Table 2 Methods and results of the consensus process

Phase 1 – Consensus exercise

The results of the studies summarised in Table 1 were used as evidence to develop the intervention. Despite the reviews, significant ambiguities remained that could not be answered with the review evidence. To make decisions concerning these areas, we conducted a consensus exercise.

We identified a total of 32 experts/key stakeholders including international academics, mental health professionals and service users with knowledge/experience of self-help techniques for depression. Potential participants were sent an invitation to take part detailing the rationale for the exercise, a summary of the results from both the meta regression and meta synthesis and a copy of a consensus questionnaire. Those who did not respond within 4 weeks were sent a follow-up invitation. Limitations in funding and time meant that a single questionnaire was used, and feedback of responses and a second questionnaire were not used.

The content of the questions is shown in Table 3. Questions related to the number, duration and time period of the intervention, how to incorporate and manage issues such as the patient being the agent of change and regaining control, the delivery mode of the guidance, the health technology, and the training and role of health professional delivering the intervention.

Nineteen individuals (59%) responded. Eight were academics, 10 were health professionals (4 GPs, 3 psychologists, 1 psychiatrist, 1 nurse, 1 primary care mental health worker). One respondent was a service user. Consensus was present in the following areas:

1) The importance of patient preference for the delivery mode of the intervention (i.e. telephone, email or face to face delivery)

2) The provision of materials in alternative formats such as a CD for those with literacy or concentration difficulties.

3) The inclusion of information on recognition and relapse strategies

4) The importance of highlighting the role of the patient as the agent of change

5) Although differences occurred in terms of number, duration and spread of sessions, the ranges of these were relatively limited.

6) Although there was agreement that definitions of depression and consideration of prior coping strategies should be incorporated into the intervention, there were some concerns that endorsing patients' prior views and short term coping strategies could be disadvantageous, and suggested the need for the facilitator to ensure that such coping strategies were helpful.