Table 2 Overview of main results by theme

Motivation to participate

 • Patients were primarily motivated to participate in Step-Dep to contribute to scientific research rather than having a desire to improve their depressive symptoms

 • Practice nurses perceived this as a barrier to motivate patients for the different treatment steps, especially the self-help course

The Step-Dep program

  Role and competences of the practice nurse:

  • In order to discuss their mental health problems, patients needed to feel a connection to the practice nurse

  • Somatic practice nurses expressed a lack of competence to recognise and treat mental health problems

  Treatment steps and stepped care protocol:

  • The offered treatments were viewed to be only suitable for specific patients

  • Practice nurses preferred flexibility in the choice of therapy over pre-determined interventions in a one-size fits all protocol

  Using the PHQ-9:

  • The PHQ functioned as a useful starting point for the conversation on mental health, but was not widely supported as monitoring instrument or to base treatment decisions on

Patient care

 • Interviewees experienced improved accessibility and decreased experienced stigma of receiving mental health care

 • The increased awareness and attention for mental aspects in chronic disease management were experienced as very valuable

 • Monitoring mental health is deemed important

Patient wellbeing

 • Patients gained more insight into their mental health status by regularly filling out the PHQ-9

Recommendations for future care

 • Monitoring of mental health in chronically ill patients should start from the time of diagnosis of the chronic disease