To the authors’ knowledge, this is the first study to empirically test whether consumer experiences with two aspects of provider communication are related to personal recovery outcomes. Individuals who reported that providers always showed respect achieved better outcomes on all five personal recovery domains. Showing respect is a key aspect of patient-centered care and a hallmark of quality mental health care [
20]. It has also been identified as a core feature of recovery-oriented services [
16]. In an online Delphi survey with consumers, treating consumers with respect was one of the top-rated recovery-related mental health provider competencies [
16]. Our results build on this finding suggesting that providers showing respect may be related to consumer recovery outcomes.
Further, our findings indicate that the associations between showing respect and recovery outcomes are even greater for mental health professionals than general medical providers. Given that mental health professionals are more likely to deliver psychotherapy-based treatment, respect may play a more prominent role in facilitating conditions that promote personal recovery outcomes, such as empowerment and hope/confidence, compared to general medical doctors who are often limited to short visits involving psychotropic medication management. Findings are consistent with previous research in which showing respect was the most important dimension of communication associated with overall physician ratings in 23 of 28 medical and surgical specialties [
41]. Moreover, showing respect was even more influential in specialty care settings where patients may feel especially vulnerable (e.g., plastic surgery). Showing respect may play a particularly important role in psychotherapy-based treatment where opportunities for more extensive discussion of mental health challenges and associated vulnerability may be greater.
Interestingly, experiences of providers explaining things understandably had no significant associations with any of the personal recovery outcomes except for internalized stigma. Relatedly, providers communicating in an understandable way was not identified as one of the top ranked recovery competencies identified by consumers in the Lakeman (2010) study. Likewise, in a qualitative analysis of recovery-oriented practice guidelines, provider communication was not even mentioned in the four practice domains that emerged, which included promoting citizenship, organizational commitment, working relationship, and supporting personally defined recovery [
42]. Supporting personally defined recovery, in which consumers are supported to define their own treatment needs, preferences and goals, is at the heart of recovery-oriented care [
4,
7,
42]. Personally defined recovery also dovetails with the concept of shared decision making, a central characteristic of patient- or person-centered care, in which providers and consumers engage in a collaborative partnership to personalize care [
43]. Communicating in an understandable manner may be tapping into the conveying of technical treatment information (e.g., psychoeducation), which may not be as directly linked to recovery outcomes. Recovery outcomes may be optimized when providers communicate understandably within the context of supporting personally defined recovery and shared decision making.
This is one of the few studies that have examined the relationship between sociodemographic characteristics and levels of psychological distress to personal recovery outcomes [
7]. Our finding that females and certain racial-ethnic minority groups (i.e., African Americans, Latino Spanish interview participants) exhibited better personal recovery outcomes warrant further research. Prior research suggests that the conceptualization of recovery outcomes may differ by gender and race/ethnicity [
44,
45]. Likewise, the negative association between psychological distress and personal recovery outcomes suggests the need to better understand how to best facilitate personal recovery outcomes among those with more severe mental illness. For instance, in a small study involving individuals with serious mental illness, interactions with professional staff in which participants felt seen and heard appeared to support personal recovery [
46]. Findings should be considered in light of study limitations. We cannot establish whether the associations between provider communication and recovery outcomes are causal given the cross-sectional nature of the study. In addition, the CWBS was designed for population surveillance and could not accommodate full length measures for many of the domains investigated. For instance, the provider communication measures are simple, single-item measures, but were drawn from a validated instrument with strong psychometric properties considered the national standard for evaluating consumer experiences [
40]. Further, measures for the personal recovery outcomes of life satisfaction and connectedness were drawn from the positive psychology field, which has developed well-validated measures that have been administered at the population level [
5,
36,
37,
47]. The remaining three recovery outcomes (i.e., hope, empowerment, and internalized stigma) were assessed with measures that have been predominantly examined among clinic or convenience samples. The conceptualization and measurement of recovery outcomes continue to be refined and further advancements are needed to facilitate recovery-oriented practices [
8,
18,
48]. A key strength of our study is the examination of recovery outcomes with a representative sample of individuals who reported experiencing mental distress and seeing a provider in the past year. Because the sample is not drawn from a particular clinic or provider, the differences by provider type could be examined in a group who saw a diverse sample of providers. It is important to note that our sample excluded certain segments of the population (e.g., homeless, incarcerated, hospitalized) in which the nature and severity of mental illness could significantly differ. Nonetheless, our analyses did control for levels of psychological distress accounting for potential differences in mental illness severity among study participants obtaining services across different mental health care settings. Finally, provider communication overlaps with other areas such as working alliance [
49‐
51] and shared decision-making [
52,
53] that have been linked to personal recovery outcomes; additional research is needed to better understand how these consumer experiences relate to one another and personal recovery. Further, some have expressed concerns that consumer experience surveys may tap into providers’ compliance with patient expectations or preferences even when they may be contraindicated (e.g., stopping medication) [
54,
55], highlighting the potentially complex relationship between consumer experiences, the delivery of evidence-based care, and personal recovery.