Optimizing Measurement Potential in Mental Health Clinical Practice: The Canadian Personal Recovery Outcome Measure (C-PROM) study

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Abstract
There is an increasing commitment to “Personal Recovery” as the desired outcome for mental health rehabilitation, yet there is little agreement about how to measure it. The purpose of this study was to develop a method of measuring recovery in community-dwelling people with mental health concerns. We describe a four-phase process, informed by guidelines for (patient-reported outcome measure) PROM development described by the Scientific Advisory Committee of the Medical Outcomes Trust, the Food and Drug Administration, and the International Society for Quality of Life Research, on how to quantify recovery in mental health care. The approach includes an iterative mixed methods process, guided by Classical Test Theory (CTT) and Rasch Measurement Theory (RMT), to develop the Canadian Personal Recovery Outcome Measure (C-PROM) for adults receiving mental health services. In Phases 1 and 2, 40 new items were generated by people with schizophrenia. In Phase 3, psychometric analysis and cognitive interviewing suggested that the item set be reduced to 30 items. Phase 4 (n = 575) showed good overall fit of the C-PROM items to the Rasch model (χ 2 = 163, df = 130, p = .05), no item misfit, high reliability ( r p = 0.92), an ordered response scale structure, high correlation between logit and scale scores (0.92) and no item bias for gender, age, or diagnosis. This study provided evidence for the C-PROM as a measure of personal recovery for people with mental health concerns. The measurement model underpinning this set of items has potential to support clinical relevance of scale scores, advancing an evidence-based approach to mental health rehabilitation practice and outcomes.

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