Skip to content

Advertisement

Open Access

The property of the Japanese version of the Recovery Knowledge Inventory (RKI) among mental health service providers: a cross sectional study

  • Rie Chiba1Email author,
  • Maki Umeda2,
  • Kyohei Goto3,
  • Yuki Miyamoto4,
  • Sosei Yamaguchi5 and
  • Norito Kawakami6
International Journal of Mental Health Systems201711:71

https://doi.org/10.1186/s13033-017-0178-7

Received: 16 August 2017

Accepted: 11 December 2017

Published: 28 December 2017

The Correction to this article has been published in International Journal of Mental Health Systems 2018 12:34

Abstract

Background

The Recovery Knowledge Inventory (RKI) is one of the influential scales to assess knowledge and attitude toward recovery-oriented practices among mental health service providers. In the present study, we aimed to develop a Japanese version of RKI and examine the validity and reliability.

Methods

We translated RKI into Japanese by reference to the guidelines for translating and adapting psychometric scales. A cross-sectional questionnaire survey was conducted with mental health service providers. Of a total of 475 eligible professionals, we used data from the 299 participants without missing value for the analyses (valid response rate = 62.9%). The questionnaire included Japanese RKI, Recovery Attitudes Questionnaire, The positive attitudes scale, and Japanese-language version of the Social Distance Scale. To examine the factorial validity of RKI, explanatory factor analysis and confirmatory factor analysis was employed. Convergent validity was assessed by calculating Pearson’s correlation coefficients between the total RKI score and the scores for the other three scales. We also calculated Cronbach’s α coefficients for the total score and for each domain of RKI to assess internal consistency reliability.

Results

The participants’ mean age was 40.4 years and 30.4% were men. 20-item RKI did not provide any adequate or interpretable factor solutions at any number of factors by EFAs. Thus four items (#1, 4, 5, and 13) were subsequently eliminated in stages, then 16-item RKI was employed as a consequence for further analyses. EFA with four factor structures yielded marginally interpretable constitution. Each factor represented the knowledge regarding psychiatric symptoms and recovery; knowledge about the recovery process; the understanding of what is important for recovery; and the understanding of the challenges and responsibility in recovery, respectively. Subsequent CFA suggested good fit to the data. Good convergent validity and understandable internal consistency reliability were also observed.

Conclusions

The Japanese 16-item RKI revealed reasonable factorial validity, good convergent validity, and understandable internal consistency reliability among mental health professionals. Japanese cultural settings seemed to influence the four-factor structure in the present study. It can be used for future study in Japan, while future large-scale research is required to ensure robust verification.

Keywords

Cross-sectional surveyJapanKnowledgeMental health servicesProfessionalRecoveryReliabilityScaleValidity

Background

“Recovery”, also known as “personal recovery”, in the context of mental health is a unique personal process of transformation. It includes subjective discovery of a new self to overcome mental illness and regain control and responsibility of one’s own life [1, 2]. The recovery paradigm has been an international policy which campaigns for better mental healthcare [3]. However, a few earlier studies have argued that attitudes among mental health service providers towards recovery are more pessimistic, prejudiced, or qualitatively different compared to that among people with mental illness [46]. Since such negative attitude towards recovery among mental health service providers could hinder recovery-focused healthcare, some researchers have indicated the need for, and difficulty in recovery orientated mental health services [710].

To date, various scales pertaining to recovery orientation have been developed, including individual’s attitude toward recovery for use with mental health service providers or people with mental illness [1113], competence to promote recovery [14, 15], and the recovery orientation of services [16]. Among such scales, the Recovery Knowledge Inventory (RKI), developed in the USA, is one of the influential and predominantly used scales to assess knowledge and attitude towards recovery-oriented practices among mental health service providers [17]. RKI has revealed some factors associated with recovery orientation in cross-sectional studies [1820], as well as in longitudinal studies [21]. Appreciably, in recent years, RKI has been notably used in several interventional studies in Australia [2225], USA [26], Canada [27, 28], UK [29], and Netherlands [30], as various educational programs have been developed for service providers to enhance recovery orientation.

The preliminary version of RKI comprised 36 items, which was reduced to 20 items based on the results of principal component analysis and feedback from stakeholders for refinement [17]. Then Bedregal et al. [17] empirically demonstrated a four-factor structure for the 20-item RKI: (1) roles and responsibilities in recovery, (2) non-linearity of the recovery process, (3) the roles of self-definition and peers in recovery, and (4) expectations regarding recovery. Cronbach’s α coefficients for each domain were .81, .70, .63, and .47, respectively [17].

Although several earlier studies using RKI employed the 20-item scale with the four-factor structure, studies among nursing students in Australia [9] and the Dutch version of RKI among professionals [31] did not yield an acceptable fit for the structure. Thus, they suggested further elimination of certain RKI items. Considering the results of the analyses, Happell et al. [9] reduced the items to 16, whereas Wilrycx et al. [31] reduced them to 14, respectively. In addition, most of the earlier studies using RKI were conducted in Western countries, with the exception of a report in Hong Kong [32]. Thus, it is yet to be elucidated whether or not RKI is a useful tool in Asian countries. Considering that the concept of “recovery” differs among countries or cultures [33], further evaluation is clearly required to examine the cross-cultural applicability of RKI, including the context of Asian culture.

