Refining the Global INSPIRE measure of recovery priorities: A qualitative, linguistic, and statistical approach

Refining the Global INSPIRE measure of recovery priorities: A qualitative, linguistic, and statistical approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Refining the Global INSPIRE measure of recovery priorities: A qualitative, linguistic, and statistical approach Yasuhiro Kotera, Akemi Hara, Akihiko Ozaki, Mike Slade, Svenja Adolphs, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7140856/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Global INSPIRE is a 20-item self-report scale assessing priorities of personal recovery, defined as living a meaningful and satisfying life despite mental health challenges. Grounded in the CHIME framework (Connectedness, Hope, Identity, Meaning, and Empowerment), it asks how important each item is to the respondent’s recovery. Its initial validation (Version 1.0), involved a UK multicultural sample, showed promise, but model fit needed refinement (CFI = 0.80, TLI = 0.77). Methods Following best practices in scale development (DeVellis, 2016), we employed a three-step approach to enhance the scale’s psychometric properties. First, multiple-group confirmatory factor analysis was conducted in the original sample to identify problematic items. Second, these items were revised using qualitative feedback from six British English-speaking reviewers and corpus linguistic analysis. Third, the revised version was tested in a new UK sample. Results Two problematic items (Items 5 and 13) were identified. Corpus linguistic analysis of six reviewers’ comments suggested Item 5 “Feeling hopeful about my future” be changed to “Believing in a positive future for myself”, and Item 13 “Understanding my mental health experience” to “Finding meaning in my mental health experiences”. The updated version of Global INSPIRE (Version 2.0) was completed by 207 people (Age 40 ± 12.50 years; 115 women, 90 men), yielding substantially improved model fit (CFI = 0.965, TLI = 0.959) and strong internal consistency (ordinal alpha = 0.93; Cronbach’s alpha = 0.91). Conclusion Global INSPIRE British English Version 2.0 offers a more robust tool for assessing recovery priorities, demonstrating the value of integrating quantitative, qualitative, and linguistic approaches in scale refinement. scale refinement mental health recovery personal recovery recovery priorities linguistic analysis Introduction Personal recovery in mental health is defined as living a meaningful, satisfying, and fulfilling life despite the presence of mental health challenges [ 1 ]. While clinical recovery focuses on symptom reduction and functional improvement, personal recovery emphasises subjective experiences such as hope, identity, and connectedness [ 2 ]. Over the past two decades, recovery has gained increasing prominence in mental health research, policy, and practice, and is now embedded in national mental health frameworks across many countries. For example, the United Kingdom (UK)’s National Health Service promotes recovery-oriented care through collaborative care planning and peer support programmes [ 3 ]. In Canada, the Mental Health Commission has developed comprehensive Guidelines for Recovery-Oriented Practice [ 4 ], while Australia’s National Mental Health Strategy integrates recovery principles at the policy level [ 5 ]. In the United States, the Substance Abuse and Mental Health Services Administration highlights recovery as a guiding principle underpinning self-direction and person-centred care [ 6 ]. The evidence base for personal recovery is growing. Meta-syntheses indicate that recovery processes can transform experiences of despair into enhanced well-being [ 7 ], and are applicable across diverse populations and mental health conditions problems [ 8 – 10 ]. A recent qualitative evidence synthesis further highlights the role of personal recovery in overcoming stigma and constructing meaning in life [ 11 ]. The CHIME framework—Connectedness, Hope, Identity, Meaning, and Empowerment—was developed through systematic review to characterise the key processes of recovery [ 12 ]. It remains the most widely used framework for understanding personal recovery internationally [ 13 , 14 ]. However, important knowledge gaps persist, particularly regarding the development of standardised measurement tools and the cross-cultural applicability of recovery constructs [ 15 – 17 ]. The Full INSPIRE measure was developed to assess how well mental health services support recovery, aligning with the CHIME framework [ 18 ]. It comprises two subscales: the Support subscale (20 items) assessing perceived support for recovery, and the Relationship subscale (7 items) assessing the therapeutic relationship. Related versions include Brief INSPIRE and Brief INSPIRE-O, designed for streamlined assessment of recovery support and recovery outcomes, respectively [ 19 ]. INSPIRE measures have been translated into 27 languages (researchintorecovery.com/inspire), and validated in diverse cultural contexts including Denmark [ 19 ], Italy [ 20 ], Japan [ 21 ] and Sweden [ 22 ]. Global INSPIRE represents a new extension of the INSPIRE family. It was developed to assess recovery priorities across cultures by asking service users to rate the importance of items from the Support subscale, mapped to the CHIME domains. Global INSPIRE was motivated by the increasing global emphasis on personal recovery, alongside emerging evidence of cross-cultural variations in recovery priorities [ 23 , 24 ]. For example, autonomy is prioritised in individualistic cultures such as the UK and USA, whereas community and social connectedness are emphasised in more collectivistic contexts [ 25 ]. In Japan, compassion for others is foundational to recovery [ 26 ]; in Arab countries, religious values strongly shape recovery experiences [ 27 ]; and in Brazil, social role fulfilment and community participation are emphasised [ 28 ]. Similar cultural distinctions are reported in Poland [ 29 ], Spain [ 30 ], South Africa [ 31 ], and Taiwan [ 32 ]. These findings underscore the need for culturally sensitive assessment tools such as Global INSPIRE. An initial validation study of Global INSPIRE in British English (hereafter “Global INSPIRE British English Version 1.0”), conducted with a multicultural sample of 512 participants in the UK, demonstrated excellent internal consistency and an overall acceptable model fit [ 33 ]. Internal consistency was confirmed by both ordinal alpha (α = 0.94, 95% CI [0.89, 0.97]) and Cronbach’s alpha (α = 0.91, 95% CI [0.90, 0.91]), exceeding the conventional threshold of 0.70 [ 34 ]. Regarding model fit, the Comparative Fit Index (CFI = 0.80) and Tucker–Lewis Index (TLI = 0.77) approached conventional thresholds for exploratory research with multicultural samples (> 0.80) [ 35 ]. The Standardised Root Mean Square Residual (SRMR = 0.12) met the recommended maximum threshold (< 0.12), while the Root Mean Square Error of Approximation (RMSEA = 0.11) slightly exceeded the preferred limit (< 0.10) [ 35 ]. These results indicated an acceptable foundation but highlighted the need for further refinement. Methods Ethics approval was obtained from the Research Ethics Committee of the Faculty of Medicine & Health Sciences, the University of Nottingham (Ref: FMHS 78-1123). This study was funded by the Great Britain Sasakawa Foundation. Measures In previous work, Global INSPIRE British English Version 1.0 was developed to assess recovery priorities in the general population. It was developed by adapting items from the Support subscale of the Full INSPIRE measure, a mental health service user-rated assessment of recovery support received from a mental health worker [ 18 ]. The Full INSPIRE subscale comprises 20 items (four per CHIME domain), each comprising two parts: (1) whether the aspect is important for the respondent's recovery (Yes/No) and (2) if Yes, the extent of support received. The subscale demonstrated strong psychometric properties in service users (n = 92), including good convergent validity with the Satisfaction Index–Mental Health (r = 0.60) [ 36 ], a five-factor structure accounting for 85.1% of the variance, and high internal consistency (α = 0.82–0.85). To create Global INSPIRE British English Version 1.0, the administration instructions and wording of each item from the Full INSPIRE Support subscale were modified to also be relevant to individuals not using mental health services. Items in Global INSPIRE British English Version 1.0 begin with the phrase "An important part of my recovery is....", for example, “…feeling supported by other people” (Connectedness) and “…feeling hopeful about my future” (Hope). Three items were slightly reworded to ensure relevance for non-service users, such as changing "Having support from other people who use services" to "Having support from other people who live with mental health difficulties." These adaptations aimed to preserve psychometric integrity while broadening applicability. Respondents rate each item on a five-point Likert scale (0 = "Not at all" to 4 = "Very much"). Subscale scores are calculated by summing four items, dividing by 16, and multiplying by 100, resulting in scores from 0 (low priority) to 100. The Global INSPIRE measure and manual are available at https://www.researchintorecovery.com/measures/inspire/ . The initial validation of Global INSPIRE British English Version 1.0 involved a multicultural sample of 512 participants in the UK, including 26.4% from ethnic minority backgrounds [ 33 ]. Model fit indices approached conventional thresholds for exploratory validation in diverse samples [ 35 , 37 ]: Comparative Fit Index (CFI) = 0.80, Tucker–Lewis Index (TLI) = 0.77, Standardised Root Mean Square Residual (SRMR) = 0.12, and Root Mean Square Error of Approximation (RMSEA) = 0.11. Measurement model reliability was acceptable, with Cronbach’s alpha values ranging from 0.70 to 0.85 across latent variables [ 34 ]. These findings suggest the model captures the underlying data structure reasonably well but may benefit from further refinement. Procedures To improve the psychometric properties of Global INSPIRE British English Version 1.0, we followed an iterative refinement process informed by best practices in scale development [ 38 ]: Step 1. Identifying problematic items, Step 2. Refining item wording, and Step 3. Re-evaluating psychometric properties. Step 1. Identifying problematic items To identify items that have caused the relatively low fit indices, we conducted a multiple-group confirmatory factor analysis (CFA), constraining both factor loadings and intercepts using the Weighted Least Squares Mean and Variance-adjusted (WLSMV) estimator to the data (n = 512) in the original validation study [ 33 ]. We then examined the modification indices (MIs). Items with the largest MIs were flagged as problematic, as their intercept constraints contributed most significantly to poor model fit. Step 2. Refining item wording We used two phases to refine item wording: reviewer-informed and linguistic. In the first phase, three individuals with lived experience of using mental health services and three individuals without such experience (all first-language speakers of British English) reviewed the items identified in Step 1. These six individuals (referred to as “item wording reviewers”) were presented with all 20 Global INSPIRE items. For each problematic item, they were informed of its associated CHIME subscale and shown the other three items from the same subscale. To stimulate thinking, they were also presented with two candidate alternatives developed by the research team (“Believing in a positive future for myself” and “Feeling confident that things will improve in my life” for Item 5; “Understanding my mental health” and “Finding meaning in my mental health experiences” for Item 13). Reviewers were then asked to (a) propose revised phrasings that would make the problematic item more consistent in tone, structure, and meaning with the other items in the same subscale, and (b) optionally provide a rationale for their proposals. We then employed corpus linguistics tools to provide a complementary, data-driven perspective on the use of terms proposed by item wording reviewers in naturally occurring British English. The analysis drew on the English Web EnTenTen21 (UK domain) corpus (a dataset comprising approximately 2.94 billion words of online language use) accessed via Sketch Engine, the online linguistic analysis platform used in this study [ 39 ]. As Global INSPIRE was evaluated within a UK context and reviewed by native British English speakers, we limited the analysis to the UK component of the corpus. This decision ensured consistency with the linguistic and cultural norms of the target population, and avoided the influence of other English varieties (e.g., American or Australian) that may exhibit different usage patterns. To assess the typical meanings and associations of the proposed terms, we examined their collocates and concordance lines. Collocates (i.e., words that statistically co-occur with a target term more frequently than would be expected by chance) offer insight into common lexical associations. Concordance lines display instances of the target word in context, revealing typical usage patterns and underlying connotations, such as whether the term tends to evoke notions of empowerment or vulnerability. Based on reviewer feedback, we specifically investigated the everyday usage of the terms “hope,” “believe,” and “understand” in British English. This analysis ensured that revised item phrasings aligned with the intended conceptualisation of personal recovery and reduced the risk