title: Service user experiences of REFOCUS: a process evaluation of a pro-recovery complex intervention.
abstract: Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed to encourage the use of recovery-supporting tools and support recovery-promoting relationships.
  
  
  
  Interviews (n = 24) and two focus groups (n = 13) were conducted as part of a process evaluation and included a purposive sample of service users who received the complex, pro-recovery intervention within the REFOCUS randomised controlled trial (ISRCTN02507940). Thematic analysis was used to analyse the data.
  
  
  
  Participants reported that the intervention supported the development of an open and collaborative relationship with staff, with new conversations around values, strengths and goals. This was experienced as hope-inspiring and empowering. However, others described how the recovery tools were used without context, meaning participants were unclear of their purpose and did not see their benefit. During the interviews, some individuals struggled to report any new tasks or conversations occurring during the intervention.
  
  
  
  Recovery-supporting tools can support the development of a recovery-promoting relationship, which can contribute to positive outcomes for individuals. The tools should be used in a collaborative and flexible manner. Information exchanged around values, strengths and goals should be used in care-planning. As some service users struggled to report their experience of the intervention, alternative evaluation approaches need to be considered if the service user experience is to be fully captured.
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Wallace
authors.affiliation: Wolfson Institute of Preventive Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK. v.j.bird@qmul.ac.uk.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bird
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Leamy
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
authors.forename: Faye
authors.initials: F
authors.lastname: Bacon
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
authors.forename: Clair
authors.initials: C
authors.lastname: Le Boutillier
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
authors.forename: Monika
authors.initials: M
authors.lastname: Janosik
authors.affiliation: 2gether NHS Foundation Trust, Gloucestershire, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: MacPherson
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Williams
authors.affiliation: Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000534:rehabilitation; D001294:Attitude to Health; D001714:Bipolar Disorder / Q000534:rehabilitation; D003866:Depressive Disorder / Q000534:rehabilitation; D005260:Female; D017144:Focus Groups; D065026:Hope; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008605:Mental Health Services; D008875:Middle Aged; D010358:Patient Participation; D011209:Power, Psychological; D017064:Process Assessment, Health Care; D000067250:Psychiatric Rehabilitation; D036301:Qualitative Research; D020127:Recovery of Function; D012559:Schizophrenia / Q000534:rehabilitation
keywords: Complex intervention; Health service and population research; Process evaluation; Recovery