Nowadays, the World Health Organization highlights that mental health services should be recovery-oriented, community-based, person-centred, and compliant with human rights (World Health Organization [WHO, 2021]). From this perspective, recovery-oriented means that rather than focusing only on symptom remission and the restoration of previous levels of functioning, the main goal of the intervention should be to promote well-being and life satisfaction, to foster hope, and to help people have a project of life and make meaningful contributions to society.

To address the issue of polysemy surrounding the concept of recovery and establish an empirically based conceptual framework, Leamy et al. (2011) developed a systematic review and narrative synthesis of 97 previous publications that had defined the concept. They identified five key elements, termed the CHIME framework: (a) connections with others and with the Community, (b) Hope and optimism about the future, (c) a positive sense of one’s own Identity, (d) a Meaning and purpose in life, and (e) Empowerment to have control over own life. The CHIME framework has gained increasing international consensus as a reference for setting the goals of recovery-oriented interventions (Penas et al., 2020).

This conception of recovery has been termed personal recovery (Leamy et al., 2011; Slade et al., 2012) to distinguish it from clinical recovery, which focuses on symptoms and functionality. Considering that they are different constructs, the literature highlights that they need to be assessed independently (Van Eck et al., 2018). Regarding personal recovery, a recent scoping review of recovery planning tools found that hope and social support were among the most commonly evaluated variables (Sampietro et al., 2022). This is because they are seen as both prerequisites for recovery and indicators of recovery.

Hope, which is the belief in the possibility of recovery, is one of the guiding principles (Substance Abuse and Mental Health Services Administration [SAMHSA, 2011]) and a subjective outcome of the recovery process (Slade et al., 2014). Some authors argue that hope is central because it acts as a catalyst for change and enables the other factors involved in recovery to take hold (Acharya & Agius, 2017). In addition, a relationship has been found between chronicity, measured by the severity and persistence of symptoms, and hopelessness (Hayes et al., 2017). Social support is also considered a guiding principle (SAMHSA, 2011) and a social outcome of the recovery process (Slade et al., 2014). Individuals do not recover in isolation, but with the support of relationships and social networks. Several systematic reviews have provided evidence of the link between social support and recovery, suggesting that social support acts as a protective element in people’s lives (Bjørlykhaug et al., 2022).

Since 2011, various systematic reviews have been published with the aim of identifying psychometric instruments that measure the personal recovery construct, in general (Burgess et al., 2011; Penas et al., 2019; Scheyett et al., 2013; Shanks et al., 2013; Sklar et al., 2013), for a specific diagnosis (Cavelti et al., 2012), or a experience such as psychosis (Law et al., 2012). One of the instruments that appear in all these reviews and that is usually recommended to be used by clinicians and researchers in the discussions of these studies, is the Recovery Process Inventory (RPI) (Jerrell et al., 2006). The RPI is a 22-item scale aimed to facilitate self-assessment of the personal recovery process, and has been described as “a brief, easily administered but psychometrically sound instrument” (Jerrell et al., 2006, p. 472). In these systematic reviews, the RPI appears as one of “the strongest instruments reviewed” (Scheyett et al., 2013, p. 300) for its psychometric properties. In this regard, in both reviews made by Burgess et al. (2011) and more recently by Penas et al. (2019), the authors followed similar steps in the inclusion and exclusion criteria until arriving at the final list of the best instruments to assess personal recovery. Following this selection process, it is highlighted that the RPI explicitly measures domains related to personal recovery, is brief and easy to complete, takes users’ perspectives into account (was created by or with their collaboration), yields quantitative data, has been scientifically tested, and demonstrates sound psychometric properties. Furthermore, the study by Burgess et al. (2011) adds that the RPI is acceptable to consumers and promotes dialogue between consumers and providers. Finally, the review by Penas et al. (2019) highlights that it does not have a Spanish adaptation.

