Table 1.

Content of the partner steps intervention.

Step	Objectivesa	Problem Solving	Activities
1. Transportation to appointments	Objective A (if barriers are identified through Objective A, then: Objectives B, C)	Encourage the couple to travel together Encourage the couple to combine medical visits with other errands on the same trip Encourage the couple to ask friends and family for support with transportation Refer the couple to a case manager to assist with transportation discounts or vouchers	Transportation mapping: facilitate an interactive transportation planning session using free, public-access mapping software
2. Obtaining medications	Objective A (if barriers are identified through Objective A, then: Objectives B, C)	Provide couple with medication delivery service options Suggest couple take turns picking up medications Encourage couple to set up auto-refills Encourage couple to set reminders to go to the pharmacy	Facilitated discussion: have each partner turn to each other and work together to come up with a plan to pick up medications regularly
3. Communicating with providers	Objective A (if barriers are identified through Objective A, then: Objectives B, C)	Encourage both partners to attend the visit. Discuss the merits of having 2 people asking questions and 2 people listening to answers Encourage both partners to come up with questions for the provider ahead of time	Writing exercise: have each partner write down questions for the provider on a 3×5 notecard or on their smartphone during the session
4. Storing and transporting medications	Objective A (if barriers are identified through Objective A, then: Objectives B, C)	Encourage the couple to bring a spare dose with them regularly or to store a dose in a strategic location (eg, in a car, work desk, or partner’s house) Suggest the couple plan ahead for long nights out or staying somewhere other than regular residence (traveling) by bringing the appropriate number of doses along	Summarization: solicit opinions on strategies discussed from both partners
5. Coping with side effects	Objective A (if barriers are identified through Objective A, then: Objectives B, C)	Encourage the couple to discuss experiences with side effects with their provider Encourage partners to be open with each other about experiences with side effects Suggest potential routine adjustments (eg, getting more sleep, drinking fluids, exercise, or relaxation practices)	Couples coping brainstorm: facilitate a brainstorming session where couples come up with and reflect upon fun activities they do at home that could be used when side effects are pressing (eg, movie night, game night, staying in)
6. Having a daily medication schedule	Objective A (if barriers are identified through Objective A, then: Objectives B, C)	Suggest other partner take a multivitamin or similar routine to taking medications Suggest the couple combine and integrate pill taking routine with other routines (eg, morning routines, regular schedules) to develop associations between the activities Encourage the couple to use pill boxes Encourage the couple to use alarms	Dot stickers: hand out dot stickers to the couple and explain how they place these in strategic locations around the house to help remind them about taking their medications; Phone reminders: have couple schedule in a recurring reminder on their phones (discretely) to take medications while they are in the session
7. Adherence, self-care, and your relationship	Objectives D, E, F, G, and H	Encourage couple to identify relationship strengths that could be useful for adherence If applicable, promote collective coping mechanisms in place that help alleviate mood considerations If applicable, promote teamwork in reducing the influence of substances on adherence	Reflection: have the couple reflect on self-care concerns (eg, mood, substance use, etc) and relationship-care concerns (eg, collective mood, routines, behaviors, etc) and how these might impact medication adherence
8. Communicating within your relationship	Objectives D, E, F, G, and H	Suggest couples write down discussion topics before discussing with each other Facilitate a discussion about signs and signals that each person feels they are “heard” Facilitate a discussion about each partner’s ideal communication style	Role play: have each partner turn to the other and identify when, where, and how it will be appropriate to discuss adherence. Then have each model an adherence discussion opener.
9. Managing your social life and other relationships	Objectives D, E, F, G, and H	Encourage couple to pool collective knowledge about people in their life to create a plan to cope with social support concerns Create an adherence plan for going out to parties or traveling on weekends Facilitate a discussion about how each partner could balance the various social support systems available to them	(No activity)
10. Dealing with privacy and disclosure	Facilitate discussion of the couples’ privacy and disclosure plan	Facilitate a detailed discussion about who the couple is willing to disclose to or not disclose to	(No activity)
	Facilitate the couples’ ability to problem-solve around privacy and disclosure concerns that serve as barriers to adherence	Provide storage and transportation ideas (eg, secret locations, containers, etc)
	Create a participant-driven plan and a backup plan to implement in the future to ensure couple leaves session two with a common vision for dealing with privacy and disclosure

^aObjectives: A: To identify “step”-relevant barriers to successfully executing “steps” 1-6; B: To facilitate the couples’ ability to overcome “step”-relevant barriers through participant-driven problem-solving; C: To create a participant-driven plan and a backup plan to implement in the future in order to overcome “step”-relevant barriers; D: To identify “step”-relevant strengths; E: To identify “step”-relevant concerns and problems; F: To promote “step”-relevant strengths for the purpose of improving medication adherence; G: To facilitate the couples’ ability to work together and problem-solve regarding “step”-relevant concerns that serve as barriers to adherence; H: To create a participant-driven plan and a backup plan to implement in the future to leverage “step”-relevant strengths for adherence.