Study Protocol for a&nbsp; co-produced rapid ethnographic study of self-care practices among Recovery College students who self-manage their mental health and wellbeing.

Xandra Miguel-Lorenzo

doi:10.12688/f1000research.161749.1

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Study Protocol

Study Protocol for a co-produced rapid ethnographic study of self-care practices among Recovery College students who self-manage their mental health and wellbeing.

[version 1; peer review: 1 approved with reservations, 1 not approved]

Xandra Miguel-Lorenzo

PUBLISHED 17 Mar 2025

Author details Author details

Applied Health Research, UCL, London, Greater London, WC1E 6BT, UK

Xandra Miguel-Lorenzo
Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Global Public Health gateway.

Abstract

Introduction

Since 2009 Recovery Colleges have offered in the UK co-produced holistic recovery educative courses for ‘social recovery’ or ‘recovery’, different from ‘clinical recovery’ as cure or symptom reduction with psychiatric medication or clinical interventions. In the wake of the UK Department of Health policy ‘No Health Without Mental Health’ (2011) for mental health ‘self-management’ and recovery, the definition of ‘recovery’ expanded to include ‘becoming an expert in your own self-care’ (Perkins et al., 2012). Instrumental in advancing the ‘recovery approach’, we know little about how Recovery Colleges facilitate students’ ‘self-care’ learning.

Method

Co-produced rapid ethnographic research examines Recovery College students’ understandings and practices of ‘self-care’ and ‘self-management’; students’ ‘self-care’ investments, materiality, embodied feeling; and its role in preventing mental health crises and maintaining mental health and wellbeing. Nine Camden & Islington Recovery College students, the North London NHS Foundation Trust, and one clinical professional to co-deliver workshops are recruited. Study participants recruitment seeks diversity, including the Recovery College’s population demographics and under-represented communities. Data from study participants, the clinical co-facilitator, and the Chief Investigator is collected.

Analysis

Rapid data analysis follows guidance for reflexible thematic analysis (Braun & Clarke 2019, 2006). Data accurately transcribed, coded by topics, is clustered in themes, to inform report writing, employing study participant’s descriptive examples or cases for each identified theme. All relevant data is uploaded into NVivo.

Ethics and Dissemination

The Northern Ireland Research Ethical Committee (24-NI-0127 - HSC REC A) gave ethical approval to the study. The Chief Investigator is a Camden & Islington Recovery College Senior Peer Recovery Tutor and ‘Embedded Researcher’, funded by the NIHR Mental Health For All programme and an NIHR Springboard Awardee, with a PhD in Anthropology. Ethical considerations include study participants’ disclosure of harm or distress; power imbalances between the Chief Investigator and study participants; pseudonymity and data management.

Keywords

Co-production; Rapid Ethnography; Recovery College; Self-Care; Self-management; Mental health; Recovery; Trauma

Corresponding author: Xandra Miguel-Lorenzo

Competing interests: No competing interests were disclosed.

Grant information: This study is funded by the National Institute for Health Research (NIHR), Springboard Award 2023. ARC Project MH-ALL Opportunity Funds_ Lorenzo
This report is independent research funded by the MH-ALL programme, National Institute for Health and Care Research ARC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research and Care or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2025 Miguel-Lorenzo X. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Miguel-Lorenzo X. Study Protocol for a co-produced rapid ethnographic study of self-care practices among Recovery College students who self-manage their mental health and wellbeing. [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2025, 14:303 (https://doi.org/10.12688/f1000research.161749.1) First published: 17 Mar 2025, 14:303 (https://doi.org/10.12688/f1000research.161749.1) Latest published: 17 Mar 2025, 14:303 (https://doi.org/10.12688/f1000research.161749.1)

Introduction

Recovery Colleges are a cornerstone to implementing the ‘recovery approach’ to mental health (Repper & Perkins, 2003; Shepherd et al., 2008; Shepherd et al., 2010; Department of Health 2011; Perkins et al., 2012; Perkins et al., 2018) and the community mental health transformation (NHS England and NHS Improvement and the National Collaborating Central for Mental Health, 2019a). Recovery Colleges, a UK educational mental health intervention first piloted in 2007, were established in 2009 in a South West London NHS Trust (Perkins et al., 2012). Currently, there are over 220 Recovery Colleges across the UK and in 26 countries worldwide (ImROC website, on 31st January 2025). Clinical and lived experience experts co-produce Recovery College courses for self-management, self-understanding, meaning-making, promoting hope, agency, and healthy relationships (Ibid). Bringing cultural change to mental health services through community-based recovery practice (Repper & Perkins, 2003; Department of Health, 2011; NHS, 2019b). The ‘No Health Without Mental Health’ policy (UK Department of Health, 2011) constitutes the framework recommending the recovery approach to mental health. Citing Anthony’s (1993) definition of recovery, the policy advocates for people to have ‘a greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates and a suitable and stable place to live’ (Perkins et al., 2012:2); referring to 2011 National Institute for Health and Clinical Excellence’s (NICE) service users guidance recommending ‘self-management’ as a key quality standard of adult mental health services (Ibid). In 2011 the UK Department of Health funded the organisation ‘Implementing Recovery through Organisational Change’ (Imroc). Imroc was founded and is led by Rachel Perkins and Julie Repper, the precursors of the recovery approach in the UK. The first Imroc Briefing paper ‘Recovery Colleges’ (2012), published by the Centre of Mental Health and the Mental Health Network NHS Confederation, includes a ‘new’ definition of recovery: a ‘personal journey of [self] discovery’ (Repper & Perkins, 2012 In Perkins et al. 2012:2), which involves ‘making sense of, and finding meaning in, what has happened; becoming an expert in your own self-care; building a new sense of self and purpose in life; discovering your own resourcefulness and possibilities and using these, and the resources available to you, to pursue your aspirations and goals’ (Perkins et al., 2012:2). Including principles of hope, choice, opportunity, co-production and peer working, a core component of Recovery Colleges is ‘helping people to become experts in their own self-care.’ (Perkins et al., 2012:7). Yet, Perkins et al. (2012) do not define the concept of ‘self-care’.