of misinterpretation in the UK context. Step 3. Re-evaluating psychometric properties The revised Global INSPIRE (“Global INSPIRE British English Version 2.0”) was administered to a new sample of 200 UK participants using the web-based research platform Prolific. Prolific has been shown to yield high-quality and reliable data for psychological and social science research [ 40 ]. A sample size of approximately 200 is considered a recommended minimum for CFA, particularly when evaluating scale refinements with modest model complexity [ 41 , 42 ]. CFA was conducted to evaluate model fit using the same indices as in the initial validation (CFI, TLI, SRMR, RMSEA), alongside assessment of internal consistency. Results Step 1. Identifying problematic items Inspection of the MIs for the relatively poor-fitting model in the original validation study date [ 33 ] revealed that the intercept constraints for items 5 (“Feeling hopeful about my future”) (MI = 2764.75) and 13 (“Understanding my mental health experience”) (MI = 1312.43) were problematic, exceeding the threshold for concern (MI > 10) by several orders of magnitude. These extreme values suggest that constraining the intercepts of items 5 and 13 to be equal across groups placed substantial strain on the model’s ability to reproduce the observed item means. This points to meaningful differences in how respondents from the UK and Japan first mention of Japan – delete or describe in Methods Measures endorse these items, even when they share similar levels of the underlying construct. To address this, we freed the intercept constraints for these two items. This adjustment led to a substantial improvement in model fit: CFI increased from 0.83 to 0.995, TLI from 0.81 to 0.993, RMSEA decreased from 0.11 to 0.016 (90% CI: 0.010–0.022), and SRMR from 0.09 to 0.03. These findings suggest that items 5 and 13 contributed disproportionately to the poor fit of the model and may reflect culturally specific patterns of response. Step 2. Refining item wording The two problematic items were reviewed by three service users and three non-service users. The five reviewer suggestions for re-wording Item 5 included “Believing in a positive future for myself” (two reviewers) and the four reviewer suggestions for re-wording Item 13 included “Finding meaning in my mental health experiences” (three reviewers). All responses are shown in Supplementary Material 1. Three terms—“hope”, “believe”, and “understand”—emerged as central to how recovery was conceptualised by reviewers. Their reflections highlighted distinct connotations attached to each term. One reviewer stressed the value of retaining “hope”, while another cautioned that the word could appear ambiguous or even disempowering, commenting that “hope can be good or bad” and might seem hollow without a firmer sense of conviction. In contrast, “believe” was viewed as more agentic and intentional, associated with active personal commitment (e.g., “the words ‘feeling’ and ‘hopeful’ without some additional belief… seem emptier”). “Understand” was perceived by one reviewer as potentially reductive, suggesting a clinical or detached interpretation of mental health, rather than one grounded in emotional or existential meaning: “some people may have a good understanding of their mental health experience, but it may not be meaningful for them.” These qualitative perspectives informed the selection of target terms for linguistic analysis. We examined how “hope”, “believe”, and “understand” are used in everyday British English to evaluate whether their typical associations aligned with the recovery-oriented tone of Global INSPIRE. We analysed collocates and concordance lines for “hope,” “believe,” and “understand.” This analysis focused on three linguistic dimensions: (1) modifiers of the target words (i.e., words that describe or intensify the meaning of the main term, such as “firmly” in “firmly believe”); (2) actions commonly associated with each term, and (3) objects linked to the actions (e.g., “hope for a miracle,” “understand the impact”). These dimensions are presented in Table 1 as Phrase types [ 1 ] through [ 5 ]. We examined the top ten general collocates for each term and reviewed their concordance lines to assess typical tone and connotations in naturally occurring British English. Table 1 Collocates for “hope”, “believe”, “understand” Phrases Focus words and top ten collocates per phrase "hope" "believe" "understand" Modifiers [ 1 ] Modifiers of "hope"/ "believe"/ "understand" sincerely, fervently, earnestly, desperately, secretly, realistically, humbly, vainly, dearly, optimistically firmly, passionately, genuinely, strongly, mistakenly, honestly, sincerely, verily, wholeheartedly, wrongly poorly, fully, incompletely, intuitively, instinctively, properly, truly, exactly, clearly, readily Actions [ 2 ] … and/or "hope"/ "believe"/ "understand" expect, pray, wish, prey*, believe, dream, fear, trust, luck, despair disbelieve, hope, repent, trust, belong, suspect, obey, practise, intent, behave, know appreciate, recognise, analyse, know, interpret, predict, address, apply, respond, empathise Objects [ 3 ] "hope" for … turnout, repeat, miracle, weather, luck, sunshine, glimpse, outcome, rain, ending [ 4 ] "hope"/ "believe" in … tatter, lord, fortnight, Jehovah, Lord, adversity, mercy, Thee, sincerity, jest God, god, ghost, importance, fairy, miracle, equality, magic, freedom, resurrection [ 5 ] objects of "understand" importance, behaviour, implication, dynamics, nature, complexity, context, mechanism, impact, significance Note: All instances of “prey” identified as collocates of hope were, upon inspection of concordance lines (i.e., examples of how the word is used in context), determined to be misspellings of “pray.” These were therefore interpreted as references to “pray” in the analysis. The analysis revealed that “hope” often co-occurred with words conveying uncertainty or desperation (e.g., “desperately,” “luck,” “miracle”), while “believe” was more commonly associated with agency and conviction (e.g., “firmly,” “freedom,” “trust”). “Understand” was typically used in analytical or clinical contexts, linked to words such as “mechanism,” “impact,” and “complexity.” These findings suggest that, within the context of personal recovery, “believe” and “finding meaning” may be more conceptually appropriate and better aligned with the empowering, emotionally resonant language of recovery than “hope” and “understand.” Table 1 highlights key differences in the language patterns associated with the terms “hope,” “believe,” and “understand.” The word “hope” frequently co-occurs with modifiers and objects that carry negative or uncertain connotations (Phrases [ 1 ] and [ 3 ]), such as “desperately,” “secretly,” “fear,” and “despair.” It is also commonly linked to actions and objects suggesting high desire but low certainty or control (Phrases [ 2 ] and [ 3 ], e.g., “pray,” “wish,” “dream,” “luck,” “miracle”). These patterns may imply a sense of vulnerability or passivity that could conflict with the active, empowered stance central to personal recovery. In contrast, “understand” is more often associated with cognitive clarity and analytical processes. It is modified by terms denoting completeness or precision (Phrase [ 1 ], e.g., “fully,” “properly,” “clearly”), and paired with verbs indicating reasoning or comprehension (Phrase [ 2 ], e.g., “analyse,” “know”). It is also linked to abstract or complex concepts (Phrase [ 5 ], e.g., “importance,” “significance,” “mechanism”). While this language reflects intellectual engagement, it may miss the emotional and experiential dimensions of recovery. By contrast, “believe” appears to strike a more appropriate balance between cognitive certainty and emotional investment. It frequently co-occurs with words that express confidence (Phrases [ 1 ] and [ 2 ], e.g., “firmly,” “strongly,” “trust,” “know”) and with terms that convey deep personal or moral conviction (Phrase [ 1 ], e.g., “passionately,” “genuinely,” “sincerely”). Moreover, “believe” is often directed toward aspirational or highly valued outcomes (Phrase [ 4 ], e.g., “equality,” “freedom,” “miracle”), which aligns closely with the motivational and hopeful aspects of recovery. Word sketches for the three target words are in Supplementary Material 2. Based on the corpus analysis and reviewers’ insights, item 5 was changed from “Feeling hopeful about my future” to “Believing in a positive future for myself”. The revised version avoids the potential misunderstandings or negative tones associated with “hope”, while maintaining the emphasis on emotional involvement, as identified for “believe”. Item 13 was changed from “Understanding my mental health experience” to “Finding meaning in my mental health experiences”. The revised version avoids the intellectual aspect associated with “understand”; instead, it describes recovery as a process of making experience meaningful. Step 3. Re-evaluating psychometric properties Two hundred and seven people completed the survey. Participant characteristics are shown in Table 2 . Table 2 Participant characteristics n = 207 n (%) Age (years) 40 ± 12.50 Gender Female 115 (55.6) Male 90 (43.5) Non-binary/prefer not to say ≤ 5 Ethnicity White British Other White Asian/Asian British Black/ African/Caribbean/Black British Mixed/Multiple ethnic groups 156 (75.4%) 14 (6.8%) 24 (11.6%) ≤ 5 8 (3.9%) Sexual Straight/Heterosexual 189 (91.3%) Gay or Lesbian ≤ 5 Bisexual 13 (6.3%) Other/Prefer not to say/Unknown ≤ 5 Mental health service experience Yes 98 (47.3%) Less than 1 year 42(20.3%) 1 to 5 years 37 (17.9%) More than 5 years 19 (9.2%) No 109 (52.7%) Note: For categories with counts of 5 or fewer, values are reported as ≤ 5 to prevent identifiability. The initial CFA using the WLSMV estimator indicated excellent comparative fit, with CFI = 0.965 and TLI = 0.959. However, absolute and residual fit indices were somewhat less favourable, with RMSEA = 0.116 (90% CI: 0.107–0.126) and SRMR = 0.103. After applying the first-order Satorra–Bentler scaling correction, the model retained acceptable comparative fit (CFI.scaled = 0.886, TLI.scaled = 0.865), though RMSEA increased slightly to 0.125 (see Supplementary Material 3 for the path diagram). These adjusted values offer a more conservative and robust assessment of model fit, particularly in the context of non-normal or ordinal data, as recommended in best practices for CFA [ 35 ]. Internal consistency was excellent, with an ordinal alpha of 0.93 (95% CI: 0.88–0.97) and a Cronbach’s alpha of 0.91 (95% CI: 0.88–0.97) [ 34 ]. These results suggest that the proposed factor structure performs well in relative terms and provides a reasonable approximation of the observed data, supporting its continued refinement and use in cross-cultural contexts. Discussion This study aimed to refine and re-evaluate the Global INSPIRE measure, which assesses the priorities of mental health personal recovery. Building on initial validation work, we sought to improve the psychometric properties by identifying and addressing items that contributed to poor fit. Using a combination of CFAs, qualitative review, and corpus linguistics analyses, we identified and revised two problematic items, and demonstrated substantial improvements in model fit. Specifically, the CFI improved from 0.80 in the Version 1.0 to 0.965 in the Version 2.0, and the TLI improved from 0.77 to 0.959, indicating a substantial enhancement in comparative model fit. Importantly, this refinement process illustrates how culturally informed methods, particularly the integration of corpus linguistics, can enhance the reliability and contextual relevance of recovery measures. This is especially valuable when working with multicultural samples, such as the UK general population, where cultural and linguistic diversity influence how recovery concepts are understood and expressed [ 43 , 44 ]. Global INSPIRE British English Version 2.0 offers promising applications for both research and practice in the field of personal recovery, which continues to expand globally. It enables the assessment of recovery priorities not only among mental health service users but also in the general population, offering a broader perspective on how recovery is understood and valued across diverse groups. Importantly, the term “service user” can carry different meanings in various cultural contexts [ 45 ]. For instance, in Japan, individuals may engage in recovery practices such as visiting Shinto shrines, drawing on cultural and spiritual traditions outside of formal mental health services [ 46 ]. In Indigenous communities, recovery may involve reconnecting with land, ancestry, and ceremony rather than accessing clinical care [ 47 ]. The structure of Global INSPIRE, rooted in the CHIME framework, can support meaningful comparison across such contexts, while allowing for attention to cultural nuance. In future research, Global INSPIRE could be adapted to specific populations through culturally responsive methods such as targeted cognitive interviews and linguistic analysis, as demonstrated in this study. It also holds strong potential as a tool for evaluating recovery-oriented service development and policy implementation internationally, by capturing people’s recovery needs in a culturally grounded way and ensuring that services are aligned with those needs. The selection of revised phrasings—“believing in a positive future for myself” and “finding meaning in my mental health experiences”—was informed by both participant feedback and corpus linguistic analysis. These revisions were chosen to better reflect the active and empowering nature of personal recovery [ 2 ]. While the term “hope” often