Pathways to Recovery-Oriented Practice: The Roles of Cultural Humility, Recovery Knowledge, and Recovery Attitudes Among Mental Health Practitioners

Background and Purpose:

Promoting recovery-oriented mental health care requires not only clinical expertise but also a reflective and culturally responsive mindset among mental health providers. Recovery-related knowledge and cultural humility are considered essential for developing the professional competencies needed to support individuals in their recovery journey. However, few studies have examined how these factors work together. In particular, little is known about whether recovery-supportive attitudes serve as a psychological mechanism linking cultural humility to recovery-promoting competency. This study aimed to investigate how recovery-related knowledge and cultural humility contribute to recovery-promoting competency, and whether attitudes toward recovery mediate the effects of cultural humility.

Methods:

An anonymous cross-sectional survey was administered via Qualtrics between June 2024 and March 2025 to licensed U.S. mental health providers serving adults with serious mental illness (a minimum of 40% required for study eligibility). Participants (N = 205) were recruited through snowball sampling using mental health provider directories, professional networks, and social media. Four latent constructs were assessed: recovery-related knowledge (20 items), cultural humility (9 items), recovery-supportive attitudes (7 items), and recovery-promoting competency (24 items). Exploratory factor analysis was conducted to reduce the number of items per construct and assess the underlying factor structure, while internal consistency was examined using Cronbach’s α. The final structural equation model (SEM) included 6 recovery knowledge items, 4 cultural humility items, 4 recovery attitude items, and 6 recovery-oriented competency items. SEM was conducted using the lavaan package in R, with full information maximum likelihood estimation and bootstrapped confidence intervals. Respondents’ age, gender, education, race, years of experience, and caseload size were included as control variables.

Results:

The final SEM demonstrated acceptable fit (CFI = 0.894, TLI = 0.881, RMSEA = 0.065, SRMR = 0.088). Recovery knowledge had a significant direct effect on recovery-promoting competency (β = 0.43, p < .001), while cultural humility did not show a direct effect (β = –0.50, p = .452). However, cultural humility was strongly associated with recovery-supportive attitudes (β = 1.05, p < .001), and these attitudes showed a marginally significant effect on recovery-promoting competency (β = 1.13, p = .088). The indirect effect of cultural humility through attitudes was also marginally significant based on bootstrapped estimates (β = 1.19, 95% CI [0.51, 5.99], p = .082). Age was negatively associated with competency (p = .014), and higher total client caseload size was positively associated with recovery-supportive attitudes (p = .035).

Conclusions and Implications:

Findings suggest that knowledge about recovery directly shapes providers’ recovery-promoting competency, while cultural humility influences this capacity indirectly by fostering positive attitudes toward recovery. These attitudes may not always translate into immediate behavioral change, but could accumulate over time to enhance recovery-oriented practice. Interventions aiming to improve recovery-oriented care should target both cognitive understanding and culturally reflective capacity. Future research should explore these pathways longitudinally and examine how organizational or contextual factors support the translation of attitudes into recovery-oriented practice.