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The design was a qualitative grounded theory study using semi-structured

interviewing (Corbin & Strauss, 2008). This approach was considered appropriate to gather detailed accounts of young people’s experiences that were not required to fit pre-determined categories. Grounded theory also moves beyond descriptive findings, and allowed for the construction of an explanatory theory of young people’s beliefs about help-seeking, capturing complex relationships between beliefs, that were grounded in the beliefs of the young people interviewed.

2.2 Participants

Twelve participants were recruited from a largely rural NHS EIP service. Participant demographic information can be found in Table 1. Inclusion criteria required participants to be: aged 18 to 25; able to participate in English; able to provide informed consent; and to have accessed an Early Intervention Service within the previous three years. The only exclusion criterion was a current diagnosis of alcohol or substance abuse disorder (as people who abuse substances are anticipated to have a different engagement pattern). No

participants were excluded on this basis.

Table 1

Participant demographic information

Demographic

Participants n= 12

Age Range= 18-25

Mean= 20.9

Gender Female= 6

Male= 6

Ethnicity White British= 12

Employment status Employed= 5

Attending College=3 Unemployed= 4 Time since first access

to EIP team

Range= 1 month-3 years Mean= 1 year 8 months

All participants had recently consented to being included on a research register for the service, indicating that they would be willing to be contacted regarding opportunities to participate in research. Participants were contacted in the order in which they signed up to the research register. Two individuals declined participation citing difficulty with time

commitments due to recently undertaking full-time work.

2.3 Ethical Considerations

Ethical approval was given by the local NHS Research Ethics Committee (Appendix 6) and Research and Development approval was granted by the NHS trust (Appendix 7). The study adhered to the British Psychological Society and the Health Professionals Council code of ethics and conduct (British Psychological Society, 2006; Health Professionals Council, 2009).

2.4 Procedure

The care co-ordinators of participants on the research register were contacted to ascertain whether it was appropriate to approach individuals, taking into account their current levels of distress or perceived risk. Subsequently, the researcher contacted potential

participants directly and provided information regarding the study (Appendix 3). As suggested by the ethics committee, interviews were scheduled at least 24 hours after the provision of information, and written consent was obtained at the beginning of each interview (Appendix 4). Face-to-face semi-structured interviews were conducted with all participants in a convenient community setting, for example youth centres or clients’ homes. Interview questions were guided by the research aims and addressed beliefs about mental health and help-seeking (Appendix 5). The questions were reviewed by a service-user research group

and by the lead project supervisor who was experienced in working with young people with psychosis. The interview guide was also piloted with a focus group of 18 to 25 year olds with a range of MHDs, who felt that the questions were clear and relevant. Those in the pilot group suggested individual interviews would be preferable to a focus group to allow participants to speak more openly. Questions were adapted as interviews progressed in response to emerging findings (Corbin & Strauss, 2008). The interviews lasted

approximately 60 minutes and were digitally recorded, transcribed and anonymised for analysis.Interviews took place over a period of two months.

2.5 Data Analysis

Data was analysed using NVivo 9, a software programme designed to facilitate the coding of qualitative data.In line with grounded theory (Charmaz, 2006; Corbin & Strauss, 2008) data were initially coded using line-by-line or incident-by incident coding following each interview. A process of focused coding was then undertaken, in which salient codes were analysed in more detail and used to make further sense of the data. During focused coding analysis was concentrated specifically on data relating to beliefs. This was considered as data in which young people reported an appraisal of a situation including its nature and potential responses, or described this occurring in others as an indication of the social

network beliefs. Constant comparison was used to evaluate similarities and differences in the data as interviews progressed (Charmaz, 2006). Codes were then progressively grouped into categories that were explored in subsequent interviews to allow for deeper understanding of the concepts. Analysis of the data continued until no new properties of the categories were found, and it was considered “theoretical sufficiency” had been achieved (Dey, 1999). On completion of the interviews, finalcategories were integrated into overarching sub-categories that were used to create an explanatory model.

2.6 Quality Assurance Checks

A reflective research diary (Appendix 8) was kept throughout the conceptualisation and implementation stages of the project to increase awareness of assumptions and minimise their influence during data collection and analysis. Quality of the data was enhanced by means of regular review by the lead supervisor, who also conducted an independent analysis of the data in order to cross-check emerging codes. Memos were reviewed in supervision throughout coding in order to ensure transparency regarding the emergence of ideas. Direct quotations are used verbatim to increase the credibility of the theoretical model by grounding it in direct examples from the data.