Table 4 Themes, sub-themes and illustrative quotes from thematic analysis

 Subtheme

Quotes from Service Users

Quotes from clinicians

 1.1: ‘Florence’ facilitating service user-clinician communication

“Florence worked well, like someone checking in, and getting the text message back giving advice or saying you’re doing well was helpful. I was looking forward to the message, like a friend.” [Flo, SU, 009]

“Perfect intervention to communicate their well-being or otherwise to their CCO regularly”. [Flo, CC, 007].

 1.2: The value of ‘Florence’ medication adherence reminders

“I just like it cause it’s so helpful. Particularly if you’re having a bad day as I would forget meds, mainly the evening ones when feeling low so having the reminders was helpful.” [Flo, SU, 025].

“Brilliant. A few times where I was busy, it would remind me to take my medication” [Flo, SU, 025]

“It changed a lot because before, a few times I used to forget to take the medications but now it prompts me to take the medications at the right time so there’s no complications.” [Flo, SU, 050]

“Would be really good for clients when they are coming out of hospital for at least a week or maybe a month to help compliance with medication. Especially for people who have regular admissions after non-compliance. I also think it would be helpful for GP surgeries when medications are first prescribed to help for compliance and monitoring”. [Flo, CC, 063]

 1.3: Florence supporting service users and clinicians to focus on feelings

“It’s very nice that the system also asks how I’m doing every day on a scale of 0–6 so it makes me think about how I’m doing all the time. It’s like mindfulness, it helps me to be aware of how I’m doing and it like helps me to be mindful” [Flo, SU, 050]

“… she’s been using it and found it very helpful to track her mood. I’ve been checking in regularly and it’s helped me to be aware of how she’s doing”. [Flo, CC, 021]

 Subtheme

Quotes from Service Users

Quotes from clinicians

 2.1: Satisfaction with Florence

“No, I think it was all good, overall, I don’t have any complaints. With the ‘Florence’ system I don’t think there’s anything that could be improved, I think it’s perfect.” [Flo, SU, 062]

“Makes you feel less isolated and that you’re being monitored when not feeling well […] I feel well supported by the team and [NHS] Trust but not my family. The Trust could use FLO to help with support and guidance which would be useful. “[Flo, SU, 009].

“Positive she was happy” [Flo, CC, 47]

 2.2: Usability of Florence

“The questions were good, straight forward, you just reply with the number that you’re feeling. It was very easy to use” [Flo, SU, 050]

“I liked the graph which I think was helpful for Y and she showed it to me sometimes too. The replies of the messages was always positive and I appreciated them most days, they made me smile.” [Flo, SU, 021]

“… 10 people with the same diagnosis as me will have 10 different ways of experiencing the illness. So I like that it’s specific to me, it makes me feel more in control. I like that you can change it to your specific needs.” [Flo, SU, 063]

“Flagging up when a service user is not doing well is helpful” [Flo, CC, 025]

 Subtheme

Quotes from Service Users

Quotes from clinicians

 3.1: Personalisation of Florence

“… 10 people with the same diagnosis as me will have 10 different ways of experiencing the illness. So I like that it’s specific to me, it makes me feel more in control. I like that you can change it to your specific needs.” [Flo, SU, 063]

“It would be good to be able to adjust the frequency so by continuing on the same score until I submit a different score.” [Flo, SU, 031]]

‘Individualising of text messages for each patient, appointment reminders’ [TAU, CC 66]

 3.2. Practical considerations implementing ‘Florence’

“A prompt for clinicians to discuss the intervention with patients would be helpful.” [Flo, Con, 007]