Using the Recovery Knowledge Inventory Scale (RKI) to Assess Nurses' Knowledge of a Recovery-Oriented Mental Health Care Approach: Findings from a Developing Country

Recovery-oriented services are a goal for policy and practice in the Australian mental health service system. Evidence-based reform requires an instrument to measure knowledge of recovery concepts. The Recovery Knowledge Inventory (RKI) was designed for this purpose, however, its suitability and validity for student health professionals has not been evaluated. The purpose of the current article is to report the psychometric features of the RKI for measuring nursing students’ views on recovery. The RKI, a self-report measure, consists of four scales: (I) Roles and Responsibilities, (II) Non-Linearity of the Recovery Process, (III) Roles of Self-Definition and Peers, and (IV) Expectations Regarding Recovery. Confirmatory and exploratory factor analyses of the baseline data (n = 167) were applied to assess validity and reliability. Exploratory factor analyses generally replicated the item structure suggested by the three main scales, however more stringent analyses (confirmatory factor analysis) did not provide strong support for convergent validity. A refined RKI with 16 items had internal reliabilities of α = .75 for Roles and Responsibilities, α = .49 for Roles of Self-Definition and Peers, and α = .72, for Recovery as Non-Linear Process. If the RKI is to be applied to nursing student populations, the conceptual underpinning of the instrument needs to be reworked, and new items should be generated to evaluate and improve scale validity and reliability.

BackgroundThe 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.MethodsWe 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.ResultsThe 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.ConclusionsThe 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.

This study explored how nurses working in inpatient mental health units perceived the development and implementation of a recovery-oriented mental healthcare programme (ROMHCP). The recovery-oriented mental healthcare approach (ROMHCA) in mental health is regarded as the future of mental health services and has been implemented in different countries worldwide. However, regarding developing and implementing the recovery approach, Africa appears to have been left behind by the rest of the continents. The study used a qualitative approach to describe how a recovery-oriented mental healthcare approach could be developed. Thirty nurses who worked in Botswana's four inpatient mental health facilities consented and voluntarily participated in the study. Data were collected from February to mid-March 2022 through online focus group discussions and analysed using thematic analysis. The COREQ checklist was used to report the findings. Two main themes emerged as follows: (i) developing and implementing a recovery-oriented mental healthcare programme is possible and (ii) certain elements are required to develop and implement ROMHCP. The participants believed that people diagnosed with mental illness could recover from the illness and suggested how it could be achieved. They also contended that the programme's success would lie mainly with multisectoral support from policymakers, facilities, hospital personnel, patients, and the community. Clinical Relevance. ROMHCP has the potential to benefit people with mental illness in the country. In addition, it would allow nurses to improve their knowledge and skills in managing mental illnesses. Patient or Public Contribution. The patients and the general public did not contribute to the study's concept, design, and outcomes. However, the nurses working in mental health facilities volunteered to participate in the study.

Introduction Cross-sectoral collaboration between mental health hospitals and municipalities addresses the multifaceted needs of individuals with mental health conditions. Recovery-oriented care emphasizes personal empowerment, holistic support, and integrated services. However, barriers to collaboration hinder effective service delivery. This scoping review explores how recovery-oriented approaches are integrated within collaborative practices and identifies key barriers and facilitators to cross-sectoral collaboration. Methods This review followed Arksey and O’Malley’s framework, with systematic searches conducted in PubMed, CINAHL, PsycINFO, and Web of Science. Studies published between 2012 and 2024 were included if they focused on cross-sectoral collaboration within a recovery-oriented framework. Data from 30 peer-reviewed articles were synthesized to identify themes related to barriers, facilitators, and best practices. Results Barriers to collaboration included fragmented communication systems, cultural and professional differences, and power imbalances across sectors. Structural challenges, such as discrepancies in legislative and funding mechanisms, hindered integration. Successful models, such as Individual Placement and Support (IPS) and Open Dialogue, demonstrated the potential of structured frameworks in overcoming barriers. User involvement emerged as a pivotal facilitator of meaningful collaboration but remains underutilized in practice. Discussion Recovery-oriented care necessitates overcoming systemic and cultural barriers to develop integrated, person-centered approaches. Despite promising practices, gaps in understanding long-term outcomes and user perspectives persist, highlighting the need for further research. Conclusion Effective collaboration between mental health hospitals and municipalities is fundamental to delivering recovery-oriented care. Future research should explore standardized metrics, enhance user involvement, and assess the scalability of successful models to strengthen integration.

