Table 3.

Description of how behavior change components and mechanisms of action worked in the intervention.

Component and mechanism of action	Evidence	Examples of quote
Self-monitoring (#1) leading to acute awareness of adherence and increased motivation to adhere (#8)
	Patients found it motivating to see the green bars on their graphs because it was a quick and easy way to see their progress	“I’m very much more conscientious of how much I’m doing it and almost kind of realized the importance of doing it a lot more.” (P1, site 2)
	Some patients reported self-monitoring leading to increased awareness of adherence level although this did not always lead to increased motivation to adhere to treatment or change to adherence behavior	“They kind of say in theory it’s a good idea and they like it but somehow they’re not doing it.” (INT2, site 2)
Tailored education about treatment (#2) leading to increased necessities and decreased concerns about doing treatments (#9)
	Educational components such as the treatment videos were perceived by clinicians and patients as beneficial and a trusted information source	“People have said that its nice having something that you know has been prepared by […] professionals so you know the information is accurate without it being scary.” (INT1, site 2)
	Some patients found it difficult to translate the education into action. The pages were not accessed frequently outside meetings with interventionists	“I don’t know what it is but if someone tells me to do something, yes I take it on board but I’m not very good at putting that into action.” (P2, site 1)
Tailored patient stories (videos; #3) leading to increased self-efficacy and motivation to adhere (#10)
	The talking heads videos did not appear to increase self-efficacy and motivation (#30) for most patients in the sample because they feared comparison with others with CF	“I don’t need to listen to somebody feeling sorry for themselves.” (P5, site 1)
	Interventionists sometimes did not share the videos because they found it difficult to know the content of each video in detail and were concerned about sharing videos that could upset patients	“Some of them said about the videos of people ‘I've not looked because I don't want to see and compare myself to that person’” (INT1, site 1)
Personalized goal setting (#4) leading to increased self-efficacy and motivation to adhere (#11)
	Some participants found it motivating to set targets that they could work to achieve	“Again, the graphs and stats and things like that […] motivate you, keep you in the right place.” (P4, site 2)
	Some patients preferred to set lower, achievable goals	“They know they are clearly struggling to do what's required so some people were quite happy to be told they could do less [than 100%].” (INT2, site 2)
	Some low adherers wanted to set unrealistically high goals that were unachievable	“The one I did this morning, we put her at 100% and I said that’s quite high and she was like, no, her words were like, all or nothing.” (INT1, site 2)
	Some high adherers did not set goals	“I do manage [treatments] practically twice a day so [the interventionist] didn’t really set me any goals.” (P1, site 2)
Goal review, rewards (#5) leading to increased self-efficacy and motivation to adhere (#11)
	Notifications were unavailable during the pilot, but some patients thought they would help them adhere	“I want to receive reminders—target achieved.” (P3, site 2)
Personalized action plans (#6) leading to increased habits and reduced chaos (#12)
	Interventionists and some patients described how action plans were beneficial for a minority of patients to create a habit or routine, but some patients disliked them because they did not want to form habits	“It [has] helped because now I’m starting to think of things that I can link with […] it’s making me make a conscious effort toward helping my health.” (P2, site 2) “My life is up and down you know and saying for every 5 days a week for example I’m going to do this at this time it don’t work for me at all.” (P2, site 1)
	Patients and interventionists perceived that the action plans could sometimes feel simplistic	“[A patient] said to be honest I did feel like you know, I’m not a child, that was her reaction but she was quite nice about it” (INT 2, site 2)
Tailored problem solving (#7) leading to reduced barriers to adherence (#13)
	Most patients interviewed did not access the problem-solving part of the website outside the meetings with interventionists but found the resources useful if they did encounter a problem	“If you’re getting in a mess with the equipment, bits and bobs like that—the few things that I investigated on that were really quite helpful.” (P4, site 2)