conveyed a sense of passivity and uncertainty in its common usage, the word “believe” suggested greater agency and conviction, particularly within British English discourse[ 48 ]. Similarly, “understand” was more closely associated with cognitive reasoning, whereas “finding meaning” captured a more interpretive and emotionally grounded process, which is consistent with how recovery is often conceptualised in first-person narratives [ 49 ]. These changes align more closely with how individuals in the UK context describe and experience personal recovery. Our methodological approach offers a structured and practical contribution to scale refinement practices. Guided by best practices in scale development [ 38 ], we employed an iterative process involving three key stages: identifying problematic items through quantitative model testing, refining item wording through target population member input and linguistic analysis, and re-evaluating psychometric properties. What distinguishes our approach is the triangulation of statistical misfit with lived experience and corpus-informed linguistic evidence. This integrative strategy addressed both psychometric and semantic challenges in a rigorous and culturally grounded way, improving scale performance while enhancing interpretability across diverse populations. This strategy is particularly valuable in multicultural settings like the UK, where diverse linguistic and cultural backgrounds shape how recovery is conceptualised and articulated. This study has several strengths. It employed a rigorous and transparent refinement process, involved participants with and without service use experience, and introduced an innovative linguistic lens for item revision. The re-validation was conducted with a sufficiently powered and diverse UK-based sample, supporting generalisability within similar contexts. However, limitations include the use of a single national sample for re-validation, limiting immediate cross-cultural comparisons. In addition, the study focused on only two items; broader item-level analysis could yield further improvements. Finally, while corpus analysis provided valuable insights, it was limited to British English usage and may not generalise to other English-speaking cultures or translations. Future research should include participants from a broader range of cultural and linguistic backgrounds and involve both service users and non-service users to explore global similarities and differences in recovery priorities. Conclusion The refined version of the Global INSPIRE, Global INSPIRE British English Version 2.0, represents a significant step forward in developing culturally sensitive tools for measuring personal recovery. Through a carefully integrated process of psychometric testing, target population member consultation, and linguistic analysis, we identified and addressed key sources of poor model fit. The resulting revisions improved both statistical performance and conceptual alignment with recovery principles. Global INSPIRE is now better positioned to support international research, policy, and practice in mental health recovery by offering a measure that respects and reflects cultural variation in what recovery means to individuals. Future work should explore the measure’s applicability in other cultural contexts and languages to further advance global recovery-oriented care. Declarations 1. Funding This study was funded by the Great Britain Sasakawa Foundation. 2. Conflicts of interest/Competing interests The authors declare no conflicts of interest. 3. Ethics approval Ethics approval: Ethics approval was obtained from the Research Ethics Committee of the Faculty of Medicine & Health Sciences, University of Nottingham (Ref: FMHS 78-1123). 4. Consent to participate All participants provided informed consent to take part in the study, in accordance with ethical guidelines and institutional approval. 5. Consent for publication Consent was obtained from all participants for the publication of anonymised data included in this manuscript. 6. Availability of data and material The data that support the findings of this study are available from the corresponding author upon reasonable request. 7. Code availability Not applicable. 8. Authors' contributions Conceptualisation and design: YK, AH, SVL; Data collection: YK; Statistical analysis: AH; Theoretical input and interpretation: YK, AH, AO, MS, SA, SVL; Manuscript draft: YK, AH, SVL; Manuscript review and revision: YK, AH, AO, MS, SA, SVL. Acknowledgement We are grateful for the Great Britain Sasakawa Foundation for their support. Mike Slade acknowledges the support of the NIHR Nottingham Biomedical Research Centre. References W. A. Anthony, "Recovery from mental illness: The guiding vision of the mental health service system in the 1990s," Psychosoc. Rehabil. J. , vol. 16, no. 4, pp. 11–23, 1993/4 1993, doi: 10.1037/h0095655 . M. Slade, Personal recovery and mental illness: A guide for mental health professionals . Cambridge University Press, 2009. G. Shepherd, J. Boardman, M. Rinaldi, and G. Roberts, "Supporting recovery in mental health services: Quality and outcomes," London: Implementing Recovery Through Organisational Change , 2014. M. Piat et al. , "Translating mental health recovery guidelines into recovery-oriented innovations: A strategy combining implementation teams and a facilitated planning process," Evaluation and Program Planning , vol. 91, p. 102054, 2022/04/01/ 2022, doi: https://doi.org/10.1016/j.evalprogplan.2022.102054 . Australian Government Department of Health, A national framework for recovery-oriented mental health services: Guide for practitioners and providers Canberra, Australia Author, 2021. [Online]. Available: https://www.health.gov.au/sites/default/files/documents/2021/04/a-national-framework-for-recovery-oriented-mental-health-services-guide-for-practitioners-and-providers.pdf . SAMHSA’s Trauma Justice Strategic Initiative, SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach . Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA), 2014. N. Dell, C. Long, and M. Mancini, "Models of mental health recovery: An overview of systematic reviews and qualitative meta-syntheses," Psychiatric rehabilitation journal , 2021-03-18 2021, doi: 10.1037/prj0000444 . A. Shepherd, M. Doyle, C. Sanders, and J. Shaw, "Personal recovery within forensic settings–Systematic review and meta-synthesis of qualitative methods studies," Criminal behaviour and mental health: CBMH , vol. 26 1, pp. 59–75, 2016-02-01 2016, doi: 10.1002/cbm.1966 . A. Ballesteros-Urpi, M. Slade, D. Manley, and H. Pardo-Hernandez, "Conceptual framework for personal recovery in mental health among children and adolescents: a systematic review and narrative synthesis protocol," (in eng), BMJ Open , vol. 9, no. 8, p. e029300, Aug 15 2019, doi: 10.1136/bmjopen-2019-029300 . A. Shepherd, C. Sanders, M. Doyle, and J. Shaw, "Personal recovery in personality disorder: Systematic review and meta-synthesis of qualitative methods studies," International Journal of Social Psychiatry , vol. 62, pp. 41–50, 2016-02-01 2016, doi: 10.1177/0020764015589133 . G. Jordan et al. , "Personal Recovery Among People at Risk for Developing Serious Mental Health Problems: A Qualitative Systematic Review," Psychiatric services , 2024-02-27 2024, doi: 10.1176/appi.ps.20230133 . M. Leamy, V. Bird, C. L. Boutillier, J. Williams, and M. Slade, "Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis," British Journal of Psychiatry , vol. 199, no. 6, pp. 445–452, 2011, doi: 10.1192/bjp.bp.110.083733 . M. N. Lases et al. , "Is personal recovery a transdiagnostic concept? Testing the fit of the CHIME framework using narrative experiences," (in eng), J Ment Health , pp. 1–9, Jun 30 2024, doi: 10.1080/09638237.2024.2361225 . World Health Organization, Guidance on community mental health services: Promoting person-centred and rights-based approaches , Geneva: World Health Organization, 2021. [Online]. Available: https://apps.who.int/iris/handle/10665/341648 . Accessed on: 5 April 2022. J. Van Weeghel, C. Van Zelst, D. Boertien, and I. Hasson-Ohayon, "Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses," Psychiatric rehabilitation journal , vol. 42 2, pp. 169–181, 2019-03-07 2019, doi: 10.1037/prj0000356 . H. Killaspy, S. White, T. L. Taylor, and M. King, "Psychometric properties of the mental health recovery star," The British Journal of Psychiatry , vol. 201, no. 1, pp. 65–70, 2012. S. Felix et al. , "Personal recovery self-report outcome measures in serious mental illness: A systematic review of measurement properties," Clinical Psychology Review , vol. 112, p. 102459, 2024/08/01/ 2024, doi: https://doi.org/10.1016/j.cpr.2024.102459 . J. Williams et al. , "Development and evaluation of the INSPIRE measure of staff support for personal recovery," Social Psychiatry and Psychiatric Epidemiology , vol. 50, no. 5, pp. 777–786, 2015/05/01 2015, doi: 10.1007/s00127-014-0983-0 . S. B. Moeller et al. , "Scalability, test–retest reliability and validity of the Brief INSPIRE-O measure of personal recovery in psychiatric services," (in English), Frontiers in Psychiatry , Original Research vol. 15, 2024-May-14 2024, doi: 10.3389/fpsyt.2024.1327020 . N. Ratti, B. Mattioli, L. Mellini, I. Negri, and A. Mastrocola, "Preliminary Evaluation of the Italian Version of the Inspire Measure of Staff Support for Personal Recovery," European Psychiatry , vol. 33, 2016-03-01 2016, doi: 10.1016/j.eurpsy.2016.01.1799 . R. Kotake et al. , "Reliability and validity of the Japanese version of the INSPIRE measure of staff support for personal recovery in community mental health service users in Japan," BMC Psychiatry , vol. 20, no. 1, p. 51, 2020/02/07 2020, doi: 10.1186/s12888-020-2467-y . U. K. Schön, P. Svedberg, and D. Rosenberg, "Evaluating the INSPIRE measure of staff support for personal recovery in a Swedish psychiatric context," (in eng), Nord J Psychiatry , vol. 69, no. 4, pp. 275–81, May 2015, doi: 10.3109/08039488.2014.972453 . Y. Kotera et al. , "28-country global study on associations between cultural characteristics and Recovery College fidelity," npj Mental Health Research , vol. 3, no. 1, p. 46, 2024/10/08 2024, doi: 10.1038/s44184-024-00092-9 . D. Hayes et al. , "Organisational and student characteristics, fidelity, funding models, and unit costs of recovery colleges in 28 countries: a cross-sectional survey," The Lancet Psychiatry , vol. 10, no. 10, pp. 768–779, 2023, doi: 10.1016/S2215-0366(23)00229-8 . A. Adeponle, R. Whitley, and L. Kirmayer, "Cultural contexts and constructions of recovery," 2012, doi: 10.1093/med/9780199691319.003.0008 . A. Kanehara et al. , "Culture-dependent and universal constructs and promoting factors for the process of personal recovery in users of mental health services: qualitative findings from Japan," BMC Psychiatry , vol. 22, 2021-03-03 2021, doi: 10.1186/s12888-022-03750-4 . J. Hickey, J. Hickey, S. Pryjmachuk, and H. Waterman, "Exploring personal recovery in mental illness through an Arabic sociocultural lens," Journal of psychiatric and mental health nursing , vol. 24 2–3, pp. 163–170, 2017-03-01 2017, doi: 10.1111/jpm.12342 . J. A. Orsi et al. , "Recovery processes reported by people with severe mental illness in Brazil: systematic review and thematic synthesis," Transcultural Psychiatry , 2025. [Online]. Available: https://nottingham-repository.worktribe.com/output/39720460 . I. Nowak, J. Waszkiewicz, P. Świtaj, M. Sokół-Szawłowska, and M. Anczewska, "A Qualitative Study of the Subjective Appraisal of Recovery Among People with Lived Experience of Schizophrenia in Poland," (in eng), Psychiatr Q , vol. 88, no. 3, pp. 435–446, Sep 2017, doi: 10.1007/s11126-016-9459-6 . J. Saavedra, S. Arias-Sánchez, J. A. Matías-García, and J. Brzeska, "“I don’t believe I’m going to recover from anything.” Understanding recovery amongst people with severe mental illness attending community health services in Spain," Disability and Rehabilitation , vol. 44, no. 20, pp. 5974–5982, 2022/09/25 2022, doi: 10.1080/09638288.2021.1954246 . A. de Wet and C. Pretorius, "Perceptions and understanding of mental health recovery for service users, carers, and service providers: A South African perspective," (in eng), Psychiatr Rehabil J , vol. 44, no. 2, pp. 157–165, Jun 2021, doi: 10.1037/prj0000460 . P. Y. Chao, W. L. Hsieh, S. T. Yeh, C. J. Hsieh, C. Y. Liu, and W. I. Liu, "Factors associated with personal recovery among psychiatric nursing home residents," (in eng), J Psychiatr Ment Health Nurs , vol. 29, no. 6, pp. 852–860, Dec 2022, doi: 10.1111/jpm.12814 . Y. Kotera et al. , "Development and evaluation of a mental health recovery priority measure for cross-cultural research: Global INSPIRE," Under review , 2025. J. C. Nunnally and I. Bernstein, Psychometric Theory , 3 ed. (McGraw-Hill Series in Psychology). Maidenhead, England: McGraw Hill Higher Education, 1993, p. 736. T. A. Brown, Confirmatory factor analysis for applied research, 2nd ed (Confirmatory factor analysis for applied research, 2nd ed.). New York, NY, US: The Guilford Press, 2015, pp. xvii, 462-xvii, 462. L. Nabati, N. Shea, L. McBride, C. Gavin, and M. S. Bauer, "Adaptation of a simple patient satisfaction instrument to mental health: psychometric properties," (in eng), Psychiatry Res , vol. 77, no. 1, pp. 51 – 6, Jan 16 1998, doi: 10.1016/s0165-1781(97)00122-4 . L. t. Hu and P. M. Bentler, "Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives," Structural Equation Modeling: A Multidisciplinary Journal , vol. 6, no. 1, pp. 1–55, 1999, doi: 10.1080/10705519909540118 . R. F. DeVellis, Scale development , 4 ed. (Applied Social Research Methods). Thousand Oaks, CA: SAGE Publications, 2016, p. 