Given that the international public mental health policies in Spanish-speaking countries are promoting a paradigm shift towards a recovery approach in which hope and social support are key factors, and that Jerrell et al.’s (2006) instrument has not yet been translated and validated into Spanish, the main purpose of this study has been to develop the Spanish version of the RPI (RPI-S), providing evidence of its validity among users of mental health services in the Spanish cultural context. Linked to validity evidence based on the relationship between the RPI-S measures and other variables, we aimed to demonstrate the relevance of hope and social support to achieve recovery. Regarding evidence based on the internal structure of the RPI, although the only structure that has received empirical support in previous studies has been the six-factor structure proposed by Jerrell et al. (2006), in the present study we also decided to test the fit of a four-factor structure reflecting a more parsimonious proposal consistent with the conceptualization of personal recovery and which included a dimension closely linked to hope and another closely related to social support, that appear to be essential for recovery (Bjørlykhaug et al., 2022; Hayes et al., 2017; Leamy et al., 2011). In this theoretical proposal, the two items (items 18 and 19) that in the original version made up the “Hopeful/Cares for Self” dimension were integrated into a dimension now called Hope, Confidence, and Purpose and the three items that in the original version made up the “others’ care and help” dimension were distributed between the dimensions now called Unwellness (item 15) and Connection with Others and Social Support (items 12 and 17), respectively. Thus, this new structure included four factors, which we called: Unwellness, Hope, Confidence, and Purpose, Connection with Others and Social Support, and Living Situation. We considered that these names more adequately reflected what the items that made up the dimensions were intended to measure. The Unwellness dimension includes items expressing situations that negatively affect a person’s psychological well-being. The Hope, Confidence, and Purpose dimension presents items that reflect the positive psychological traits that facilitate recovery. The Connection with Others and Social Support dimension comprises the items related to personal relationships and others’ support that helps people to stay well or to recover. Finally, the Living Situation dimension encompasses the items that evaluate the appropriateness of a person’s current home (a basic material condition of existence), which is an enabling condition for recovery.

The implementation of recovery-oriented mental health interventions requires the development of a solid conceptual framework of recovery and the availability of adequate instruments to evaluate such interventions. In order to respond to these objectives, the present study aims to cross-culturally adapt and validate Spanish version of the Recovery Process Inventory (RPI-S), a short and easy-to-administer instrument that, based on several systematic reviews, shows good psychometric properties. Linked to validity evidence based on the relationship between the RPI-S measures and other variables, we aim to demonstrate the relevance of hope and social support to achieve recovery.

The instrument was adapted according to the Standards for Educational and Psychological Testing and the guidelines of the International Test Commission. The results obtained in the translation and cultural adaptation of the instrument were based on the use of an appropriate design for the translation of the items, on the evaluation by experts and on the use of cognitive interviews with the target population, and provided confirmation of semantic, linguistic, and contextual equivalence between the RPI-S and the original instrument, thus providing evidence of content validity.

Regarding validity evidence of its internal structure, the RPI-S showed consistency with the four-factor structure proposed in this study. This structure was chosen because it showed a better fit and was more parsimonious than the structure of the original scale. In addition, from a theoretical approach, this structure included two dimensions closely related to hope (Hope, Confidence, and Purpose dimension) and to social support (Connection with Others and Social Support dimension), which are key elements in the conceptual framework of recovery (Bjørlykhaug et al., 2022; Hayes et al., 2017; Leamy et al., 2011). Furthermore, regarding the Unwellness dimension, recovery-oriented care has been defined as a wellness approach (Swarbrick, 2012). This is in line with the current World Health Organization definition of mental health, which is more than the absence of symptoms, and is conceptualized as “a state of well-being in which the individual realizes his or her own abilities and can cope with the normal stresses of life” (WHO, 2021, p. 1). Wellness is therefore highlighted as one of the basic standards that should be used in evaluating recovery-oriented interventions (Davidson et al., 2021). Finally, the Living Situation dimension recognizes that housing is an enabling condition for recovery from a mental health problem (Browne et al., 2008). In this sense, the recognition of the importance of the Living Situation for the recovery process is the basis of the Housing First programmes that have been implemented in different countries around the world (Greenwood et al., 2020). The structure of the RPI-S proposed in this research incorporates these four key dimensions for assessing personal recovery.

