title: Identifying configurations of behavior change techniques in effective medication adherence interventions: a qualitative comparative analysis.
abstract: BACKGROUND
  Interventions to improve medication adherence are diverse and complex. Consequently, synthesizing this evidence is challenging. We aimed to extend the results from an existing systematic review of interventions to improve medication adherence by using qualitative comparative analysis (QCA) to identify necessary or sufficient configurations of behavior change techniques among effective interventions.
  
  
  METHODS
  We used data from 60 studies in a completed systematic review to examine the combinations of nine behavior change techniques (increasing knowledge, increasing awareness, changing attitude, increasing self-efficacy, increasing intention formation, increasing action control, facilitation, increasing maintenance support, and motivational interviewing) among studies demonstrating improvements in adherence.
  
  
  RESULTS
  Among the 60 studies, 34 demonstrated improved medication adherence. Among effective studies, increasing patient knowledge was a necessary but not sufficient technique. We identified seven configurations of behavior change techniques sufficient for improving adherence, which together accounted for 26 (76 %) of the effective studies. The intervention configuration that included increasing knowledge and self-efficacy was the most empirically relevant, accounting for 17 studies (50 %) and uniquely accounting for 15 (44 %).
  
  
  CONCLUSIONS
  This analysis extends the completed review findings by identifying multiple combinations of behavior change techniques that improve adherence. Our findings offer direction for policy makers, practitioners, and future comparative effectiveness research on improving adherence.
authors.affiliation: RTI International, Research Triangle Park, NC, USA. lkahwati@rti.org.
authors.forename: Leila
authors.initials: L
authors.lastname: Kahwati
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Viswanathan
authors.affiliation: Departments of Medicine and Health Behavior, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Golin
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Kane
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Lewis
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Jacobs
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D057186:Comparative Effectiveness Research; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence; D062405:Motivational Interviewing / Q000379:methods*; D036301:Qualitative Research; D020377:Self Efficacy
keywords: Behavior change; Medication adherence; Qualitative comparative analysis; Systematic review