In the present study, we aimed to develop a Japanese version of RKI and examine the factorial validity, convergent validity, and internal consistency reliability of the Japanese version of RKI among mental health service providers in community and inpatient settings in Japan. We hypothesized that the Japanese version of RKI had good factorial validity, convergent validity, and internal consistency. The use of RKI would promote the understanding of recovery, and thus, encourage recovery-oriented care in Japan where traditional psychiatric treatment and paternalistic care through long-term inpatient treatment has been prevalent for a long period.

Methods

Participants

A cross-sectional questionnaire survey was implemented with mental health service providers from February to March 2012. Eligible professions included psychiatrists, registered or assistant nurses, public health nurses, clinical psychologists, pharmacists, occupational therapists, and social workers. Participants came from two psychiatric hospitals in the Kanto region, as well as a total of 56 psychiatric clinics and community service agencies in Tokyo, Japan.

In the two psychiatric hospitals, there were 220 eligible professionals, of whom 180 agreed to participate and returned completed questionnaires. In the psychiatric clinics and community service agencies, there were 255 eligible professionals, of whom 151 agreed to participate and responded to the questionnaire. This gave a total of 331 respondents; however, 32 were excluded because of missing responses for one or more of the items on RKI. We used data from the remaining 299 participants for the analyses (valid response rate = 62.9%).

Measures

Development of the Japanese version of RKI

On the RKI, higher total scores mean greater knowledge and more positive attitudes towards the concept of recovery [17]. All items follow a Likert-style response format ranging from 1 (strongly disagree) to 5 (strongly agree). Of the total 20 items, 15 are scored inversely to minimize the effect of social desirability. Items are shown in Table 2.

We translated the RKI into Japanese with the consent of the original developer, by reference to the guidelines for translating and adapting psychometric scales [34, 35]. We developed the Japanese RKI in accordance with the following five procedures. (1) Forward translation: two of the authors separately translated RKI from English into Japanese. (2) Reconciliation: five of the authors went through them and gained consensus on a draft Japanese translation of RKI that best reflected the literal and conceptual content of the original English version. (3) Cognitive debriefing and review of the cognitive debriefing results: after we reworded some items as needed, two mental health service providers, a peer-support group leader with chronic mental illness, and five peer-support group members tested the Japanese RKI. (4) Back-translation: two native English-speaking professional translators, who did not know the original RKI, back-translated the Japanese version into English. (5) Back-translation review and finalization: all of us reviewed the back translations by comparison with the original RKI, and assured the literal and conceptual equivalence between the original and Japanese RKIs.

Recovery Attitudes Questionnaire (RAQ)

The seven-item RAQ is a five-point Likert scale to assess attitudes toward, and knowledge of, recovery [11]. Items such as “To recover requires faith” or “People in recovery sometimes have setbacks” constitute two domains, i.e., “recovery is possible and needs faith” and “recovery is difficult and differs among people”. Higher total scores indicate a more positive attitude to the concept of recovery. A study in USA has revealed the reasonable internal consistency reliability (Cronbach’s α = .70), marginally acceptable test–retest reliability (r = .67), and reasonable factorial validity of RAQ [11]. The Japanese version of RAQ revealed acceptable validity (GFI = .95; AGFI = .90; CFI = .86) and mediocre reliability (Cronbach’s α = .64; ICC for test–retest reliability = .68) [36]. RAQ was assumed to be positively associated with RKI.

The positive attitudes scale

The positive attitudes scale is a scale to assess one’s positive attitudes toward people with mental illness. Nineteen items including “I think most people with mental illness have ability to understand their illness” comprise three domains such as “expectations for the abilities and recovery”, “attitudes toward living alongside people with mental illness”, and “supportive helping behaviors”. Items require responses on a four-point Likert scale ranging from “strongly disagree” to “strongly agree”, with a higher scores indicating a more positive attitude toward people with mental illness. Good internal consistency reliability and convergent validity have been confirmed for the positive attitudes scale among mental health service providers in Japan (Cronbach’s α = .88) [37]. The positive attitudes scale was supposed to be positively associated with RKI.

Japanese-language version of the Social Distance Scale (SDSJ)

The SDSJ is a scale to assess people’s desire and perception for social distance toward people with schizophrenia and it is not limited to professionals. It includes items such as “I do not want to take a taxi with a driver who has a history of schizophrenia”, which require responses on a four-point Likert scale ranging from “disagree” to “agree”, with a higher scores indicating a more negative attitude. The SDSJ has good internal consistency reliability (Cronbach’s α = .70), good test–retest reliability (r = .95), and acceptable factorial validity (GFI = .94; AGFI = .81; CFI = .90) [38]. SDSJ was assumed to be negatively associated with RKI.

