Developing an internet-delivered intervention targeting residual cognitive symptoms after major depressive disorder: a person-based approach

Figures & data

Table 1. Overview of activities in the planning and development phases.

Planning phase		Development phase
Exploratory interviews	Prototype development	Pre-sent modules	Think-aloud interviews
Individual face-to-face interviews done by a clinical psychologist or student in clinical psychology.	Search for relevant literature and knowledge from clinical expertise was initiated in parallel with exploratory interviews. Prototype content and digital front-end developed after exploratory interview.	Two modules pre-sent to participants about one week before think-aloud interviews.	Face-to-face interview with clinical psychologist about perceptions of pre-sent prototype text. Observation while engaging with the prototype on computer, mobile phone or tablet.

Figure 1. Logic model.

Figure 2. Participant front-end of prototype module 1.

Table 2. Participant characteristics.

Participants	Gender	Age	Higher education	MADRS-S	Episodes MDD	MDD length
1	Female	32	Yes	10	1	2
2	Female	25	Yes	11	3	2
3	Female	28	Yes	11	1	5
4	Female	32	Yes	2	1	2
5	Male	22	Yes	16	1	>5
6	Male	27	Yes	8	1	1
7	Female	26	Yes	7	5	2
8	Female	33	Yes	0	1	>5
9	Female	41	Yes	0	1	1
10	Female	36	Yes	16	9	>5
11	Female	41	No	0	5	5
12	Male	47	Yes	10	1	2
13	Male	47	No	10	9	>5
14	Male	48	No	6	1	2
15	Female	41	Yes	12	1	5
16	Male	42	Yes	16	5	>5

MDD: major depressive disorder; Depression length: total year (s) of MDD.

Table 3. Summary of qualitative themes identified in exploratory interviews.

Themes	Sub-themes (n)	Sub-theme examples
Theme 1: Experiences of residual cognitive symptoms	Everyday life is more demanding (16)	It is the issue of maintaining concentration over time. I notice that I constantly must pull myself back into it.
	Concerns about cognitive difficulties (13)	Some days I can sit and fiddle for hours and cannot get any work done. And then I think “Oh my god, is this how it is supposed to be? Or is it just me getting worse?”
Theme 2: Coping with residual cognitive symptoms	Compensatory strategies (12)	I write down quite a lot of notes, thoughts, and try to organize my life because I cannot manage it in my head.
	Acceptance (8)	I think “I made a mistake.” It doesn’t matter if the day becomes a bit different than anticipated. (108)
Theme 3: Needs from an intervention	Need for information (9)	Being told by qualified people that this is normal, and you can do something about it. That gives you a feeling of control.
	Therapist support (10)	I believe there must be someone there, but it doesn’t need to be every day or week.
Theme 4: Barriers for engagement	Being overwhelmed (12)	It would have been overwhelming to receive all at once.
	Not being motivated (6)	Treatment got me thinking: “Now I just must do this. If I want a good life for myself, I have to work [with the treatment].”
	Frequent registration (9)	It was too much to register and write down.

Table 4. Summary of qualitative themes identified in think-aloud interviews.

Theme (n)	Themes examples
Positive perceptions of content (11)	This was very good. I really like how it is written. It is concrete and it is not like…Some people talk around the subject, but it is not like that here.
Concerns regarding content (10)	No, when you are over the depression then this becomes a somewhat low bar [in terms of difficulty]. But I get it. (Female, 41 years)
Perceptions of Layout, Visuals and Navigation (11)	I thought it was very nice and professional [looking], very easy to navigate. How much text does this module contain? It would be nice to have an indication that I am on page 3 of 6, so it is like, should I complete this before I go do the dishes or should I save it for later?