83 4 DISCLOSURE IN THE MILITARY - A QUALITATIVE STUDY second took notes. Notes were reviewed after every focus group, and if needed minor adjustments were made to the topic list to ensure sufficient attention was paid to all topics in subsequent focus groups. As no major new topics came up in the last focus group, saturation was reached. All focus groups were facilitated by two (female) researchers (first author (RB, MSc.) and a coauthor (EB or AR, both PhD)), all with a background in psychology and health sciences and experienced in qualitative research. None of the researchers were actively involved in patient treatment. The first author was familiar with two participants through a friend but had no personal relationship with them. Written informed consent was obtained from all participants prior to the start of the focus groups. Anonymity in reporting of results was guaranteed to all participants. All procedures were approved by the Tilburg School of Social and Behavioral Sciences Ethics Review Board (approval number EC-2018.107) and the Military Ethics Review Board. Patient and Public Involvement Several stakeholders from the Dutch military (psychologists, psychiatrists, policy-makers and military personnel) were involved in the development of this study. The stakeholders provided advice on the recruitment of participants. For example, they ensured military appropriate language was used during recruitment. Additionally, they provided advice on the conduct of the study. For example, to ask participants to come in civilian clothing in order to not emphasize differences in ranks within each focus group. All participant groups, including patients (group soldiers with MHC/SA), were involved in recruitment by using word-of-mouth as a recruitment method. Measurement As this study was explorative, the aim was to see what barriers to and facilitators for disclosure participants identified themselves, using open questions. Therefore, the topic list focused on the question ‘What are barriers to and facilitators for the decision to disclose MHC/SA?’. When needed, probes were used to encourage participants to elaborate on their answers, which can be found in the topic list (supplementary materials). These probes were informed by existing research (12, 15, 30). The same topic list was used for all focus groups. Prior to the focus groups, the topic list was piloted among experts within the military, by discussing what they thought was important for the disclosure decision (N=6). Analysis Content analysis was used by applying a general inductive approach using ATLAS.ti (8.4.4) software (31). All transcripts were coded independently by the main researcher (RB) and a second member of the research team (EB/EG/JW/AR/FL) to ensure reliability. Differences were discussed, where-after about one fifth of all codes were modified.
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