Study protocol 71 Our pilot study showed that most modules will require an average of three to four sessions. Each IMR group will be guided by two trainers, who will use 1.) motivationenhancement strategies such as conveying confidence and exploring the pros & cons of change; 2.) educational strategies (psychoeducation) such as interactive teaching, breaking down information, and checking for understanding; and 3.) cognitive behavioural techniques such as shaping, modelling and role playing. Peergroup support and coping & social skills training are integral to IMR. Homework assignments will be provided. Workbooks and homework assignments can be accessed through an e-health module. IMR model fidelity To promote the fidelity of the intervention, the trainers will be experienced clinicians (mostly psychiatric nurses) who will receive a 2-day course in teaching IMR before the study starts and who will attend supervision once every 2 weeks for 2 h. Twice a year, all IMR trainers will come together for a morning or afternoon of additional training. To measure whether the IMR-programme is implemented according to the original intent, the researchers will determine model fidelity using the IMR fidelity scale and the IMR General Organisational Index (GOI) (19, 21). These scales have been translated, and the principal investigator was trained in their use by two American specialists (M.P. Salyers, Ph.D. and A. McGuire, Ph.D., both of UIPUI, University of Indianapolis USA). We will also use the Illness Management and Recovery Treatment Integrity Scale (IT-IS) (22), which gives more precise information on the quality of the trainers’ interventions. These fidelity scales will be applied by the principal researcher and a research assistant, scoring independently according to a protocol. For one team, fidelity measurement takes almost a day, and consists of interviews with two participants and the two trainers, in addition to observation of one session, and checking forms. The researchers will give periodic feedback in the supervision groups on the results of the fidelity measurements. Care as usual CAU will involve outpatient case management, medication, and rehabilitation services, with no restrictions on anything. The usual frequency of treatment contacts is 1.) one face-to-face contact with a mental health nurse every 2 weeks, and 2.) contact with a psychiatrist when indicated and no less than once a year. To indicate what CAU actually comprised, we will register the use of care in the control group.
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