Defining and Measuring Personal Recovery in Latin America
This project was informed by the significant gap between the intention of mental health policy and services to become recovery-oriented, and the absence of user-focused recovery models and measurement tools. Latin America in particular is at a critical time in the development of community mental health services in the region and little if any research has explored the concept of recovery from a service user/carer perspective. Thus, the overarching objective aim of this project was to define recovery and provide a basis to measure recovery from a user and informal carer perspective, with a focus on a Latin American population.
This project used an exploratory sequential mixed methods design consisting of three theory generating studies (qualitative meta-narrative review, qualitative interview study and a systematic review) that informed a quantitative data analysis and interpretation (psychometric evaluation).
Study 1 involved a meta-narrative synthesis of 50 articles. Four main recovery domains were identified (“Recovery Constructed in Society”, “Normalcy”, “Individual Recovery” and “Clinical Recovery Experience”). Both users and carers emphasised individual recovery goals such as becoming self-sufficient, however, users’ understanding of recovery revolved especially around connecting with others, while caregivers focused more on clinical definitions of recovery.
Study 2 examined knowledge, experiences, and perceptions of recovery in 41 interviews with Latin American mental health service users and carers. There was considerable overlap between the themes identified in this Study and those found in Study 1, yet this Latin American sample placed greater emphasis on recovery goals such as reaching economic stability, adhering to medical treatment, and getting along with their families.
Study 3 consisted of a systematic review of 14 studies about the psychometric properties of the Recovery Assessment Scale (RAS). Studies reported the RAS had adequate construct validity, internal consistency, and sensitivity to change. However, there were important concerns about psychometric quality at an item level.
Study 4, a psychometric evaluation of the RAS in a Latin American sample, found less encouraging results than those reviewed in Study 3. Factor analysis and item content evaluation suggested the measure represented the unidimensional construct of Individual Recovery proposed in Studies 1 and 2. However, subthemes within this dimension such as being healthy or having a good appearance were not covered by the RAS.