We study the existence of various sign and value patterns in sequences defined by multiplicative functions or related objects. For any set$A$whose indicator function is ‘approximately multiplicative’ and uniformly distributed on short intervals in a suitable sense, we show that the density of the pattern$n+1\in A$,$n+2\in A$,$n+3\in A$is positive as long as$A$has density greater than$\frac{1}{3}$. Using an inverse theorem for sumsets and some tools from ergodic theory, we also provide a theorem that deals with the critical case of$A$having density exactly$\frac{1}{3}$, below which one would need nontrivial information on the local distribution of$A$in Bohr sets to proceed. We apply our results first to answer in a stronger form a question of Erdős and Pomerance on the relative orderings of the largest prime factors$P^{+}(n)$,$P^{+}(n+1),P^{+}(n+2)$of three consecutive integers. Second, we show that the tuple$(\unicode[STIX]{x1D714}(n+1),\unicode[STIX]{x1D714}(n+2),\unicode[STIX]{x1D714}(n+3))~(\text{mod}~3)$takes all the$27$possible patterns in$(\mathbb{Z}/3\mathbb{Z})^{3}$with positive lower density, with$\unicode[STIX]{x1D714}(n)$being the number of distinct prime divisors. We also prove a theorem concerning longer patterns$n+i\in A_{i}$,$i=1,\ldots ,k$in approximately multiplicative sets$A_{i}$having large enough densities, generalizing some results of Hildebrand on his ‘stable sets conjecture’. Finally, we consider the sign patterns of the Liouville function$\unicode[STIX]{x1D706}$and show that there are at least$24$patterns of length$5$that occur with positive upper density. In all the proofs, we make extensive use of recent ideas concerning correlations of multiplicative functions.