127 Perspective matters in recovery We made use of semi-structured interviews to collect rich, in-depth information from the perspective of persons with severe mental illness, family and professionals on their experience in the triad during recovery. After initial analysis, we held focus group meetings to enrich our material by including peer-to-peer and betweenperspective interactions, and triangulate our initial findings. Four “homogeneous” focus groups included participants of one perspective per group, and one “mixed” focus group included all three perspectives. The study had a participatory design. The research aim and methods were developed in a project group in which the perspectives of persons with severe mental illness, their family and professionals were represented. Individual interviews and focus groups were conducted by pairs of a researcher and an expert by experience from a personal or family perspective, to facilitate rapport with the respondent based on similar experiences. Indeed, some respondents explicitly stated that the input of the expert by experience was essential for their openness, and our impression was that this often was the case. Lastly, the project group reviewed preliminary results and the draft manuscript. Recruitment and ethical considerations Recruitment took place within Arkin, a large mental healthcare institution in Amsterdam, The Netherlands, between July 2018 and March 2020. We recruited persons with severe mental illness receiving assertive community-based treatment, or treatment in long-term inpatient rehabilitation units, via their mental health professionals and used snowball-sampling to recruit their family and professionals. Additionally, family members were approached directly through family meetings regularly organised by the institution. Within this convenience sample, we purposively sought for variety in sex and setting (long-term assertive community based/long-term inpatient service). For families and professionals, we additionally sought for heterogeneity in role (e.g. sibling or parent; nurse or psychiatrist). Interview and homogeneous focus group participants did not overlap. Mixed focus group participants were recruited from interview- and homogeneous focus group participants, and did not include persons who were part of the same triad. Inclusion criteria were age of 18 years or older, ability to give informed consent, and proficiency in Dutch. The study protocol was reviewed by the institutional review board of the Vrije Universiteit Medical Centre (reference 2018/196), and was granted an exemption from approval based on the fact that participants in the study were not subject to procedures or interventions, or required to follow rules of behavior. All respondents gave written informed consent to participate. When patients had a court-appointed legal representative, which especially occurred in respondents living in long-term inpatient services, we additionally obtained their informed consent. 7
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