‘Self-care’ and ‘Self-management’ have been used interchangeably in the literature. The Health Foundation’s (2011) ‘Evidence: Helping people help themselves. A review of the evidence considering whether it is worthwhile to support self-management.’, looked at 550 research outcomes supporting health care self-management through behaviour change and self-efficacy development (de Silva, 2011:v). It defined ‘self-management’ as: ‘[t]he actions individuals and carers take for themselves, their children, their families, and others to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long term conditions; and maintain health and wellbeing after an acute illness or discharge from hospital.’ This definition of self-management is the same definition that the Department of Health’s (2005) position paper ‘Self-care – a real choice’ uses for ‘self-care’. The turn towards mental health self-management is supported by Geoff Shepherd, Jed Boardman, and Mike Slade’s (2008) policy paper ‘Making Recovery a Reality’; and Mike Slade’s (2009) book ‘Personal Recovery and Mental Illness’, especially its Chapter 18 ‘Supporting the development of self-management skills’, citing Pat Deegan’s work. Deegan’s ‘personal medicine’ is defined as ‘self-initiated, non-pharmaceutical self-care activities that served to decrease symptoms, avoid undesirable outcomes such as hospitalization, and improve mood, thoughts, behaviours, and overall sense of wellbeing’ (Deegan, 2005:31); differentiating between two main categories of ‘personal medicine’: ‘activities that gave meaning and purpose to life’ and ‘specific self-care strategies’ (Ibid:32). Other lived experience advocates such as Chamberlin (2022 [1977]), mental disability rights activist, argued ‘self-care skills’ enable people to live outside mental health institutions. Faulkner and Sarah (1999) advocated for ‘personal and self-help strategies’ to live well with mental health challenges. Lorde (1988), a black lesbian feminist, claimed ‘[c]aring for myself is not self-indulgence, it is self-preservation, and that’s an act of political warfare.’, advocating for self-care among marginalised groups facing discrimination based on race, class, gender and sexuality. Herman (2015 [1992]:166) stated that ‘self-care’ helped rebuilding the ego functions more severely damaged by interpersonal trauma.

Learning ‘self-management’ for recovery defines what a Recovery College is, and Recovery College students report learning ‘self-management’ at Recovery Colleges (McGregor et al., 2014; Meddings et al., 2014, 2015a; Zabel et al., 2016; Muir-Cochrane et al., 2018). A literature review of Recovery Colleges research shows scarce reference to ‘self-care’ (except for Critchley et al., 2019; Reid et al., 2020). The concepts of ‘coping strategies’ (Kelly et al., 2017; Roeg, 2021; Thompson et al., 2021), ‘recovery goals’ (Burhouse et al., 2015; Sommer et al., 2019; Yoeli et al., 2022), ‘lifestyle’ (Hall et al., 2018), ‘needs’ (Ebrahim et al., 2018), ‘skills’ (Sommer et al., 2018; Kay & Edgley, 2019; Lane, 2022), and ‘tools’ (Wilson et al., 2018) are used as proxy terms. Miguel-Lorenzo (2025) argues that practices to manage mental health or relational challenges with Recovery College course tools are referred to as ‘self-management’; while self-care holistic practices are usually offered for the students to manage the negative impact of experiencing difficulties in living, or challenges implementing self-management tools. ‘Self-care’ helps students to create or reinforce a sense of ‘being a worthy human being’ who ‘attends to herself, making time for, or prioritising herself’. ‘Self-care’ is one of the elements, alongside, safety, sharing, and self-regulation that make Recovery College courses conducive to trauma recovery (Miguel-Lorenzo, 2025); and holistic self-care is one of the aspects necessary for ‘intersectional trauma-informed recovery’ (Miguel-Lorenzo, 2025). This study will consider ‘materialities of care’ (Buse et al., 2018) and ‘acts of caring through things’ (Puig de Bellacasa, 2011, In Ibid:245), to ascertain recovery logics of [self-]care (Mol, 2006) considering Town’s (2021, 2022) examination of ‘self-care’ practices among LGBTQ+.young people. It will consider ‘self-care’ and ‘self-management’ practices as ‘restorative work’, embodied practices that heal disruptions or threats to the self (Buse et al., 2018:250). Ethnography has been used to study ‘what people do with objects’ and how things ‘create a “world of practice”’ (Miller, 1997:19, In Buse et al., 2018:251). From this theoretical approach sensory ethnography is recommended. Pink (2007) argues that ethnography ‘should account not only for the observable, recordable realities that may be translated into written notes and texts, but also for objects, visual images, the immaterial, and the sensory nature of human experience and knowledge’ (Pink, 2007:2, In Buse et al., 2018:251). Paying attention to ‘multi-sensory relationships to materialities and environments, drawing out everyday experiences, and understandings of social identities and hierarchies’ (Ibid). Thus, the relationship between materialities of care and person, as well as person relationships through materialities of care, identity, and sensory experiences of what ‘feels right’, are investigated.

