Primary Health Care Research & Development


Factors influencing engagement of patients in a novel intervention for CFS/ME: a qualitative study

Carolyn Chew-Grahama1 c1, Joanna Brooksa2a, Alison Weardena3, Christopher Dowricka4 and Sarah Petersa5

a1 Professor of Primary Care, School of Community-Based Medicine, University of Manchester, Manchester, UK

a2 Research Associate, School of Psychological Sciences, University of Manchester, Manchester, UK

a3 Reader in Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK

a4 Professor of Primary Medical Care, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, UK

a5 Senior Lecturer in Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK


Aim To establish what factors are important for patients to engage in a new intervention for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and make recommendations to general practitioners (GPs) on preparing a patient for referral to such a service.

Background NICE guidelines recommend a prominent role for primary care in the management of patients with CFS/ME, with prompt diagnosis and appropriate referral for evidence-based treatments.

Methods A qualitative study nested within a multi-centre randomised controlled trial of two new nurse therapist delivered interventions. Semi-structured interviews carried out with 19 patients who had received pragmatic rehabilitation (PR) in the trial. Interviews were transcribed verbatim and an iterative approach used to develop themes from the data set.

Findings Factors that influence whether or not a patient engages with PR for CFS/ME are ensuring that the patient feels accepted and believed, that they accept the diagnosis, and that the model implicated by the treatment offered to the patient matches the model of illness held by the patient. If patients hold a clearly incompatible model of their illness, it is unlikely that they will engage with, and successfully complete, therapy. It is vital that the GP elicits and explores such illness beliefs either before making a referral to maximise patient engagement in therapy, or that an initial session with the therapist explores attitudes to the treatment model offered and then works with the patient’s model.

(Received January 28 2010)

(Accepted August 10 2010)

(Online publication October 01 2010)


a Currently Research Fellow, University of Huddersfield.