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Understanding implementation of HEARTS for hypertension and diabetes in Guatemala: Qualitative and mixed-methods

Taryn M Valley1,2, Chris Santizo-Malafronti3, Irmgardt Alicia Wellmann4

  • 1School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Medrxiv : the Preprint Server for Health Sciences
|May 18, 2026
PubMed

Insights

Implementing the HEARTS program in Guatemala showed high feasibility but revealed challenges in sustainability and supply chains. Refinements are needed for successful national scale-up of hypertension and diabetes care.

Area of Science:

  • Public Health
  • Primary Care
  • Health Systems Strengthening

Background:

  • Latin American countries are adopting the HEARTS initiative for hypertension and diabetes management.
  • A pilot study was conducted in Guatemala to assess and refine the HEARTS approach for broader implementation.

Purpose of the Study:

  • To understand and refine a HEARTS pilot program for successful scale-up within Guatemala's primary care system.
  • To identify barriers and facilitators for the integration of the HEARTS initiative into national health strategies.

Main Methods:

  • Semi-structured interviews were conducted with 30 patients and health workers across 10 primary care facilities.
  • Convergent mixed methods, including inductive-deductive analysis and the Tailored Implementation in Chronic Diseases framework, were employed.

Main Results:

  • Health workers reported competing responsibilities, and patients navigated an unreliable system, impacting retention.
  • Sustainability concerns and supply chain issues were identified, despite improved medication availability.
  • Gaps in education and treatment gains favoring hypertension over diabetes were noted.

Conclusions:

  • The HEARTS pilot met quantitative targets but highlighted critical qualitative barriers to scale-up.
  • Refinements include simplifying protocols, enhancing diabetes care, targeted training, supply chain reform, and securing Ministry of Health commitment.
Abstract

Keywords:
GuatemalaHEARTSLatin Americadiabeteshealth systemshypertensionimplementation sciencemixed methodsprimary carequalitative research

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