280. A. Kilgarriff et al. , "The Sketch Engine: ten years on," Lexicography , vol. 1, no. 1, pp. 7–36, 2014/07/01 2014, doi: 10.1007/s40607-014-0009-9 . E. Peer, L. Brandimarte, S. Samat, and A. Acquisti, "Beyond the Turk: Alternative platforms for crowdsourcing behavioral research," Journal of Experimental Social Psychology , vol. 70, pp. 153–163, 2017, doi: 10.1016/j.jesp.2017.01.006 . R. L. Worthington and T. A. Whittaker, "Scale Development Research: A Content Analysis and Recommendations for Best Practices," The Counseling Psychologist , vol. 34, no. 6, pp. 806–838, 2006/11/01 2006, doi: 10.1177/0011000006288127 . R. B. Kline, Principles and practice of structural equation modeling, fourth edition , 4 ed. (Methodology in the Social Sciences). New York, NY: Guilford Publications, 2015, p. 534. F. J. R. van de Vijver and K. Leung, V. H. Fetvadjiev, J. He, and J. R. J. Fontaine, Eds. Methods and Data Analysis for Cross-Cultural Research , 2 ed. (Culture and Psychology). Cambridge: Cambridge University Press, 2021. J. Panadevo, Y. Kotera, N. R. Køcks, L. D. Kring, and S. B. Møller, "Personal recovery after mental illness from a cultural perspective: A scoping review," International Journal of Social Psychiatry , vol. 71, no. 3, pp. 444–468, 2025/05/01 2024, doi: 10.1177/00207640241303026 . D. Rose, G. Thornicroft, and M. Slade, "Who decides what evidence is? Developing a multiple perspectives paradigm in mental health," (in eng), Acta Psychiatr Scand Suppl , no. 429, pp. 109 – 14, 2006, doi: 10.1111/j.1600-0447.2005.00727.x . M. Nakao and C. Ohara, "The perspective of psychosomatic medicine on the effect of religion on the mind-body relationship in Japan," (in eng), J Relig Health , vol. 53, no. 1, pp. 46–55, Feb 2014, doi: 10.1007/s10943-012-9586-9 . J. P. Gone, "Redressing First Nations historical trauma: theorizing mechanisms for indigenous culture as mental health treatment," (in eng), Transcult Psychiatry , vol. 50, no. 5, pp. 683–706, Oct 2013, doi: 10.1177/1363461513487669 . Sketch Engine. "EnTenTen21 corpus – UK English dataset." Author. https://www.sketchengine.eu/ (accessed 25 Apr, 2025). M. Slade et al. , "Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial," (in eng), World Psychiatry , vol. 23, no. 1, pp. 101–112, Feb 2024, doi: 10.1002/wps.21176 . Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterialsRefiningGlobalINSPIREv02.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7140856","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492176674,"identity":"455223d7-ca5b-4c60-bf47-790ec221a77c","order_by":0,"name":"Yasuhiro Kotera","email":"data:image/png;base64,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","orcid":"","institution":"University of Nottingham","correspondingAuthor":true,"prefix":"","firstName":"Yasuhiro","middleName":"","lastName":"Kotera","suffix":""},{"id":492176676,"identity":"22235fa0-795b-493a-acd0-3d8bdf3c829b","order_by":1,"name":"Akemi Hara","email":"","orcid":"","institution":"Medical Governance Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Akemi","middleName":"","lastName":"Hara","suffix":""},{"id":492176678,"identity":"83e2ec11-9e3d-4b74-bda7-d6bed7933f82","order_by":2,"name":"Akihiko Ozaki","email":"","orcid":"","institution":"Medical Governance Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Akihiko","middleName":"","lastName":"Ozaki","suffix":""},{"id":492176680,"identity":"20f05a56-8152-4fd2-9ba2-ccbe7460717c","order_by":3,"name":"Mike Slade","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Mike","middleName":"","lastName":"Slade","suffix":""},{"id":492176681,"identity":"c3a61a63-3a77-49f4-a123-fae74062610b","order_by":4,"name":"Svenja Adolphs","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Svenja","middleName":"","lastName":"Adolphs","suffix":""},{"id":492176682,"identity":"4679dc3e-ef6d-4c8f-828e-62c0f73240b4","order_by":5,"name":"Sara Vilar Lluch","email":"","orcid":"","institution":"Cardiff University","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"Vilar","lastName":"Lluch","suffix":""}],"badges":[],"createdAt":"2025-07-16 14:08:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7140856/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7140856/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93006341,"identity":"3ab94c5f-ce71-4aba-b58a-30db53d302a0","added_by":"auto","created_at":"2025-10-08 06:47:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":629519,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7140856/v1/a9735686-61ec-46ce-8f79-d204288e4d54.pdf"},{"id":87915462,"identity":"142420c9-5131-4fd3-8da2-23569a82a6bf","added_by":"auto","created_at":"2025-07-30 10:51:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1052319,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsRefiningGlobalINSPIREv02.docx","url":"https://assets-eu.researchsquare.com/files/rs-7140856/v1/245032b3b26904c76819ae31.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Refining the Global INSPIRE measure of recovery priorities: A qualitative, linguistic, and statistical approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePersonal recovery in mental health is defined as living a meaningful, satisfying, and fulfilling life despite the presence of mental health challenges [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While clinical recovery focuses on symptom reduction and functional improvement, personal recovery emphasises subjective experiences such as hope, identity, and connectedness [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Over the past two decades, recovery has gained increasing prominence in mental health research, policy, and practice, and is now embedded in national mental health frameworks across many countries. For example, the United Kingdom (UK)\u0026rsquo;s National Health Service promotes recovery-oriented care through collaborative care planning and peer support programmes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Canada, the Mental Health Commission has developed comprehensive Guidelines for Recovery-Oriented Practice [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], while Australia\u0026rsquo;s National Mental Health Strategy integrates recovery principles at the policy level [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the United States, the Substance Abuse and Mental Health Services Administration highlights recovery as a guiding principle underpinning self-direction and person-centred care [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe evidence base for personal recovery is growing. Meta-syntheses indicate that recovery processes can transform experiences of despair into enhanced well-being [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and are applicable across diverse populations and mental health conditions problems [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A recent qualitative evidence synthesis further highlights the role of personal recovery in overcoming stigma and constructing meaning in life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe CHIME framework\u0026mdash;Connectedness, Hope, Identity, Meaning, and Empowerment\u0026mdash;was developed through systematic review to characterise the key processes of recovery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It remains the most widely used framework for understanding personal recovery internationally [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, important knowledge gaps persist, particularly regarding the development of standardised measurement tools and the cross-cultural applicability of recovery constructs [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Full INSPIRE measure was developed to assess how well mental health services support recovery, aligning with the CHIME framework [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It comprises two subscales: the Support subscale (20 items) assessing perceived support for recovery, and the Relationship subscale (7 items) assessing the therapeutic relationship. Related versions include Brief INSPIRE and Brief INSPIRE-O, designed for streamlined assessment of recovery support and recovery outcomes, respectively [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. INSPIRE measures have been translated into 27 languages (researchintorecovery.com/inspire), and validated in diverse cultural contexts including Denmark [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Italy [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Japan [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Sweden [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobal INSPIRE represents a new extension of the INSPIRE family. It was developed to assess recovery priorities across cultures by asking service users to rate the importance of items from the Support subscale, mapped to the CHIME domains. Global INSPIRE was motivated by the increasing global emphasis on personal recovery, alongside emerging evidence of cross-cultural variations in recovery priorities [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. For example, autonomy is prioritised in individualistic cultures such as the UK and USA, whereas community and social connectedness are emphasised in more collectivistic contexts [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In Japan, compassion for others is foundational to recovery [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]; in Arab countries, religious values strongly shape recovery experiences [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]; and in Brazil, social role fulfilment and community participation are emphasised [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similar cultural distinctions are reported in Poland [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Spain [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], South Africa [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and Taiwan [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These findings underscore the need for culturally sensitive assessment tools such as Global INSPIRE.\u003c/p\u003e\u003cp\u003eAn initial validation study of Global INSPIRE in British English (hereafter \u0026ldquo;Global INSPIRE British English Version 1.0\u0026rdquo;), conducted with a multicultural sample of 512 participants in the UK, demonstrated excellent internal consistency and an overall acceptable model fit [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Internal consistency was confirmed by both ordinal alpha (α\u0026thinsp;=\u0026thinsp;0.94, 95% CI [0.89, 0.97]) and Cronbach\u0026rsquo;s alpha (α\u0026thinsp;=\u0026thinsp;0.91, 95% CI [0.90, 0.91]), exceeding the conventional threshold of 0.70 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Regarding model fit, the Comparative Fit Index (CFI\u0026thinsp;=\u0026thinsp;0.80) and Tucker\u0026ndash;Lewis Index (TLI\u0026thinsp;=\u0026thinsp;0.77) approached conventional thresholds for exploratory research with multicultural samples (\u0026gt;\u0026thinsp;0.80) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The Standardised Root Mean Square Residual (SRMR\u0026thinsp;=\u0026thinsp;0.12) met the recommended maximum threshold (\u0026lt;\u0026thinsp;0.12), while the Root Mean Square Error of Approximation (RMSEA\u0026thinsp;=\u0026thinsp;0.11) slightly exceeded the preferred limit (\u0026lt;\u0026thinsp;0.10) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These results indicated an acceptable foundation but highlighted the need for further refinement.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003cp\u003ewas obtained from the Research Ethics Committee of the Faculty of Medicine \u0026amp; Health Sciences, the University of Nottingham (Ref: FMHS 78-1123). This study was funded by the Great Britain Sasakawa Foundation.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn previous work, Global INSPIRE British English Version 1.0 was developed to assess recovery priorities in the general population. It was developed by adapting items from the Support subscale of the Full INSPIRE measure, a mental health service user-rated assessment of recovery support received from a mental health worker [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The Full INSPIRE subscale comprises 20 items (four per CHIME domain), each comprising two parts: (1) whether the aspect is important for the respondent's recovery (Yes/No) and (2) if Yes, the extent of support received. The subscale demonstrated strong psychometric properties in service users (n\u0026thinsp;=\u0026thinsp;92), including good convergent validity with the Satisfaction Index\u0026ndash;Mental Health (r\u0026thinsp;=\u0026thinsp;0.60) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], a five-factor structure accounting for 85.1% of the variance, and high internal consistency (α\u0026thinsp;=\u0026thinsp;0.82\u0026ndash;0.85).\u003c/p\u003e\u003cp\u003eTo create Global INSPIRE British English Version 1.0, the administration instructions and wording of each item from the Full INSPIRE Support subscale were modified to also be relevant to individuals not using mental health services. Items in Global INSPIRE British English Version 1.0 begin with the phrase \"An important part of my recovery is....\", for example, \u0026ldquo;\u0026hellip;feeling supported by other people\u0026rdquo; (Connectedness) and \u0026ldquo;\u0026hellip;feeling hopeful about my future\u0026rdquo; (Hope). Three items were slightly reworded to ensure relevance for non-service users, such as changing \"Having support from other people who use services\" to \"Having support from other people who live with mental health difficulties.