Table 2 Sub-themes and TFA constructs by participant group

A. Affective attitude

(How an individual feel about MI)

A-FC-01

A medium to express views freely and be listened to*

A-FP-01

A novel behavioural therapy with a prospect of a new skills acquisition*

A-FC-02

Mutual understanding and support in deciding to initiate HIV treatment*

A-FP-02

MI empowered and facilitated to explore clients’ problems*

A-BC-01^†

Inconsistent engagement leading to discomfort^†

A-BP-01

Extra time and effort in the learning curve to effectively deliver MI^†

A-BC-02

Initial doubts over MI as another form of “talk therapy”^†

A-BP-02

Limited capacity of MI to engage clients with severe drug use^†

B. Ethicality

(The extent to which MI has good fit with an individual's value system)

B-FC-01

Freedom to express emotions and articulate ideas were cathartic and encouraged truthful conversations*

B-FP-01

Re-affirmation of a client's problems through active listening acknowledged their dignity and appreciated their participation*

B-BP-01

Provider-centric values with emphasis on abstinence, compliant ART, and other noble health pursuits hindered MI adaptation*

C. Burden

(Amount of effort that is required to participate in MI)

C-BC-01

Unique life circumstances posed a chall- enge to participation in fixed schedules^†

C-BP-01

Other clinical and clerical duties posed a challenge to sustained MI delivery^†

C-BC-02

Discomfort in detaching oneself from deep-seated problems for planning an effective course of action^†

C-BP-02

“Trials and errors” in reconciling MI principles with preferred counselling style^†

D. Opportunity cost

(The extent to which benefits, profits or values must be given up to engage in MI)

D-BC-01

Disruptions in daily routines due to MI sessions being scheduled at the provider’s convenience^†

D-BP-01

Forgoing other duties to accommodate extra time for MI^†

E. Intervention coherence

(The extent to which the participant understands MI and how it works)

E-FC-01

MI exposed underlying social relations and unmet expectations that deviated clients from their care*

E-FP-01

MI built on the client's personal achievements towards a health objective*

E-FP-02

MI demands careful attention to the client's needs and their acknowledgement and contributions in resolving a health problem*

E-FC-02

Solutions in MI are reflective of subjective life circumstances as opposed to be-ing prescriptive

E-BC-01

An unmet expectation of a ‘closure’ or 'milestone' after each session^†

F. Self-efficacy

(The participant's confidence that they can perform the behavior[s] required to participate in in MI)

F-FC-01

High confidence in adhering to MI sessions and negotiating among the daily activities to commit to change*

F-BP-01

Generational gaps in the client-provider relationship posed a challenge^†

F-BP-02

Confusion in determining the appropriate stage of change^†

F-BC-01

Doubts if the resulting change was durable^†

F-BP-03

Compromised commitment to MI due to competing duties^†

G. Perceived effectiveness

(The extent to which MI is perceived as likely to achieve its purpose)

G-FC-01

MI confronted long held irrational beliefs and situated the problem around the interactions with personal and professional aspects of life*

G-FP-01

MI helps clients deal with social problems driving medication non-adherence*

G-FP-02

HIV treatment adherence is the first step towards improvements in quality of life*

G-FC-02

MI worked to resolve social conflicts in order to expand support resources and enable change*

G-BP-01

Effectiveness is contingent on the severity of client’s drug use^†

G-BC-01

Prioritising which conflicts to resolve can be a challenge^†