Barriers and Facilitators of Hypertension and Diabetes Screening in Primary Healthcare Facilities in Addis Ababa, Ethiopia: A Mixed-Methods Study
Endalew Gemechu Sendo, Bezaye Abebe Bekele, Elizabeth C. Rhodes, Leslie C. M. Johnson, Rebecca Gary, Saria Hassan, Fekadu Aga, Yewondwossen Tadesse Mengistu, Megan UrbanskiIntroduction/Objectives
To identify health-system and provider-level barriers and facilitators influencing hypertension and diabetes screening in public primary health care (PHC) facilities in Addis Ababa, Ethiopia.
Methods
We conducted a qualitatively dominant convergent mixed-methods study from May to December 2025 in 10 public PHC facilities. Facility readiness was assessed using a checklist adapted from the WHO Service Availability and Readiness Assessment and analyzed descriptively. Semi structured interviews with 21 clinical staff were analyzed thematically using the Capability, Opportunity, Motivation–Behavior (COM-B) model and Theoretical Domains Framework.
Results
Overall readiness was 82.3%, but only 4.6% of clinical staff had received NCD-related training and 4.2% of the workforce was dedicated to NCD care. Stock-outs of glucose test strips and HbA1c reagents, limited HbA1c availability, inadequate equipment maintenance, and duplicate documentation constrained screening. Providers described limited refresher training, selective age- or symptom-based diabetes screening, heavy workload, and burnout as barriers. Peer learning, supportive supervision, NGO assistance, community-based health insurance, teamwork, and professional commitment were facilitators.
Conclusions
Screening was constrained by interacting capability, opportunity, and motivation barriers rather than by the absence of guidelines alone. Priorities include competency-based in-service training, reliable diagnostic supplies and equipment maintenance, reduced documentation burden, and protected provider motivation. Transfer to similar settings requires contextual adaptation.