A phenomenological anthropological approach focuses on embodiment (Csordas, 1990, 1993, 1994a; Jackson, 1996; Merleau-Pont, 2007), considering the body as a locus of experience of the world which is culturally diverse (Desjarlais & Thropp, 2011:89; Throop, 2003; see Csordas, 1994b, Desjarlais, 2003 for healing; see Good, 1994, Jenkins & Barrett, 2004 for illness and ‘madness’) and the body as a source of knowing the environmental habits (Jackson, 1983). Traumatic experiences can be ‘dis/embodied’ (Lester, 1997) experience, a state of ‘ontological alienation’ (Lester, 2013b:753), ‘[t]rauma is disconnection from others; ontological aloneness, relational injury’ (Ibid:754); ‘a radical loss of agency to preserve bodily integrity or psychological existence’ (van der Kolk, 2003: In Lester, 2013b: 756); a loss of present existence by reliving the past (Ibid: 757; Antze & Lambek, ([2016]1996). Trauma healing can be observed in collective embodied everyday practices enfolding and refashioning memories of loss and violence (Ibid:106). It involves bodily processes out folding into social spaces, and reciprocally, enfolding culture into the body (Kleinman and Kleinman, 1994, In Warim & Denis, 2008:113), questioning ‘self-governance’ (Lester, 2017), and ‘authenticity’ (Lester, 2009). ‘The phenomenological immediacy of trauma can be transformed enfolding that which lies outside of speech and reason, into a semiosis of culture’ (Warim & Denis, 2008:113), that requires thick description, interpretation (Geertz,1973) and critical analysis of embodied power (Foucault, 1972; Lester, 2007; Jenkins, 2008; Myers, 2015; Pope et al., 2016; Luhrmann et al., 2019). This study considers recovery through ‘moral agency’ projects (Myers, 2015, 2016; Myers et al., 2016); and trauma recovery by the ‘rebuilding of social connection’ and the self (Lester, 2013b:759; Luhrmann et al., 2019), embodied cultural practices, symbols, structures (Lester, 2016:753), and logics of care (Mol, 2006).

NIHR Mental Health for All Fellowship

The NIHR Mental Health Research for All (MH-All) programme is an initiative that funds research opportunities for mental health staff and researchers in the North Thames region. The programme aims to improve research participation for underserved communities and staff. The Chief Investigator’s Mental Health For All Fellowship application, signed in December 2022 by the Camden & Islington Recovery College manager and approved by the Camden & Islington NHS Trust (now the North London Foundation Trust) Recovery Lead, defined the scope of the Chief Investigator’s post-doctoral research as follows: ‘I will study the new “recovery approach” to mental health at the NHS Camden & Islington Recovery College. Recovery Colleges first opened in 2009 in the UK. From a biosocial medical anthropology perspective, I will examine how the College’s courses, co-produced and including lived experience, benefit students’ mental health, well-being, and trauma recovery. Also, how the College is changing the “mental health culture” in London communities (NHS, 2019b).’; This is to complete a ‘co-produced ethnography’. ‘A monograph on the subject of “Mental Health Recovery” will illustrate what a “recovery culture is” by examining: the C&I Recovery College’s students’ “self-transformative recovery journeys” considering inclusion, diversity, and intersectionality; how “recovery” is embedded within C&I professionals’ embodied practices, particularly by peer tutors, peer workers, and professional tutors and students, but also policies; and how “recovery” is changing statutory and voluntary services in Camden and Islington.’ Given the newly formed North London Foundation Trust, the study will expand to include North London Foundation Trust’s London Boroughs; with pan-London, national, and international comparative scope. This study on Recovery College students’ ‘self-care’ practices, funded by the NIHR Springboard Award is a pilot study innovating anthropological methodology underpinning the Chief Investigator’s post-doctoral long-term research plan. Furthermore, based on theory of change, the study seeks to provide evidence on the effectiveness of the implementation of a co-produced somatic intersectional trauma-informed (SITI) recovery educational programme for adults with trauma mental health challenges comprising a set of Recovery College courses. Its implementation to be underpinned by knowledge mobilisation activities and interventions paving the way towards impact on service delivery and policy.

Aims and objectives

Reproducing a Recovery College course environment, this co-produced rapid ethnographic study of Recovery College students’ understanding and practices of ‘self-care’ and ‘self-management’ will include: mutual participant observations field notes; journaling; group discussions; reflective handouts; interviews; and ethnographic options, such as, photo-voice, voice notes, drawings, video recording or artistic outputs. This study seeks to understand Recovery College students’ lives providing thick descriptions (Geertz, 1973) of students’ ‘self-care’ practices, investments, materiality, and embodied feelings.

Research question

What are Recovery College students’ understanding and practices of ‘self-care’ and ‘self-management’?

Objectives

1) What do Camden & Islington Recovery Colleges students understand ‘self-care’ or ‘self-management’ are? And, how does ‘self-care’ feel in their bodies?
2) Do Camden & Islington Recovery College students learn ‘self-care’ practices in the Camden & Islington Recovery College? Did they ‘self-care’ before attending a Recovery College course? Do their ‘self-care’ practices change after attending a Recovery College course? Do they practice newly learned ‘self-care’ practices after attending a Recovery College course? Do ‘self-care’ practices become part of their everyday routines or lifestyle?
3) What ‘self-care’ practices do Camden & Islington Recovery Colleges students use for their mental health in their everyday lives? And how much money, resources (e.g., time and space), and materials do they invest in for their ‘self-care’?
4) Do ‘self-care’ practices help Camden & Islington Recovery Colleges students to overcome relapses and symptoms preventing mental health crises? Or, to cope while waiting for clinical support? To maintain or improve mental health and well-being?

Method

Study design

Anthropological methods are recommended to understand Recovery College’s ‘mechanisms of change’ (Meddings et al., 2015b: 219). Ethnography entails the participatory immersion of researchers in the cultural event that is observed and documented, enquiring about, and learning from people’s cognitive, embodied, and social processes (Mosse et al., 2023)-that bring about recovery. Auto-ethnography entails self-exploration, documenting personal experiences in relation to the cultural context (see Taber, 2010 & Ellis et al., 2011, In Mosse et al., 2023:8). Rapid ethnographic research is suitable for short Recovery College courses, lasting from some hours in a day to few hours spread over several days (6 days maximum). Rapid ethnographic research has five defining factors: ‘(1) the research is carried out over a short, compressed or intensive period; (2) the research captures relevant social, cultural and behavioural information and focused on human experiences and practices; (3) the research engages with anthropological and other social science theories and promotes reflexivity; (4) data is collected from multiple sources and triangulated during analysis; and (5) more than one field researcher is used to save time and cross-check data (Vindrola-Padros, 2021a:6). This study’s scope goes further than using ethnographic methods in a realistic evaluation of a Recovery College course (see Birt et al., 2023). It engages with anthropological and other social science theories.