Statistical analysis

The suitability of the data for factor analysis was first examined using the Kaiser–Mayer–Olkin (KMO) measure of sampling adequacy and Bartlett’s Chi square test of sphericity. Subsequently, the KMO indicator was assessed by the adequacy criteria (meritorious > .80) [39]. To extract a factor structure of the scale items for the assessment of factor-based validity, we first applied an explanatory factor analysis (EFA) using the maximum likelihood method and promax rotation, from one- to four-factor structures with reference to earlier studies [9, 17, 31]. In the case that these analyses failed to provide any admissible solution, we implemented further EFA by step-by-step elimination of some items to refine the factor structure with reference to earlier studies [9, 17, 31].

Then a confirmatory factor analysis (CFA) was employed to test the fitness of the data to the factor structure extracted by EFA in this study. We also conducted CFAs for the data of the original four-factor structure [17], as well as for the three-factor structure of the 16-item version [9] and the one-factor structure of the 14-item version [31] for reference. Model fit was assessed using a combination of fit indices, including the goodness-of-fit (GFI), the adjusted goodness-of-fit (AGFI), the comparative fit index (CFI), and the root mean square error of approximation (RMSEA). The acceptability of model fit was judged by the recommended standards of GFI, AGFI, and CFI greater than .90, and RMSEA values of .06 or less, for a close fit [40]. Convergent validity was assessed by calculating Pearson’s correlation coefficients between the total RKI score and the scores for the other three scales, i.e., RAQ, positive attitudes scale, and SDSJ.

We calculated Cronbach’s α coefficients for the total score and for each domain of the RKI to assess internal consistency reliability. Cronbach’s α of no less than .70 was assumed to be acceptable [31].

All statistical analyses including descriptive analyses, but excluding CFA, were conducted using IBM SPSS Statistics Base version 24.0. CFA was conducted in IBM SPSS Amos version 24.0 using structural equation modeling. p values of less than .05 were considered statistically significant (two-tailed tests).

Results

Participant characteristics

The participants’ sociodemographic and occupational characteristics are shown in Table 1. Most of the participants were female (about 70%), and the mean age was 40.4 years (range: 22–75 years). The mean length of experience in psychiatric services was 9.9 years (range: 0–45 years). The largest professional group was registered or assistant nurses. In this study, all doctors were psychiatrists because of the absence of general practitioner/family physician under the Japanese health care system. Regarding the educational background, most health service providers had a bachelor’s degree or higher, whereas some associate nurses were high school graduates.
Table 1

Participants’ socio-demographic and occupational characteristics (N = 299)

Variables

n

[Mean]

(%)

[SD]

Sex

 Female

206

(68.9)

 Male

91

(30.4)

 Unknown

2

(0.7)

Age (years)

[40.4]

[11.9]

Years of work tenure in psychiatric or mental health services

[9.9]

[8.5]

Occupation

 Registered nurse/assistant nurse

132

(44.1)

 Social worker

103

(34.4)

 Occupational therapist

20

(6.7)

 Clinical psychologist

20

(6.7)

 Psychiatrist

14

(4.7)

 Pharmacist

5

(1.7)

 Public health nurse

3

(1.0)

 Others

2

(0.7)

Department

 Ward

129

(43.1)

 Job assistance

60

(20.1)

 Out-patient clinic/Home-visit nursing

40

(13.4)

 Psychiatric day-care

26

(8.7)

 Home assistance/rehabilitation

15

(5.0)

 Group home

5

(1.7)

 Community activity support center

2

(0.7)

 Others, Unknown

22

(7.3)

Employment status

 Full-time job

238

(79.6)

 Part-time job

53

(17.7)

 Unknown

8

(2.7)

Education

 High school

6

(2.0)

 Vocational school

117

(39.2)

 Junior college

18

(6.0)

 College

122

(40.8)

 Graduate school

33

(11.0)

 Unknown

3

(1.0)

Validity of RKI

Factorial validity

The mean total 20-item RKI score was 66.1 [standard deviation (SD) = 6.6; range: 48–89]. There was no item with either a ceiling or floor effect (Table 2).
Table 2

Descriptive statistics for the 20-item RKI (N = 299)

No.

Items

Mean

SD

Min

Max

1

The concept of recovery is equally relevant to all phases of treatment

2.93

.95

1

5

2

People receiving psychiatric/substance abuse treatment are unlikely to be able to decide their own treatment and rehabilitation goals

3.98

.77

2

5

3

All professionals should encourage clients to take risks in the pursuit of recovery

2.74

.84

1

5

4

Symptom management is the first step towards recovery from mental illness/substance abuse

2.31

.79

1

4

5

Not everyone is capable of actively participating in the recovery process

2.44

.88

1

5

6

People with mental illness/substance abuse should not be burdened with the responsibilities of everyday life

3.86

.73

2

5

7

Recovery in serious mental illness/substance abuse is achieved by following a prescribed set of procedures

3.55

.77

1

5

8

The pursuit of hobbies and leisure activities is important for recovery

4.16

.57

3

5

9

It is the responsibility of professionals to protect their clients against possible failures and disappointments

3.36

.95

1

5

10

Only people who are clinically stable should be involved in making decisions about their care

3.91

.78

2

5

11

Recovery is not as relevant for those who are actively psychotic or abusing substances

