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Table 4 Quotes regarding the results and relationships with emergent categories

From: Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study

Core aspects Categories Properties Quotes
Personal aspects Personal History (patient’s perspective) -History and comorbidity Q1: “While my husband was ill [with cancer], I didn’t cry… But when he died, my life changed completely…. I was not the same person…, I withdrew into myself…” (Patient 7)
Q2: “I have osteoarthritis... and chronic lower back pain… a lot of pain”. (Patient 6)
  -Vital changes Q3:“When you have a problem, if you don’t change the way you live, you don’t solve it”. (Patient 9)
Disposition (patient’s perspective) -General facilitators (e.g. simplicity) Q4: “…very simple and effective things… very easy to do things, and they don’t involve anything out of the ordinary”. (Patient 3)
  -General barriers (e.g. apathy) Q5:“You read the recommendations several times and yes, you see that they’re good… but you aren’t going to follow them every day. You are stuck and wound up and you can’t pick yourself up... There are always things that make you lose heart”. (Patient 4)
Program aspects Presentation and monitoring -Instructions (patient’s perspective) Q6: “I would have appreciated receiving more information and more encouragement”. (Patient 1)
  -Assessment (professional’s perspective) Q7: “The degree of compliance has to be objectified and measured in some way in order to obtain clear conclusions about the intervention and the change in mood”. (General practitioner 8)
  -Supervision (patient’s perspective) Q8: “The fact that the psychologist would phone me and ask me how I was doing and about whether I was following instructions was a big help for me”. (Patient 8)
  -Pharmaceutical consumption (professional’s perspective) Q9: “You have to explain what the drugs are, the possible side effects, how long it will take to feel an effect and how long the treatment can last”. (General practitioner 25)
Cognitive habits (patient’s perspective) -Agency Q10: “Motivation, will, determination. It costs a lot of work and you go as you can, but you end up improving”. (Patient 11)
  -Ruminations Q11: “You feel useless, absolutely useless… why should you do anything if there’s no point? I don’t think that any more, but at the time I couldn’t help but feel that way.” (Patient 9)
  -Avoidance Q12: “The only thing that saved me was reading; it blocked everything out and I found some relief.” (Patient 3)
  -Restructurings Q13: “I see that when other people don’t feel like doing something, they don’t, and nothing happens. Why should it be different for me? Well, I also have to get on with things my way.” (Patient 4)
  -Guilt Q14: -So you are blaming yourself for failing…
-Yes, that’s right.
-Guilt is the first problem in this illness…
-Guilt is very difficult…
-It’s a very important factor…
(Interactions of several patients in a focus group)
Behavioural habits (professional’s perspective) -Activation Q15: “We have to motivate our patients to go out and stay in touch with people, but gradually, with a guide, for instance by avoiding situations of conflict at the beginning, because they have to make a great effort at this stage”. (General practitioner 21)
  -Empowerment Q16:“When dealing with a person suffering from depression, we’re starting with a very low level of motivation”. (General practitioner 12)
Q17:“A person with depression has their ups and downs; if you want your advice to have an effect, you have to wait until the right moment, when the person is open to it”. (General practitioner 18)
  -Time pressure Q18:“…high-speed medicine, which means you have to get eight messages across to them in five minutes”. (General practitioner 18)
  -Habit control Q19:“There’s no doubt about it that if you’re going to change your eating habits, you must have control over your diet. You have to do it yourself, because if you eat out for work or if somebody prepares your meals for you, it’s more complicated”. (General practitioner 5)
  -Opportunities Q20:“One difficulty that patients may find when changing their habits, especially with regard to food, is cost... eating certain foods is more expensive than eating others”. (General practitioner 8)
Q21: “Patients should be able to go for a walk or do exercise in nice places, in a pleasant urban environment that is well looked after”. (General practitioner 23)
Transversal aspects Social Support (patient’s perspective) -Group format of intervention Q22:“The (intervention) group helped a lot because you realize that there are other people who are in the same situation as you.” (Patient 5)
  -Contact with others Q23: “Having contact with others has been very useful for me. Going out for coffee with someone, people phoning me and showing interest in me, regaining face-to-face contact”. (Patient 8)
Q24:“When you’re depressed, you need somebody to help you along, and your family and friends are there for that. But when you’re really down, your family can lose patience, friends too; so it’s important to have someone from outside to lend you a hand.” (Patient 2)
Q25:“The group is a good thing, but then you need to have your personal, more private space….” (Patient 8)
Objectives (professional’s perspective) -Adjustment Q26:“…because you can’t ask people to do something they’ve never done before or something that is very difficult for them”. (General practitioner 11).
Q27: “I believe that this programme would obtain better results by applying it to prevent recurrences in patients who have already improved their depression (...) that is, to acquire this lifestyle and maintain it.”(General practitioner 21).
  -Intervention level Q28: “When it comes to personal level intervention, healthcare professionals should be the ones to do it, but if we’re talking about a mass intervention, the media – radio, television, press – should be involved.” (General practitioner 15)
Q29: “…in schools for young children… I think schools should teach children healthy lifestyle habits from a very young age”. (General practitioner 17)