Table 6 Exemplar quotations illustrating themes from qualitative interviews

Social determinants

Poverty/Healthcare access: “I am requesting that the health workers continue to treat us and also to provide us with some transport since we stay very far, travel long distances yet we are very poor”

Female gender role: “As a woman, there is too much work to do no matter whether you are sick or not, you have to carry on with the duties like digging.”

Health literacy: “I used to sell charcoal, we could go and buy it from far places, climb those Lorries, and I think that is where I got this disease from”

“I would like to stop giving birth but am afraid of which family planning method to use and from the rumors that I hear, with this heart problem how will it treat me”

Central role of spouse in medical decision making

“My husband told [the healthcare worker] that we had come here to be helped and if she found a disease and she could treat it, she should go ahead as long as it was free because we did not have any money for that. And when the health worker agreed, I started on treatment.”

“My husband and family felt bad and they thought I was going to die since we do not have money to treat such a complicated disease”

“I told my husband after I went back home about my diagnosis, he was scared but as a man, he had to keep strong”

“I don’t find any problem telling the community because every time you hide your illness, you don’t get the help you need. I like it because in case of any attack, people around can help you call your husband”

RHD diagnosis negatively affecting female societal wellbeing

“I do not want the community members to know because they will stress me and stigmatize me thinking I am HIV positive”

“I can no longer keep up with my colleagues because the speed at which I do things has reduced so much due to my heart condition”

“There are some things I used to do that I can no longer do as my body has weakened like digging, carrying heavy stuff”

“I don’t have hopes of getting pregnant because I am worried of the complications which might result from the heart disease which I already have”