3.61

.90

1

5

12

Defining who one is, apart from his/her illness/condition, is an essential component of recovery

3.90

.75

1

5

13

It is often harmful to have too high of expectations for clients

2.32

.77

1

5

14

There is little that professionals can do to help a person recover if he/she is not ready to accept his/her illness/condition or need for treatment

3.67

.76

1

5

15

Recovery is characterized by a person making gradual steps forward without major steps back

3.49

.85

1

5

16

Symptom reduction is an essential component of recovery

2.65

.78

1

5

17

Expectations and hope for recovery should be adjusted according to the severity of a person’s illness/condition

2.47

.83

1

5

18

The idea of recovery is most relevant for those people who have completed, or are close to completing, active treatment

3.40

.77

1

5

19

The more a person complies with treatment, the more likely he/she is to recover

3.40

.77

2

5

20

Other people who have a serious mental illness or are recovering from substance abuse can be as instrumental to a person’s recovery as mental health professionals

3.96

.68

2

5

The following fifteen item scores were reversed before computing the statistics: No. 2, 4, 5, 6, 7, 9, 10, 11, 13, 14, 15, 16, 17, 18, and 19

The 20-item RKI did not provide any adequate or interpretable factor solutions at any number of factors by EFAs. Thus, four items (#1, 4, 5, and 13) were subsequently eliminated in stages, and consequently, the 16-item RKI was employed for further analyses.

The KMO was .84, indicating meritorious sampling adequacy. Bartlett’s test of sphericity was statistically significant (approximate Chi square = 1074, df = 120, p < .001), suggesting that there were correlations between the variables. EFA with four-factor structures yielded a marginally interpretable constitution (Table 3). In the present study, Factor 1 represents knowledge regarding psychiatric symptoms and recovery, Factor 2 denotes knowledge about the recovery process, Factor 3 indicates the understanding of what is important for recovery, and Factor 4 denotes the understanding of the challenges and responsibility in recovery. Inconsistent with the theoretical assumption, item #3 “All professionals should encourage clients to take risks in the pursuit of recovery” was negatively loaded on Factor 4 with a factor loading of .32.
Table 3

Factors derived from the Japanese version of the 16-item RKI: an item factor analysis with the maximum likelihood method and promax rotation (N = 299)

No.

Items

Factor

1

2

3

4

11

Recovery is not as relevant for those who are actively psychotic or abusing substances

.82

   

10

Only people who are clinically stable should be involved in making decisions about their care

.74

   

2

People receiving psychiatric/substance abuse treatment are unlikely to be able to decide their own treatment and rehabilitation goals

.45

   

14

There is little that professionals can do to help a person recover if he/she is not ready to accept his/her illness/condition or need for treatment

.44

   

19

The more a person complies with treatment, the more likely he/she is to recover

 

.73

  

18

The idea of recovery is most relevant for those people who have completed, or are close to completing, active treatment

 

.64

  

16

Symptom reduction is an essential component of recovery

 

.45

  

17

Expectations and hope for recovery should be adjusted according to the severity of a person’s illness/condition

 

.41

  

15

Recovery is characterized by a person making gradual steps forward without major steps back

 

.32

  

12

Defining who one is, apart from his/her illness/condition, is an essential component of recovery

  

.59

 

20

Other people who have a serious mental illness or are recovering from substance abuse can be as instrumental to a person’s recovery as mental health professionals

  

.58

 

8

The pursuit of hobbies and leisure activities is important for recovery

  

.56

 

6

People with mental illness/substance abuse should not be burdened with the responsibilities of everyday life

   

.54

7

Recovery in serious mental illness/substance abuse is achieved by following a prescribed set of procedures

   

.54

9

It is the responsibility of professionals to protect their clients against possible failures and disappointments

   

.39

3

All professionals should encourage clients to take risks in the pursuit of recovery

   

− .32

The following twelve item scores were reversed before computing the statistics: No. 2, 6, 7, 9, 10, 11, 14, 15, 16, 17, 18, and 19

Subsequent CFA suggested good fit to the data; GFI, AGFI, CFI, and RMSEA reached the recommended standards (GFI = .93; AGFI = .90; CFI = .91; RMSEA = .053) (Table 4). This factor structure resulted in the best fit to the data over the three-factor 16-item version [9] and one-factor 14-item version of RKI [31]. The four-factor structure in the original study [17] resulted in an unfitting solution in this sample (Table 4).
Table 4

Results of confirmatory factor analysis: comparison of goodness-of-fit indices between four-, three-, and one-factor RKI models (N = 299)

Model

GFI

AGFI

CFI

RMSEA

Chi square

df

p

4-factor a

.93

.90

.91

.053

179.59

98

.00

3-factorb

.89

.85

.76

.080

295.63

101

.00

1-factorc

.87

.82

.77

.093

274.96

77

.00

Four-factor model derived in the original study by Bedregal et al. [17] is not shown because of an improper solution in this study

GFI goodness of fit index, AGFI adjusted goodness of fit index; CFI confirmatory fit index, df degrees of freedom; better fit model denoted by italic letters

a20 items loaded on a four-factor structure in the present study

b16 items loaded on a three-factor structure by Happell et al. [9]

c14 items loaded on one factor structure by Wilrycx et al. [31]

Convergent validity

The mean total score of the 16-item RKI was significantly and positively correlated with both the mean RAQ total score (r = .34; p < .01) and the mean total score for the positive attitudes scale (r = .46; p < .01). Conversely, the mean total score of the 16-item RKI score was significantly and negatively correlated with the mean total SDSJ score (r = − .46; p < .01).