The Recovery Knowledge Inventory (RKI) is a widely used self-report instrument that assesses recovery-oriented knowledge among mental health professionals. The purpose of this study is to translate the RKI into the Malay language (RKI-M) and to examine its psychometric properties among Malaysian health care workers. A cross-sectional study involving 143 participants was conducted at an urban teaching hospital, an urban government hospital, and a rural government hospital. Following the translation of the RKI, its internal reliability was determined using Cronbach's alpha. Construct validity was also determined using confirmatory factor analysis. The Malay-Version RKI (RKI-M) has good internal reliability with a Cronbach's alpha of 0.83. However, the Malay-version RKI failed to replicate the original four-factor structure. The final model only achieved the best model fit after the removal of 9 items with two-factor loadings: (GFI = 0.92; AGFI = 0 0.87; CFI = 0.91; RMSEA = 0.074). The 20-item RKI-M is reliable but has poor construct validity. However, the modified 11-item Malay-version RKI is a more reliable measure as it has good construct validity, with room for future studies to examine the psychometric properties of the modified 11-item RKI among mental health care workers. More training on recovery knowledge should be done, and a simple worded questionnaire should be developed in keeping with local practitioners.

This study explored how Russian-speaking immigrant families in Israel perceive recovery-oriented mental health rehabilitation services for their relatives with severe mental illness. Qualitative interviews with 18 families identified six key themes: lack of directive care, tension between personal autonomy and professional responsibility, family exclusion, privatization concerns, language barriers, and inadequate responses to treatment non-adherence. Findings highlight cultural gaps between Israel’s individualistic recovery-oriented services and the collectivistic, directive care expectations of Russian-speaking caregivers. Social workers can play a pivotal role in bridging these gaps by involving families in care planning and advocating for more proactive, accessible, and culturally safe services.

Leadership and mental health recovery: Rhetoric or reality.

The Recovery Knowledge Inventory (RKI) was developed to operationalise the recovery construct and in turn contribute to moving mental health services towards recovery-oriented practice. This study validated the RKI in a sample of Norwegian mental health care practitioners and examined mental health workers' knowledge of and attitudes towards patient recovery. The RKI was translated into Norwegian and tested on 317 mental health workers from 7 primary and 22 specialised mental health care units within a defined geographical area of Norway. Psychometric challenges to the RKI were observed and called into question the previously proposed four-factor structure. The findings of the scale revealed that the study sample scored significantly lower than a comparable sample in a previous study, suggesting that the Norwegian mental health workers have relatively low orientation towards recovery. This finding was especially applicable to the reduction of symptoms and treatment, which the respondents perceived as essential for recovering from mental illnesses and substance abuse disorders. To operationalise the recovery construct, the development of a measure such as the RKI needs further attention. For psychiatric practice to be moved in a more recovery-oriented direction, consensus on what constitutes well-functioning recovery must be reached by patients, practitioners and researchers alike.

This case study explores the multifaceted roles of a nurse with lived experience of mental illness in facilitating peer support for mental health recovery in China. Drawing on qualitative interviews with the nurse, four service users, and four family caregivers, as well as non-participant observations, the study highlights how the nurse enacted four interrelated roles: wounded healer, educator, coordinator, and advocate. Through shared narratives and empathetic engagement, the nurse fostered emotional resonance and challenged internalized stigma among participants. Her integration of family caregivers and mobilization of external resources further strengthened the recovery environment. The study applies the “wounded healer” framework to examine three stages of role transformation—trauma recognition, pain transformation, and transcendence—within a culturally collectivist setting. Findings suggest that even a single nurse with lived experience can play a transformative role in recovery-oriented care, promoting both individual healing and broader social inclusion. By highlighting the therapeutic potential of integrating experiential knowledge into nursing practice, this study offers practical insights for expanding peer support models in under-resourced mental health systems. It also provides culturally relevant implications for the training and inclusion of nurses with lived experience in recovery-oriented mental health care in China and beyond.

Despite increased interest in relationships and emotions in social work, not enough is known about the role of emotions in recovery-oriented mental health care settings. Reflecting on my graduate research, I explore the inconsistent understandings and comfort levels with emotions in mental health social work practice. I make connections with findings which show that uneven attempts at relationship-building lead to missed opportunities for connection, understanding, and supporting recovery. I discuss the tensions faced by mental health practitioners implementing recovery-oriented interventions within a new public management and risk reduction paradigm of care and the ways that attending to emotions might help critique or dismantle the status quo. These reflections suggest pathways to resist these tensions through realizing the potential of emotions as a source of knowledge in constructing recovery-oriented mental health care interventions.

