Effects of IMR: a randomized controlled trial 113 Functional recovery was assessed using the Social Functioning Scale (50). Personal recovery was assessed using the Mental- Health Recovery Measure (MHRM), a composite personal recovery scale that measures “self-empowerment,” “learning and new potentials,” and “spirituality” (51), the Internal Stigma of Mental Illness scale (ISMI) (52), and the Self-Esteem Rating Scale-Short Form (SERS-SF) (6, 53). The IMR Fidelity Scale was used to measure fidelity to IMR program implementation at the group level (31, 54). Details regarding all scales have been described previously (6, 55). Procedures During interviews with an assistant researcher, the caseloads of all clinicians on the community mental health teams were reviewed by the clinicians themselves for their potential suitability for IMR. The clinicians then asked the selected clients about participating in IMR and about their willingness to be informed about the study. If clients expressed interest and agreed to be contacted by an assistant researcher with more detailed information, the assistant researcher explained the study objectives, the randomization procedure, and the three measurement moments. The clients were then asked if they were willing to participate in the study. After written informed consent was given, the baseline interview was followed by randomization (6). For allocation of participants to receive IMR plus CAU (i.e., the intervention group) or CAU only (i.e., the control group), we used computer generated random permuted blocks of five stratified across the treatment teams. Blocks were independently constructed by a research assistant using a randomization plan (http://www.randomization.com). The results of our pilot study suggested an expected 50% dropout rate from treatment within the experimental condition (55). Therefore, to facilitate completer analyses, we allocated more participants to the intervention group than to the control group with a ratio of 3:2. Written informed consent was obtained from all participants prior to participation. Since research assistants were blinded to group allocation, the data collection procedure was single-blinded (11). Before each assessment, participants and clinicians were instructed through letter or e-mail not to disclose the treatment assignment. At the start of each session, the participants were verbally reminded of this requirement of the investigation. Assessments were performed at baseline (T1), after 12 months (post-treatment, T2), and after 18 months (six months of follow-up, T3). The research assistants, who were centrally instructed, met the study participants at several institute branches to conduct the assessments.
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