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Reflexivity describes the process of the researcher engaging in a “self-aware meta- analysis of the research process” (Finlay 2002 p531). It is a recognition that the researcher’s values, core beliefs and experiences shape the way that they conceive, conduct, analyse and present their research, and that “meanings are seen to be

negotiated between researcher and researched within a particular social context so that another researcher in a different relationship will unfold a different story” (Finaly 2002 p531).

The process of reflexivity is important, especially in qualitative research as it encourages us to reflect on the way in which we can impact on the research and its findings. This not only includes acknowledging our biases, but also reflecting on how our own experiences and our reactions to the research context can lead to certain insights and understandings (Willig, 2013).

Prior to starting my PhD, I developed a digital stress management intervention,

WorkGuru, and I continue to have a commercial interest in it. My interest in researching adherence to and take-up of occupational digital mental health interventions came from my experience of developing and running my own intervention. Researcher allegiance

has been shown to significantly affect the results of research (Luborsky et al., 1999), and there is a suggestion that developer led research in trials of Internet interventions can report greater effect sizes than independent evaluations (Gilbody et al., 2015). A number of measures have been taken to ensure transparency in the research. Both the systematic review and meta-analysis and the RCT were conducted and reported

following rigorous guidance. The protocol for the systematic review and meta-analysis was pre-registered with the International Prospective Register of Systematic Reviews, it was conducted following the Cochrane guidance (Higgins & Green, 2011) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Moher, Liberatir, Tetzlaff & Altman for the PRISMA group 2009). The protocol for the RCT was pre-registered with ClinicalTrials.gov, and it was published in a peer review journal; it was conducted and reported in line with the

CONSORT eHealth checklist (Eysenbach et al., 2011). As recommended by Rozental et al., (2014) a question was included to identify any negative effects of the intervention. The pre-registering of the protocol, the reporting against specific criteria, and the reporting of negative effects ensured maximum transparency. While I was responsible for the collection and analysis of the data for both of these studies, the process was supervised by my co-authors who had full access to all the data.

The epistemological assumptions of quantitative research suggest that the aim of research is to obtain ‘objective’ knowledge that is free of the influence of researchers, but this aspiration is seen as being unachievable and inappropriate in qualitative research (Yardley, 2017). The criterion for demonstrating the validity and quality of quantitative research does not apply to qualitative research. Yardley (2000, 2017) has identified four key dimensions for enhancing, evaluating and demonstrating the quality of qualitative research: sensitivity to context, commitment and rigour, transparency and coherence, and impact and importance. Further information on these dimensions is given in Table 2.1.

Table 2.1: Characteristics of good (qualitative) research. (Yardley, 2000)

Sensitivity to context Theoretical; relevant literature; empirical data;

sociocultural setting; participants’ perspectives; ethical issues.

Commitment and rigour In-depth engagement with topic; methodological

competence/skill; thorough data collection; depth/breadth of analysis.

Transparency and coherence

Clarity and power of description/argument; transparent methods and data protection; fit between theory and method; reflexivity.

Impact and importance Theoretical (enriching understanding); socio-cultural; practical (for community, policy makers, health workers).

Sensitivity to context is demonstrated in both the qualitative studies in this thesis by the grounding of the research in previous relevant empirical studies. Both studies explore findings in the context of previous research rather than present them in isolation; this ensures that the programme of research has a wider relevance than my own self-interest. Context is also relevant because both studies are conducted in the context of the

workplace. Meaning is derived through an awareness of that context (e.g. expectations of employees, financial pressures on organisations, and the perception of mental health in the workplace). My experience of working in organisations provided a basis from which I engaged with participants and with the data.

Commitment, rigour, transparency and coherence are demonstrated in the studies in a number of ways: commitment has been demonstrated through the prolonged

engagement I have had with the subject area in my role as developer of a stress management intervention; through the process of marketing WorkGuru I have spoken with numerous employers about their perception of digital mental health interventions, and I have supported organisations to deliver these interventions in their workplace.

This knowledge provided insight and context for developing, and conducting the research and was particularly useful for recruiting organisations to the research. Rigour was demonstrated through the quality of the data that was collected and the

completeness of the analysis. Both myself and the second author for each study coded a subset of verbatim transcripts, inconsistencies were resolved, and the remaining

transcripts were coded by me with supervisory overview. Transparency was achieved by detailing the data collection and analysis process, and by presenting excerpts of the textual data which allowed readers to identify themes and meaning for themselves. Coherence was achieved through the fit of the research questions (predominantly evaluative and refinement), the philosophical perspective (realist/positivist), the method of investigation (semi-structured individual interviews), and the analysis undertaken (thematic analysis). Comprehensive reflections on the limitations of the research were made in both studies.

Both studies were conducted in the context of the workplace resulting in a close fit between the research and the practice it wished to influence, this enhanced both the impact and the importance of the research; this was further demonstrated by me being asked to present the research to practitioner (occupational therapy, and HR) groups.

As well as developing the intervention used in the RCT, for pragmatic reasons (this research was conducted as part of a PhD and did not have access to external funding) I also provided the online coaching delivered as part of the program. No attempt was made to conceal the fact that I had developed the intervention or that I had provided the coaching (my first name was used in all contact with the participants), but a separation was made between my role as a coach (contact was made through the WorkGuru messaging system) and my role as a researcher (contact was made through my university email); furthermore, no reference was made during the interviews to me developing the intervention, or to me acting as the coach; the role of the coach was only discussed as an abstract construct. Information that I had as a developer or as a coach was not disclosed during the interviews. For example, if a participant said something that was factually untrue about the program, or recalled an event that I recalled differently as a coach, this was not commented on. This separation between roles was helped by the semi-structured nature of the interviews (the focus of the interviews was

pre-defined) and the use of telephone interviews; using the telephone added a layer of anonymity.

Finally, during the course of the interviews with the employers, no mention was made of WorkGuru (not all of the participants were familiar with WorkGuru), digital health interventions were discussed in the abstract rather than talking about a specific

3 Systematic review and meta-analysis of digital