Recovery-oriented mental health care emphasizes hope, empowerment, personally defined recovery, and the importance of systemic change and action on the social determinants of mental health and wellbeing. It has been argued that music therapy is highly compatible with recovery principles. This critical interpretive synthesis explores published music therapy assessments designed for use with children and adolescents experiencing mental health challenges, including assessment development, contextual influences, and potential applications in recovery-oriented mental health settings. Database searches, citation tracking, and hand searching identified nine relevant publications (1988-2019), reflecting eight separate assessments. Publications describe the assessment of multiple domains to inform planning; use a range of quantitative rating scales and qualitative descriptions; focus on information sharing and enhancing credibility; and reveal the influence of verbal psychotherapeutic models. Some assessments use terminology that was common in the era that they were published but are not considered congruent with recovery-oriented care. An emphasis on clinician dominance and duplication of information collected by other professionals in interdisciplinary settings is also apparent, potentially affecting usability in mental health services. Exploration of musical phenomena is evident in all assessments and may offer a unique contribution to interdisciplinary processes. Although a significant focus on individual pathology is evident, consumers' resources and contexts are explored in many of the music therapy assessments. This synthesis reveals a need to explore and develop music therapy assessment practices that align with recovery-oriented principles to meet consumer needs and improve integration in interdisciplinary contexts.

Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess convergent-concurrent validity between clinical recovery, citizenship and personal recovery. Recovery-oriented mental health care and services are particularly recognizable by the presence of Peer Support Workers, who are persons with lived experience of recovery. Upon training, they can personify personalized mental health care and services, that is to say services that are centered on the person’s recovery project and not only on their symptoms. Data from our overall research strategy will lay the ground for the evaluation of the effects of the intervention of Peer Support Workers on clinical recovery, citizenship and personal recovery.

In mental health care, shared decision making (SDM) is a central part of the recovery paradigm. However, implementing SDM can be challenging, and professionals may prefer different decision-making styles. This study explored preferences for decision-making style and examined their association with knowledge of and attitudes to recovery among mental health professionals in routine hospital-based services. An exploratory cross-sectional survey was conducted among mental health professionals (N = 552) in hospital-based services in one of Denmark’s five regions. Preferences for decision-making style were measured using the Clinical Decision Making Style Scale – Staff Questionnaire, while professionals’ knowledge of and attitudes to recovery were assessed using the Recovery Knowledge Inventory. Although the majority of participants (72.4%) preferred a shared decision-making style, there were differences in preferences based on profession, work experience, and setting. One in five reported having received SDM training, and fewer reported having access to decision-support tools. Indications of differences in knowledge of and attitudes to recovery between professionals’ preferences for decision-making styles were found: those who preferred a shared or active style seemed to score higher on the RKI compared to those who preferred a passive, clinician-led style. While descriptive in nature, the findings suggest patterns in decision-making preferences that may help inform future implementation efforts. The results also suggest a potential alignment between endorsement of shared- or active decision-making styles and recovery-oriented values. Further research is needed to investigate how preferences translate into actual clinical practice and how knowledge about and attitudes to recovery may be operationalized as recovery-oriented care.

Recovery-Oriented Care With Community Providers: An Analysis of the Recovery Knowledge Inventory

Recovery-oriented intersectoral care is described as an aim in mental healthcare to create a holistic framework for planning that provides integration of treatment and rehabilitation. Existing studies show that nurses and other professionals do not take responsibility for the collaborative element of intersectoral care between mental health hospitals and community mental health services. The users of mental healthcare do not experience their patient journey as a cohesive process when they are discharged from a mental health hospital to community mental health services. The integrative review aims to examine the professionals' experience with recovery-oriented intersectoral care between mental health hospitals and community mental health services. Since the aim was to review user experience, we chose an integrative review as an obvious choice for design. Not applicable. Seven studies met the inclusion criteria. The interactive inductive and deductive analysis generated four themes, which clarify the experience of professionals with recovery-oriented intersectoral care between the mental health hospitals and community mental health services, namely 'structurally routine care', 'unequal balance of power between the sectors', 'bureaucracy as a barrier to recovery-oriented intersectoral care' and 'flexible mental healthcare approaches'. This review achieves specific knowledge of recovery-oriented intersectoral care. The studies included show that recovery-oriented intersectoral care is not clearly defined. It is challenging to transfer intersectoral care to an organisation with different structural and linguistic barriers.