Personal del Instituto

Having presented my theoretical framework, I introduce the ‘means proposed to study’ my topic.149 _{In the next two subsections, I elaborate on my RQs and then present my research}

design and method. After that, I explain my approach to dissemination.

Ravitch and Riggan define a conceptual framework as ‘an argument about why the topic one wishes to study matters, and why the means proposed to study it are appropriate and rigorous’.150 _{Thus far, I have declared my study's relevance, asserting the ethics of}

co-production's potential to improve MHS–FC responses to spiralling mental health problems. However, I have yet to evidence meeting Ravitch and Riggan's added requirements for a conceptual framework, namely that it:

should argue convincingly that (a) the research questions are an outgrowth of the argument for relevance; (b) the data to be collected provide the researcher with the raw material needed to explore the research questions; and (c) the analytic approach allows the researcher to respond effectively (if not always answer) those questions.151

I evidence my data's sufficiency (b) when detailing my use of GT in Section 3.1. I argue for (c) when I defend my validity and rigour in Section 7.4. I address (a) below.

Research Questions

My RQs (see the introduction to Section 1) seek a better solution to MHS–FC relationships. The RQs, addressed using GT methodology — chosen to theorize from participant experience and

148 _{Peter Kevern, 'Ageing, Religion and (In)Equality', in Ageing, Diversity and Equality: Social Justice}

Perspectives, ed. by Sue Westwood (Abingdon: Routledge, 2018), pp. 210-22.

149 _{Ravitch and Riggan, p. 7.} 150 _Ibid.

opinion — interrogate my argument for relevance. Fortuitously, a core concept matches each RQ. I consider each in turn.

My first RQ — the expectation of benefits from greater MHS–FC cooperation — arose from Wonders' analysis.152 _{She argued that MHSs might gain from FC perspectives on}

community and that MHS non-cooperation hampers FCs.153 _{My rationale for exploring}

stakeholders' opinions is that, if service users and carers welcome greater cooperation between MHSs and FCs, any contrary opinion may expose covert interests. To triangulate and

contextualize service user and carer views, I interviewed other stakeholders. In phrasing RQ1, I sought equipoise, allowing the possibility that stakeholders might want less cooperation (in contrast with Wonders).

RQ2 — safe and effective protocols — acknowledges that closer cooperation would call for careful attention to processes in order to mitigate possible harms. Obtaining stakeholder opinion on protocols circumvented possible institutional anxieties projected onto service users and carers. It also addressed the converse, that organizations might overlook genuine service user concerns. I chose the five participant groups to balance these risks and seek a ‘thick’ description.154

RQ3 — factors believed to contribute to well-being and recovery — draws on GT's surfacing of basic social processes to underpin proposals for MHS–FC cooperation. Challenging assumptions behind MHS delivery and potentially realigning the church to God's kingdom purposes, this question invites a Christian (and other–faith) response to mental health statistics. It deliberately gives ‘voice’ to stakeholders, placing them centrally in essential debates.

Since GT's inductive/abductive nature encourages new insights beyond researchers' horizons, the ethics of co-production is a reasonable candidate for legitimacy. I provide the warrant for its legitimacy in Section 5.4 which I delay because, being more abstracted than my

152 _{Wonders, p. 61.} 153 _{Ibid., pp. 85-86.} 154 _{Geertz, pp. 6-10.}

core concepts, its relevance will be more apparent after reading the intervening material.155

Having argued that my RQs are ‘an outgrowth of the argument for relevance’, I introduce my research design.

Research Design

In 1967, the sociologists Glaser and Strauss introduced GT to systematize qualitative enquiry.156

The methodology offers an epistemology and set of methods broadly corresponding to those used in quantitative research. Grounded in interview data, GT enables researchers to explore social processes and derive theories from participants' experience. The methodology was particularly suited to addressing my RQs.