Reliability of RKI

Cronbach’s α coefficient was .77 for the total 16-item RKI score, with Factor 1 for .75, Factor 2 for.66, Factor 3 for .59, and Factor 4 for .24.

Discussion

In the current study, we developed the Japanese version of the RKI. After omitting four items (#1, 4, 5, and 13), the resulting Japanese 16-item RKI revealed reasonable factorial validity, good convergent validity, and poor to good internal consistency reliability among mental health professionals.

We considered the elimination of these four items to be adequate because item #1 was also omitted in both of the earlier studies [9, 31]. Items #4, 5, and 13 had the lowest mean scores; in addition, items #5 and 13 had insufficient factorial attribution in the earlier study [17].

Explanatory factor analysis revealed a four-factor structure different from the one in the original study [17], even though they also had structural similarity. Factor 1 in the present study, representing knowledge regarding psychiatric symptoms and recovery, had three items in common with Factor 1 in the original study, whereas Factor 2 in the present study, representing knowledge about the process of recovery, had four items in common with Factor 2 in the original study. All three items in Factor 3 in the present study, representing the understanding of what is important for recovery, were included in Factor 3 in the original study. In contrast, the three items out of Factor 4 in the present study, about the understanding of the challenges and responsibility in recovery, emanated from Factor 1 in the original study. Although it is inconsistent compared to the earlier one [17], the current factor structure may provide a modest interpretation, given that successive CFA resulted in good levels of fit to the data. Nevertheless, the four-factor structure in the original study [17] did not yield a proper solution by the CFA, as in the earlier studies [9, 31].

Interestingly, item #3 “All professionals should encourage clients to take risks in the pursuit of recovery” negatively loaded on Factor 4 with a low factor loading. It might be affected by the therapeutic culture of the participants. In this study, > 40% of the participants came from ward settings; thus, our participants might be more protective and gave preference to safety over taking risks. It also seems to indicate a prevailing attitude that emphasizes the safe ground, reflecting the long history of prolonged hospitalizations for psychiatric treatment in Japan. According to Nonaka and Hirasawa [41], interdependence originating in collaborative agriculture culture is the foundation of traditional social structures in Japan. Thus, the harmonious attitude towards one’s life, rather than risk-taking behavior, is valued in Japan. Therefore, one can argue that this negative loading is construable in the context of Japanese culture. In addition, Factors 1 and 4 in the present study, stemming mainly from one factor in the original study [17], can also be explained by such specific settings in Japan. It means that, in Japan, knowledge regarding psychiatric symptoms and recovery is somehow independent of the understanding of challenges and responsibility in recovery (Appendix).

The 16-item RKI was significantly and positively correlated with RAQ and positive attitude scores, whereas the RKI score was significantly and negatively correlated with the SDSJ score. Although these correlations were weak, they were consistent with our hypotheses. The comparatively weak correlation between the RKI and RAQ scores suggests that they do not share the same assessment aspects, even though both the scales suitably assess knowledge and attitude towards recovery. The relationship observed in the present study was consistent with that in an earlier study in the Netherlands, which revealed a relatively weak positive relationship between the RKI and RAQ scores (r = .20; p = .004) [31]. The moderate correlation between RKI and positive attitude score suggests that these scales are related, although they are conceptually dissimilar. The positive attitude scale domains of “expectations for abilities and recovery” and “supportive helping behaviors” are similar to several RKI items. In contrast, the positive attitude domain of “attitudes toward living alongside people with mental illness” was not in accordance with the RKI items. Besides, the negative correlation between the RKI and SDSJ scores in the present study also demonstrated reasonable validity because previous conceptual and empirical studies have suggested that the recovery of people with mental illness can be impeded by negative attitude towards them [4244].

The Cronbach’s α coefficient for the total 16-item RKI in the present study indicated good internal consistency reliability. This finding was consistent with the results of studies undertaken by service providers in Australia (α = .78 [45], α = .83 [23], and α = .79 [24]). Alternatively, the Cronbach’s α for each domain indicated varying reliability from good to poor. This fairly broad result was also similar to those in the earlier studies (α = .47–.81 [17], α = .49–.75 [9], α = .43–.79 [23], α = .45–.77 [45]). In particular, poor reliability indicated in Factor 4 in the present study was because of item #3 with negative factor loading. With respect to the scales to assess one’s knowledge, high internal consistency would not necessarily be expected, because people may possess knowledge in a certain area but may lack knowledge in others [46]. Thus, the lower reliability observed in the present study seems fathomable, given that RKI is a scale to assess one’s knowledge.

