In a groundbreaking advancement for mental health assessment in Iran, researchers have successfully translated, culturally adapted, and validated the Persian version of the widely used Recovery Assessment Scale – Domains and Stages (RAS-DS). This instrument, now known as the P-RAS-DS, offers clinicians and researchers a scientifically robust tool to measure personal recovery among Persian-speaking individuals affected by mental illness. Recovery-oriented care has long been hailed as a transformative approach globally, emphasizing individuals’ empowerment and holistic well-being beyond symptom remission. However, culturally sensitive measures to accurately reflect recovery experiences in non-Western populations have been lacking—until now.
The translation and validation study was meticulously conducted following Beaton’s internationally recognized guidelines for cross-cultural adaptation of self-report measures. This rigorous framework ensures semantic, idiomatic, experiential, and conceptual equivalences between the original and the target language versions. The adaptation process also involved modifying two culturally sensitive items to better fit the Iranian context, exemplifying the thoughtful balance between preserving core content and respecting local nuances. Such meticulous adaptation is critical for maintaining the scale’s reliability and validity across diverse cultural settings.
Psychometric evaluation was implemented through a large sample of 373 participants diagnosed with various mental illnesses, recruited from outpatient psychiatric clinics in Tehran via convenience sampling. These service users, averaging 42.7 years of age with a balanced gender distribution, completed the P-RAS-DS alongside complementary measures such as the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) and the Engagement in Meaningful Activities Survey (EMAS) to enable convergent validity assessment. The cross-sectional nature of the study allowed for a comprehensive snapshot of reliability and validity metrics.
Statistical analysis underscored the P-RAS-DS’s exemplary internal consistency, achieving a Cronbach’s alpha of 0.940, indicating outstanding item interrelatedness. Further, test-retest reliability was impressively high (ICC = 0.941), suggesting the tool’s stable performance over time—a vital criterion for clinical and research utility. Notably, the measurement precision was affirmed by low values of Standard Error of Measurement (SEM = 3.19) and Minimum Detectable Change (MDC = 8.81), reinforcing the scale’s sensitivity to detect meaningful changes in recovery status.
Content validity received rigorous scrutiny through Content Validity Ratio (CVR) and Item-level Content Validity Index (I-CVI), both surpassing established thresholds, confirming the items’ relevance and representativeness from expert evaluations. This substantiates the instrument’s suitability for capturing diverse aspects of personal recovery in the Persian-speaking mental health population. The experts’ involvement was integral to refining scale items and ensuring clarity and cultural resonance without diluting the original constructs.
Exploratory Factor Analysis (EFA) further illuminated the P-RAS-DS’s underlying structure, revealing a coherent four-factor model: Self-determination and Connectedness, Hope and Purpose, Personally Valued Activities, and Seeking Support. This factor solution accounted for an impressive 64.67% of the total variance, highlighting the multifaceted nature of recovery. Interestingly, inter-factor correlations varied from weak to moderate, with Self-determination and Connectedness exhibiting the strongest associations with other domains and the total score, emphasizing its centrality in the recovery process.
Convergent validity results demonstrated a moderate positive correlation between the P-RAS-DS and the WEMWBS (ρ = 0.582), indicating that enhanced mental well-being aligns with higher perceived recovery levels. Meanwhile, a weaker but significant correlation with the EMAS (ρ = 0.268) suggests that engagement in meaningful activities partially overlaps with recovery domains, reflecting the complexity and individuality inherent in personal recovery journeys. These findings provide robust support that the P-RAS-DS sensitively captures key dimensions of mental health recovery.
The introduction of the P-RAS-DS fills a crucial gap in mental health evaluation tools available in Iran and other Persian-speaking regions. Its proven psychometric strengths ensure that clinicians can confidently utilize it to monitor recovery trajectories and tailor interventions aimed at enhancing personal meaning, connectedness, hope, and purposeful engagement. Researchers likewise benefit from a validated scale that facilitates culturally appropriate investigations into recovery-oriented outcomes, thereby fostering evidence-based care reforms.
Although the current study robustly establishes the P-RAS-DS’s reliability, validity, and cultural suitability, the authors acknowledge the necessity for further research employing confirmatory factor analysis (CFA). Such analyses would finalize the scale’s factor structure and possibly refine subtle item performance nuances, enhancing its precision and utility. Future longitudinal and intervention studies will also elucidate the scale’s responsiveness and predictive validity, paving the way for broader integration into mental health services.
This pioneering endeavor is emblematic of a growing international movement toward culturally sensitive mental health assessment. Recognizing cultural context’s profound influence on recovery experiences and expressions is fundamental for advancing inclusive care paradigms. The P-RAS-DS exemplifies how thoughtful translation and validation can yield effective tools that honor linguistic and cultural diversity while maintaining rigorous scientific standards—ultimately promoting global mental health equity.
As mental health practitioners and policymakers seek innovative methods to bolster recovery-oriented services, the accessibility of culturally adapted tools like the P-RAS-DS will catalyze better client engagement, individualized treatment planning, and outcome tracking. Notably, the emphases on self-determination, hope, and meaningful activity align with contemporary best practices advocating for person-centered care models worldwide.
The benefits of this validated Persian recovery assessment scale extend beyond clinical applications. It offers researchers a versatile instrument to explore recovery determinants, intervention impacts, and sociocultural dynamics influencing mental health outcomes. Its deployment across diverse Persian-speaking populations can generate comparative data to inform global mental health discourse and bridge cross-cultural knowledge gaps.
In conclusion, the development and validation of the Persian Recovery Assessment Scale – Domains and Stages mark a significant milestone in mental health care resource development for Iran and adjacent regions. This culturally adapted, reliable, and valid tool promises to enhance both clinical practice and research, embodying a critical step towards empowering individuals with mental illness on their unique recovery journeys.
Subject of Research:
Translation, cross-cultural adaptation, and psychometric evaluation of the Recovery Assessment Scale – Domains and Stages (RAS-DS) for Persian-speaking individuals with mental illness.
Article Title:
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.
Article References:
Fathi Azar, E., Hancock, N., Doroud, N. et al. 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. BMC Psychiatry 25, 1057 (2025). https://doi.org/10.1186/s12888-025-07526-4
Image Credits: AI Generated
DOI: 10.1186/s12888-025-07526-4
Keywords:
Recovery Assessment Scale, RAS-DS, Persian version, mental illness, psychometric validation, cross-cultural adaptation, personal recovery, mental health, reliability, validity
