Table 4 Matrix used for synthesis of findings concerning the 'core components' of GSH
| Â | Level of guidance | Nature of guidance | Health Technology |
|---|---|---|---|
Meta regression findings | Number of sessions not related to outcome | Better outcomes where guidance provided, and where based on CBT | No differences between technologies (email, telephone, face to face) |
Meta synthesis findings | No relevant findings | No relevant findings | No relevant findings |
Consensus exercise | Agreement on timing, duration, and number of sessions | Agreement that patient preference should determine the nature of guidance | Agreement that health technology should be accessible, and help with literacy problems. |
Incorporated into the intervention | 3–10 sessions, 15–30 minutes duration over 5–12 weeks | CBT based. Patient preference delivery of guidance | Devised a self-help manual and also a CD |
| Â | Who should deliver guided self-help | Personal experience of depression | Ambivalent help seeking and covert presentation of problems |
Meta regression findings | No differences in outcome between professional and paraprofessionals | No relevant findings | No relevant findings |
Meta synthesis findings | No relevant findings | Personal experience characterised by feeling of inability to cope, and disturbances to functioning. Use of lay language/metaphors important | Point in illness trajectory where people make service contact, and their prior contact with other help may determine acceptability |
Consensus exercise | Most frequent were nurses and primary care graduate workers. Specific training needed | Mixed response to inclusion of lay language and metaphors. Agreement on importance of social functioning, and relapse prevention | None relevant |
Incorporated into the intervention | Primary care graduate workers or other mental health professionals | Emphasised return of social functioning. Lay language, metaphors and causal explanations included. Relapse prevention incorporated | Expectations and prior contact emphasised and included in the intervention. Choices and patient preference for interventions included |
| Â | Control and helplessness in engaging with treatment | Stigma associated with treatment | Patients' understanding of self-help |
Meta regression findings | No relevant findings | No relevant findings | No relevant findings |
Meta synthesis findings | Patients reported coping strategies such as distraction, or the use of locations associated with feelings of safety and control | Extent to which guided self-help acknowledges issues of stigma likely to determine acceptability | Seeing the self as the agent of change may be very important |
Consensus exercise | Mixed response but emphasis on collaborative working, patient centred goals, and roles i.e. patient as change agent | None relevant | Agreement of collaborative working, explicitly detail roles of both patient and MHW i.e. patient as change agent, coach as facilitator |
Incorporated into the intervention | Highlighting intervention as a method of regaining control and incorporating use of coping strategies termed 'respite' in the intervention | Discussed guided self-help as requiring a sense of acting on the world and enhancing self-worth | Explicit team rationale, with the patient as 'team captain', facilitator renamed as 'self-help coach' |