Patient and public involvement: co-produced research

Co-production entails ‘service users designing and delivering services in equal partnership with professionals’ (Boyle & Harris, 2009:3). Co-produced research is ‘research which brings together experts by experience, experts by occupation and researchers who work together, sharing power and responsibility to form equitable partnerships on a study from the beginning to the end’ (Trevillion et al.,, 2022). This includes research questions, data collection and analysis, and writing up. ‘User-led research’ entails ‘developing the topics for research, deciding on the approach and conducting the research are all done by mental health service users and survivors’, supported by researchers (Faulkner & Nicholls, 2001:32; Faulkner, 2004). The Chief Investigator who is a Senior Peer Recovery Tutor since September 2021 formulated the research aim and objectives. She attended the C&I Recovery College course ‘How to cope with traumatic events’ which included ‘self-care’ options as a student; she uses holistic ‘self-care’ practices for her recovery and wellbeing; and she co-produces and delivers recovery courses including ‘self-care’ content. The NIHR North Thames PPIE Advisory Panel, including Recovery College students, provided a favourable opinion. This study will ‘co-produce recovery ethnography with and by’ Recovery College students..

Recruitment

The study will include ten study participants: nine student-researchers and one clinical professional who will co-facilitate workshops with the Chief Investigator. A promotional study flyer will be available at the Recovery College’s open days, enrolment days, End-of-term celebrations, and events. A study invitation e-mail will be sent to Recovery College students in consented contact lists, and students who enrolled in courses with a ‘self-care’ component between September 2021 and the present. The e-mail will include the study participation information sheet, the consent, and demographic forms. Data from study participants, the clinical co-facilitator, and the Chief Investigator is collected.

Sample

The sample might be or not representative of the Camden & Islington Recovery College student population, which agrees with Hayes et al. (2023) that Recovery College students’ mean age is 40.7 years, mostly White/White British (71.5%) and female (57.5%), yet includes Black/Black British (8.9%) and Asian/Asian British (6.4%) students (Ibid) and other ethnicities. It might be that a lower percentage of White/White British students or female students are included in the sample to widen diversity in the sample. Participants include the underserved groups of the Camden & Islington Recovery College’s population: mental health service users, minority ethnic groups (Black, Caribbean, and Asian students), neurodivergent women, and people who are socio-economic disadvantaged, with multiple needs, experiencing multiple forms of discrimination (intersectional perspective), and trauma survivors (Edelman, 2023).

Inclusion criteria

• adults (18 years of age or older)
• they attended a Camden & Islington Recovery College course with a ‘self-care’ component between October 2021 and the present
• they can be or have been North London NHS Foundation Trust (NHS Camden & Islington Foundation Trust side only) service users, but this is not a requirement to participate in the study
• they practice ‘self-care’ for mental health and well-being and ‘self-management’ for recovery
• their capacity will be assumed under The Mental Capacity Act (2005)
• they can attend two full days of workshops (10:00 am – 4:00 pm) and an hour interview; collect personal data for two weeks

Exclusion criteria

The Chief Investigator will invite students interested in study participation for an informal interview on Microsoft Teams, Zoom, or over the phone, to ascertain suitability and to ensure sample diversity. Study participants who lose mental health capacity and/or fail to demonstrate ‘self-care’ expertise will be excluded from the study.

Data collection

The co-produced rapid ethnography is phased in three stages which will take place over approximately a month:

Stage 1/Day 1. (10:00 am – 4:00 pm) Workshop on co-producing recovery ‘self-care’ course content and ethnographic research methodology to study Recovery College students’ ‘self-care’ practices, at a North London NHS Foundation Trust site.

Stage 2/Day 2. The Chief Investigator interviews study participants for one hour at a North London NHS Foundation Trust site, or online via Microsoft Teams or Zoom.

Stage 3/Day 3. (10:00 am – 4:00 pm) Workshop on co-produced co-learning of lived-experience recovery of ‘self-care’ practices led by study participants at a North London NHS Foundation Trust site.

Co-produced rapid ethnography

This study reproduces a Recovery College course environment where study participants co-produce rapid ethnographic research. The Chief Investigator and the study participants will have a notebook in which to write down their ethnographic observation field notes during the Day 1 and Day 3 Workshops. Study participants are expected to actively participate in the Workshop activities to voice their knowledge and views which the Chief Investigator will write down in flip-chart paper and voice record. Study participants might also write down their views on flip-chart paper, paper, or post-its and handouts, which will be handed over to the Chief Investigator for data analysis. On Day 1 students will be: a) provided with a list of suggested interview questions to co-produce interview questions; b) explained how to record their ‘self-care’ practices for two weeks in a journal; c) given auto-ethnographic research options; d) explained what a photo voice is; e) explained how to submit ethnographic data via e-mail or in person. The Chief Investigator will send study participants the interview protocol before their interview on Day 2. The Chief Investigator will share with the study participants a draft summary of Day 1 and 2 research outcomes, resulting from data transcription and preliminary analysis, on the Day 3 Workshop. Study participants will comment and add to the findings draft summary. On Day 3 study participants will teach a chosen ‘self-care’ practice to the other study participants, with the consent option to be video recorded. The Chief Investigator will provide compensation gift vouchers as stated in the participation information sheet at the end of each study stage. On Day 3 Workshop the Chief Investigator will give the study participants a study participation certificate.

