Table 1 Studies included in analysis

Paper 1: Rogers and Kennedy, [16]

Qualitative study within an RCT, assessing a self-help guidebook and patient-centred consultations in IBD.

Patients were given an information guidebook by their hospital consultant, and a written self-management plan was negotiated during the consultation.

Hospitals in the North West of England

In depth interviews were conducted with 28 patients and 11 physicians

A purposeful maximum variation sample of patients

Organisation and physician factors inhibiting effective patient-centered consultations were identified.

Attending to these barriers might maximize opportunities for self-management based on a therapeutic alliance with health care professionals.

Paper 2: Mcdonald et al., (SHADE) [17]

Qualitative study to assess the clinical and cost effectiveness of facilitated self-help vs waiting list control in the management of anxiety and depression in primary care.

Patients on a waiting list for conventional psychological therapy were randomised to receive self-help material facilitated by assistant psychologists or to waiting list control.

Three psychological therapy services in Greater Manchester, United Kingdom

Semi-structured interviews were conducted with 24.

Further sample of 6 re-interviewed

Purposeful sample of patients who had completed the guided self-help.

Further sample re-interviewed after they had been invited to attend for traditional therapy

There were important gaps between patients' expectancies of psychological therapy and their experience of the guided self-help.

The effective implementation of 'minimal interventions' requires an understanding of the expectancies of patients concerning psychological therapy, in order to provide a basis for effective communication and negotiation between professionals and patients.

Paper 3: Protheroe et al., (MENTIP) [18, 19]

Qualitative study within an RCT evaluating whether the addition of a computerised decision aid to written information improves decision-making in women consulting their GP with menorrhagia compared with written information alone.

General Practices in the North of England

Semi-structured interviews were conducted with 18 patients.

The intervention group was purposefully sampled

Decisional conflict was significantly reduced using decision aid.

Use of a decision aid was reported as significantly empowering to women.

Paper 4: Rogers et al., IBS Study, [20]

Qualitative study within a 3 armed RCT of a self-help information book in the management of IBS in primary care.

Patients were randomised to receive the self-help guidebook; to receive the guidebook plus attendance at a self-help group meeting or to receive treatment as usual

Three health authorities in the North West of England

Ten focus groups (total 59 patients).

In depth interviews with 12 patients 1 year post intervention.

Ten facilitated self-help group meetings – focus groups

The intervention groups were purposefully sampled after one year of follow-up.

IBS was transposed from a condition unsatisfactorily managed by medicine to one successfully managed within the life worlds of individuals.

The design and evaluation of complex interventions should view participation as part of a process of continuity as well as change.

The benefits of understanding the prior experience of managing illness and contact with health services include the acceptability and workability of complex interventions in patients' everyday lives.