Barriers to antiretroviral therapy adherence in developed countries: a qualitative synthesis to develop a conceptual framework for a new patient-reported outcome measure

Figures & data

Table 1. Iterative phases of the thematic analysis for the qualitative synthesis.

Phase*	Operationalization for the synthesis
1. Familiarizing yourself with the data	Repeated and active reading for familiarization with the global content of the studies’ results and discussion sections
2. Generating initial codes	Selecting a subset of studies (n = 16; 39%) with the richest qualitative analyses and representation of a range of participating populations (e.g., women, substance users, men who have sex with men, previously incarcerated individuals, visible minorities, geographically mobile individuals) Based on relevant study findings, identifying 21 encompassing and cross-cutting codes, each relating to a class of ART adherence barriers Producing working definitions for each code Coding the 41 studies’ qualitative results sections and their interpretations within the discussion sections with the software Atlas.ti version 8
3. Searching for themes	Examining the Atlas.ti output for each code (i.e., all related data extracts) to ensure content relevance, readjusting the coding, as necessary Creating a Microsoft Word table for each code, including, per contributing study, all essential data Analyzing the Word table content, with methods of constant comparison, to refine the initial codes into themes, specify subthemes, and identify relationships between themes
4. Reviewing the themes	Producing a summary document for each theme and its subthemes (identifying definitions, supporting studies and succinct data extracts) Charting all relationships articulated by study authors between the themes identified Deriving higher-order themes, reorganizing the analysis into 3 orders of themes Discussing theme labels with team members based primarily on the summary documents Reexamining the summary documents (125 pages) (and when necessary, the Word tables and original articles) and the theme interrelationships table (Table 2), supporting all themes to reevaluate their prevalence, coding, labels, definitions and interrelations
5. Defining and naming themes	Refining theme definitions and producing a description of each
6. Producing the report	Generating this manuscript, including graphically representing the thematic framework derived from the analysis (see Figure 2)

*Based on Braun and Clarke (2006).

Figure 1. Search flow diagram for the qualitative synthesis.

Figure 2. Conceptual framework of barriers to antiretroviral therapy adherence derived from the thematic analysis.

Table 2. Prevalence across studies (n = 41) of relationships articulated between antiretroviral therapy (ART) adherence barrier themes (Level 2 themes).

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

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