Development and validation of the personal recovery scale (ReConnect) for mental health in Ethiopia

Background: Socio-cultural context is crucial for conceptualising personal recovery in mental health, but existing measures are from Western, high-income countries. Aim: To develop and validate a mental health personal recovery measure for people with mental health conditions in Ethiopia that is grounded in their recovery journey. Study Design: The study stages were: reviewing existing measures; qualitative exploration of the concept in Ethiopia (n=25 interviews); expert workshops (n=3); cognitive interviewing for semantic and content validity (n=20); pilot study for item reduction and exploratory factor analysis and Item Response Theory (IRT) to determine the dimensional structure (n=213); and assessment of construct (confirmatory factor analysis) and divergent validity in an independent sample (n=401), and test-retest reliability in a sub-sample (n=48). Divergent validity was assessed against symptom severity and disability. Study Results: Participants gave greater emphasis to social recovery than self-actualisation or empowerment; hence, no existing measures had face validity. We piloted 26 items from existing measures and 19 newly developed items. The draft measure was unidimensional, explaining 71% of variance, and had item-test correlations > 0.58. Item reduction resulted in 20-item scale, ReConnect (Recovery and Connection Scale). In the validation study, the ReConnect was unidimensional with acceptable goodness of fit indices and test-retest reliability, and correlated significantly with symptom severity and functioning. Conclusions: The ReConnect is a valid and reliable measure of personal recovery in Ethiopia. The ReConnect has potential applicability to other similar settings where the community has a greater role in the recovery journey.