability-opportunity-motivation-behavior (COM-B) domains. Results: Facilitators included dietary modifications (reducing sugar/salt), medication adherence, family support, physical activity, and stress reduction. Barriers encompassed the asymptomatic nature of illness, medication stock-outs, poor dietary adherence, low awareness, and financial constraints. Thematic analysis revealed three cognitive clusters under both domains: systemic/behavioral, interpersonal, and isolated factors. When reorganized using COM-B, disease control was shaped by interacting capability-related deficits in knowledge and behavioral skills, opportunity-related constraints in medicine availability and family support, and motivation-related beliefs, fears, and habits. Conclusion: Control of HTN and T2DM in this rural setting is influenced by factors of interdependent capability, opportunity, and motivation rather than by patient behavior alone. The findings support program actions focused on repeated behaviorally specific counseling, reliable medicine supply, and stronger community-level adherence support through rural primary care systems.