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The development of a contextually-appropriate measure of individual recovery for mental health service users in a South African context

Mental health is a crucial part of the overall wellbeing of persons. Recovery is increasingly recognised worldwide as an essential approach to mental health. In this study recovery is regarded as personal recovery, a multidimensional construct differing from remission. In high-income countries, the study of recovery has developed and expanded to raise individuals' awareness of, and involvement in, their own recovery and to change mental health services to have a recovery orientation. With increasing awareness and involvement, and changing orientations, comes the importance to measure individuals' recovery for personal, professional and funding purposes. Individual recovery measurement has increased worldwide. In South Africa, the study of recovery and its measurement is still emerging in a context of great challenges and resource constraints. Thus, this study aimed to contribute to the growing knowledge of recovery in South Africa by exploring the understanding of recovery among service users, carers and service providers, the barriers to, and facilitators of, recovery, and by developing an individual measure of recovery that is appropriate to a South African context. The study employed an exploratory sequential mixed-method design. Exploring the understanding of recovery through 37 interviews and three focus groups with service users, carers and service providers at three tertiary psychiatric hospitals in the Western Cape Province of South Africa, and comparing these results with recovery processes established through other empirical work, yielded dimensions and sub-dimensions of recovery appropriate to the study context, which were formulated into a South African definition of recovery. The dimensions of recovery were closely linked to each other and confirmed the layered, iterative and non-linear nature of the recovery process. Together with the barriers to, and facilitators of, recovery, which were also explored during the interviews and focus groups and indicated how recovery happens (or does not) in the lives of service users, the definition and dimensions of recovery were used to inform the formulation of items and format of the measure. The items were reduced and format refined through a process of preliminary content validity, which consisted of (a) a Delphi panel of professional experts; (b) cognitive interviews with service users; (c) the matching of items and dimensions by clinical experts; and (d) a readability test. The resultant Measure of Individual Mental Health Recovery for a South African context consists of 38 items. This is the first such measure developed for a South African context and makes it possible for service users, together with carers and direct service providers, to use the results from the administration of the measure as a starting point for discussions about the recovery process for the service user. The measure may also provide recovery-oriented programme implementers with a means to determine how participants are moving along in their recovery to report to funders, either to obtain or retain funding. The emphasis throughout the results on support in various forms as crucial to recovery suggests the appropriate and circumspect development of formal peer support work for South African contexts, which may ultimately be beneficial on many levels.

Full Name
Dr Anneliese De Wet