Elements of the chronic care model included in the studies
| Author (year) | Self-management support | Delivery system design | Decision support | Clinical information system | Healthcare organisation | Community resources |
| Havlir et al (2019)43 | Enhanced lifestyle modification counselling in primary care centres. | Point-of-care multidisease screening for HIV, hypertension and diabetes with structured follow-up and care linkages. | Telephone and in-person oversight from a senior physician on the services provided by general physicians and nurses. | Quality improvement strategies such as guaranteed access to medication, flexible hours of operations and reduced wait time at clinics. | Multidisease testing community health campaigns using community resource persons. | |
| Jackson and Ukwe (2021)44 | Education on self-monitoring of BP, lifestyle modification, self-care and appropriate use of medicines. | Structured pharmaceutical care including prescription review and follow-up. | ||||
| Myers et al (2022)46 | Task shifting and empowerment of community health workers to provide basic psychological interventions. | Trained community health workers on basic psychological intervention including motivational interviewing and problem-solving therapy. | ||||
| Okube et al (2022)47 | Individualised health recommendations on CVD risk factors. | Community-based health education on lifestyle modification. | ||||
| Owolabi et al 201948 | Post-clinical follow-up phone texts and waiting room educational video. | Enhanced follow-up visits and pre-appointment phone texts. | Hospital registry and patient report card as part of medical chart. | |||
| Petersen et al (2021)49 | Collaborative care model for patients with hypertension and comorbid depressive symptoms including doctors, nurses, clinical psychologist and lay counsellors. | Supplementary training of primary care nurses and doctors on mental health and clinical communication skills. | ||||
| Rabkin et al (2018)50 | – | One stop shop for CVD risk factors screening and structured referrals among patients living with HIV. | Training of HIV clinical nurses and doctors to conduct CVD risk factors screening during routine clinical appointments of patients. | |||
| Roos et al (2014)51 | A pedometer and a physical activity diary with education materials and self-monitoring documents. Monthly SMS text motivational messages. | Structured regular clinical sessions for review of physical activity diary and risk factors for ischaemic heart disease. | Patient diary for self-monitoring of risk factors for ischaemic heart disease. | |||
| Sarfo et al (2018)52 | Self-monitoring of BP using a bluetoothed device. Tailored motivational text messages delivered based on the levels of adherence to medication. | Structured follow-up for BP measurements and medication adherence. | Digital platform for tracking BP measurements and medication adherence. | |||
| Thuita et al (202053 | Nutrition counselling and peer support group. | Monthly follow-up visits and structured regular clinical sessions to review patient progress. Facility-based patient support groups. |
BP, blood pressure; CVD, cardiovascular disease ; SMS, short messaging service.