Documentary evidence

The Chief Investigator will analyse the material culture of Camden & Islington Recovery College’s lesson plans, PowerPoints, handouts, and resources, for courses that include a ‘self-care’ component, and which the Chief Investigator attended, co-produced, and/or co-delivered in her role of Peer Recovery Tutor from October 2021 to present. Including: ‘How to Cope With Traumatic Events’; ‘Being Kind to Yourself’; ‘Alone but Not Lonely’; ‘Nurturing Self-Compassion’; ‘Dealing With Difficult Emotions’; ‘Building Healthy Relationships’; ‘Hoarding’; ‘Tree of Life’; ‘Building Resilience via Tree of Life’; ‘Thinking Differently and Living Well with Neurodivergence’; ‘Creating a Meaningful Life’; ‘Dealing with Low Mood and Depression’; ‘Introduction to Dance and Movement for Health and Wellbeing’; ‘Building your Assertiveness toolbox’; ‘Assertiveness for All’; ‘Living; Well With a Long-Term Condition”; ‘Understanding and Coping With Anxiety’; ‘Coping with Anxiety’; ‘What is Peer Working’; ‘Steps into Peer Roles’; ‘Expressive Writing’; ‘Understanding Anger’; and ‘History Wellbeing Walk’. The relevant documents on ‘self-care’ will provide context and triangulation with observations, interviews, and other co-produced ethnographic material.

Data analysis

The data analysis will run parallel to data collection, using rapid assessment procedures (RAP) (Vindrola-Padros, 2021b). Data collected on Stages 1, 2, and 3 will be analysed following guidance for reflexible thematic analysis (Braun & Clarke, 2019, 2006), adapted for rapid ethnographic research. Interview data will be transcribed accurately, ‘coded’ by topics, and clustered in themes which will inform the report writing employing the participants’s descriptive examples or cases for each of the themes identified. To do this, the Chief Investigator will audio record Workshops group discussions, and interviews; she will write participant observations field notes, to include salient topics and idioms of what has been heard or seen; to guide the posterior audio files full transcription and to provide study participants with real-time summaries in Day 3 Workshop. To speed up audio files verbatim transcriptions O365 package Word Dictate will be used. The Day 1 Workshop handout and the Day 1 Workshop co-produced interviews handout, will help to structure the collection of data by areas of inquiry in group discussions and individually, akin to RAP sheets (Vindrola-Padros, 2021b), which are a flexible table with a list of the main data we hope to obtain during data collection. Data triangulation includes data audio recorded in workshops and interviews; study participants’ views collected for example in flip-chart paper, written in handouts, notebooks, journals, and other ethnographic tools; and the Chief Investigator participant observations field notes. The study participants will collect data on their ‘self-care’ practices, materialities, investments, embodied feelings in a journal, and other sensory research methods (Pink, 2009): photo voices, audio notes, video recordings, drawings, and artistic outputs to capture in-depth data.

Data management

All confidential data such as consent forms and other study documents will be archived securely for 5 years by sponsor policy. The recordings and transcriptions will be stored in a UCL website data management secure system called UCL Data Safe Haven, which is password-protected and accessible to the Chief Investigator only. All relevant data will be uploaded into NVivo, a software package for qualitative data analysis, which is password-protected and accessible to the Chief Investigator only. The audio recordings will be deleted upon transcription. When study participants give additional consent for video recordings of the Day 3 workshop ‘self-care’ practices these will be used for academic or teaching purposes only. Any other non-digital research data will be stored safely in a locked cabinet at UCL the Chief Investigator has only a key.

Ethics and dissemination

The study received a favourable opinion from the Northern Ireland Research Committee (HSC REC A), REC reference: 24/NI/0127; Protocol number: M-691-2551; and IRAS project ID: 349185 on the 10th of December 2024. The Health Research Authority (HRA) and Health and Care Research Wales (HCRW) issued an approval letter on the 24th of December 2024. This study gained OSF registration on the 21st of November 2024: https://doi.org/10.17605/OSF.IO/ZHGQK. The Chief Investigator has completed Information Governance training and will be refreshed annually. The Chief Investigator will comply with the principles of UK data protection law, including the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018. The Chief Investigator has a current registration with the Association of Social Anthropologists of the UK which represents the interest of professional social anthropologists, guardian of the ASA’s Ethical Guidelines for Good Practice. The Chief Investigator will be the data custodian and the North London NHS Foundation Trust will act as the data controller. It follows the UK Policy Framework for Health and Social Care Research principles of good practice in the management and conduct of health and social care research and research transparency: registering research studies; reporting results; informing participants; and sharing study data. The Chief Investigator completed the NIHR Good Clinical Practice certificate training on the 26th of October 2023, and the NOCLOR-UCL Principal Investigator certificate training on the 20th of November 2023. This study complies with the World Medical Association Declaration of Helsinki- ethical principles for medical research involving human participants.

Ethical considerations include study participants’ disclosure of harm or distress in the present or past, experiencing a setback in their recovery, or being triggered by recalling memories of past events. For this, the Chief Investigator designed a distress protocol and mental health support signposting document. The participant information sheet (PIS) explains safeguarding options for disclosures of harm; e-mail addresses where to complaint about the Chief Investigator’s treatment; and possible disadvantages of taking part in the study, such as feeling distressed when recalling or listening to difficult experiences in life, which might have been traumatic. The workshops’ trauma-informed lesson plans include group agreements, so the data heard or discussed during the study remains confidential. Study participants, free to withdraw from the study at any point without explanation, will confirm consent verbally at every study stage. It also considers potential power imbalances between the Chief Investigator and study participants: participants are Camden & Islington Recovery College students, and they might feel obliged to participate in the study. The research topic ‘self-care’ is relevant to the study participants because ‘self-care’ is a key component in the Camden & Islington Recovery College courses lesson plans co-produced by ‘experts by experience’ and ‘experts by profession’. It is not a topic of research imposed on the participants, e.g. a topic that might not be relevant to Recovery College students. Power imbalances will be minimised because the Chief Investigator has lived experience of mental health challenges and recovery, attended a Camden & Islington Recovery College ‘How to cope with traumatic events’ course as a student, and uses ‘self-care’ for recovery. Furthermore, she is an intersectional trauma-informed practitioner and researcher who will seek the study participants’ consent at every step of the study ensuring that participants do not feel coerced to take part in the study. Finally, there is a theoretical risk of a data breach due to the pseudonymised data. All data will be pseudonymised using study IDs unless the study participants consent to use their names in the study. Study participants can choose to co-author publications. The risk of breach of information has been limited by having a clear plan for secure data storage. Special category data processing and data storage will entail the safe storage of data in UCL Data Safe Haven and Nvivo. All non-digital data will be stored in a locked cabinet in the UCL Department of Applied Health Research. The Chief Investigator will be the only person with passwords and a key to access the study data. Study participation ID records will be kept separate from the information collected from participants.

