Page 165 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 10 of 14 Original Research

TABLE 6: Intervention–context–actor–mechanism–outcome matrix formulated from the study findings.
Intervention Context Actor Mechanism Outcome
modalities
Club rules and - Standard operating protocol - Patient - Perceived barriers - Nudged to adhere to club
regulations - Being reminded of the rules and regulations of the club - Perceived coercion appointments
- HIV policy - Perceived fear
- Reinforcement
- Nudged
Group dynamics - Availability of space for meeting - Patient - Perceived social support - Better adherence resulting
- Relationship with other club members - Group - Bonding and formation of group identity from developed self-efficacy
Health talks - Good availability of personnel - Patient - Knowledge acquisition - Improved self-efficacy
or education - Effective teamwork - Reinforcement of club rules and regulations
Quick medication - Availability of medication - Patient - Perceived benefit - Adherence to medication
access - Eligibility criteria - Motivation related to medication
- The organisation of the pickup process and club sessions - Satisfaction availability
- Buy-in from care providers
Prompt continuity - Availability of clinicians - Clinicians - Trust - Retained in care through
of care - Staffing dynamics - Patient - Satisfaction problem resolution
- The organisation of club activities
- Buy-in from care providers
Club facilitator– - Staffing dynamics - Facilitator - Trust - Adherence to medication
patient relationship - Teamwork or collaboration - Patient - Perceived support - Motivation
- Buy-in from care providers - Retention in care
Overall intervention - Availability of programme champion - Patients - Motivation - Improved retention in care
- Buy-in from care providers - Club teams - Self-efficacy and adherence to
- Preparation and organisation - Satisfaction medication

Goals and objec ves of South African AIDs Commiee
Staffing dynamics Context
Na onal HIV/AIDs treatment
guidelines Buy-in from health
care workers Availability of conducive
implementa on condi ons
Perceived threat
Rules and regula ons
(Constraints)
Fear Organisa onal
Being culture
Care provider – pa ent Trust nudged
Rela onship
(Opportuni
es) Perceived Adherence to Reduced workload
Support medica on for clinicians
Improved self-
Knowledge efficacy
Health talks and acquisi on Retained in Deconges on of
counselling care facility
(Resources) Mo va on Pa ent’s decision
Mo va on and ac on
Groupong and quick Bonding
medica on collec on Perceived social
(Resources and support Number of clubs run
Opportuni
es) by the facility
Perceived benefit and Separated from the
Clinic sa sfac on
organisa on management of non-HIV-
Availability of posi ve pa ents
medica on

Interven on and modali es Mechanisms Actors Outcomes
FIGURE 4: Modified programme theory.

this process. Retroduction is a form of inference that seeks (creating possible alternatives) to trace the various pathways
to identify and verify mechanisms that are theorised to (demi-regularities). 40,41
39
have generated the phenomena under study. Firstly, we
paid attention to the outcomes of interest and then While having ICAMO links, such as in Table 6, is useful, we
identified the mechanism(s) most associated with each constructed a configurational map to obtain a bigger picture.
outcome. This transfactual thinking approach helped us According to Byng et al. the bigger picture adds value to
42
40
to identify mechanisms that were associated with the understanding the programme theory. The result of this
different modalities of the intervention and how these exercise is a model illustrating how adherence clubs
mechanisms relate to the different actors (patients, health contribute to adherence and retention in care (Figure 4).
professionals). Then, we examined the context in which the
mechanisms are contingent to perpetuate the observed Our analysis reveals that the two theories identified as initial
outcome as informed by the data. Thirdly, we confirmed programme theories complement each other to provide a full
each ICAMO chain by applying counterfactual thinking picture of how and why the adherence club intervention

http://www.sajhivmed.org.za 158 Open Access