General discussion 189 General discussion This thesis had four major aims: (1) to explore the effectiveness of Illness Management and Recovery (IMR); (2) to explore the impact of IMR fidelity and the level of IMR exposure (completion) on IMR efficacy; (3) to comprehensively explore the implementation of the clinical skills of IMR practitioners; and (4) to explore the working of IMR based on a conceptual framework. This general discussion summarizes the major findings of this dissertation, including an elaboration and reflection on these findings, a comparison of the results with other studies, strengths and limitations, future directions, clinical implications, and conclusions. Major findings Effects of IMR Effects on overall illness self-management and on personal recovery Compared with the control group, patients who received IMR showed a statistically significant improvement in overall illness self-management, as measured using the IMR scale client version, which was the primary outcome of this study (d =.34). Moreover, these patients showed a statistically significant improvement in selfesteem, a component of personal recovery (d =.52). There were no effects on illness self-management measured with the IMR scale clinician version, illness selfmanagement components (including social support, coping, medication adherence, addiction, and insight), or clinical, functional, and personal recovery measured using two other personal recovery scales. Both the experimental and control groups showed statistically significant improvements over time with respect to overall illness management as measured using the clinician version of the IMR scale, and with respect to social support, clinical and functional recovery, and self-stigma (Chapter 5). Greater model fidelity and a higher completion rate enhanced IMR efficacy The effect of IMR fidelity on IMR effectiveness was demonstrated in terms of selfesteem. To our knowledge, this is the first study to provide indications of the predictive value of IMR fidelity in the context of an RCT. However, IMR fidelity did not affect self-rated overall illness management. IMR completion (exposure to > 50% of the IMR program) strengthened and expanded positive results for overall illness self-management and personal
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