Measurement properties of the Health of the Nation Outcome Scales (HoNOS) family of measures: protocol for a systematic review

Harris, Meredith; Sparti, Claudia; Scheurer, Roman; Coombs, Tim; Pirkis, Jane; Ruud, Torleif; Kisely, Steve; Hanssen‐Bauer, Ketil; Siqveland, Johan; Burgess, Philip

doi:10.1136/bmjopen-2017-021177

Cited by 8 publications

(19 citation statements)

References 47 publications

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“…The analysis included only subjects with complete CGI and HoNOS data sets at baseline and discharge; HoNOS with three or more missing items were considered incomplete (Harris et al, 2018; James et al, 2018). To avoid an overlap of the time frame of evaluation, for the analysis of change, we excluded patients discharged the first week after admission.…”

Section: Methodsmentioning

confidence: 99%

“…As a result, it has become a well-established measurement instrument and is primarily used to assess the outcome of psychiatric treatment (Delaffon et al, 2018; James et al, 2018). In the meantime, it is available in several languages (Delaffon et al, 2018; Harris et al, 2018), and in some countries, the HoNOS is a mandatory outcome measure (Delaffon et al, 2018; Speak et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Despite a large number of publications and the profound implications of its use, the ability of the HoNOS to assess and differentiate the severity of psychiatric disorders is still unchartered (Harris et al, 2018). This is attributable to several factors, mainly the methodological and statistical intricacy of comparing heterogeneous groups across multiple domains (Gift et al, 1980; Zimmerman et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…This is attributable to several factors, mainly the methodological and statistical intricacy of comparing heterogeneous groups across multiple domains (Gift et al, 1980; Zimmerman et al, 2018). The interpretation of change in the HoNOS sum score can be arduous, due to the construction of the scale, where each item measures a separate issue (Boon et al, 2019; Egger et al, 2015; Harris et al, 2018; Parabiaghi et al, 2014). Clinical change may, therefore, be captured by a single item, with sub-threshold changes in other items potentially cancelling this out (MacDonald, 2009).…”

Section: Introductionmentioning

confidence: 99%

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Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Egger

Bobes

Theodoridou

et al. 2020

Aust N Z J Psychiatry

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Objective: The Health of the Nation Outcome Scales was developed as an overall measure of mental health, applicable to the complete range of psychiatric disorders. Meanwhile, it is a benchmark tool for service providers and is also used for the allocation of costs and funding. The ability of the Health of the Nation Outcome Scales to assess and differentiate the severity of psychiatric disorders is largely unknown, as it is the interpretation of a change in score. We aim to establish Health of the Nation Outcome Scales cut-off and benchmark values for severity and improvement – respectively change, using equipercentile linking to the Clinical Global Impression scales. Methods: In a clinical sample of 30,616 individuals with a psychiatric disorder, we used a multivariate regression analysis to determine the correlation between the scales and possible confounders. We used an equipercentile linking analysis of the Clinical Global Impressions severity scale with the Health of the Nation Outcome Scales sum score to establish cut-off values for severity. The linking of the Health of the Nation Outcome Scales sum score difference and the percentage of change to the Clinical Global Impression improvement scale determined benchmark values for change (i.e. improvement or deterioration). Results: The Health of the Nation Outcome Scales and Clinical Global Impression scales showed a Spearman correlation of 0.38 ( p < 0.000). Clinical Global Impression–Severity: ‘borderline-ill’ corresponded to Health of the Nation Outcome Scales score 3–5; ‘mildly ill’ to 6–10; ‘moderately ill’ to 11–16; ‘markedly ill’ to 17–25; ‘severely ill’ to 26–35; and ‘extremely ill’ to a score ⩾36. The Spearman correlation between the percentage change of the Health of the Nation Outcome Scales was 0.39 ( p > 0.000); Clinical Global Impression–Improvement: ‘minimally improved’ corresponded to Health of the Nation Outcome Scales reduction of 4 points or 9%; ‘much-improved’ to 12 points or 48%; ‘very-much-improved’ to ⩾20 points or ⩾90%. Clinical Global Impression–Improvement: ‘minimally worse’ corresponded to an increase of 6 points or 25%; ‘much-worse’ to 12 points or 54%; and finally, ‘very-much-worse’ to >18 points or ⩾82%. Conclusion: Our results allow for the comparison of severity and response to treatment of patients with a psychiatric disorder, independent of diagnosis.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Egger

Bobes

Theodoridou

et al. 2020

Aust N Z J Psychiatry

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“…Five studies of the IRR of HONOS item ratings report a range of coefficients from very low (−0.05, Luo et al , 2016) to very good (0.88, Brooks, 2000); all report some weak item IRRs (Orrell et al , 1999; Trauer et al , 1999; Brooks, 2000; Webster et al , 2013; Luo et al , 2016). Two reviews of studies of IRR found reports of mixtures of weak and good coefficients (Jacobs, 2009; Harris et al , 2017). Item 8 (other mental and behavioural problems) may add to variability in the interpretation of items because it is used to rate a variety of difficulties; in heterogeneous samples, its “meaning” may change from rating one service user to another.…”

Section: Introductionmentioning

confidence: 99%

An exploratory factor analysis of HONOS-LD scales

Turton

2020

AMHID

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Purpose The purpose of this study is to identify clinically meaningful groups of Health of the Nation Scales Learning Disabilities (HONOS-LD) single-item scales that might be used as short scales that are more reliable than single-item scale scores and more focused than the sum of scale scores. The single-item scales are likely to be unreliable in many applications. The sum of scale scores is a heterogeneous measure that is not a good representative of any specific difficulties that people who have intellectual disabilities may have and the effects of interventions on any specific difficulties may be masked by fluctuations in the ratings of other scales. Design/methodology/approach A total of 2,109 pseudonymised complete HONOS-LD ratings were factor-analysed using principal factor extraction and oblimin rotation. Three-, four- and five-factor rotated patterns were examined. Findings Three factors that each have three or more strong loadings (≥|0.50|) were identified that jointly included 11 single-item scales: one representing problems with cognitive competencies, one representing depressive phenomena or other mood problems and one representing problems with social competencies. A weaker factor that represents behaviour that challenges services is indicated; it includes five single-item scales. Both the cognitive competencies and social competencies groups of items were also reported in a previous study by Skelly and D’Antonio (2008) and may be stable. The present study’s factor representing behavioural difficulty has some similarity to Skelly and D’Antonio’s “functional behaviour and attachment disturbance” group. In other respects, the present study and the previous study differ. Research limitations/implications The outcomes of these factor analyses indicate that some of the single-item scales can be combined into groups. However, the specific groups found in this study must be regarded as possibly unstable because of the likelihood of weak inter-rater reliability in HONOS-LD data and differences between this analysis and Skelly and D’Antonio’s. Further research is needed to support or modify them. Practical implications The cognitive competence and social competence groups of items may be used as subscales if they are convenient. The groups representing mood and behavioural problems should be supported by further research before being used. Originality/value This is the second published factor analysis of the HONOS-LD and includes a much larger data set than the first. It has some similarities to and differences from the first and is a further step in the process of identifying useful groupings of HONOS-LD single-item scales.

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