32 2 CHAPTER 2 Procedure Participants were approached through (a) flyers in waiting rooms of the mental health departments, (b) flyers at several military bases, (c) military psychologists who invited their patients, (d) adverts in a military newsletter, (e) personal contacts of one of the researchers, and (e) word-of-mouth between participants. After potential participants showed interest in participating (through email or telephone), they received an information letter and registration information. Participants were assigned to the specific focus groups based on whether they indicated having (had) MHC/SA or not or being a military MH professional. Written informed consent was obtained from all participants prior to participation in the focus groups. First, participants filled out a demographic’s questionnaire (including mental health diagnosis), and then the focus group leaders introduced themselves (names and research background). Focus groups were held in multiple rounds to facilitate iteration (19). All focus groups took place at military locations, lasted 2 hours and were audio-recorded and transcribed verbatim. Additionally, the second focus group leader took notes. After every focus group, notes were reviewed, and if needed slight adjustments were made to the topic list to ensure sufficient attention was paid to all topics. No major new topics came up in the last focus group, indicating saturation. All focus groups were facilitated by two (female) researchers (first author (RB, MSc.) and a coauthor (EB or AR, both PhD), all with background in psychology and health sciences and experienced in qualitative research. None of the researchers were actively involved in treatment of patients. The first author was familiar with two participants (both soldiers without MHC/SA) through a friend, but had no personal relationship with them. It was made clear that the mutual friend would not find out about their participation. Measurement A topic list was developed based on existing literature. As this study was explorative, the aim was to see what barriers and facilitators for treatment seeking the participants identified themselves, using open questions. However, when needed, probes based on current literature were used (e.g. ‘What role does a supervisor play in the decision to seek treatment?’) (7-9). The same topic list was used for all focus groups, with slight adjustments that made questions applicable to participants of a specific group. The topic list was piloted among experts within the military. This topic list can be found in the appendix. Analysis Content analysis was done by applying a general inductive approach using ATLAS.ti (8.4.4) software (22). To ensure reliability, all transcripts were coded independently by the main researcher (RB) and a second member of the research team (EB, SG, JW, AR, or FL). Differences were discussed until consensus was reached, where about one fifth of
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