A GROUNDED THEORY OF PERSONAL RECOVERY AMONG PEOPLE WITH MENTAL ILLNESS IN QATAR A thesis submitted to the University of Manchester for the degree of Doctor of Philosophy in the Faculty of Biology, Medicine and Health 2018 Jason Hickey School of Health Sciences 1 Contents List of tables ......................................................................................................................... 5 List of figures ........................................................................................................................ 5 List of appendices ................................................................................................................ 5 Declaration ........................................................................................................................... 7 Copyright statement ............................................................................................................ 8 Acknowledgments ................................................................................................................ 9 Personal statement ............................................................................................................ 10 Use of the alternative format ............................................................................................ 11 Chapter 1. Introduction and background .............................................................................. 13 1.1 Introduction ........................................................................................................... 14 1.2 Literature Reviews ................................................................................................. 14 1.2.1 Study 1 - Mental illness in the Gulf Cooperation Council: A scoping review ........ 15 1.2.2 Study 2 - Exploring personal recovery in mental illness through an Arabic sociocultural lens ........................................................................................................... 16 1.3 Context ......................................................................................................................... 17 1.4 Motivation for studying mental illness in Qatar .......................................................... 18 1.5 Impetus for undertaking the literature reviews .......................................................... 20 1.6 Summary of review findings leading to research aims ................................................ 20 1.7 Contribution of the project .......................................................................................... 24 1.8 Summary ...................................................................................................................... 24 Chapter 2. Methodology ........................................................................................................ 26 2.1 Introduction and rationale for empirical study............................................................ 27 2.2 Aims.............................................................................................................................. 28 2.3 Methodology ................................................................................................................ 28 2.3.1 Philosophical Orientation and Reflexivity ............................................................. 34 2.4 Methods ....................................................................................................................... 35 2.4.1 Sampling ................................................................................................................ 35 2.4.2 Gaining Access....................................................................................................... 38 2.4.3 Stakeholder consultations .................................................................................... 38 2.4.4 Recruitment .......................................................................................................... 41 2.4.5 Consent ................................................................................................................. 46 2.4.6 Data Collection ...................................................................................................... 47 2.4.7 Constant Comparative Analysis (CCA) .................................................................. 52 2.5 Ethical considerations .................................................................................................. 61 2.5.1 Autonomy and informed consent ......................................................................... 62 2 2.5.2 Confidentiality and data protection ...................................................................... 63 2.5.3 Safety .................................................................................................................... 64 2.6 Rigour ........................................................................................................................... 65 2.7 Summary ...................................................................................................................... 67 Chapter 3. Results .................................................................................................................. 69 3.1 Introduction ................................................................................................................. 70 3.2 Study 3 – Reciprocity membership. A grounded theory of recovery among adults with mental illness in an Arabic context .................................................................................... 71 3.3 Summary .................................................................................................................... 105 Chapter 4. Discussion ........................................................................................................... 106 4.1 Introduction ............................................................................................................... 107 4.2 The nature of recovery in an Arabic context ............................................................. 107 4.3 Key findings ................................................................................................................ 108 4.3.1 Study 1 (p.15) - Mental illness in the Gulf Cooperation Council: A scoping review (Hickey, Pryjmachuk, and Waterman 2016) . ................................................................ 109 4.3.2 Study 2 (p.16) - Exploring personal recovery in mental illness through an Arabic sociocultural lens (Hickey, Pryjmachuk, and Waterman 2017) . ................................... 110 4.3.3 Study 3 (p.73) - Reciprocity membership. A grounded theory of recovery among adults with mental illness in an Arabic context (Hickey, Pryjmachuk, Waterman, submitted November 2017) ......................................................................................... 110 4.4 General discussion ..................................................................................................... 112 4.4.2 Modernisation, shifting roles and recovery beyond extended families ............. 120 4.4.3 Reciprocity, recovery and religion ...................................................................... 123 4.4.4 Reciprocity membership and recovery in a Western context ............................ 126 4.5 Strengths, limitations and personal benefit .............................................................. 134 4.5.1 Methodology ....................................................................................................... 134 4.5.2 My ‘position’ in relation to participants ............................................................. 136 4.5.3 Study sample ....................................................................................................... 138 4.5.4 Personal benefit .................................................................................................. 139 4.6 Summary .................................................................................................................... 140 Chapter 5. Conclusions ........................................................................................................ 141 5.1 Introduction ............................................................................................................... 142 5.2 Review of work undertaken ....................................................................................... 142 5.3 Summary of contributions to the body of knowledge ............................................... 147 5.4 Implications for research ........................................................................................... 149 5.4.1 Role of the family in supporting recovery ........................................................... 150 5.4.2 Role of religion in supporting recovery ............................................................... 150 3 5.4.3 Stigma ................................................................................................................. 151 5.4.4 Further examining reciprocity membership theory ............................................ 152 5.4.5 Further exploratory research in the GCC ............................................................ 153 5.5 Implications for mental health services ..................................................................... 153 5.5.1 Using reciprocity membership theory to guide work with families ................... 154 5.5.2 Promoting engagement with extra-familial communities .................................