Introduction: This research portfolio set out to examine service user defined recovery in psychosis. A systematic review was undertaken to examine the evidence-base for the effectiveness of psychosocial interventions on personal recovery, empowerment and other recovery-related outcomes. An empirical study was conducted to examine the relationships between self-stigma, decisional capacity for treatment and personal recovery in service users with psychosis. Methods: A review of published literature identified ten randomised controlled trials investigating the effects of psychosocial interventions on personal recovery. A narrative synthesis was reported for findings relating to primary and secondary outcomes, and standardised effect sizes were calculated to quantify within-group change from pre-to post-intervention and follow-up. Studies were assessed for risk of bias. The empirical study recruited twenty-four participants with diagnoses of non-affective psychosis. Semi-structured interviews and self-report measures were administered to assess self-stigma, decisional capacity for treatment, psychopathology, emotional distress and personal recovery. Results: A small number of studies found that recovery-focused psychosocial interventions improved personal recovery. There were more consistent effects on psychiatric symptoms, functioning and depression. The empirical study found that self-stigma and personal recovery were associated with each other. Large effect sizes were found for the associations between self-stigma and symptoms. These associations persisted when controlling for personal recovery scores. Understanding of treatment was predicted by excitement symptoms, but no other prediction model emerged for decisional capacity. Conclusion: Taken together, the systematic review and empirical project support service user definitions of recovery which highlight the role of psychosocial factors. The systematic review found some evidence for the role of recovery-focused psychosocial interventions in improving personal recovery. Further research is needed so that interventions specifically targeting the processes in personal recovery can be developed. The findings from the empirical project suggested that interventions designed to overcome self-stigmatising beliefs and reduce emotional distress are likely to improve personal recovery outcomes in psychosis. More research is needed to develop a broader conceptualisation of decisional capacity in psychosis, to support the active participation of service users in their recovery journey.

Yes / In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The initial programme theory was developed from these sources in an iterative process between researchers and stakeholders (service users, practitioners, commissioners) involving four activities: articulation of 442 explanatory statements systematically developed using realist methods; debate and consensus; communication; and interrogation. We refute two criticisms of theory-driven evaluation of complex interventions. We demonstrate how the process of initial theory-building made a meaningful contribution to our complex intervention in five ways. Although time-consuming, it allowed us to develop an internally coherent and well-documented intervention. This study and the lessons learnt provide a detailed resource for other researchers wishing to build theory for theory-driven evaluation. / This research was funded by a UK NIHR Programme Grant (RP-PG-0611- 20004) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula).

Research has shown that people who participate in regular physical activity (PA) can experience improved wellbeing and quality of life, including better physical health, cognitive function, positive affect, and self-esteem (Fox, 1999). Such benefits support the application of PA as a strategy to improve the general population's mental health and those recovering from mental illness. However, the contemporary understanding of PA and the recovery from mental illness is almost exclusively underpinned by the principles of clinical recovery (e.g. symptom remission), which can overlook the patient's values. Conversely, personal recovery may reconnect people with their inner resources, personal strengths, and offer opportunities for people to reconstruct hope, meaning, responsibility and a positive identity as part of recovery (Slade, 2009). These values also mark a shift in the UK Government's (2011a) mental health strategy, toward integrating personal recovery as part of people's mental health care. Yet, few studies have examined the role of PA within the context of personal recovery, including the impact of PA on the wider elements of personal recovery. Accordingly, this thesis sets out to examine the role of PA during the personal recovery from mental illness, as a case study at a voluntary sector mental health organisation. The research methodology was guided by social constructivism, and data was collected between October 2010 and June 2014 using participant-observations, semi-structured interviews, focus groups and photo elicitation methods. Seven members of staff and twenty-two attendee's volunteered to participate in the research study, and their accounts were analysed thematically (Braun & Clarke, 2006) using NVivo to manage and aid the data analysis. Additionally, effort was made to satisfy the authenticity criteria throughout the research to maintain constructivist rigour (Lincoln & Guba, 2013). The research findings identified six high-ordered themes that indicate a process of personal recovery through PA. These were (a) 'Battles against the mind', (b) 'the centre as a place of refuge and support', (c) 'exercise is one part of the whole package', (d) 'the connection between body and mind', (e) 'my gateway onto other things', and (f) 'from small acorns to big oak trees'. These findings were congruent with the existing literature, and added that PA participation can support people's meaningful engagement in their personal medicines and other life events (e.g. employment, being with family, and relationship with pets). The findings are discussed in relation to the delivery of PA in mental health services, the relationship of PA with meaningful activities during recovery, and the impact of PA on elements of hope, meaning, positive identity, and personal responsibility. The thesis concludes with a guiding standpoint on the application of PA for personal recovery as a personal medicine or as an adjunct activity. This standpoint can be used to inform the general population, mental health and exercise professionals, multiagency mental health service staff and attendees, commissioning bodies and policymakers.