Table 6 Summary of thematic analysis

Organizational level

Staff-turnover is an obstacle to meet goals of intervention

Staff perceive they should be paid more for the time commitment

“I’m going after tomorrow... but pay the exercise trainers more because the rate I get is quite a bit lower than I would get as a personal trainer at the gym.”

“[Being an RA] has been a great experience but I’m not getting paid to do this. Then I was given more tasks and things to do.”

Difficult to find motivated and qualified staff

“Just motivating people in my position is very hard… it is very hard to motivate either the training of the CHW or the RAs the environment we have right now is uncomfortable.”

“[there is a] lack of support from my supervisor and lack of interest, lack of commitment and lack of understanding of the trial.”

Organizational level

Ensuring CBOs ability to provide effective capacity-building

Identifying individuals in agency who are motivated and can be trained to train

“It is important to find someone that is serious about being part of the program, understands it’s goals… has been in the organization for a longer period.”

“We need people that are serious about being part of the program, because it helps to be invested in it. To understand what are the goals, the focus, and be mindful of the core concepts.”

Including technology

“It would be easier if [CHWs] have recordings of sessions to practice before their initial training.”

“Include videos for the exercise trainers so they learn the exercise before, but I think we still need to make sure the person is doing it correctly in person.”

More roleplay (CHW)

“More roleplays would be good to help people practice. They need to practice more.”

“Sometimes [CHWs] get stuck so someone else can help clarify the situations and concepts so they deliver more eloquently if they practice in roleplays.”

“More roleplays would be good to make sure they understand the mindfulness CBT component, which is crucial.”

Cultural adjustments

“Since Cantonese is a spoken language, the questions we have to read in Cantonese sound mechanic, so more flexibility in the interpretations.”

“Let them talk about cultural stigma in the sessions because [Asian elders] come with a barrier to participate and if they talk about it, they feel more empowered and accepted.”

Having strategies to overcome financial obstacles

More flexibility with managing funds to adapt to local needs and improve compensation

“There needs to be more flexibility in terms of supporting staff and understanding the real costs of the intervention at the center because that would allow us to figure out how much it really costs the organization to staff someone onboard.”

Community level

Applying for other grants

“I consider each organization should look for their own grants.”

“I think we need to work to find sources of funding and write grants with help of partnering organizations.”

“There is potential for other grants… or test a more adapted version of the [intervention].”

“If [partnering organizations] can prove that [PM-SB] works and people are going to get better and benefit from this, then I think that’s enough to continue the intervention [through grants].”

Obtaining funds from the government or private sector to provide reimbursements

“I think about Medicare and some are Medicare/Medicaid so there could be a reimbursement for prevention…Or United Healthcare reimburses local YMCAs for people they lift into diabetes prevention so maybe if we enroll a certain number of Medicare or Medicaid participants, [agencies] will get reimbursed at a certain level.”

“The council in aging is connected to other senior centers so seeing how they could help out in terms of funding.”

“We are working with a growing population, so I think the mayor of [site] would be interested in supporting the project and providing funding.”