To follow GT order, I sought ethical permissions at the earliest possible opportunity. I received a favourable opinion from Durham University, North East — Newcastle and North Tyneside 1 NHS Research Ethics Committee (reference 15/NE/0327), and from Mersey Care NHS Foundation Trust's Research and Development Committee. While waiting, I read widely on methodology and study skills, avoiding literature that might prejudice my interpretation of participants' opinions. I deliberately interviewed service users and carers ahead of staff and other leaders.

Further to discussion with the LEAP, I used purposive sampling (see Appendix B) to recruit six each of MHS users, carers, staff, FC leaders, and leaders of FBOs serving people with mental health problems. I tried to ensure the participants were:

a) as representative of the local population (or their FBO role) as possible b) representative of different faith/non-faith groups (where fitting) c) able to give informed consent

d) fluent in English.

Service user participants were additionally:

155 _{Charmaz, p. 38.}

156 _{Barney Glaser and Anselm Strauss, The Discovery of Grounded Theory: Strategies for Qualitative}

e) receiving services from Mersey Care

f) reflective of a sample of psychiatric conditions g) reflective of a spread of ages within the service. I excluded anyone:

a) under eighteen

b) needing an interpreter (due to costs) c) lacking capacity to consent

d) likely to experience distress from taking part.

My study included qualitative data consisting of interview recordings, interview notes, and basic demographics (see Appendix C). I used the constant comparative method to read in pursuit of lines of enquiry raised by participants in their interviews. 157 _{No participants asked for}

a copy of their transcript, and none withdrew. There were no adverse incidents. Of the thirty participants, twenty-six requested and were sent a Summary of Findings.

Research Method

I recruited service users through Mersey Care's User and Carer research leads. I circulated posters and Invitation Letters, Participant Information Sheets and Consent Forms, offering the choice of declining, supplying contact details, or getting in touch via the nursing team. I ensured that prospective participants had capacity to consent.

Because of possible fluctuating capacity, I invited staff to screen prospective service user participants.158 _{I addressed sensitive subject matter in the Participant Information Sheet.}

During the interviews, I offered to pause/stop the recorder/interview, checked for concerns, and sought advice where appropriate (see Appendix E).

157 _{Charmaz, pp. 140-41.}

158 _{Bridgit Dimond, 'The Mental Capacity Act 2005: Mental Capacity and Mental Illness', British Journal}

I recruited carers through Service User and Carer Coordinators, attending carer groups to publicize the research. I recruited the other participants, prioritizing service user and carer interviews. I built the pilot study into the research evidence base.

I recorded semi-structured interviews, most lasting up to an hour. I transcribed and analysed the interviews within a few days.159 _{Using NVivo software and Charmaz's approach to}

coding, I formed initial codes and early memos.160 _{Deploying axial coding and GT's ‘constant}

comparative method’, I created focused codes and advanced memos to frame the questions for the next interview and build categories.161 _{I reached theoretical saturation in each participant}

group.162

I derived my theory from the categories, codes, memos, interview notes, and research journal. To ensure rigour, I followed Corbin and Strauss's criteria for evaluation.163 _{The core}

concepts guided my literature review. I used elementary quantitative analysis to compare my sample with the population.

Regarding confidentiality, I alerted all participants to Trust policies at the beginning of interviews. I explained that any disclosure might result in communication with staff. The Participant Information Sheet listed sources of support. I anonymized all data at the earliest possible opportunity. I used encrypted recorders, directly downloading recordings to NHS- approved servers. I encrypted all documents, storing them on Mersey Care's servers. I secured paper records in a locked filing cabinet following Trust policies. Separate passwords restricted

159 _{See Appendix D for my analysis framework.}

160 _{QSR International, 'Nvivo' ([n.p.]: QSR International, 2012); Charmaz, pp. 109-}61; Saldaňa defined a

code as ‘a word or short phrase that symbolically assigns a summative, salient, essence-capturing, and/or evocative attribute for a portion of language-based or visual data’; The Coding Manual for Qualitative

Researchers (Los Angeles, CA: Sage, 2010), p. 3.

