Figure 4. Patient Participation and Self-management Related Contexts, Mechanisms, and Outcomes.

The figure depicts how each of the three identified mechanisms (i.e., motivation, engagement, and education) individually contributes to one or both of the outcomes (i.e., clinic attendance and self-management) as indicated with dashed arrows, but the presence of all three mechanisms as indicated with solid arrows resulted in patient activation which enabled patients to manage their conditions without the structure provided by the study. These mechanisms were triggered differentially based on key contextual factors. Clinic-level resources were added to address barriers to care.