Considering that the current study supported a certain level of validity and reliability of the total 16-item RKI, the Japanese 16-item RKI can be used in future studies. However, Wilrycx et al. [31] reported that the composition and formulation of the RKI items were complex and difficult to interpret. Thus, the original RKI itself may be considered for the establishment of a more robust factor structure. In addition, a more careful review of Japanese wording and expression may improve the conceptual equivalence and conceptualize “recovery knowledge and recovery attitudes” in the context of the original RKI more concretely.

The “recovery” concept developed in Western countries is not the same between the Western, Asian countries [4749], and even in the English-speaking countries [50]. Therefore, culturally different features of recovery attitude and knowledge must be the focus of future studies. Future cross-cultural studies may reveal internal and external aspects of influence on the knowledge and attitude towards recovery.

The present study has some limitations. First, test–retest reliability was not assessed. Second, three-quarters of the total study population were registered nurses, assistant nurses, or psychiatric social workers. Therefore, the generalizability of our findings may be limited to these occupations. Further large-scale research in a more diverse population of mental health service providers is required for robust verification of the Japanese version of RKI.

Conclusions

The present study examined factorial validity, convergent validity, and internal consistency reliability of the Japanese version of RKI among mental health professionals. The Japanese 16-item RKI revealed reasonable factorial validity, good convergent validity, and understandable internal consistency reliability among mental health professionals. Japanese cultural settings seemed to influence the four-factor structure in the present study. Although the scale can be used for future study in Japan, future large-scale research is required to ensure robust verification.

Notes

Abbreviations

RKI: 

Recovery Knowledge Inventory

RAQ: 

Recovery Attitudes Questionnaire

SDSJ: 

Japanese-language version of the Social Distance Scale

KMO: 

Kaiser–Mayer–Olkin

EFA: 

explanatory factor analysis

CFA: 

confirmatory factor analysis

GFI: 

goodness-of-fit index

AGFI: 

adjusted goodness-of-fit

CFI: 

comparative fit index

RMSEA: 

root mean square error of approximation

Declarations

Authors’ contributions

RC was involved in conceptualizing the idea and writing the first draft of the manuscript. MU, YM, and SY supervised the implementation of the study together with NK. KG, MU and RC were involved in data collection. MU, YM and SY provided guidance on the initial draft, reviewed final version of the manuscript. All authors were involved in the translation procedure of RKI. All authors read and approved the final manuscript.

Acknowledgements

The authors are grateful to all participants for their cooperation and willingness to participate in the study.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author on request.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The aim and procedures of the study were approved by the Ethical Committee of the University of Tokyo (#3607) in November 2011. Recruitment was approved at all sites from which participants were enrolled. All participants received full explanations in writing about the purpose and methods, as well as the data storage and privacy protection methods employed. Those who agreed to participate in the study answered the questionnaire. The survey was conducted on an anonymous basis.

Funding

This study was funded by the Charitable trust of the Fumiko Yamaji Foundation for Nursing Education and Research, and Gushinkai Foundation, Japan. It was also partially supported by JSPS KAKENHI Grant Numbers 25862241 and 17K17513.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Research Institute of Nursing Care for People and Community, University of Hyogo, Akashi, Japan
(2)
Department of Public Health Nursing, Graduate School of Nursing, St Luke’s International University, Tokyo, Japan
(3)
Tokyo Musashino Hospital, Tokyo, Japan
(4)
Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
(5)
Department of Psychiatric Rehabilitation, Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
(6)
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

