Measuring Recovery Using the Individual Recovery Outcomes Counter: A Cross-Sectional Multi-Center Study on Structural Validity in Dutch Mental Health Care

The Individual Recovery Outcomes Counter (I.ROC) is a recovery orientated measure, originating from Scotland, which is increasingly used in Dutch mental health care. The aim of this study is to extend previous research into the structural validity of the I.ROC. We investigated the factor structure of the Dutch I.ROC among mental health care clients treated in various settings using data (N = 8635) from five Dutch mental health care organisations. We conducted an exploratory factor analysis (EFA, N = 4295) and confirmatory factor analysis (CFA, N = 4340), and tested the fit of factor structures found in previous research. EFA revealed support for both a one- and a two-factor structure: ‘Total-scale’ (12 items; α = 0.88), ‘Empowerment’ (8 items; α = 0.86) and ‘Vitality and Activity’ (4 items; α = 0.67). CFA indicated a good fit for a modified two-factor model found in previous research on a representative sample of the Dutch population comprising ‘Wellbeing, control, network and meaningfulness’ and ‘Health safety and abilities’ (CFI = 0.944). Furthermore, the two-factor solution of this study showed a good fit (CFI = 0.940). However, these findings were not conclusive, as the one and alternative two-, three-, or four-factor models of other studies also demonstrated an acceptable fit. For use with individual patients, inspection of scores on individual items (in a spider graph) is most useful. As proven in several studies, the one-factor structure can be used for summarisation. Additionally, multiple solutions for subscale scores proved to be a good fit. Overall, the structural validity of the I.ROC requires further investigation and research with longitudinal data is recommended.