Consent

Once confirmation of capacity and capability has been received from the North London NHS Foundation Trust, the Chief Investigator will recruit study participants. Study participants will read the participation information sheet, the consent, and demographic forms before they sign the consent form and complete the demographic form. The participation information sheet explains that there are different consent options. Study participants can choose their information to be pseudonymised, which means that their name will not be linked to their information, and identifiable data from their information will be removed; Or they can choose to ask for their name to be linked to their information. Study participants can choose to become a co-author, being their personal information pseudonumised or not. Study participants’ participation is voluntary and they can withdraw from the study at any time without giving a reason. Personal data collected until that point will be retained. The Chief Investigator will support prospective study participants in reading, understanding the study participation sheet, and completing the consent, and demographic forms. The Chief Investigator will ask study participants to confirm consent verbally at every study stage.

Discussion

The Chief Investigator is a Senior Peer Recovery College Tutor and thus, this study is conducted by an NHS underrepresented staff in medical research. Against the stigma of living with or having recovered from mental health challenges, this study methodology is designed to be participatory, and led by lived experience experts. The Chief Investigator has designed this ethical study protocol based on Recovery College’s professional experience and Anthropological expertise. The study will contribute to the academic fields of recovery, trauma, and medical anthropology; and will create content for a Recovery College ‘self-care’ course.

Disclaimer

The views expressed are those of the author(s) and not necessarily those of the National Institute for Health Research, the North London NHS Foundation Trust, or the Department of Health and Social Care.

Provenance and peer review

Not commissioned; externally peer reviewed.

Data availability statement

No data are associated with this article.

Acknowledgements

Thanks to the Camden & Islington Recovery College, the North London NHS Foundation Trust, for approving my NIHR Mental Health For All Fellowship research project application in December 2022, that I was awarded with, and for accepting my NIHR Springboard Award in 2023 to implement my NIHR Mental Health For All Fellowship research project. Thanks to the NIHR Mental Health for All programme, to the UCL Department Applied health research for hosting the NIHR ARC North thames, to the NIHR Mental Health For All Team, Fellows and Awardees, to the NIHR North Thames PPIE Advisory Panels, NOCLOR, family and friends, and most importantly thanks to the Camden & Islington Recovery College students who provided me with feedback on research topics and methodology.

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Version 1

VERSION 1 PUBLISHED 17 Mar 2025

Author details Author details

Applied Health Research, UCL, London, Greater London, WC1E 6BT, UK

Xandra Miguel-Lorenzo
Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This study is funded by the National Institute for Health Research (NIHR), Springboard Award 2023. ARC Project MH-ALL Opportunity Funds_ Lorenzo
This report is independent research funded by the MH-ALL programme, National Institute for Health and Care Research ARC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research and Care or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Miguel-Lorenzo X. Study Protocol for a co-produced rapid ethnographic study of self-care practices among Recovery College students who self-manage their mental health and wellbeing. [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2025, 14:303 (https://doi.org/10.12688/f1000research.161749.1)

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Reviewer Report 16 Apr 2025

Michael John Norton, University College Cork, Cork, County Cork, Ireland

Not Approved

https://doi.org/10.5256/f1000research.177825.r373748

Dear Author
Many thanks for submitting this study protocol for peer review. Although a potentially worthwhile study, the protocol needs some work in order to pass open peer review. Please see my comments below.

Entire Paper ... Continue reading

Dear Author
Many thanks for submitting this study protocol for peer review. Although a potentially worthwhile study, the protocol needs some work in order to pass open peer review. Please see my comments below.

Entire Paper - There are significant grammatical errors in this paper which makes this paper difficult to read. I understand English may not be the first language of the author, but in order for this protocol to pass open peer review, the way the narrative is presented in this paper needs to be drastically improved.

Author - You mention this is a co-produced study, yet there is only one author listed. The author either needs to include the whole co-production panel as authors or needs to provide an exceptional rationale as to why there is only one author on a manuscript that was meant to be co-produced.

Abstract - Several spelling and grammatical errors here. Little philosophical positioning noted here. I do not believe that reflexive thematic analysis links philosophically with a rapid ethnographic study which may cause concern as the study progresses. You mention NVivo in data analysis, but you need to tell me what version of the package is to be used, In ethics and dissemination you introduce the primary investigator but do not elaborate whether this is the author or someone else. If someone else, why are they not co-authors here? Additionally, you do not tell me how you will disseminate the results of this study to both the academic community and the lay population.

Keywords - If of equal value, place in alphabetical order.

Introduction - You say recovery colleges were first piloted in 2007 but this is incorrect. The first recovery college was in the US in the 1990s. Imroc is spelled wrong, it should be ImROC. Poor English grammar and spelling throughout. Before moving to your methods you provide half a page to describing a fellowship which has no relevance to the study bar the fact they are your funders. Please shorten or remove.

