A holistic psychometric analysis of the individual recovery outcomes counter
: balancing user needs in the use of personal outcome measures

  • Bridey Rudd

Student thesis: Doctoral Thesis


The recent focus on recovery and personal outcomes in Scotland has increased pressure on mental health services to evidence that their work is achieving recovery-related outcomes. Developed in response to such pressures, the Individual Recovery Outcomes Counter (I.ROC) is used both to measure change in recovery outcomes, and effect change through use as a therapeutic tool.

This thesis aims to evaluate the extent to which I.ROC can be considered a valid, reliable and feasible measure of personal recovery for routine use in practice.

A mixed-methods action research approach was taken; data was collected in a series studies investigating psychometric properties and stakeholder perspectives. Studies were designed to investigate structural, convergent, face and consequential validity, internal consistency and test-retest reliability. A systematic review of nine personal recovery measures was used to set a series of benchmarks against which I.ROC is evaluated.

I.ROC is consistent with a broad conceptualisation of personal recovery, and is generally considered comprehensive and well-liked by people who use it, although feedback suggests some areas for improvement. Early development of I.ROC, distinctive in its organic and non-research-led approach, falls just short of standards of measure coproduction regarded as best practice; but in this it is not alone. Factor analysis revealed a three-factor model, internal consistency both for the total measure and its subscales is good, and I.ROC correlates as predicted with measures of personal and clinical recovery and recovery-related concepts (e.g. hope). Themes arising from qualitative studies with stakeholders reflect a range
of perceived benefits and barriers to using I.ROC. Used as a conversational tool, I.ROC is beneficial in establishing a recovery-focused support relationship, facilitating personal planning and reviewing progress. At a service level, I.ROC can demonstrate impact and support the embedding of recovery-oriented practice. Barriers to use were reported at the individual and service level. Service level barriers include resource restrictions, staff attitudes and service models inconsistent with recovery. Lack of engagement or honesty in answering questions stops I.ROC being used effectively, and the potential for the tool to trigger negative emotions was acknowledged.

Overall, this thesis provides support for the validity, reliability and usability of I.ROC as a measure of personal recovery. Results of psychometric testing shows the tool to have comparably good properties to other measures of recovery, and feedback from users is positive. Areas for further development of I.ROC are identified; future research should investigate potential improvements to scoring and question wording. I.ROC demonstrates the potential for measures of recovery to be used to both measure change and promote recovery within mental health services, but several challenges remain. Recovery-orientation requires wholesale culture change, and barriers to I.ROC use are reflective of the challenges this presents. Future research should seek to explore how barriers identified within this thesis can be overcome.
Date of Award19 Dec 2018
Original languageEnglish
Awarding Institution
  • Abertay University
SupervisorScott Hardie (Supervisor)


  • Recovery
  • Mental health
  • Outcomes
  • Psychometrics

Cite this