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Table 2 Pathways identified to effective and ineffective interventions

From: Using qualitative evidence on patients’ views to help understand variation in effectiveness of complex interventions: a qualitative comparative analysis

Effective interventions

The configuration most commonly associated with effectiveness (found in eight trials) involved one factor: ‘a focus on personal risk factors’ (pathway 1: [1517, 19, 20, 23, 26, 27]). Other configurations each involved the presence of one factor, and the absence of other factors. One configuration involved ‘explaining the value of adherence’ with the absence of:

(i) ‘Discuss circumstances that lead to forgetting to take treatment’ and ‘a focus on improving social support’ (pathway 2: [24, 25, 29]).

Or the absence of:

(i) ‘Discussion relating to not stopping the medication if there are no symptoms’ and ‘improving social support’ (pathway 3: [16, 18, 22, 29]).

The other configurations involved ‘provision of clear/appropriate information on how to take medication’, with the absence of:

(i) ‘Exploration of attitudes to therapy/disease’ and ‘discussion relating to not stopping taking medication if there are no symptoms’ (pathway 4:[17, 18, 22, 29]).

Or the absence of:

(ii) ‘Discussion relating to missing a drug’ and ‘discussion relating to not stopping taking medication if there are no symptoms’ (pathway 5: [24, 25, 27, 29]).

Or the absence of:

(iii) ‘Discussion relating to not stopping taking medication if there are no symptoms’ and ‘improving social support’ (pathway 6: [17, 18, 22, 29]).

Ineffective interventions

All four configurations (pathways) for the ineffective interventions included the absence of one factor: ‘a focus on personal risk factors’. Two of the configurations also involved the absence of either:

(i) ‘Information on side effects’ and ‘pointing out the value of adherence’ (pathway 1: [31, 3335]).

or

(ii) ‘Pointing out the value of adherence’ and ‘provision of clear or appropriate information’ (pathway 2: [30, 3335]).

In the other two configurations the absence of ‘a focus on personal risk factors’ also involved the presence of either:

(i) ‘Discussion relating to missing a drug’ (pathway 3: [28, 3032]). or

(ii) ‘Emphasis that experiencing no symptoms does not mean stopping medication’ (pathway 4: [21, 32]).