Introduction: Chronic diseases have become a major cause of death in the world, and a major source of morbidity and misery. Approximately 80% of related deaths occur in developing countries. Chronic Disease Management Program (CDMP) is an integrative program aimed to control the prevalence of chronic diseases. Therefore, this study aimed to evaluate the interaction between context and process in CDMP services, and to determine how CDMP was implemented in developed and underdeveloped regions.
Methods: This qualitative study used the Consolidated Framework for Implementation Research (CFIR). Subjects were selected by purposive sampling from CDMP organizers in Primary Health Centers for a commitment-based capitation assessment. Transcript data were analyzed thematically by summarizing and identifying major themes based on the CFIR domains.
Results: The main activities of the CDMP (medical consultations, monitoring of health status, health educational, reminders, home visit and group activities/gymnastics) in developed regions were conducted according to the technical manual. However, in underdeveloped regions, some modifications were needed, i.e. the medical consultations, medical checkups and health education undertaken by a nurse in charge and not always conducted by a doctor; and, the services were conducted at the village meeting halls. Also, the reminders were delivered through socialization by local governments and direct invitation by team members when they met the participants on the roadway or in the neighborhood around the participantsâ€™ homes.
Conclusion: CDMP cannot fully be implemented in underdeveloped regions and some modifications were needed according to local conditions.