The reliability coefficients obtained for these four dimensions showed that the RPI-S had good internal consistency and temporal stability. For all these reasons we considered that the four dimensions that make up the internal structure empirically validated in this study could be very useful for users, clinicians, and researchers to assess the personal recovery process.

Furthermore, validity evidence based on the relationship between the RPI-S measures and other variables was provided. Specifically, the results showed negative correlations of moderate magnitude of the Unwellness dimension of the RPI-S with the QPR-15-SP and MARS-12 scores, and positive correlations of high magnitude of the other three dimensions of the RPI-S with the QPR-15-SP and MARS-12 scores. These findings can be considered evidence of convergent validity.

With regard to the relationship of the RPI-S measures with hope and social support, the results confirmed the central role of hope and social support to achieve recovery. In fact, people with greater hope and social support from family, friends, and significant others, reported better levels of personal recovery in all the aspects assessed by the RPI-S. To the best of our knowledge, this is the first study to provide direct evidence of the importance of hope for the recovery process in the Spanish-speaking population with severe mental disorders. There are recent studies that support this idea, but in an indirect and inverse way. For example, a study developed in Catalonia (Northeastern Spain) found that only people who had participated in spaces of mutual support and activism, that is, who had been given hope by meeting other people who had made or were making a recovery process, believed that they too could recover (Sampietro et al., 2022). On the other hand, although there is an extensive literature on the importance of social support for mental health in the Spanish-speaking population, studies focusing on recovery are less numerous. Among them, there are two recent studies showing positive effects of social support on recovery in people with psychotic symptoms (Guerrero-Jiménez et al., 2022) or adults over 50 years old with a major depressive disorder (Gabarrell-Pascuet et al., 2022). In the same vein, our study shows that there is a high correlation between perceived social support and personal recovery among the Spanish population with severe mental disorders.

The main limitation of this study is that participants were recruited through convenience sampling within specific regions of Spain. However, it is important to note that the number of participants was adequate making up a representative sample of service users with severe mental disorders.

The results of the validation of the RPI-S suggest that it is a valid and reliable tool for assessing personal recovery among Spanish people with severe mental disorders. The final Spanish version of the RPI, including the instructions and the response options for completing it, can be found in supplementary_files_S6. Furthermore, because it is short and easy to administer, it is a very useful tool for researchers, users, and especially mental health professionals, such as psychiatrists, psychologists, and nurses, who want to adequately assess personal recovery in the Spanish-speaking population.

The study has several important strengths. One is that the RPI-S was developed in strict accordance with internationally recognized guidelines for test adaptation. In addition, its psychometric properties have been thoroughly examined in a substantial sample of the target population, namely Spanish adults with severe mental disorders. It also contributes to the conceptualization of the recovery framework by providing additional evidence on the relevance of psychosocial factors, especially hope and social support, as key elements to be promoted in interventions aimed at personal recovery.

The availability of this new tool, which is both short and easy to administer, provides mental health professionals with a convenient means of assessing recovery. Indeed, the RPI-S assesses psychosocial aspects that promote or hinder personal recovery. In addition, it facilitates the implementation of evidence-based interventions aimed at promoting recovery, thus contributing positively to the provision of recovery-focused mental health care in Spain. From the perspective of users and families, the instrument may encourage interventions that go beyond the clinical goals that have traditionally focused on symptom control and functionality (Sampietro et al., 2023; Pilgrim, 2008) responding to a long-standing request from organizations representing them. From an international perspective, the RPI-S also provides a platform for further adaptations within the Spanish-speaking world, extending the potential applicability of this tool to populations in over 20 countries.