Translation, cross-cultural adaptation, reliability, and validity of the Persian version of the Recovery Assessment Scale-Domains and Stages (P-RAS-DS) for people with mental illness

Abstract

Introduction: Recovery-oriented care in mental health is an increasing priority internationally, including in Iran. The Recovery Assessment Scale - Domains and Stages (RAS-DS) is widely used to assess personal recovery, but no validated Persian version exists. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the RAS-DS (P-RAS-DS) in Iran.

Methods: The study followed Beaton's guidelines for translation and cross-cultural adaptation. Psychometric evaluation was conducted with 373 service users diagnosed with mental illness, recruited from psychiatric outpatient clinics in Tehran through convenience sampling. A cross-sectional design was used. Reliability was assessed using internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient, ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Content validity was assessed via the Content Validity Ratio (CVR) and Content Validity Index (CVI). Construct validity was evaluated through exploratory factor analysis (EFA), and Spearman's rho was used to examine both convergent validity with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Engagement in Meaningful Activities Survey (EMAS), and inter-factor correlations.

Results: Service users had a mean age of 42.68 years (SD = 11.47) and were 41.3% female and 58.7% male. Two items were culturally modified during adaptation. The P-RAS-DS demonstrated excellent internal consistency (α = 0.940) and test-retest reliability (ICC = 0.941). SEM and MDC values were low (3.19 and 8.81, respectively), indicating good measurement precision. CVR and I-CVI values exceeded standard thresholds, supporting strong content validity. EFA extracted a four-factor structure (Self-determination and connectedness, Hope and Purpose, Personally valued activities, and Seeking support) accounting for 64.67% of the total variance. Inter-factor correlations ranged from weak to moderate (ρ = - 0.037 to 0.495), and self-determination and connectedness showed the strongest associations with other subscales and total score. Convergent validity was supported by moderate correlation with the WEMWBS (ρ = 0.582) and weak correlation with the EMAS (ρ = 0.268).

Conclusion: The P-RAS-DS is a culturally appropriate, reliable, and valid instrument for assessing recovery in Persian-speaking individuals with mental illness. It can be used in clinical practice and research to evaluate personal recovery outcomes. Future research should include confirmatory factor analysis.

Clinical trial number: Not applicable.

Keywords: Cross-cultural validation; Mental illness; Persian RAS-DS (Recovery Assessment Scale- Domains and Stages); Psychometric properties; Recovery.