Aims: Engagement in psychological therapy during a first episode of psychosis (FEP) has been found to involve emotional, social, practical, and service level factors. This qualitative comparative analysis (QCA) aims to identify which factors are most relevant to service users as barriers and facilitators to engagement in FEP.

Method: QCA combines qualitative and quantitively methodology by utilising set theory to understand configurations of factors which are necessary and sufficient for engagement in psychological therapy. This aims to find the shortest possible expression of potential combinations of conditions (barriers and facilitators) that are sufficient for the outcome of engagement. Themes from the concurrent meta-ethnography review of 22 studies were utilised in this QCA.

Results: The QCA found that ‘Emotional distress’ was most relevant to service users as a barrier to engagement and that ‘Destigmatizing’ and ‘Therapist interpersonal approach and skills’ were most relevant to service users as facilitators to engagement.

Conclusions: QCA builds upon qualitative methodology by identifying the themes which are most frequently referred to across multiple studies. Strengths, limitations, and further directions are discussed.