161 _{Charmaz, pp. 140-41, 47, 32, 57-60, 72-85.} 162 _{Ibid., p. 214.}

163 _{Juliet Corbin and Anselm Strauss, Basics of Qualitative Research: Techniques and Procedures for}

auditor access to either participant or research data (see Appendix D). I used lean principles to manage the project and evidence how I formed the theory from codes.164

My employer paid service user and carer participants' expenses in line with their policies.165 _{I neither offered nor received any direct financial reward. I had no reason to declare}

any conflict of interest.

Dissemination

Far from an afterthought, dissemination is concurrent with my write-up. Publication and presentation enabled me to test my ideas continually and evaluate responses. Major works include a chapter on co-production in Essentials of Mental Health Nursing and another in

Chaplaincy and the Soul of Health and Social Care.166 _{An edited book, Co-Production in}

Mental Health: Lighting up Dark Places — co-edited with the LEAP — is accepted for

publication.167 _{More deliberately popular contributions include an article in the Trust}

magazine.168

Early signs suggest my project is gaining interest, not least 200 reads of one on ResearchGate.169 _{I have led a couple of seminars at Durham; one at the College of Health Care}

Chaplains' Annual Conference, and another at the Critical Voices Network.170 _These

164 _{Neil Westwood, Mike James-Moore, and Matthew Cooke, 'Going Lean in the NHS' ([Coventry]: NHS}

Institute for Innovation and Improvement/Warwick University, 2007).

165 _{Cf. Michael Turner and Peter Beresford, 'Contributing on Equal Terms: Service User Involvement and}

the Benefits System' (London: Social Care Institute for Excellence, 2005).

166 _{Julian Raffay and Don Bryant, 'Spiritual Care: Understanding Service Users, Understanding}

Ourselves', in Essentials of Mental Health Nursing, ed. by Karen Wright and Mick McKeown (London: Sage, 2018), pp. 232-48; Julian Raffay and Don Bryant, 'Co-Production and Promoting Spiritual Wellbeing in Mental Health', in Chaplaincy and the Soul of Health and Social Care: Fostering Spiritual

Wellbeing in Emerging Paradigms of Care, ed. by Ewan Kelly and John Swinton (London: Jessica

Kingsley, 2019), pp. 232-48.

167 _{Raffay, McKeown, and Thornton.}

168 _{Jackie Rankin and Julian Raffay, 'More Tea Vicar? More People Than Ever Are Turning to a Faith}

Community in Times of Mental Anguish', in MCT Magazine (Prescot: Mersey Care NHS Foundation Trust, 2018), pp. 13-15.

169 _{Raffay, Wood, and Todd; ResearchGate, '200 Reads' (Berlin: ResearchGate, 2018).}

170 _{Julian Raffay, 'Perspectives on the Relationship between Statutory Mental Health Services and Faith}

Communities: A Co-Produced Constructivist Grounded Theory Study', in Spirituality, Theology and

Health Seminar (Durham: Durham University, 2016); Julian Raffay, 'Co-Productive Ethics: Bridging the

Fact–Value Divide in Mental Health Service Provision', in Spirituality, Theology and Health Seminar (Durham: Durham University, 2018); Julian Raffay, 'Co-Productive Ethics: Transforming Tomorrow’s

contemporaneous projects enabled me to revise my claims. I am planning to publish further papers in academic and practitioner journals and author a book or monograph. I predict speaking at conferences.

In the first two sections of this chapter, I declared the importance of the study, asserting the ethics of co-production's potential to improve MHS–FC responses to spiralling mental health problems and presented my theoretical framework. In Section 3, I outlined the

components of my theoretical framework. In Section 4, I introduced my conceptual framework as the ‘means proposed to study’ my topic.171 _{I evidenced that my methodology was suitable for}

answering my RQs. I then explained the coherence of my approach to dissemination.