References

  1. Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J. 1993;16(4):11–23.Google Scholar
  2. Deegan PE. Recovery: the lived experience of rehabilitation. Psychosoc Rehabil J. 1988;11(4):11–9.Google Scholar
  3. Schwartz R, Estein O, Komaroff J, Lamb J, Myers M, Stewart J, Vacaflor L, Park M. Mental health consumers and providers dialogue in an institutional setting: a participatory approach to promoting recovery-oriented care. Psychiatr Rehabil J. 2013;36:113–5.View ArticlePubMedGoogle Scholar
  4. Hansson L, Jormfeldt H, Svedberg P, Svensson B. Mental health professionals’ attitudes towards people with mental illness: do they differ from attitudes held by people with mental illness? Int J Soc Psychiatry. 2013;59:48–54.View ArticlePubMedGoogle Scholar
  5. Jacob S, Munro I, Taylor BJ. Mental health recovery: lived experience of consumers, carers and nurses. Contemp Nurse. 2015;50:1–13.View ArticlePubMedGoogle Scholar
  6. Turton P, Wright C, White S, Killaspy H, Group DE. Promoting recovery in long-term institutional mental health care: an international Delphi study. Psychiatr Serv. 2010;61:293–9.View ArticlePubMedGoogle Scholar
  7. Davidson L, Tondora J, O’Commell MJ, Kirk T Jr, Rockholz P, Evans AC. Creating a recovery-oriented system of behavioral health care: moving from concept to reality. Psychiatr Rehabil J. 2007;31:23–31.View ArticlePubMedGoogle Scholar
  8. Gale J, Marshall-Lucette S. Community mental health nurses’ perspectives of recovery-oriented practice. J Psychiatr Ment Health Nurs. 2012;19:348–53.View ArticlePubMedGoogle Scholar
  9. Happell B, Byrne L, Platania-Phung C. The Recovery Knowledge Inventory for measurement of nursing student views on recovery-oriented mental health services. Issues Ment Health Nurs. 2015;36:799–808.View ArticlePubMedGoogle Scholar
  10. Tickle A, Brown D, Hayward M. Can we risk recovery? A grounded theory of clinical psychologists’ perceptions of risk and recovery-oriented mental health services. Psychol Psychother. 2014;87:96–110.View ArticlePubMedGoogle Scholar
  11. Borkin JR, Steffen JJ, Ensfield LB, Krzton K, Wishnick H, Wilder K, et al. Recovery Attitudes Questionnaire: development and evaluation. Psychiatr Rehabil J. 2000;24:95–102.View ArticleGoogle Scholar
  12. Salyers MP, Brennan M, Kean J. Provider expectations for recovery scale: refining a measure of provider attitudes. Psychiatr Rehabil J. 2013;36:153–9.View ArticlePubMedPubMed CentralGoogle Scholar
  13. Resnick SG, Fontana A, Lehman AF, Rosenheck RA. An empirical conceptualization of the recovery orientation. Schizophr Res. 2005;75:119–28.View ArticlePubMedGoogle Scholar
  14. Blau G, Surges Tatum D, Goldberg CW, Viswanathan K, Karnik S, Aaronson W. Psychiatric rehabilitation practitioner perceptions of frequency and importance of performance domain scales. Psychiatr Rehabil J. 2014;37:24–30.View ArticlePubMedGoogle Scholar
  15. Russinova Z, Rogers ES, Cook KF, Ellison ML, Lyass A. Conceptualization and measurement of mental health providers’ recovery-promoting competence: the recovery promoting relationships scale (RPRS). Psychiatr Rehabil J. 2013;36:7–14.View ArticlePubMedGoogle Scholar
  16. Williams J, Leamy M, Bird V, Harding C, Larsen J, Le Boutillier C, Oades L, Slade M. Measures of the recovery orientation of mental health services: systematic review. Soc Psychiatry Psychiatr Epidemiol. 2012;47:1827–35.View ArticlePubMedGoogle Scholar
  17. Bedregal LE, O’Connell M, Davidson L. The Recovery Knowledge Inventory: assessment of mental health staff knowledge and attitudes about recovery. Psychiatr Rehabil J. 2006;30:96–103.View ArticlePubMedGoogle Scholar
  18. Cleary A, Dowling M. Knowledge and attitudes of mental health professionals in Ireland to the concept of recovery in mental health: a questionnaire survey. J Psychiatr Ment Health Nurs. 2009;16:539–45.View ArticlePubMedGoogle Scholar
  19. Klockmo C, Marnetoft SU, Nordenmark M, Dalin R. Knowledge and attitude regarding recovery among mental health practitioners in Sweden. Int J Rehabil Res. 2012;35:62–8.View ArticlePubMedGoogle Scholar
  20. Marshall S, Deane F, Crowe T, White A, Kavanagh D. Carers’ hope, wellbeing and attitudes regarding recovery. Community Ment Health J. 2012;49:344–53.View ArticlePubMedGoogle Scholar
  21. Gaffey K, Evans DS, Walsh F. Knowledge and attitudes of Irish mental health professionals to the concept of recovery from mental illness—five years later. J Psychiatr Ment Health Nurs. 2016;23:387–98.View ArticlePubMedGoogle Scholar
  22. Crowe TP, Deane FP, Oades LG, Caputi P, Morland KG. Effectiveness of a collaborative recovery training program in Australia in promoting positive views about recovery. Psychiatr Serv. 2006;57:1497–500.View ArticlePubMedGoogle Scholar
  23. Meehan T, Glover H. Using the Recovery Knowledge Inventory (RKI) to assess the effectiveness of a consumer-led recovery training program for service providers. Psychiatr Rehabil J. 2009;32:223–6.View ArticlePubMedGoogle Scholar
  24. Salgado JD, Deane FP, Crowe TP, Oades LG. Hope and improvements in mental health service providers’ recovery attitudes following training. J Ment Health. 2010;19:243–8.View ArticlePubMedGoogle Scholar
  25. Williams V, Oades LG, Deane FP, Crowe TP, Ciarrochi J, Andresen R. Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions. Implement Sci. 2013;8:75.View ArticlePubMedPubMed CentralGoogle Scholar
