86 Chapter 5 METHODS Study design This qualitative approach is part of a larger mixed-methods study. Firstly, a quantitative approach was used to investigate the relationship between clinical and personal recovery cross sectionally and over time. The research was set in the treatment context of five Flexible Assertive Community Treatment teams (F-ACT) of Mentrum, part of Arkin Institute for Mental Health, in the western part of Amsterdam, the Netherlands. F-ACT is a Dutch version of Assertive Community Treatment (ACT), aimed exclusively at patients with Severe Mental Illness (SMI) (26). SMI has different definitions worldwide, but we used the following: patients with prolonged psychiatric illness and need for long-term treatment (i.e. more than 2 years), who experience severe social, occupational, or school dysfunctioning, regardless of a specific diagnosis (27, 28). F-ACT teams offer a combination of ACT and individual case management, working with an outreaching method in the community. The F of F-ACT stands for a team that is flexible to temporarily intensify treatment to ACT if this is needed (29). Patients were recruited for this research project by posters and flyers in the waiting room and all mental health workers were requested to ask their patients if they would be willing to participate in this research project. Participants consented to participate, after receiving an information leaflet explaining the aim of the study and interview procedure. Questionnaires about clinical and personal recovery were administered at baseline and three years later to patients with SMI. The characteristics of this study were described in earlier published articles (30, 31). The original sample consisted of 105 patients. Of these, 90 gave permission to be contacted again for a follow-up interview. All participants met the inclusion criteria of having a SMI, being 18 years or older and being able to understand the Dutch language. Sampling strategy Participants from the previously conducted quantitative study were approached again, now by a researcher, through telephone or e-mail correspondence, to participate in a qualitative interview. We used purposive sampling to select participants. We based the selection on the scores of patients on the quantitative measures of clinical and personal recovery, for instance a combination of high clinical recovery and low personal recovery, or low clinical recovery and low personal recovery, to ensure the most diverse views on the impact of clinical interventions on personal recovery. In other words, we aimed to explore a maximum variation in experiences, rather than representativeness for the total study population. 8 participants refused to participate on second thought with multiple reasons, for instance, no time, or not willing to talk for 30 minutes or more (which was longer
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