Table 1 Overview of determinants that facilitated or hindered the implementation of the ‘Lust for Life’ programme

I. Proactive case finding

Participants with depressive symptoms

Illness perceptions

Depressive symptoms were seen as normal ageing and not perceived as burdensome.

Perceived need

The usefulness of the programme was questioned, or people preferred to handle problems themselves.

Healthcare professionals (and their interactions)

Attitude toward screening

Case finding was the main reason for GPs to participate; nurses were more critical.

Innovation (i.e., case finding procedure)

Experiences with case finding

Included participants had no problem with being screened. However, screening was problematic for the entire patient population in a general practice.

Perceived results of case finding

Were limited, attracted persons from non-target groups, and were perceived to not reach a considerable part of the target group.

Context

Availability of treatments

Other treatments for this target group were already available.

II. Personalised, stepped care clinical interventions

Participants with depressive symptoms

Preferences for the interventions

Choices for the exercise programme and Life Review were made more easily and with more enthusiasm compared to the other interventions.

Transitions to subsequent steps

Were limited, and mostly determined by participants’ illness perceptions.

Healthcare professionals (and their interactions)

Professional backgrounds

Home care nurses felt insufficiently equipped to provide the interventions, questioned their effectivity and the eligibility of participants for the study. Mental healthcare nurses were confident of their own skills and perceived participants’ limited motivation as a challenge to their jobs.

Professional interactions

Nurse and physiotherapists did not perceive working as a team, and missed out on information and limited involvement from one another.

Innovation (i.e., the clinical interventions)

Intervention choice and effectiveness

The course of depressive symptoms was similar for people who participated in the various interventions. Drop-out was higher in persons who participated in PST than in life review.

Suitability of the interventions

Participants highly valued their interaction with the nurses/ physiotherapists. The exercise programme and Life Review were perceived as meeting participants’ needs; many hindering factors were mentioned about the self-help course.

Theme

Level

Factor

Provision of the interventions

• Much guidance was required in the provision of the self-help course.

• Physiotherapists missed opportunities to discuss depressive symptoms with participants; the exercise programme could not be provided according to the protocol’s demanded intensity.

• Nurses questioned whether participants adopted the intervention methods in Life Review and PST.

• Referrals to specialised mental healthcare when depressive symptoms remained were not always considered appropriate.

Context

Embedment in different organisations

Limited embedment caused high work pressure on the home care nurses. Embedment of the programme in specialised mental healthcare facilitated additional treatment by this organisation when depressive symptoms remained.