\" These adaptations aimed to preserve psychometric integrity while broadening applicability. Respondents rate each item on a five-point Likert scale (0 = \"Not at all\" to 4 = \"Very much\"). Subscale scores are calculated by summing four items, dividing by 16, and multiplying by 100, resulting in scores from 0 (low priority) to 100. The Global INSPIRE measure and manual are available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchintorecovery.com/measures/inspire/\u003c/span\u003e\u003cspan address=\"https://www.researchintorecovery.com/measures/inspire/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe initial validation of Global INSPIRE British English Version 1.0 involved a multicultural sample of 512 participants in the UK, including 26.4% from ethnic minority backgrounds [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Model fit indices approached conventional thresholds for exploratory validation in diverse samples [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]: Comparative Fit Index (CFI)\u0026thinsp;=\u0026thinsp;0.80, Tucker\u0026ndash;Lewis Index (TLI)\u0026thinsp;=\u0026thinsp;0.77, Standardised Root Mean Square Residual (SRMR)\u0026thinsp;=\u0026thinsp;0.12, and Root Mean Square Error of Approximation (RMSEA)\u0026thinsp;=\u0026thinsp;0.11. Measurement model reliability was acceptable, with Cronbach\u0026rsquo;s alpha values ranging from 0.70 to 0.85 across latent variables [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These findings suggest the model captures the underlying data structure reasonably well but may benefit from further refinement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo improve the psychometric properties of Global INSPIRE British English Version 1.0, we followed an iterative refinement process informed by best practices in scale development [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]: Step 1. Identifying problematic items, Step 2. Refining item wording, and Step 3. Re-evaluating psychometric properties.\u003c/p\u003e\u003cp\u003e\u003cem\u003eStep 1. Identifying problematic items\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTo identify items that have caused the relatively low fit indices, we conducted a multiple-group confirmatory factor analysis (CFA), constraining both factor loadings and intercepts using the Weighted Least Squares Mean and Variance-adjusted (WLSMV) estimator to the data (n\u0026thinsp;=\u0026thinsp;512) in the original validation study [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. We then examined the modification indices (MIs). Items with the largest MIs were flagged as problematic, as their intercept constraints contributed most significantly to poor model fit.\u003c/p\u003e\u003cp\u003e\u003cem\u003eStep 2. Refining item wording\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe used two phases to refine item wording: reviewer-informed and linguistic.\u003c/p\u003e\u003cp\u003eIn the first phase, three individuals with lived experience of using mental health services and three individuals without such experience (all first-language speakers of British English) reviewed the items identified in Step 1. These six individuals (referred to as \u0026ldquo;item wording reviewers\u0026rdquo;) were presented with all 20 Global INSPIRE items. For each problematic item, they were informed of its associated CHIME subscale and shown the other three items from the same subscale. To stimulate thinking, they were also presented with two candidate alternatives developed by the research team (\u0026ldquo;Believing in a positive future for myself\u0026rdquo; and \u0026ldquo;Feeling confident that things will improve in my life\u0026rdquo; for Item 5; \u0026ldquo;Understanding my mental health\u0026rdquo; and \u0026ldquo;Finding meaning in my mental health experiences\u0026rdquo; for Item 13). Reviewers were then asked to (a) propose revised phrasings that would make the problematic item more consistent in tone, structure, and meaning with the other items in the same subscale, and (b) optionally provide a rationale for their proposals.\u003c/p\u003e\u003cp\u003eWe then employed corpus linguistics tools to provide a complementary, data-driven perspective on the use of terms proposed by item wording reviewers in naturally occurring British English. The analysis drew on the English Web EnTenTen21 (UK domain) corpus (a dataset comprising approximately 2.94\u0026nbsp;billion words of online language use) accessed via Sketch Engine, the online linguistic analysis platform used in this study [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. As Global INSPIRE was evaluated within a UK context and reviewed by native British English speakers, we limited the analysis to the UK component of the corpus. This decision ensured consistency with the linguistic and cultural norms of the target population, and avoided the influence of other English varieties (e.g., American or Australian) that may exhibit different usage patterns.\u003c/p\u003e\u003cp\u003eTo assess the typical meanings and associations of the proposed terms, we examined their collocates and concordance lines. Collocates (i.e., words that statistically co-occur with a target term more frequently than would be expected by chance) offer insight into common lexical associations. Concordance lines display instances of the target word in context, revealing typical usage patterns and underlying connotations, such as whether the term tends to evoke notions of empowerment or vulnerability. Based on reviewer feedback, we specifically investigated the everyday usage of the terms \u0026ldquo;hope,\u0026rdquo; \u0026ldquo;believe,\u0026rdquo; and \u0026ldquo;understand\u0026rdquo; in British English. This analysis ensured that revised item phrasings aligned with the intended conceptualisation of personal recovery and reduced the risk of misinterpretation in the UK context.\u003c/p\u003e\u003cp\u003e\u003cem\u003eStep 3. Re-evaluating psychometric properties\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe revised Global INSPIRE (\u0026ldquo;Global INSPIRE British English Version 2.0\u0026rdquo;) was administered to a new sample of 200 UK participants using the web-based research platform Prolific. Prolific has been shown to yield high-quality and reliable data for psychological and social science research [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. A sample size of approximately 200 is considered a recommended minimum for CFA, particularly when evaluating scale refinements with modest model complexity [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. CFA was conducted to evaluate model fit using the same indices as in the initial validation (CFI, TLI, SRMR, RMSEA), alongside assessment of internal consistency.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eStep 1. Identifying problematic items\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInspection of the MIs for the relatively poor-fitting model in the original validation study date [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] revealed that the intercept constraints for items 5 (\u0026ldquo;Feeling hopeful about my future\u0026rdquo;) (MI\u0026thinsp;=\u0026thinsp;2764.75) and 13 (\u0026ldquo;Understanding my mental health experience\u0026rdquo;) (MI\u0026thinsp;=\u0026thinsp;1312.43) were problematic, exceeding the threshold for concern (MI\u0026thinsp;\u0026gt;\u0026thinsp;10) by several orders of magnitude. These extreme values suggest that constraining the intercepts of items 5 and 13 to be equal across groups placed substantial strain on the model\u0026rsquo;s ability to reproduce the observed item means. This points to meaningful differences in how respondents from the UK and Japan first mention of Japan \u0026ndash; delete or describe in Methods Measures endorse these items, even when they share similar levels of the underlying construct.\u003c/p\u003e\u003cp\u003eTo address this, we freed the intercept constraints for these two items. This adjustment led to a substantial improvement in model fit: CFI increased from 0.83 to 0.995, TLI from 0.81 to 0.993, RMSEA decreased from 0.11 to 0.016 (90% CI: 0.010\u0026ndash;0.022), and SRMR from 0.09 to 0.03. These findings suggest that items 5 and 13 contributed disproportionately to the poor fit of the model and may reflect culturally specific patterns of response.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStep 2. Refining item wording\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe two problematic items were reviewed by three service users and three non-service users. The five reviewer suggestions for re-wording Item 5 included \u0026ldquo;Believing in a positive future for myself\u0026rdquo; (two reviewers) and the four reviewer suggestions for re-wording Item 13 included \u0026ldquo;Finding meaning in my mental health experiences\u0026rdquo; (three reviewers). All responses are shown in Supplementary Material 1.\u003c/p\u003e\u003cp\u003eThree terms\u0026mdash;\u0026ldquo;hope\u0026rdquo;, \u0026ldquo;believe\u0026rdquo;, and \u0026ldquo;understand\u0026rdquo;\u0026mdash;emerged as central to how recovery was conceptualised by reviewers. Their reflections highlighted distinct connotations attached to each term. One reviewer stressed the value of retaining \u0026ldquo;hope\u0026rdquo;, while another cautioned that the word could appear ambiguous or even disempowering, commenting that \u0026ldquo;hope can be good or bad\u0026rdquo; and might seem hollow without a firmer sense of conviction. In contrast, \u0026ldquo;believe\u0026rdquo; was viewed as more agentic and intentional, associated with active personal commitment (e.g., \u0026ldquo;the words \u0026lsquo;feeling\u0026rsquo; and \u0026lsquo;hopeful\u0026rsquo; without some additional belief\u0026hellip; seem emptier\u0026rdquo;). \u0026ldquo;Understand\u0026rdquo; was perceived by one reviewer as potentially reductive, suggesting a clinical or detached interpretation of mental health, rather than one grounded in emotional or existential meaning: \u0026ldquo;some people may have a good understanding of their mental health experience, but it may not be meaningful for them.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThese qualitative perspectives informed the selection of target terms for linguistic analysis. We examined how \u0026ldquo;hope\u0026rdquo;, \u0026ldquo;believe\u0026rdquo;, and \u0026ldquo;understand\u0026rdquo; are used in everyday British English to evaluate whether their typical associations aligned with the recovery-oriented tone of Global INSPIRE.\u003c/p\u003e\u003cp\u003eWe analysed collocates and concordance lines for \u0026ldquo;hope,\u0026rdquo; \u0026ldquo;believe,\u0026rdquo; and \u0026ldquo;understand.\u0026rdquo; This analysis focused on three linguistic dimensions: (1) modifiers of the target words (i.e., words that describe or intensify the meaning of the main term, such as \u0026ldquo;firmly\u0026rdquo; in \u0026ldquo;firmly believe\u0026rdquo;); (2) actions commonly associated with each term, and (3) objects linked to the actions (e.g., \u0026ldquo;hope for a miracle,\u0026rdquo; \u0026ldquo;understand the impact\u0026rdquo;). These dimensions are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e as Phrase types [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] through [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. We examined the top ten general collocates for each term and reviewed their concordance lines to assess typical tone and connotations in naturally occurring British English.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCollocates for \u0026ldquo;hope\u0026rdquo;, \u0026ldquo;believe\u0026rdquo;, \u0026ldquo;understand\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003ePhrases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eFocus words and top ten collocates per phrase\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\"hope\"\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"believe\"\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\"understand\"\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModifiers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Modifiers of \"hope\"/ \"believe\"/ \"understand\"\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003esincerely, fervently, earnestly, desperately, secretly, realistically, humbly, vainly, dearly, optimistically\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003efirmly, passionately, genuinely, strongly, mistakenly, honestly, sincerely, verily, wholeheartedly, wrongly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003epoorly, fully, incompletely, intuitively, instinctively, properly, truly, exactly, clearly, readily\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] \u003cb\u003e\u0026hellip; and/or\u003c/b\u003e \"hope\"/ \"believe\"/ \"understand\"\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eexpect, pray, wish, prey*, believe, dream, fear, trust, luck, despair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003edisbelieve, hope, repent, trust, belong, suspect, obey, practise, intent, behave, know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eappreciate, recognise, analyse, know, interpret, predict, address, apply, respond, empathise\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eObjects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] \"hope\" \u003cb\u003efor\u003c/b\u003e \u0026hellip;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eturnout, repeat, miracle, weather, luck, sunshine, glimpse, outcome, rain, ending\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] \"hope\"/ \"believe\" \u003cb\u003ein\u003c/b\u003e \u0026hellip;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003etatter, lord, fortnight, Jehovah, Lord, adversity, mercy, Thee, sincerity, jest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGod, god, ghost, importance, fairy, miracle, equality, magic, freedom, resurrection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] objects of \"understand\"\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eimportance, behaviour, implication, dynamics, nature, complexity, context, mechanism, impact, significance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: All instances of \u0026ldquo;prey\u0026rdquo; identified as collocates of hope were, upon inspection of concordance lines (i.e., examples of how the word is used in context), determined to be misspellings of \u0026ldquo;pray.