92 4 CHAPTER 4 The first limitation relates to the generalizability of this study. Even though a stratified sample was approached, the sample contained a relatively low diversity of age and rank, with a majority of older and higher-ranking soldiers. Additionally, there was an overrepresentation of the army within the soldiers with MHC/SA group and the navy within the soldiers without MHC/SA group. Results might differ for different layers and branches of the military organization, and younger, lower-ranking soldiers, may face different barriers than older, higher-ranking ones. For example, a study among Dutch employees showed that compared to people who had disclosed their MHC/ SA, those who had not were significantly younger (22). However, generalizability was not the purpose of the study. As with other qualitative studies, the aim was to provide insight into a complex challenge of which more knowledge is urgently needed. Future quantitative research should further examine disclosure using a representative sample, which will also provide opportunity to examine actual disclosure rates within the military and whether disclosure depends on certain demographics, but also whether it depends for example on type of MHC/SA, beyond whether MHC/SA are work-related or not. Second, the current study did not include the perspective of supervisors, while supervisor support was found to be important for the decision to disclose. A previous study within the German military did include the supervisor perspective and found similar results. Supervisors indicated more knowledge and awareness surrounding PTSD compared to other MHC/SA and recognized that stigma was a barrier for disclosure. However, to gain more insight into supervisor support, and how to increase it, future research should further examine the perspective of supervisors. Third, risk of self-selection bias cannot be ruled out, as participants could freely sign up for this study, meaning that views on the topic could be different for other soldiers and MMH professionals. Additionally, there is a risk of researcher bias, as the researchers coded the transcripts. However, to limit this bias and prevent the subjective interpretation of one researcher, multiple researchers coded the data. Fourth, a limitation of using a focus group study is that participants are not anonymous to each other. This poses the risk that participants only provide socially desirable answers, especially when the topic studied is sensitive topic such as in the present study. However, focus groups were chosen because compared to individual interviews, focus groups have the advantage that participants can respond to each other’s answers, providing additional insight into the topic (25). Furthermore, the first author was familiar with two participants, also forming a risk for socially desirable answers. However, as there was no personal relationship and only familiarity, it is expected that effects of socially desirable answers are negligible. Additionally, several measures were taken to allow participants to speak freely, as discussed in the strengths section.
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