Table 7.

Themes and subthemes

Theme 1: Seeing the bigger picture: psoriasis as more than a skin condition
Sub‐theme	Data extract
Newly discovered aspects of psoriasis Learning about co‐morbidities	It was something I didn't know…I thought that perhaps [psoriatic arthritis] applied to me…I didn't realise that psoriasis and arthritis could be combined (P1 female 65)
Learning about lifestyle behaviour links	A lot of the information was new to me…[leaflets] gave me a lot to think about…I didn't realise smoking and alcohol could affect [psoriasis] (P3 female 42)
Learning about treatments	I didn't even know there were things for psoriasis other than the ointment I'm using – I thought everybody used that! I wasn't aware there were other types of treatment…light therapy and that (P5 male 69)
Learning about disease/treatment mechanisms	Nobody had ever explained why you get…plaques…it's your skin cells speeded up and you've got a build‐up of what you can physically see (P17 female 32)
Enablers of learning
Plain language style	The [materials] were at the right level without patronising people – it was just at the right level for me and just going in (P4 female 57)
Ease of navigation	[Leaflets] were uniform, so they'd all look nice and you'd choose your colour…and could go straight to it (P9 female 59)
Chunking of information	It's little bits at a time, little bits of information…bite‐sized, that's it (P7 female 45)
Positive/hopeful tone	It just puts the two things together [psoriasis and heart health]. The way it's written isn't threatening at all, it just makes it plain that there could be a link (P2 male 62)
Unintended consequences
Disappointment in health services	It was a bit disappointing really that my doctor had never said there are new things (P5 male 69)
Self‐blaming	Having the leaflets, it made me angry with myself for not looking things up…I was a bit angry with myself and annoyed (P8 female 31)
Regret that information not made available earlier	When I saw all of [materials] I thought – all right, so this is the kind of information you can get access to! If we had this back then it would've been brilliant…I wouldn't have felt so alone with [psoriasis] (P6 male 44)

Theme 2: Personalising psoriasis: developing illness coherence
Sub‐theme	Data extract
Making personal sense of psoriasis Finding a ‘reference point’	I had no reference points or anything to know what should be happening or how bad [psoriasis] could get, so by having the leaflets – they said – if this doesn't work you can try this (P8 female 31)
Linking disease aspects to self	I recognised the sort of things that were me…a greater knowledge from reading all the different things and relating certain aspects to myself…I do understand [psoriasis] more now than I did (P4 female 57)
New awareness of bi‐directional links	I hadn't put the links together in my mind. I realised being withdrawn had made my psoriasis worse but hadn't…linked that one relates to the other. By having the leaflets I was able to understand all the little things that can affect it, things I hadn't thought about (P8 female 31)
Enablers of engagement with materials
Personally relevant/resonant content (acknowledging emotional impact)	I thought…yes that's how it is…there it is on the page…it's not just a skin condition, it's the whole range of emotions that come with it as well (P6 male 44)
Perceived trustworthiness of the materials	The source of the information is the thing. You get all sorts of stuff on the internet, put up by all sorts of people, bloggers of every description…if you can go to a trusted source…the NHS is very much in that category (P18 male 61)
Perceived ‘high quality’ of materials content and design	[Leaflets] were quite professional…and…attractive, like you want to read them – they're not just your boring leaflets in waiting rooms in the NHS…you want to pick them up (P17 female 32)
Changing emotions and cognitions (feelings and thoughts) Reduced feelings of self‐blame/increased confidence	It's not my fault is one of the biggest things. By knowing all these things affect [psoriasis], it's not something I've done…that's made this happen…by having the leaflets… I felt more confident to go and sit and have breakfast in a coffee shop (P8 female 31)
Increased feelings of self‐esteem (being valued)	To be given something like [materials]…made me as a psoriasis sufferer feel valued, because so often dermatology – psoriasis – is the bottom of the pile…so this…the way it was presented…actually made me feel for once, somebody was trying to make me feel valued about it (P19 female 67)
Bringing previously ‘unconscious’ thoughts to the fore	I kind of made a personal link and I thought – hey – when I get stressed there are times when my psoriasis starts getting worse. So maybe I'd better watch that. Maybe I can do something about it (P17 female 32)
Self‐questioning about managing psoriasis differently	When I saw the leaflets…it did make me question things more, especially the use of lotions and things, that made me re‐think my journey with my doctor over the years, how I've let things lapse and not ask for further consultations. Those leaflets made me think, well actually, I should be more proactive (P3 female 42)

Theme 3: Managing psoriasis differently: making changes?
Sub‐theme	Data extract
Materials as ‘stand‐alone’ tool Consulting in a different way Using medications differently	That leaflet was good in that it made me go back and think about [medication] and I got on a different topical lotion – changed it for the first time in as long as I can remember (P3 female 42) I make sure I look after [skin] properly and put the creams on the right way…I take more care…it's reading [materials] and trying to do things differently than I was before…sometimes I used to just ignore [psoriasis] (P1 female 65)
Taking action to address lifestyle behaviour	It [re‐joining Weight Watchers] was after that [reading leaflets]…because I felt better. Somebody understood me, understood my condition, understood how I feel (P7 female 45)
Perceived change mechanisms Tracking psoriasis with body diagram	Looking at [body diagram] from 5 months ago I'd have said [psoriasis] didn't do that [fluctuate]. I'm shocked looking now… when I completed the leaflets I felt I was in a good place, but my psoriasis is much better months along the line than it was (P3 female 42)
Identifying concerns and priorities with activities/charts	Seeing it written down made me realise that there were phases [to psoriasis] because – yes it's controlled…but…something would trigger it off again. It…made me realise what was bothering me (P4 female 57)
Identifying goals and strategies with activities/charts	You need a strategy…you need a plan…and I started to…write down what I need to do and then – right…the next stage is this (P1 female 65)
Increasing intention/motivation to make changes through engagement with activities	The activities was something I was able to use to help me…being able to put that tick…gave you a boost – like – yeah, you're doing what you need to do, you're going to get there (P8 female 31)
Materials as a ‘shared’ management tool Materials as a useful to ‘share’ with doctor	It would open up a conversation, if [GP] was to say – we've got these leaflets – where are you? It might make you feel…there's somebody caring and trying to improve the situation (P5 male 69)
‘Shared’ tool as an incentive to change	The doctor could actually use [leaflet] and say – look – what we're going to do is I need you to keep a diary, to keep noting and…I want you to fill this in. Then the person is going to use the leaflet rather than…stick it in my drawer when I get home (P17 female 32)
Materials as a support for clinicians’ practice	I imagine [materials] would help GPs massively because I wonder how much GPs actually update their information about [skin] conditions…invaluable information here that you could use with the doctor (P3 female 42)
Resistance to using the materials
Psoriasis experienced as mild/not bothersome	I don't think I was so keen on the [activities]…because it's saying how much is [psoriasis] affecting you at the moment and it wasn't affecting me…my psoriasis isn't normally that bad (P9 female 59)
Feeling ‘bombarded’ with lifestyle behaviour change messages in general	I'm not sure anything in the [weight] leaflet would help…it's on the telly all the time, there's stop smoking things all over…all these years I've been trying to lose weight by doing what the doctors and everyone have said…and I think I was probably feeling like strangling them. (P9 female 59)
Perceiving messages as rigid/rule‐based	For me personally it smacks a bit of work…you went on various courses and it would be ‘let's have a target here’ and… ‘we need to write an action plan!’…oh crikey here we go again (P13 female 64)