Chapter 1 22 The analyses described in Chapter 5 aimed to comprehensively investigate the effectiveness of IMR, including the impacts of completion and fidelity. Research questions were (1) whether IMR + CAU (IMR offered in group format) leads to better self-reported illness management (primary outcome) and to fewer symptoms and relapses (clinical recovery) than CAU alone, (2) whether IMR + CAU leads to better personal and functional recovery than CAU alone, (3) whether any improvement resulting from IMR + CAU is associated with the fidelity of IMR implementation, and (4) whether a higher IMR completion rate is associated with stronger effects (see above for Chapters 2 and 3). The analyses described in Chapter 6 evaluated whether IMR was implemented following the treatment model or program (model integrity). The objectives were to assess the fidelity and clinician competency in 15 IMR groups to establish the implementation level of all IMR elements and to explore the complementarity of the IT-IS with the standard IMR Fidelity Scale. The analyses described in Chapter 7 explored the working mechanisms of IMR, as described in the IMR conceptual framework, using longitudinal data. The research questions were as follows: what is the association between changes over time in illness self-management skills and changes in personal recovery, and to what degree is this association mediated by changes in clinical and functional recovery? Finally, Chapter 8 summarizes the major findings of this dissertation, followed by an elaboration and reflection on their strengths and limitations, future directions, clinical implications, and conclusions.
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