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Table 6 Service users’ and mental health professionals’ quotes

From: Acceptability of a technology-supported and solution-focused intervention (DIALOG+) for chronic depression: views of service users and clinicians

DIALOG+ structure
Clarity & focus
T1P08_service user
“… our sessions weren’t really aimed at anything, it was just me talking about how my last week’s gone and that’s it, whereas this one was more targeted at what problems I have and what issues I have and how we combat those issues and what we’ll do to move forward from those issues. So I think that was quite good …”
T1C07_clinician
“And it helps them to keep focused on the one topic in hand as well. Sometimes if you’re just having a conversation with a person they can tend to drift to another topic. At least with this it kept them focused on, OK, my physical health, let’s just talk about that. So it was good on that score.”
Getting a whole picture
T1P15_service users
“… it’s better really because then your therapist can get a whole picture of your life as opposed to only certain aspects of it, which can all contribute on your mental health wellbeing, because they might be causing a certain amount of the issues …”
T3C01_clinician
“And that would be helpful to cover, to look at somebody’s life in a holistic way like that I think is great and it kind of reminds you that actually there’s other domains to this person’s life that if there were an improvement actually it would have a knock on effect on their mental health.”
Constraints of the format
T3P01_service user
“… with (care co-ordinator) we only have half an hour session, so it can be a little bit, rather than spending time, I felt a little bit rushed … to answer some of these. Rather than when you sit down, and you physically go through them and care co-ordinator will say how’s this, how’s that.”
T3C02_clinician
“But because I have had an established relationship and we already had set ways of working it kind of got in the way of things that we’d already found to work ... So some of the questions weren’t relevant or they were too broad for us …”
Therapeutic communication
Topics Reminder
T2P10_service user
“… once or twice I suppose when we were going down, I thought, oh actually we haven’t talked about that, and it sort of jogged memory a few times. … So that’s again where I think the headings are valuable because they do, they are quite a useful jab in the ribs almost …”
T1C12_clinician
“I think the app is brilliant, it’s very good, it helps clinicians because sometimes we get complacent on what sort of questions we ask patients and so it helps to explore more on issues ….”
Opening new conversations
T1P08_service user
” I think it wouldn’t have come up because I wouldn’t have thought about it. But having these specific questions make you think more so then you’ve got more to add to the conversation …”
T2C05_clinician
“This particular patient seemed to see its logic straightaway and just go with it and find it pretty helpful and it did lead us into quite useful discussions I hadn’t had with him before so that was all good …”
Disrupting the flow
T3P03_service user
” I think it didn’t really cover the way that I feel and my problems really … I just felt like it was ticking the boxes really rather than an in depth conversation.”
T3C02_clinician
“It disrupts the flow of a conversation because you’re having to stick to topics one at a time whereas actually quite often they all mush into one. Medication affects motivation and sleep affects everything else. So it’s just kind of, it’s, yeah, it doesn’t really take into account that which I found frustrating.”
Losing personal touch
T3P01_service user
“I think it is a bit impersonal, a little bit. Because sometimes when you’re in a mental health meeting, you go in and speak to your mental health worker, it can make it a little bit, well you’ve got to stick to this. “
T2C03_clinician
“… a lot of work that we do is personable and takes a lot of just general chatting whereas this is like …. some patients … need the focus and other … don’t need that focus, you need to have more of a personal edge to things. … … it’s less personal and I think people with depression (…) they want to feel that you’re listening to them as opposed to collecting scores.”
Reflecting and monitoring
Reflecting on strengths & difficulties
T1P15_service user
“… it makes a refreshing change to talk about something that’s good … as opposed to everything doom and gloom and no hope and light at the end of the tunnel. So it’s nice to talk about the good things as well as the bad things.”
T2C01_clinician
“… following the four step thing actually … made the patients think about what they had scored a little more carefully than they might otherwise have done necessarily. Just that little extra …. helped them to think a little bit more about this … even if didn’t necessarily achieve what they said they did it stimulated them to think about … what could be going on here, what could be doing to try and make a difference even if I can’t do it.”
Mapping change
T3P02_service user
“It feels often quite a bit of backsliding, but you looked and thought, oh, actually, that wasn’t as bad as I remembered it to be, or oh actually, that was quite a good week. And, oh damn, this week is not very good, but last week was fine (…) I think it would be great for mapping progress.”