\u0026rdquo; These were therefore interpreted as references to \u0026ldquo;pray\u0026rdquo; in the analysis.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe analysis revealed that \u0026ldquo;hope\u0026rdquo; often co-occurred with words conveying uncertainty or desperation (e.g., \u0026ldquo;desperately,\u0026rdquo; \u0026ldquo;luck,\u0026rdquo; \u0026ldquo;miracle\u0026rdquo;), while \u0026ldquo;believe\u0026rdquo; was more commonly associated with agency and conviction (e.g., \u0026ldquo;firmly,\u0026rdquo; \u0026ldquo;freedom,\u0026rdquo; \u0026ldquo;trust\u0026rdquo;). \u0026ldquo;Understand\u0026rdquo; was typically used in analytical or clinical contexts, linked to words such as \u0026ldquo;mechanism,\u0026rdquo; \u0026ldquo;impact,\u0026rdquo; and \u0026ldquo;complexity.\u0026rdquo; These findings suggest that, within the context of personal recovery, \u0026ldquo;believe\u0026rdquo; and \u0026ldquo;finding meaning\u0026rdquo; may be more conceptually appropriate and better aligned with the empowering, emotionally resonant language of recovery than \u0026ldquo;hope\u0026rdquo; and \u0026ldquo;understand.\u0026rdquo;\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e highlights key differences in the language patterns associated with the terms \u0026ldquo;hope,\u0026rdquo; \u0026ldquo;believe,\u0026rdquo; and \u0026ldquo;understand.\u0026rdquo; The word \u0026ldquo;hope\u0026rdquo; frequently co-occurs with modifiers and objects that carry negative or uncertain connotations (Phrases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]), such as \u0026ldquo;desperately,\u0026rdquo; \u0026ldquo;secretly,\u0026rdquo; \u0026ldquo;fear,\u0026rdquo; and \u0026ldquo;despair.\u0026rdquo; It is also commonly linked to actions and objects suggesting high desire but low certainty or control (Phrases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], e.g., \u0026ldquo;pray,\u0026rdquo; \u0026ldquo;wish,\u0026rdquo; \u0026ldquo;dream,\u0026rdquo; \u0026ldquo;luck,\u0026rdquo; \u0026ldquo;miracle\u0026rdquo;). These patterns may imply a sense of vulnerability or passivity that could conflict with the active, empowered stance central to personal recovery.\u003c/p\u003e\u003cp\u003eIn contrast, \u0026ldquo;understand\u0026rdquo; is more often associated with cognitive clarity and analytical processes. It is modified by terms denoting completeness or precision (Phrase [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], e.g., \u0026ldquo;fully,\u0026rdquo; \u0026ldquo;properly,\u0026rdquo; \u0026ldquo;clearly\u0026rdquo;), and paired with verbs indicating reasoning or comprehension (Phrase [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], e.g., \u0026ldquo;analyse,\u0026rdquo; \u0026ldquo;know\u0026rdquo;). It is also linked to abstract or complex concepts (Phrase [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], e.g., \u0026ldquo;importance,\u0026rdquo; \u0026ldquo;significance,\u0026rdquo; \u0026ldquo;mechanism\u0026rdquo;). While this language reflects intellectual engagement, it may miss the emotional and experiential dimensions of recovery.\u003c/p\u003e\u003cp\u003eBy contrast, \u0026ldquo;believe\u0026rdquo; appears to strike a more appropriate balance between cognitive certainty and emotional investment. It frequently co-occurs with words that express confidence (Phrases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], e.g., \u0026ldquo;firmly,\u0026rdquo; \u0026ldquo;strongly,\u0026rdquo; \u0026ldquo;trust,\u0026rdquo; \u0026ldquo;know\u0026rdquo;) and with terms that convey deep personal or moral conviction (Phrase [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], e.g., \u0026ldquo;passionately,\u0026rdquo; \u0026ldquo;genuinely,\u0026rdquo; \u0026ldquo;sincerely\u0026rdquo;). Moreover, \u0026ldquo;believe\u0026rdquo; is often directed toward aspirational or highly valued outcomes (Phrase [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], e.g., \u0026ldquo;equality,\u0026rdquo; \u0026ldquo;freedom,\u0026rdquo; \u0026ldquo;miracle\u0026rdquo;), which aligns closely with the motivational and hopeful aspects of recovery. Word sketches for the three target words are in Supplementary Material 2.\u003c/p\u003e\u003cp\u003eBased on the corpus analysis and reviewers\u0026rsquo; insights, item 5 was changed from \u0026ldquo;Feeling hopeful about my future\u0026rdquo; to \u0026ldquo;Believing in a positive future for myself\u0026rdquo;. The revised version avoids the potential misunderstandings or negative tones associated with \u0026ldquo;hope\u0026rdquo;, while maintaining the emphasis on emotional involvement, as identified for \u0026ldquo;believe\u0026rdquo;. Item 13 was changed from \u0026ldquo;Understanding my mental health experience\u0026rdquo; to \u0026ldquo;Finding meaning in my mental health experiences\u0026rdquo;. The revised version avoids the intellectual aspect associated with \u0026ldquo;understand\u0026rdquo;; instead, it describes recovery as a process of making experience meaningful.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStep 3. Re-evaluating psychometric properties\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwo hundred and seven people completed the survey. Participant characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;207\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115 (55.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (43.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-binary/prefer not to say\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e White British\u003c/p\u003e\u003cp\u003eOther White\u003c/p\u003e\u003cp\u003eAsian/Asian British\u003c/p\u003e\u003cp\u003eBlack/ African/Caribbean/Black British\u003c/p\u003e\u003cp\u003eMixed/Multiple ethnic groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e156 (75.4%)\u003c/p\u003e\u003cp\u003e14 (6.8%)\u003c/p\u003e\u003cp\u003e24 (11.6%)\u003c/p\u003e\u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e\u003cp\u003e8 (3.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSexual\u003c/b\u003e Straight/Heterosexual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e189 (91.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGay or Lesbian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBisexual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther/Prefer not to say/Unknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMental health service experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (47.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eLess than 1 year\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e42(20.3%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003e1 to 5 years\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e37 (17.9%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMore than 5 years\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e19 (9.2%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109 (52.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eNote: For categories with counts of 5 or fewer, values are reported as \u0026le;\u0026thinsp;5 to prevent identifiability.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe initial CFA using the WLSMV estimator indicated excellent comparative fit, with CFI\u0026thinsp;=\u0026thinsp;0.965 and TLI\u0026thinsp;=\u0026thinsp;0.959. However, absolute and residual fit indices were somewhat less favourable, with RMSEA\u0026thinsp;=\u0026thinsp;0.116 (90% CI: 0.107\u0026ndash;0.126) and SRMR\u0026thinsp;=\u0026thinsp;0.103. After applying the first-order Satorra\u0026ndash;Bentler scaling correction, the model retained acceptable comparative fit (CFI.scaled\u0026thinsp;=\u0026thinsp;0.886, TLI.scaled\u0026thinsp;=\u0026thinsp;0.865), though RMSEA increased slightly to 0.125 (see Supplementary Material 3 for the path diagram). These adjusted values offer a more conservative and robust assessment of model fit, particularly in the context of non-normal or ordinal data, as recommended in best practices for CFA [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Internal consistency was excellent, with an ordinal alpha of 0.93 (95% CI: 0.88\u0026ndash;0.97) and a Cronbach\u0026rsquo;s alpha of 0.91 (95% CI: 0.88\u0026ndash;0.97) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These results suggest that the proposed factor structure performs well in relative terms and provides a reasonable approximation of the observed data, supporting its continued refinement and use in cross-cultural contexts.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to refine and re-evaluate the Global INSPIRE measure, which assesses the priorities of mental health personal recovery. Building on initial validation work, we sought to improve the psychometric properties by identifying and addressing items that contributed to poor fit. Using a combination of CFAs, qualitative review, and corpus linguistics analyses, we identified and revised two problematic items, and demonstrated substantial improvements in model fit. Specifically, the CFI improved from 0.80 in the Version 1.0 to 0.965 in the Version 2.0, and the TLI improved from 0.77 to 0.959, indicating a substantial enhancement in comparative model fit. Importantly, this refinement process illustrates how culturally informed methods, particularly the integration of corpus linguistics, can enhance the reliability and contextual relevance of recovery measures. This is especially valuable when working with multicultural samples, such as the UK general population, where cultural and linguistic diversity influence how recovery concepts are understood and expressed [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobal INSPIRE British English Version 2.0 offers promising applications for both research and practice in the field of personal recovery, which continues to expand globally. It enables the assessment of recovery priorities not only among mental health service users but also in the general population, offering a broader perspective on how recovery is understood and valued across diverse groups. Importantly, the term \u0026ldquo;service user\u0026rdquo; can carry different meanings in various cultural contexts [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. For instance, in Japan, individuals may engage in recovery practices such as visiting Shinto shrines, drawing on cultural and spiritual traditions outside of formal mental health services [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. In Indigenous communities, recovery may involve reconnecting with land, ancestry, and ceremony rather than accessing clinical care [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The structure of Global INSPIRE, rooted in the CHIME framework, can support meaningful comparison across such contexts, while allowing for attention to cultural nuance. In future research, Global INSPIRE could be adapted to specific populations through culturally responsive methods such as targeted cognitive interviews and linguistic analysis, as demonstrated in this study. It also holds strong potential as a tool for evaluating recovery-oriented service development and policy implementation internationally, by capturing people\u0026rsquo;s recovery needs in a culturally grounded way and ensuring that services are aligned with those needs.\u003c/p\u003e\u003cp\u003eThe selection of revised phrasings\u0026mdash;\u0026ldquo;believing in a positive future for myself\u0026rdquo; and \u0026ldquo;finding meaning in my mental health experiences\u0026rdquo;\u0026mdash;was informed by both participant feedback and corpus linguistic analysis. These revisions were chosen to better reflect the active and empowering nature of personal recovery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While the term \u0026ldquo;hope\u0026rdquo; often conveyed a sense of passivity and uncertainty in its common usage, the word \u0026ldquo;believe\u0026rdquo; suggested greater agency and conviction, particularly within British English discourse[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Similarly, \u0026ldquo;understand\u0026rdquo; was more closely associated with cognitive reasoning, whereas \u0026ldquo;finding meaning\u0026rdquo; captured a more interpretive and emotionally grounded process, which is consistent with how recovery is often conceptualised in first-person narratives [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. These changes align more closely with how individuals in the UK context describe and experience personal recovery.\u003c/p\u003e\u003cp\u003eOur methodological approach offers a structured and practical contribution to scale refinement practices. Guided by best practices in scale development [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], we employed an iterative process involving three key stages: identifying problematic items through quantitative model testing, refining item wording through target population member input and linguistic analysis, and re-evaluating psychometric properties. What distinguishes our approach is the triangulation of statistical misfit with lived experience and corpus-informed linguistic evidence. This integrative strategy addressed both psychometric and semantic challenges in a rigorous and culturally grounded way, improving scale performance while enhancing interpretability across diverse populations. This strategy is particularly valuable in multicultural settings like the UK, where diverse linguistic and cultural backgrounds shape how recovery is conceptualised and articulated.