The Development and Examination of the Stages of Recovery Instrument

Background and Purpose: For the last few decades, the perspective of recovery has been widely accepted as the major treatment orientation in the field of mental illness. To differentiate the progress, the stages of recovery have drawn a lot of attention. However, in terms of measurement, the two existing instruments have not been able to fully tap the holistic concept of process and outcome of recovery and demonstrate strong psychometric properties. Thus, this study aimed to develop a "stages of recovery instrument" and to use it in the following evaluation study of a recovery-oriented treatment program on persons with psychiatric disability in Taiwan.

Methods: The initial items were developed to capture the 13 components and outcomes of recovery, including hope, willing to cope, taking responsibility, management of disability, sense of self, new meaning, self-determination, awareness and potentiality, competence, better social functioning, overall well-being, life satisfaction, and helping others. Four experts were asked to examine the face validity of the items. The process yielded a 51-item instrument and was administered on 471 participants. The sample was drawn from 24 community psychosocial rehabilitation centers, including 370 members receiving the services as well as 101 persons living a purposeful life in the community. Data were collected through self-administration. Research assistants were present to answer questions concerning the questionnaires during the process. Reliability and validity of the instrument were examined through factor analysis, a reliability test, and the Pearson correlation test. Cluster analysis, discriminant analysis, one-way ANOVA were conducted to differentiate the stages of recovery. Results: The sample was composed of 55.6% males; 72% of the sample had a diagnosis of schizophrenia and 22.9% had a diagnosis of affective disorder. The common factor analysis with varimax rotation revealed a 6-factor structure within the scale, including "regain autonomy" (15 items, a=0.95), "management of disability" (9 items, a=0.92), "overall well-being' (8 items, a=0.91), "social functioning" (7 items, a=0.85), "hope" (3 items, a=0.80) and "help others" (3 items, a=0.89). A total of 45 items remained and each had a factor loading ³a 0.40 on its corresponding factor. Three to five weeks test-retest reliability was 0.72 for the total score of recovery (n=55). In terms of discriminant validity, the total score could significantly differentiate the participants receiving service in the rehabilitation centers and community sample. The instrument also has good external construct validity; the total score significantly correlated with empowerment (g=0.61), social functioning (g=0.57), and life satisfaction (g=0.49). Moreover, the analyses yielded four stages of recovery. The results showed significant differences among the four stages on all the six factors of recovery, with the participants in higher stages scoring higher than those in the previous stage. The cutoff score for each stage was further developed. Conclusions and Implications: The findings demonstrated that the "stages of recovery instrument" developed in this study is reliable and valid. The trace of recovery could be made clear through the usage of this instrument, both in process and outcomes.