T3C01_clinician
“… you can literally show a patient, look how things have changed for you. Or even if things haven’t changed so much, it might be that they had a, maybe a good week or a good month, whatever it might be where you can talk about, well, look how well you did here. I know it feels like everything’s bad now but you had that really good time there and what were the things that were contributing to that? So again I think that could be really helpful.”
Quantifying feelings
T3P04_service user
“Sometimes it’s hard because if you’re trying to think over the week, obviously, some days are different to others so it can be quite hard to actually pick a number of what it is overall.”
T2C02_clinician
“… for them it was hard to sometimes say, well, I’ll give it a four then rather than a three, without really thinking through, well, what does a four mean compared to a three sort of thing. So I think they were just, it was just throw numbers at me a little bit really. So I don’t think the rating thing was marvellously helpful for the patient or myself. “
Empowerment and powerlessness
Taking ownership of recovery
T1P07_service user
“ … previously, as I said, I would just be sitting down and waiting for him to bring the idea and so that I will bring conversation. But with this it helps to remind me and also help me to speak my mind on what I want to tell him”
T1C09_clinician
“And also they get more involved I think … they have to think about how, what they can do to make an improvement, whereas otherwise …. a lot of people … tend to put it on … the professional, they just feel that … there’s nothing they can do and here it’s very much focusing on, they’re taking a bit more responsibility as well, and expectation so they can do something or the family.”
Setting & achieving goals
T2P02_service user
“I think the helpful element was again to go back to my experience, was the goals it gave me on physical health which built me, started walking, were very helpful in improving my health and fighting depression. I felt quite combative and as though I was fighting the depression by virtue of the fact that I was walking.”
T3C03_clinician
“I think again it’s about specific goal setting, and I think a lot of the patients with depression struggle with functionality, and I think it does break down the different areas in their life, and I think that foundation is really good around recovery.”
Becoming discouraged
T1P08_service user
“So like I picked two from the topics for 1 week, and the next week, because those two hadn’t been resolved, I’m still on those two and so it’s kind of like a vicious circle and not being able to do the other lot.”
T3C01_clinician
“… job situation for some people that might be a bit of, something that’s contributing to their depression … That might be something that’s quite a trigger thing for them to say, well, no, still no job. Come back to that week by week. It’s like, oh gosh, how’s that going to feel then just revisiting that.”
Feeling scrutinised
T2P03_service user
“I found that quite hard to judge the level of where I’m on those topics. After the first session and we come back to the second session, I felt the need to rate it higher. Just so I could see improvement even though I didn’t feel like that.”
T3C05_clinician
“Then we introduced the DIALOG system and he dropped out... maybe the expectation of in a conversation … let’s set some goals, and the app was like quantifying how much they’d improved. So if they felt a little bit guilty, like, oh, I’ve got to go and see him now and I haven’t really improved my relationships and things, and he just thought, oh, I’ve got bigger things, whatever …”
The impact of technology
Transparency & accessibility
T1P10_service user
“Well, before he’d ask me all these issues … but there was no way that he could make a comparison … he’d have to spend a lot of time to analyse what notes have been written last time and then he’d have to read them when I came the next time to make the comparison that have I moved forward or not. But with this it was instant.”
T1C09_clinician
“I think also with noting it down on the tablet it makes it easier to remember the actions … you could just go back and you remind yourself what you put down as actions. So that’s good.
Therapeutic aid & hindrance
T2P09_service user
“I think again, yeah, just having a visual representation of how certain things feel at the time, kind of allowed me to explain it a bit more.”
T2C03_clinician
“..,you’re trying to establish a relationship with someone to help them get better and that’s normally focused on talking and showing empathy and understanding, it’s quite hard to do that when you’re typing in or when you’re pressing numbers.”
Technical competence & issues
T3P04_service user
“… I mean it was quite frustrating because it was quite slow and unresponsive, if I wasn’t necessarily having a good day I didn’t really have the patience to be working with it."
T2C02_clinician
“… certainly the first patient was pressing the buttons for me because I got confused and so he seemed to know a bit more about what he was talking, so I relied on him which I suppose is good and bad really. I suppose he owns the session by doing that … “