\u003c/p\u003e\u003cp\u003eThis study has several strengths. It employed a rigorous and transparent refinement process, involved participants with and without service use experience, and introduced an innovative linguistic lens for item revision. The re-validation was conducted with a sufficiently powered and diverse UK-based sample, supporting generalisability within similar contexts. However, limitations include the use of a single national sample for re-validation, limiting immediate cross-cultural comparisons. In addition, the study focused on only two items; broader item-level analysis could yield further improvements. Finally, while corpus analysis provided valuable insights, it was limited to British English usage and may not generalise to other English-speaking cultures or translations. Future research should include participants from a broader range of cultural and linguistic backgrounds and involve both service users and non-service users to explore global similarities and differences in recovery priorities.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe refined version of the Global INSPIRE, Global INSPIRE British English Version 2.0, represents a significant step forward in developing culturally sensitive tools for measuring personal recovery. Through a carefully integrated process of psychometric testing, target population member consultation, and linguistic analysis, we identified and addressed key sources of poor model fit. The resulting revisions improved both statistical performance and conceptual alignment with recovery principles. Global INSPIRE is now better positioned to support international research, policy, and practice in mental health recovery by offering a measure that respects and reflects cultural variation in what recovery means to individuals. Future work should explore the measure\u0026rsquo;s applicability in other cultural contexts and languages to further advance global recovery-oriented care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e1. Funding\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Great Britain Sasakawa Foundation.\u003c/p\u003e\n\u003cp\u003e2. Conflicts of interest/Competing interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e3. Ethics approval\u003c/p\u003e\n\u003cp\u003eEthics approval: Ethics approval was obtained from the Research Ethics Committee of the Faculty of Medicine \u0026amp; Health Sciences, University of Nottingham (Ref: FMHS 78-1123).\u003c/p\u003e\n\u003cp\u003e4. Consent to participate\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent to take part in the study, in accordance with ethical guidelines and institutional approval.\u003c/p\u003e\n\u003cp\u003e5. Consent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent was obtained from all participants for the publication of anonymised data included in this manuscript.\u003c/p\u003e\n\u003cp\u003e6. Availability of data and material\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e7. Code availability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e8. Authors' contributions\u003c/p\u003e\n\u003cp\u003eConceptualisation and design: YK, AH, SVL; Data collection: YK; Statistical analysis: AH; Theoretical input and interpretation: YK, AH, AO, MS, SA, SVL; Manuscript draft: YK, AH, SVL; Manuscript review and revision: YK, AH, AO, MS, SA, SVL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful for the Great Britain Sasakawa Foundation for their support. Mike Slade acknowledges the support of the NIHR Nottingham Biomedical Research Centre.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eW. A. Anthony, \"Recovery from mental illness: The guiding vision of the mental health service system in the 1990s,\" \u003cem\u003ePsychosoc. Rehabil. J.\u003c/em\u003e, vol. 16, no. 4, pp. 11\u0026ndash;23, 1993/4 1993, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/h0095655\u003c/span\u003e\u003cspan address=\"10.1037/h0095655\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM. Slade, \u003cem\u003ePersonal recovery and mental illness: A guide for mental health professionals\u003c/em\u003e. Cambridge University Press, 2009.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG. Shepherd, J. Boardman, M. Rinaldi, and G. Roberts, \"Supporting recovery in mental health services: Quality and outcomes,\" \u003cem\u003eLondon: Implementing Recovery Through Organisational Change\u003c/em\u003e, 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM. Piat \u003cem\u003eet al.\u003c/em\u003e, \"Translating mental health recovery guidelines into recovery-oriented innovations: A strategy combining implementation teams and a facilitated planning process,\" \u003cem\u003eEvaluation and Program Planning\u003c/em\u003e, vol. 91, p. 102054, 2022/04/01/ 2022, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.evalprogplan.2022.102054\u003c/span\u003e\u003cspan address=\"10.1016/j.evalprogplan.2022.102054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustralian Government Department of Health, \u003cem\u003eA national framework for recovery-oriented mental health services: Guide for practitioners and providers\u003c/em\u003e Canberra, Australia Author, 2021. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.gov.au/sites/default/files/documents/2021/04/a-national-framework-for-recovery-oriented-mental-health-services-guide-for-practitioners-and-providers.pdf\u003c/span\u003e\u003cspan address=\"https://www.health.gov.au/sites/default/files/documents/2021/04/a-national-framework-for-recovery-oriented-mental-health-services-guide-for-practitioners-and-providers.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSAMHSA\u0026rsquo;s Trauma Justice Strategic Initiative, \u003cem\u003eSAMHSA\u0026rsquo;s Concept of Trauma and Guidance for a Trauma-Informed Approach\u003c/em\u003e. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA), 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eN. Dell, C. Long, and M. Mancini, \"Models of mental health recovery: An overview of systematic reviews and qualitative meta-syntheses,\" \u003cem\u003ePsychiatric rehabilitation journal\u003c/em\u003e, 2021-03-18 2021, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/prj0000444\u003c/span\u003e\u003cspan address=\"10.1037/prj0000444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. Shepherd, M. Doyle, C. Sanders, and J. Shaw, \"Personal recovery within forensic settings\u0026ndash;Systematic review and meta-synthesis of qualitative methods studies,\" \u003cem\u003eCriminal behaviour and mental health: CBMH\u003c/em\u003e, vol. 26 1, pp. 59\u0026ndash;75, 2016-02-01 2016, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cbm.1966\u003c/span\u003e\u003cspan address=\"10.1002/cbm.1966\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. Ballesteros-Urpi, M. Slade, D. Manley, and H. Pardo-Hernandez, \"Conceptual framework for personal recovery in mental health among children and adolescents: a systematic review and narrative synthesis protocol,\" (in eng), \u003cem\u003eBMJ Open\u003c/em\u003e, vol. 9, no. 8, p. e029300, Aug 15 2019, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2019-029300\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2019-029300\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. Shepherd, C. Sanders, M. Doyle, and J. Shaw, \"Personal recovery in personality disorder: Systematic review and meta-synthesis of qualitative methods studies,\" \u003cem\u003eInternational Journal of Social Psychiatry\u003c/em\u003e, vol. 62, pp. 41\u0026ndash;50, 2016-02-01 2016, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0020764015589133\u003c/span\u003e\u003cspan address=\"10.1177/0020764015589133\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG. Jordan \u003cem\u003eet al.\u003c/em\u003e, \"Personal Recovery Among People at Risk for Developing Serious Mental Health Problems: A Qualitative Systematic Review,\" \u003cem\u003ePsychiatric services\u003c/em\u003e, 2024-02-27 2024, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1176/appi.ps.20230133\u003c/span\u003e\u003cspan address=\"10.1176/appi.ps.20230133\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM. Leamy, V. Bird, C. L. Boutillier, J. Williams, and M. Slade, \"Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis,\" \u003cem\u003eBritish Journal of Psychiatry\u003c/em\u003e, vol. 199, no. 6, pp. 445\u0026ndash;452, 2011, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1192/bjp.bp.110.083733\u003c/span\u003e\u003cspan address=\"10.1192/bjp.bp.110.083733\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM. N. Lases \u003cem\u003eet al.\u003c/em\u003e, \"Is personal recovery a transdiagnostic concept? Testing the fit of the CHIME framework using narrative experiences,\" (in eng), \u003cem\u003eJ Ment Health\u003c/em\u003e, pp. 1\u0026ndash;9, Jun 30 2024, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/09638237.2024.2361225\u003c/span\u003e\u003cspan address=\"10.1080/09638237.2024.2361225\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization, \u003cem\u003eGuidance on community mental health services: Promoting person-centred and rights-based approaches\u003c/em\u003e, Geneva: World Health Organization, 2021. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apps.who.int/iris/handle/10665/341648\u003c/span\u003e\u003cspan address=\"https://apps.who.int/iris/handle/10665/341648\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed on: 5 April 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. Van Weeghel, C. Van Zelst, D. Boertien, and I. Hasson-Ohayon, \"Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses,\" \u003cem\u003ePsychiatric rehabilitation journal\u003c/em\u003e, vol. 42 2, pp. 169\u0026ndash;181, 2019-03-07 2019, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/prj0000356\u003c/span\u003e\u003cspan address=\"10.1037/prj0000356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eH. Killaspy, S. White, T. L. Taylor, and M. King, \"Psychometric properties of the mental health recovery star,\" \u003cem\u003eThe British Journal of Psychiatry\u003c/em\u003e, vol. 201, no. 1, pp. 65\u0026ndash;70, 2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS. Felix \u003cem\u003eet al.\u003c/em\u003e, \"Personal recovery self-report outcome measures in serious mental illness: A systematic review of measurement properties,\" \u003cem\u003eClinical Psychology Review\u003c/em\u003e, vol. 112, p. 102459, 2024/08/01/ 2024, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cpr.2024.102459\u003c/span\u003e\u003cspan address=\"10.1016/j.cpr.2024.102459\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. Williams \u003cem\u003eet al.\u003c/em\u003e, \"Development and evaluation of the INSPIRE measure of staff support for personal recovery,\" \u003cem\u003eSocial Psychiatry and Psychiatric Epidemiology\u003c/em\u003e, vol. 50, no. 5, pp. 777\u0026ndash;786, 2015/05/01 2015, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00127-014-0983-0\u003c/span\u003e\u003cspan address=\"10.1007/s00127-014-0983-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS. B. Moeller \u003cem\u003eet al.\u003c/em\u003e, \"Scalability, test\u0026ndash;retest reliability and validity of the Brief INSPIRE-O measure of personal recovery in psychiatric services,\" (in English), \u003cem\u003eFrontiers in Psychiatry\u003c/em\u003e, Original Research vol. 15, 2024-May-14 2024, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyt.2024.1327020\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2024.1327020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eN. Ratti, B. Mattioli, L. Mellini, I. Negri, and A. Mastrocola, \"Preliminary Evaluation of the Italian Version of the Inspire Measure of Staff Support for Personal Recovery,\" \u003cem\u003eEuropean Psychiatry\u003c/em\u003e, vol. 33, 2016-03-01 2016, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eurpsy.2016.01.1799\u003c/span\u003e\u003cspan address=\"10.1016/j.eurpsy.2016.01.1799\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR. Kotake \u003cem\u003eet al.\u003c/em\u003e, \"Reliability and validity of the Japanese version of the INSPIRE measure of staff support for personal recovery in community mental health service users in Japan,\" \u003cem\u003eBMC Psychiatry\u003c/em\u003e, vol. 20, no. 1, p. 51, 2020/02/07 2020, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12888-020-2467-y\u003c/span\u003e\u003cspan address=\"10.1186/s12888-020-2467-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eU. K. Sch\u0026ouml;n, P. Svedberg, and D. Rosenberg, \"Evaluating the INSPIRE measure of staff support for personal recovery in a Swedish psychiatric context,\" (in eng), \u003cem\u003eNord J Psychiatry\u003c/em\u003e, vol. 69, no. 4, pp. 275\u0026ndash;81, May 2015, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/08039488.2014.972453\u003c/span\u003e\u003cspan address=\"10.3109/08039488.2014.972453\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eY. Kotera \u003cem\u003eet al.\u003c/em\u003e, \"28-country global study on associations between cultural characteristics and Recovery College fidelity,\" \u003cem\u003enpj Mental Health Research\u003c/em\u003e, vol. 3, no. 1, p. 46, 2024/10/08 2024, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s44184-024-00092-9\u003c/span\u003e\u003cspan address=\"10.1038/s44184-024-00092-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD. Hayes \u003cem\u003eet al.