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Table 3 Themes on acceptability and sustainability of FDC intervention, by participant group

From: Implementation of fixed-dose combination therapy for secondary prevention of atherosclerotic cardiovascular disease among Syrian refugees in Lebanon: a qualitative evaluation

Construct

Theme

Patients

MSF staff

External stakeholders

ACCEPTABILITY

 Affective attitude

Makes life easier

Among those who did not switch or discontinued:

Fear of unfamiliar

Lack of control

Treatment improvement

Perception of high risk

Ok for the poor/uninsured

 Intervention coherence

Attribution of side effects

Clarity regarding pill and how it works

 

 Burden

Easier than previous treatment

Early effort, long-term reward

 

 Self-efficacy

High capability to execute

Empowered by information

 

 Ethicality

Helps achieve patient goals

Fit with values/patient welfare

 

 Opportunity costs

  

Sacrifices treatment flexibility

 Perceived effectiveness

Make patients feel better

High efficiency

Improved efficiency

 

 Other

Trust in (MSF) doctors

  

SUSTAINABILITY

 Challenges

Dependence on MSF/lack of faith in external system

Financial barriers

Inconsistent supply of drugs to clinic

Lack of coherence

Lack of transition plan

Background context (i.e. political, social, health system factors outside of MSF control)

Changing established practice of clinicians

Lack of commercial interest outside MSF

 Supporting factors

 

Time investment

Contextualisation of intervention within local health system and political circumstances.

Intervention as advocacy

MSF as catalyst/precedent for change

Stakeholder engagement

Integration into health system

Price/economic crisis as opportunity