Objectives - You provide a list of questions and not objectives, this needs to be rewritten as objectives.

Methods - Firstly you need a section discussing the philosophical foundations of the paper and how they influenced the type and mechanism of data collected in this study. In sample, you need to discuss information power and how this helped determine when to stop data collection. If not, you need to then tell me how a consensus was reached to the extent that agreement was made that data collection could cease. The exclusion criteria is not suffcient enough and needs to be presented similar to that of the inclusion crtiteria. In data analysis, it is reflexive thematic analysis, not reflexible. In ethics and dissemination, you give a lot of time to ethics - which is important and should be kept - but you tell me nothing of how the study results will be dissemninated to the lay and academic communities.

Discussion - is small and insufficient for what you are doing. This is a study protocol and a discussion cannot be made here as there is no data produced as of yet to discuss.

Unfortunately, although the study has promise, there are a number of errors that needs improvement and rectifying before this paper can pass open peer review.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Stated in the report

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report 09 Apr 2025

Tessa-May Zirnsak, La Trobe University, Melbourne, Victoria, Australia

Approved with Reservations

https://doi.org/10.5256/f1000research.177825.r373749

This is an interesting proposal for an innovative study. I have some feedback around clarity, which I have outlined below. I think this will strengthen the author's proposal and bring out the strengths of their research.

Abstract
... Continue reading

This is an interesting proposal for an innovative study. I have some feedback around clarity, which I have outlined below. I think this will strengthen the author's proposal and bring out the strengths of their research.

Abstract
- The abstract would benefit from refining. The first sentence has many ideas in it, which is confusing for the reader. I suggest re-writing the first sentence to ease the reader into the topic, and providing more connections with the research question/exposition of the paper in the introduction section. Further, it should be in the future tense (e.g., "will be recruited" rather than "are recruited"). Some sentences are brief and incomplete (e.g. "Data accurately transcribed, coded by topics, is clustered in themes, to inform report writing, employing study participant’s descriptive examples or cases for each identified theme")
Introduction
- There's a referent to "the community mental health transformation". I am not sure what this is referring to?
- "Bringing cultural change to mental health services through community-based recovery practice (Repper & Perkins, 2003; Department of Health, 2011; NHS, 2019b)." This sentence is incomplete
- You describe Chamberlin as both a "lived experience advocate" and "mental disability rights activist" in the same sentence - I suggest removing the second description
- Chamberlin doesn't use the phrase "self-care skills" in her 1977 text - I suggest removing quotation marks
- At the end of the introduction, several theoretical frameworks are introduced - trauma, embodied cultural practices, embodied power, etc, and it's not clear how these relate to the study design
- I suggest that the introduction may need some reworking to reduce some of the background (I think this could be synthesised) and directly address the need for the study and the theoretical framing
NIHR Mental Health for All Fellowship
- "The Chief Investigator’s Mental Health For All Fellowship application, signed in December 2022 by the Camden & Islington Recovery College manager and approved by the Camden & Islington NHS Trust (now the North London Foundation Trust) Recovery Lead, defined the scope of the Chief Investigator’s post-doctoral research as follows: ‘I will study the new “recovery approach” to mental health at the NHS Camden & Islington Recovery College" this sentence is very long - I suggest breaking up for readability
- Some information in this section is repeated from the Introduction - needs revising
- New concepts are being introduced here - "recovery culture" - I suggest introducing all key concepts in introduction
Aims and Objectives
- This section includes information on the methodology, when it should just include a clear statement on what the study hopes to achieve.
- What is a "thick description"?
Research question
- This is an excellent and clear statement. I suggest reformulating the introduction to only address this question, and limiting the number of concepts employed to those only relevant to this question - otherwise it becomes hard to follow for the reader, and exceptionally ambitious.
Objectives
- This is an extraordinary number of questions for the study to answer. I think some of these might be better situated in an interview schedule, or in analysis, rather than as primary objectives.
Method
- Study design is well justified
- For co-production, I would expect there to be some engagement with lived experience experts beyond the lead CIs experience, although I note that this experience does increase the legitimacy of the research. It would be good to include more information about the consultations with lived experience experts in the development of the protocol
- Capacity criteria isn't clear - does this mean that the study is only open to people who aren't on a compulsory treatment order?
- Interview format shouldn't be included under the exclusion criteria - unless you are saying that participants who can't use a computer or phone will be excluded?
- It's not clear what "fail[ing] to demonstrate "self-care" expertise" means
- The study design and analysis plan sound really inclusive and innovative - well done
Discussion
- Discussions typically situate the study in the literature. I suggest moving some of the content form the introduction here. So, the introduction would provide a rationale for the study, and the discussion would put it in conversation with similar work.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Recovery colleges, mental health, compulsion, lived experience involvement in research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Tessa-May Zirnsak, La Trobe University, Melbourne, Australia
Michael John Norton, University College Cork, Cork, Ireland

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16 Apr 2025 | for Version 1

Michael John Norton, University College Cork, Cork, County Cork, Ireland

24 Views Cite this report Responses(0)

Not Approved

Dear Author
Many thanks for submitting this study protocol for peer review. Although a potentially worthwhile study, the protocol needs some work in order to pass open peer review. Please see my comments below.

Entire Paper - There are significant grammatical errors in this paper which makes this paper difficult to read. I understand English may not be the first language of the author, but in order for this protocol to pass open peer review, the way the narrative is presented in this paper needs to be drastically improved.

Author - You mention this is a co-produced study, yet there is only one author listed. The author either needs to include the whole co-production panel as authors or needs to provide an exceptional rationale as to why there is only one author on a manuscript that was meant to be co-produced.