\u003c/em\u003e, \"Organisational and student characteristics, fidelity, funding models, and unit costs of recovery colleges in 28 countries: a cross-sectional survey,\" \u003cem\u003eThe Lancet Psychiatry\u003c/em\u003e, vol. 10, no. 10, pp. 768\u0026ndash;779, 2023, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2215-0366(23)00229-8\u003c/span\u003e\u003cspan address=\"10.1016/S2215-0366(23)00229-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. Adeponle, R. Whitley, and L. Kirmayer, \"Cultural contexts and constructions of recovery,\" 2012, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/med/9780199691319.003.0008\u003c/span\u003e\u003cspan address=\"10.1093/med/9780199691319.003.0008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. Kanehara \u003cem\u003eet al.\u003c/em\u003e, \"Culture-dependent and universal constructs and promoting factors for the process of personal recovery in users of mental health services: qualitative findings from Japan,\" \u003cem\u003eBMC Psychiatry\u003c/em\u003e, vol. 22, 2021-03-03 2021, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12888-022-03750-4\u003c/span\u003e\u003cspan address=\"10.1186/s12888-022-03750-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. Hickey, J. Hickey, S. Pryjmachuk, and H. Waterman, \"Exploring personal recovery in mental illness through an Arabic sociocultural lens,\" \u003cem\u003eJournal of psychiatric and mental health nursing\u003c/em\u003e, vol. 24 2\u0026ndash;3, pp. 163\u0026ndash;170, 2017-03-01 2017, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jpm.12342\u003c/span\u003e\u003cspan address=\"10.1111/jpm.12342\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. A. Orsi \u003cem\u003eet al.\u003c/em\u003e, \"Recovery processes reported by people with severe mental illness in Brazil: systematic review and thematic synthesis,\" \u003cem\u003eTranscultural Psychiatry\u003c/em\u003e, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nottingham-repository.worktribe.com/output/39720460\u003c/span\u003e\u003cspan address=\"https://nottingham-repository.worktribe.com/output/39720460\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eI. Nowak, J. Waszkiewicz, P. Świtaj, M. Sok\u0026oacute;ł-Szawłowska, and M. Anczewska, \"A Qualitative Study of the Subjective Appraisal of Recovery Among People with Lived Experience of Schizophrenia in Poland,\" (in eng), \u003cem\u003ePsychiatr Q\u003c/em\u003e, vol. 88, no. 3, pp. 435\u0026ndash;446, Sep 2017, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11126-016-9459-6\u003c/span\u003e\u003cspan address=\"10.1007/s11126-016-9459-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. Saavedra, S. Arias-S\u0026aacute;nchez, J. A. Mat\u0026iacute;as-Garc\u0026iacute;a, and J. Brzeska, \"\u0026ldquo;I don\u0026rsquo;t believe I\u0026rsquo;m going to recover from anything.\u0026rdquo; Understanding recovery amongst people with severe mental illness attending community health services in Spain,\" \u003cem\u003eDisability and Rehabilitation\u003c/em\u003e, vol. 44, no. 20, pp. 5974\u0026ndash;5982, 2022/09/25 2022, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/09638288.2021.1954246\u003c/span\u003e\u003cspan address=\"10.1080/09638288.2021.1954246\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. de Wet and C. Pretorius, \"Perceptions and understanding of mental health recovery for service users, carers, and service providers: A South African perspective,\" (in eng), \u003cem\u003ePsychiatr Rehabil J\u003c/em\u003e, vol. 44, no. 2, pp. 157\u0026ndash;165, Jun 2021, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/prj0000460\u003c/span\u003e\u003cspan address=\"10.1037/prj0000460\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eP. Y. Chao, W. L. Hsieh, S. T. Yeh, C. J. Hsieh, C. Y. Liu, and W. I. Liu, \"Factors associated with personal recovery among psychiatric nursing home residents,\" (in eng), \u003cem\u003eJ Psychiatr Ment Health Nurs\u003c/em\u003e, vol. 29, no. 6, pp. 852\u0026ndash;860, Dec 2022, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jpm.12814\u003c/span\u003e\u003cspan address=\"10.1111/jpm.12814\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eY. Kotera \u003cem\u003eet al.\u003c/em\u003e, \"Development and evaluation of a mental health recovery priority measure for cross-cultural research: Global INSPIRE,\" \u003cem\u003eUnder review\u003c/em\u003e, 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. C. Nunnally and I. Bernstein, \u003cem\u003ePsychometric Theory\u003c/em\u003e, 3 ed. (McGraw-Hill Series in Psychology). Maidenhead, England: McGraw Hill Higher Education, 1993, p. 736.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eT. A. Brown, \u003cem\u003eConfirmatory factor analysis for applied research, 2nd ed\u003c/em\u003e (Confirmatory factor analysis for applied research, 2nd ed.). New York, NY, US: The Guilford Press, 2015, pp. xvii, 462-xvii, 462.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eL. Nabati, N. Shea, L. McBride, C. Gavin, and M. S. Bauer, \"Adaptation of a simple patient satisfaction instrument to mental health: psychometric properties,\" (in eng), \u003cem\u003ePsychiatry Res\u003c/em\u003e, vol. 77, no. 1, pp. 51\u0026thinsp;\u0026ndash;\u0026thinsp;6, Jan 16 1998, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0165-1781(97)00122-4\u003c/span\u003e\u003cspan address=\"10.1016/s0165-1781(97)00122-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eL. t. Hu and P. M. Bentler, \"Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives,\" \u003cem\u003eStructural Equation Modeling: A Multidisciplinary Journal\u003c/em\u003e, vol. 6, no. 1, pp. 1\u0026ndash;55, 1999, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/10705519909540118\u003c/span\u003e\u003cspan address=\"10.1080/10705519909540118\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR. F. DeVellis, \u003cem\u003eScale development\u003c/em\u003e, 4 ed. (Applied Social Research Methods). Thousand Oaks, CA: SAGE Publications, 2016, p. 280.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eA. Kilgarriff \u003cem\u003eet al.\u003c/em\u003e, \"The Sketch Engine: ten years on,\" \u003cem\u003eLexicography\u003c/em\u003e, vol. 1, no. 1, pp. 7\u0026ndash;36, 2014/07/01 2014, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40607-014-0009-9\u003c/span\u003e\u003cspan address=\"10.1007/s40607-014-0009-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eE. Peer, L. Brandimarte, S. Samat, and A. Acquisti, \"Beyond the Turk: Alternative platforms for crowdsourcing behavioral research,\" \u003cem\u003eJournal of Experimental Social Psychology\u003c/em\u003e, vol. 70, pp. 153\u0026ndash;163, 2017, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jesp.2017.01.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jesp.2017.01.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR. L. Worthington and T. A. Whittaker, \"Scale Development Research: A Content Analysis and Recommendations for Best Practices,\" \u003cem\u003eThe Counseling Psychologist\u003c/em\u003e, vol. 34, no. 6, pp. 806\u0026ndash;838, 2006/11/01 2006, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0011000006288127\u003c/span\u003e\u003cspan address=\"10.1177/0011000006288127\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR. B. Kline, \u003cem\u003ePrinciples and practice of structural equation modeling, fourth edition\u003c/em\u003e, 4 ed. (Methodology in the Social Sciences). New York, NY: Guilford Publications, 2015, p. 534.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eF. J. R. van de Vijver and K. Leung, V. H. Fetvadjiev, J. He, and J. R. J. Fontaine, Eds. \u003cem\u003eMethods and Data Analysis for Cross-Cultural Research\u003c/em\u003e, 2 ed. (Culture and Psychology). Cambridge: Cambridge University Press, 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. Panadevo, Y. Kotera, N. R. K\u0026oslash;cks, L. D. Kring, and S. B. M\u0026oslash;ller, \"Personal recovery after mental illness from a cultural perspective: A scoping review,\" \u003cem\u003eInternational Journal of Social Psychiatry\u003c/em\u003e, vol. 71, no. 3, pp. 444\u0026ndash;468, 2025/05/01 2024, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00207640241303026\u003c/span\u003e\u003cspan address=\"10.1177/00207640241303026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD. Rose, G. Thornicroft, and M. Slade, \"Who decides what evidence is? Developing a multiple perspectives paradigm in mental health,\" (in eng), \u003cem\u003eActa Psychiatr Scand Suppl\u003c/em\u003e, no. 429, pp. 109\u0026thinsp;\u0026ndash;\u0026thinsp;14, 2006, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1600-0447.2005.00727.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1600-0447.2005.00727.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM. Nakao and C. Ohara, \"The perspective of psychosomatic medicine on the effect of religion on the mind-body relationship in Japan,\" (in eng), \u003cem\u003eJ Relig Health\u003c/em\u003e, vol. 53, no. 1, pp. 46\u0026ndash;55, Feb 2014, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10943-012-9586-9\u003c/span\u003e\u003cspan address=\"10.1007/s10943-012-9586-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. P. Gone, \"Redressing First Nations historical trauma: theorizing mechanisms for indigenous culture as mental health treatment,\" (in eng), \u003cem\u003eTranscult Psychiatry\u003c/em\u003e, vol. 50, no. 5, pp. 683\u0026ndash;706, Oct 2013, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1363461513487669\u003c/span\u003e\u003cspan address=\"10.1177/1363461513487669\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSketch Engine. \"EnTenTen21 corpus \u0026ndash; UK English dataset.\" Author. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sketchengine.eu/\u003c/span\u003e\u003cspan address=\"https://www.sketchengine.eu/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed 25 Apr, 2025).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM. Slade \u003cem\u003eet al.\u003c/em\u003e, \"Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial,\" (in eng), \u003cem\u003eWorld Psychiatry\u003c/em\u003e, vol. 23, no. 1, pp. 101\u0026ndash;112, Feb 2024, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/wps.21176\u003c/span\u003e\u003cspan address=\"10.1002/wps.21176\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"scale refinement, mental health recovery, personal recovery, recovery priorities, linguistic analysis","lastPublishedDoi":"10.21203/rs.3.rs-7140856/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7140856/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eGlobal INSPIRE is a 20-item self-report scale assessing priorities of personal recovery, defined as living a meaningful and satisfying life despite mental health challenges. Grounded in the CHIME framework (Connectedness, Hope, Identity, Meaning, and Empowerment), it asks how important each item is to the respondent\u0026rsquo;s recovery. Its initial validation (Version 1.0), involved a UK multicultural sample, showed promise, but model fit needed refinement (CFI\u0026thinsp;=\u0026thinsp;0.80, TLI\u0026thinsp;=\u0026thinsp;0.77).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eFollowing best practices in scale development (DeVellis, 2016), we employed a three-step approach to enhance the scale\u0026rsquo;s psychometric properties. First, multiple-group confirmatory factor analysis was conducted in the original sample to identify problematic items. Second, these items were revised using qualitative feedback from six British English-speaking reviewers and corpus linguistic analysis. Third, the revised version was tested in a new UK sample.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eTwo problematic items (Items 5 and 13) were identified. Corpus linguistic analysis of six reviewers\u0026rsquo; comments suggested Item 5 \u0026ldquo;Feeling hopeful about my future\u0026rdquo; be changed to \u0026ldquo;Believing in a positive future for myself\u0026rdquo;, and Item 13 \u0026ldquo;Understanding my mental health experience\u0026rdquo; to \u0026ldquo;Finding meaning in my mental health experiences\u0026rdquo;. The updated version of Global INSPIRE (Version 2.0) was completed by 207 people (Age 40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.50 years; 115 women, 90 men), yielding substantially improved model fit (CFI\u0026thinsp;=\u0026thinsp;0.965, TLI\u0026thinsp;=\u0026thinsp;0.959) and strong internal consistency (ordinal alpha\u0026thinsp;=\u0026thinsp;0.93; Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.91).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eGlobal INSPIRE British English Version 2.0 offers a more robust tool for assessing recovery priorities, demonstrating the value of integrating quantitative, qualitative, and linguistic approaches in scale refinement.\u003c/p\u003e","manuscriptTitle":"Refining the Global INSPIRE measure of recovery priorities: A qualitative, linguistic, and statistical approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-30 10:50:57","doi":"10.21203/rs.3.rs-7140856/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"353ae34c-42fc-467d-9e16-79bb65bc1167","owner":[],"postedDate":"July 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T06:38:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-30 10:50:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7140856","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7140856","identity":"rs-7140856","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}