Elsevier

Psychiatry Research

Volume 160, Issue 2, 15 August 2008, Pages 228-235
Psychiatry Research

The psychometric properties of the illness management and recovery scale: Client and clinician versions

https://doi.org/10.1016/j.psychres.2007.06.013Get rights and content

Abstract

The present study examined the psychometric properties of the clinician and client versions of the Illness Management and Recovery (IMR) scale. Using a 5-point behaviorally anchored response format, these scales were designed to tap the critical illness management and recovery domains targeted by the IMR program. This program is a curriculum-based approach to helping persons with a serious mental illness (SMI) acquire the knowledge and skills they need to manage their illness effectively and to achieve personal recovery goals. Two hundred and ten persons with a diagnosis of a SMI and their 13 clinicians filled-out the client and clinician versions of the IMR questionnaire. The clients also responded to measures of coping efficacy and social support. While indicating limitations of the IMR scales and pointing to how they could be improved, this study provided some support for the construct and concurrent validity of the client and clinician versions of the IMR questionnaire. Moderate reliabilities were uncovered for these parallel versions of the questionnaire. Client responses to the client IMR scale and clinician responses to the clinician IMR scale were shown to be characterized by similar major components of the IMR intervention.

Introduction

The Illness Management and Recovery (IMR) intervention (Mueser et al., 2006) was developed by practitioners and consumers as part of the National Implementing Evidence-Based Practices program (Drake and Goldman, 2003, Mueser et al., 2003). IMR includes psychosocial interventions that a review of controlled research (Mueser et al., 2002) found to be effective in helping clients acquire the knowledge and skills they need to manage their illnesses effectively and achieve personal recovery goals. To facilitate the attainment of the IMR program, the implementation resource kit is made-up of the following modules (Gingerich and Mueser, 2005):

  • 1.

    Recovery strategies—this module introduces the client to the concept of recovery, especially emphasizing client exploration and development of own definitions of recovery and personal goals.

  • 2.

    Practical facts about mental illness—this module provides clients with information about their illness (schizophrenia, major depression, mania–depression).

  • 3.

    Stress-vulnerability and treatment strategies—this module presents the stress-vulnerability model of SMI and shows how it is relevant to treatment of, and coping, with SMI.

  • 4.

    Building social support—this module exposes clients to strategies designed to improve social relationships.

  • 5.

    Using medication effectively—this module provides clients with information about how they can use medication as an aide to achieving their goals.

  • 6.

    Reducing relapses—by means of this module, clients learn to examine their experiences with past relapses to develop ways of preventing future relapses.

  • 7.

    Coping with stress—this module helps clients identify different kinds of stress and their physical and emotional reactions to stress and a variety of strategies for coping with stress.

  • 8.

    Coping with problems and symptoms—clients learn two approaches to coping with problems and symptoms.

  • 9.

    Getting your needs met in the mental health system—this module exposes the clients to an overview of the mental health system.

While research findings support the effectiveness of the IMR components (Mueser et al., 2002), efforts have just begun to be invested in the evaluation of the effectiveness of the IMR as a comprehensive standardized intervention. The IMR scales were developed as a methodological adjunct to these efforts (Mueser et al., 2005). The questionnaire that represents these scales were designed to measure the extent to which persons with a SMI have achieved the goals of the IMR intervention. These scales differ from other measures of psychiatric disability (i.e., Alptekin et al., 2005) in that they were developed to assess the effectiveness of a specific evidence based intervention. Thus, whereas other psychiatric disability measures tend to focus on either illness management (i.e., Yamada et al., 2006) or recovery (i.e., Bullock et al., in press), because the IMR intervention emphasizes the link between illness management and recovery, these scales include both illness management and recovery items and items that refer to the link between these phenomena.

Another important difference between the approach to assessing IMR described here and most other measures of disability and recovery is the formulation of client and clinician versions of the IMR scale. This innovation enables the assessment of IMR goals from the clinician and client perspectives. Evaluating these two perspectives is important because clinician–client agreement on client goals has been found to contribute significantly to the effectiveness of therapeutic interventions (Bachelor and Horvath, 1999, Bordin, 1979).

The IMR questionnaire was constructed by the practitioners and consumers who developed the IMR intervention. Care was exercised in formulating the IMR items to ascertain that they represent the major content areas addressed by the intervention while maintaining the brevity of the questionnaire. Feedback with regard to item selection and wording was obtained from other clinicians and consumers. Items were then modified in response to this feedback. The purpose of the present study was to evaluate the construct and concurrent validity of the IMR scale.

Each of the above modules applies the IMR component strategies to attain different illness management and recovery process goals. When they complete their involvement with the IMR intervention, participants should have increased their knowledge of their illness. Especially, when complemented by exposure to, and the internalization of recovery beliefs, experiences, and practices, this increase in knowledge, in turn, should contribute to the effectiveness of the manner in which they manage their illness. Consequently, participants should learn to recognize the symptoms of the illness and the early signs of relapse, to make use of both formal and informal help, how to manage their medication, to develop a relapse prevention plan, and techniques for coping with persistent symptoms and personal and interpersonal disabilities. They also should learn to improve their ability to identify and to work towards a number of personal goals. Furthermore, they also should internalize the manner in which the contents of the various modules are mutually facilitative.

Although the developers of the IMR scales claim that the IMR items represent different aspects of illness management and recovery (Mueser et al., 2006, p.32), they treat these scales as unidimensional measures. In this study, as a first step toward establishing the scale's construct validity, exploratory factor analysis was used to examine whether and how the structure of the scale items represent the IMR goals. Concurrent validity was evaluated by assessing the correspondence between the client and clinician perceptions of the client's IMR outcome. In addition, because the IMR intervention emphasizes the central role that coping plays in linking illness management to recovery and the significance of social support both as a component and goal of illness management and recovery, concurrent validation also included assessing the relations between the IMR scales and measures of coping and social support.

Section snippets

Research setting

The present investigation was part of a larger study in which a random group design with pre-and post-measures was applied toward evaluating the effectiveness of the IMR intervention (see Hasson-Ohayon et al., submitted, for a detailed description of the larger study). Data collected during the baseline pre-intervention administration of the scales were used to examine the psychometric properties of the IMR scales. These data were collected in 13 psychiatric community rehabilitation centers in

Factor analyses of the IMR scale

The IMR scales were originally scored as unidimensional measures. However, the 15 IMR items were constructed to represent major aspects of IMR (Mueser et al., 2005). In addition, the Cronbach alpha coefficients for the client and clinician versions of the IMR scale were 0.55 and 0.73, respectively. These moderate alpha coefficients suggest that the IMR scales are multidimensional.

Exploratory factor analyses were carried out to assess the extent to which the IMR scales reflect the goals of the

Discussion

This study, which was carried out with the cooperation of clients with a SMI who had not yet participated in the IMR intervention, provides limited evidence for the construct and concurrent validity of the client and clinician versions of the IMR scales. These scales were constructed by the practitioners and consumers who developed the IMR scale as user friendly self-report measures of the extent to which participants in the IMR intervention have attained this intervention's goals. Although the

Acknowledgments

The authors thank Israel's Ministry of Health and the National Council for the Rehabilitation of Persons with a Psychiatric Disability in the Community for support and assistance in conducting this study.

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