Abstract - Several spelling and grammatical errors here. Little philosophical positioning noted here. I do not believe that reflexive thematic analysis links philosophically with a rapid ethnographic study which may cause concern as the study progresses. You mention NVivo in data analysis, but you need to tell me what version of the package is to be used, In ethics and dissemination you introduce the primary investigator but do not elaborate whether this is the author or someone else. If someone else, why are they not co-authors here? Additionally, you do not tell me how you will disseminate the results of this study to both the academic community and the lay population.

Keywords - If of equal value, place in alphabetical order.

Introduction - You say recovery colleges were first piloted in 2007 but this is incorrect. The first recovery college was in the US in the 1990s. Imroc is spelled wrong, it should be ImROC. Poor English grammar and spelling throughout. Before moving to your methods you provide half a page to describing a fellowship which has no relevance to the study bar the fact they are your funders. Please shorten or remove.

Objectives - You provide a list of questions and not objectives, this needs to be rewritten as objectives.

Methods - Firstly you need a section discussing the philosophical foundations of the paper and how they influenced the type and mechanism of data collected in this study. In sample, you need to discuss information power and how this helped determine when to stop data collection. If not, you need to then tell me how a consensus was reached to the extent that agreement was made that data collection could cease. The exclusion criteria is not suffcient enough and needs to be presented similar to that of the inclusion crtiteria. In data analysis, it is reflexive thematic analysis, not reflexible. In ethics and dissemination, you give a lot of time to ethics - which is important and should be kept - but you tell me nothing of how the study results will be dissemninated to the lay and academic communities.

Discussion - is small and insufficient for what you are doing. This is a study protocol and a discussion cannot be made here as there is no data produced as of yet to discuss.

Unfortunately, although the study has promise, there are a number of errors that needs improvement and rectifying before this paper can pass open peer review.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Stated in the report

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report

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09 Apr 2025 | for Version 1

Tessa-May Zirnsak, La Trobe University, Melbourne, Victoria, Australia

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Approved With Reservations

This is an interesting proposal for an innovative study. I have some feedback around clarity, which I have outlined below. I think this will strengthen the author's proposal and bring out the strengths of their research.

Abstract
- The abstract would benefit from refining. The first sentence has many ideas in it, which is confusing for the reader. I suggest re-writing the first sentence to ease the reader into the topic, and providing more connections with the research question/exposition of the paper in the introduction section. Further, it should be in the future tense (e.g., "will be recruited" rather than "are recruited"). Some sentences are brief and incomplete (e.g. "Data accurately transcribed, coded by topics, is clustered in themes, to inform report writing, employing study participant’s descriptive examples or cases for each identified theme")
Introduction
- There's a referent to "the community mental health transformation". I am not sure what this is referring to?
- "Bringing cultural change to mental health services through community-based recovery practice (Repper & Perkins, 2003; Department of Health, 2011; NHS, 2019b)." This sentence is incomplete
- You describe Chamberlin as both a "lived experience advocate" and "mental disability rights activist" in the same sentence - I suggest removing the second description
- Chamberlin doesn't use the phrase "self-care skills" in her 1977 text - I suggest removing quotation marks
- At the end of the introduction, several theoretical frameworks are introduced - trauma, embodied cultural practices, embodied power, etc, and it's not clear how these relate to the study design
- I suggest that the introduction may need some reworking to reduce some of the background (I think this could be synthesised) and directly address the need for the study and the theoretical framing
NIHR Mental Health for All Fellowship
- "The Chief Investigator’s Mental Health For All Fellowship application, signed in December 2022 by the Camden & Islington Recovery College manager and approved by the Camden & Islington NHS Trust (now the North London Foundation Trust) Recovery Lead, defined the scope of the Chief Investigator’s post-doctoral research as follows: ‘I will study the new “recovery approach” to mental health at the NHS Camden & Islington Recovery College" this sentence is very long - I suggest breaking up for readability
- Some information in this section is repeated from the Introduction - needs revising
- New concepts are being introduced here - "recovery culture" - I suggest introducing all key concepts in introduction
Aims and Objectives
- This section includes information on the methodology, when it should just include a clear statement on what the study hopes to achieve.
- What is a "thick description"?
Research question
- This is an excellent and clear statement. I suggest reformulating the introduction to only address this question, and limiting the number of concepts employed to those only relevant to this question - otherwise it becomes hard to follow for the reader, and exceptionally ambitious.
Objectives
- This is an extraordinary number of questions for the study to answer. I think some of these might be better situated in an interview schedule, or in analysis, rather than as primary objectives.
Method
- Study design is well justified
- For co-production, I would expect there to be some engagement with lived experience experts beyond the lead CIs experience, although I note that this experience does increase the legitimacy of the research. It would be good to include more information about the consultations with lived experience experts in the development of the protocol
- Capacity criteria isn't clear - does this mean that the study is only open to people who aren't on a compulsory treatment order?
- Interview format shouldn't be included under the exclusion criteria - unless you are saying that participants who can't use a computer or phone will be excluded?
- It's not clear what "fail[ing] to demonstrate "self-care" expertise" means
- The study design and analysis plan sound really inclusive and innovative - well done
Discussion
- Discussions typically situate the study in the literature. I suggest moving some of the content form the introduction here. So, the introduction would provide a rationale for the study, and the discussion would put it in conversation with similar work.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Recovery colleges, mental health, compulsion, lived experience involvement in research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Study Protocol for a co-produced rapid ethnographic study of self-care practices among Recovery College students who self-manage their mental health and wellbeing.

Abstract

Introduction

Method

Analysis

Ethics and Dissemination

Keywords

Introduction

NIHR Mental Health for All Fellowship

Aims and objectives

Research question

Objectives

Method

Study design

Patient and public involvement: co-produced research

Recruitment

Sample

Inclusion criteria

Exclusion criteria

Data collection

Co-produced rapid ethnography

Documentary evidence

Data analysis

Data management

Ethics and dissemination

Consent

Discussion

Disclaimer

Provenance and peer review

Data availability statement

Acknowledgements

References

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