  26. Peebles SA, Mabe PA, Fenley G, Buckley PF, Bruce TO, Narasimhan M, Frinks L, Williams E. Immersing practitioners in the recovery model: an educational program evaluation. Community Ment Health J. 2009;45:239–45.View ArticlePubMedGoogle Scholar
  27. Kidd SA, McKenzie K, Collins A, Clark C, Costa L, Mihalakakos G, Paterson J. Advancing the recovery orientation of hospital care through staff engagement with former clients of inpatient units. Psychiatr Serv. 2014;65:221–5.View ArticlePubMedGoogle Scholar
  28. Park MM, Zafran H, Stewart J, Salsberg J, Ells C, Rouleau S, Estein O, Valente TW. Transforming mental health services: a participatory mixed methods study to promote and evaluate the implementation of recovery-oriented services. Implement Sci. 2014;9:119.View ArticlePubMedPubMed CentralGoogle Scholar
  29. Slade M, Bird V, Clarke E, Le Boutillier C, McCrone P, Macpherson R, Pesola F, Wallace G, Williams J, Leamy M. Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial. Lancet Psychiatry. 2015;2:503–14.View ArticlePubMedGoogle Scholar
  30. Wilrycx GK, Croon MA, van den Broek AH, van Nieuwenhuizen C. Mental health recovery: evaluation of a recovery-oriented training program. Sci World J. 2012;2012:820846.View ArticleGoogle Scholar
  31. Wilrycx G, Croon MA, van den Broek A, van Nieuwenhuizen C. Psychometric properties of three instruments to measure recovery. Scand J Caring Sci. 2012;26:607–14.View ArticlePubMedGoogle Scholar
  32. Mak WW, Lam BY, Yau SS. Recovery knowledge and recovery-oriented services in Hong Kong. Psychiatr Serv. 2010;61:1164.View ArticlePubMedGoogle Scholar
  33. Slade M, Amering M, Farkas M, Hamilton B, O’Hagan M, Panther G, Perkins R, Shepherd G, Tse S, Whitley R. Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry. 2014;13:12–20.View ArticlePubMedPubMed CentralGoogle Scholar
  34. Knudsen HC, Vazquez-Barquero JL, Welcher B, Gaite L, Becker T, Chisholm D, et al. Translation and cross-cultural adaptation of outcome measurements for schizophrenia: EPSILON study 2. Br J Psychiatry. 2000;39:s8–14.View ArticleGoogle Scholar
  35. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health. 2005;8:94–104.View ArticlePubMedGoogle Scholar
  36. Chiba R, Umeda M, Goto K, Miyamoto Y, Yamaguchi S, Kawakami N. Psychometric properties of the Japanese version of the Recovery Attitudes Questionnaire (RAQ) among mental health providers: a questionnaire survey. BMC Psychiatry. 2016;16:32.View ArticlePubMedPubMed CentralGoogle Scholar
  37. Iwai K, Nonaka T. The influence of workplace environment on the positive attitudes of staff toward persons with mental disorder. Jpn Bull Soc Psychiatry. 2011;20:94–105 (in Japanese).Google Scholar
  38. Makita K. Development and reliability of the Japanese-language version of Social Distance Scale. Jpn Bull Soc Psychiatry. 2006;14:231–41 (in Japanese).Google Scholar
  39. Kaiser HF. An index of factorial simplicity. Psychometrika. 1974;39:31–6.View ArticleGoogle Scholar
  40. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structural analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1–55.View ArticleGoogle Scholar
  41. Nonaka T, Hirasawa E. A community mental health support system for people with mental illness in Japan. Int J Ment Health. 2012;41:19–28.View ArticleGoogle Scholar
  42. Jacobson N, Greenley D. What is recovery? A conceptual model and explication. Psychiatr Serv. 2001;52:482–5.View ArticlePubMedGoogle Scholar
  43. Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC. Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatr Serv. 2001;52:1621–6.View ArticlePubMedGoogle Scholar
  44. Tsang HWH, Tam PKC, Chan F, Cheung WM. Stigmatizing attitudes towards individuals with mental illness in Hong Kong: implications for their recovery. J Community Psychol. 2003;31:383–96.View ArticleGoogle Scholar
  45. Hungerford C, Dowling M, Doyle K. Recovery outcome measures: is there a place for culture, attitudes, and faith? Perspect Psychiatr Care. 2015;51:171–9.View ArticlePubMedGoogle Scholar
  46. Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, Thornicroft G. Development and psychometric properties of the mental health knowledge schedule. Can J Psychiatry. 2010;55:440–8.View ArticlePubMedGoogle Scholar
  47. Chiba R, Miyamoto Y, Kawakami N. Reliability and validity of the Japanese version of the Recovery Assessment Scale (RAS) for people with chronic mental illness: scale development. Int J Nurs Stud. 2010;47:314–22.View ArticlePubMedGoogle Scholar
  48. Fukui S, Shimizu Y, Rapp CA. A cross-cultural study of recovery for people with psychiatric disabilities between US and Japan. Community Ment Health J. 2012;48:804–12.View ArticlePubMedGoogle Scholar
  49. Tse S, Davidson L, Chung KF, Ng KL, Yu CH. Differences and similarities between functional and personal recovery in an Asian population: a cluster analytic approach. Psychiatry. 2014;77:41–56.View ArticlePubMedGoogle Scholar
  50. Slade M, Leamy M, Bacon F, Janosik M, Le Boutillier C, Williams J, Bird V. International differences in understanding recovery: systematic review. Epidemiol Psychiatr Sci. 2012;21:353–64.View ArticlePubMedGoogle Scholar

Copyright

© The Author(s) 2017

Advertisement