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Health and Quality of Life Outcomes

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Open Access 01-12-2005 | Review

A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures

Authors: Jane E Pirkis, Philip M Burgess, Pia K Kirk, Sarity Dodson, Tim J Coombs, Michelle K Williamson

Published in: Health and Quality of Life Outcomes | Issue 1/2005

Abstract

Background

The Health of the Nation Outcome Scales was developed to routinely measure outcomes for adults with mental illness. Comparable instruments were also developed for children and adolescents (the Health of the Nation Outcome Scales for Children and Adolescents) and older people (the Health of the Nation Outcome Scales 65+). All three are being widely used as outcome measures in the United Kingdom, Australia and New Zealand. There is, however, no comprehensive review of these instruments. This paper fills this gap by reviewing the psychometric properties of each.

Method

Articles and reports relating to the instruments were retrieved, and their findings synthesised to assess the instruments' validity (content, construct, concurrent, predictive), reliability (test-retest, inter-rater), sensitivity to change, and feasibility/utility.

Results

Mostly, the instruments perform adequately or better on most dimensions, although some of their psychometric properties warrant closer examination.

Conclusion

Collectively, the Health of the Nation Outcome Scales family of measures can assess outcomes for different groups on a range of mental health-related constructs, and can be regarded as appropriate for routinely monitoring outcomes.

Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A: Health of the Nation Outcome Scales (HoNOS). Research and development. British Journal of Psychiatry 1998, 172: 11–18.PubMedCrossRef

Wing JK, Lelliott P, Beevor AS: Progress on HoNOS. British Journal of Psychiatry 2000, 176: 392–393. 10.1192/bjp.176.4.392CrossRef

Gowers SG, Harrington RC, Whitton A, Lelliott P, Beevor A, Wing J, Jezzard R: Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA). British Journal of Psychiatry 1999, 174: 413–416.PubMedCrossRef

Gowers S, Bailey-Rogers SJ, Shore A, Levine W: The Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA). Child Psychology and Psychiatry Review 2000, 5: 50–56. 10.1017/S1360641700002148CrossRef

Burns A, Beevor A, Lelliott P, Wing J, Blakey A, Orrell M, Mulinga J, Hadden S: Health of the Nation Outcome Scales for elderly people (HoNOS 65+). Glossary for HoNOS 65+ score sheet. British Journal of Psychiatry 1999, 174: 435–438.PubMedCrossRef

Royal College of Psychiatrists: http://www.rcpsych.ac.uk/cru/honoscales/what.htm.

Pirkis J, Burgess P, Coombs T, Clarke A, Jones-Ellis D, Dickson R: Routine measurement of outcomes in Australian public sector mental health services. Australia and New Zealand Health Policy 2005, 2: 8. 10.1186/1743-8462-2-8PubMedCentralPubMedCrossRef

Turner S: Are the health of the Nation Outcome Scales (HoNOS) useful for measuring outcomes in older people's mental health services? Ageing and Mental Health 2004, 8: 387–396. 10.1080/13607860410001725063CrossRef

Cook DJ, Mulrow CD, Haynes RB: Systematic reviews: Synthesis of best evidence for clinical decisions. Annals of Internal Medicine 1997, 126: 376–380.PubMedCrossRef

10.

Greenhalgh J, Long AF, Brettle AJ, Grant MJ: Reviewing and selecting outcome measures for use in routine practice. Journal of Evaluation in Clinical Practice 1998, 4: 339–350.PubMedCrossRef

11.

Green RS, Gracely EJ: Selecting a rating scale for evaluating services to the chronically mentally ill. Community Mental Health Journal 1987, 23: 91–102. 10.1007/BF00757163PubMedCrossRef

12.

McDowell I, Newell C: Measuring Health: A Guide to Rating Scales and Questionnaires. Oxford, Oxford University Press; 1996.

13.

Chronbach LJ, Meehl PE: Construct validity in psychological tests. Psychological Bulletin 1955, 52: 281–302.CrossRef

14.

Shergill SS, Shankar KK, Seneviratna K, Orrell MW: The validity and reliability of the Health of the Nation Outcome Scales (HoNOS) in the elderly. Journal of Mental Health (UK) 1999, 8: 511–521.CrossRef

15.

Orrell M, Yard P, Handysides J, Schapira R: Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community. British Journal of Psychiatry 1999, 174: 409–412.PubMedCrossRef

16.

McClelland R, Trimble P, Fox ML, Stevenson MR, Bell B: Validation of an outcome scale for use in adult psychiatric practice. Quality in Health Care 2000, 9: 98–105. 10.1136/qhc.9.2.98PubMedCentralPubMedCrossRef

17.

Stedman T, Yellowlees P, Mellsop G, Clarke R, Drake S: Measuring Consumer Outcomes In Mental Health: Field Testing of Selected Measures of Consumer Outcome in Mental Health. Canberra, Department of Health and Family Services; 1997.

18.

Trauer T: The subscale structure of the Health of the Nation Outcome Scales (HoNOS). Journal of Mental Health (UK) 1999, 8: 499–509. 10.1080/09638239917193CrossRef

19.

Page AC, Hooke GR, Rutherford EM: Measuring mental health outcomes in a private psychiatric clinic: Health of the Nation Outcome Scales and Medical Outcomes Short Form SF-36. Australian and New Zealand Journal Psychiatry 2001, 35: 377–381. 10.1046/j.1440-1614.2001.00908.xCrossRef

20.

Eagar K, Trauer T, Mellsop G: Performance of routine outcome measures in adult mental health care. Australian and New Zealand Journal of Psychiatry 2005, 39: 713–718. 10.1111/j.1440-1614.2005.01655.xPubMedCrossRef

21.

Trauer T: Comment. Australian and New Zealand Journal of Psychiatry 2000, 34: 520–521. 10.1046/j.1440-1614.2000.00757.xCrossRef

22.

Preston NJ: The Health of the Nation Outcome Scales: Validating factorial structure and invariance across two health services. Australian and New Zealand Journal Psychiatry 2000, 34: 512–519. 10.1046/j.1440-1614.2000.00726.xCrossRef

23.

Parker G, O'Donnell M, Hadzi-Pavlovic D, Proberts M: Assessing outcome in community mental health patients: A comparative analysis of measures. International Journal of Social Psychiatry 2002, 48: 11–19. 10.1177/002076402128783046PubMedCrossRef

24.

Browne S, Doran M, McGauran S: Health of the Nation Outcome Scales (HoNOS): Use in an Irish psychiatric outpatient population. Irish Journal of Psychological Medicine 2000, 17: 17–19.

25.

Amin S, Singh SP, Croudace T, Jones P, Medley I, Harrison G: Evaluating the Health of the Nation Outcome Scales. Reliability and validity in a three-year follow-up of first-onset psychosis. British Journal of Psychiatry 1999, 174: 399–403.PubMedCrossRef

26.

Rees A, Richards A, Shapiro DA: Utility of the HoNOS in measuring change in a community mental health care population. Journal of Mental Health 2004, 13: 295–304. 10.1080/09638230410001700925CrossRef

27.

Bebbington P, Brugha T, Hill T, Marsden L, Window S: Validation of the Health of the Nation Outcome Scales. British Journal of Psychiatry 1999, 174: 389–394.PubMedCrossRef

28.

Hope JD, Trauer T, Keks NA: Reliability, validity and utility of the Health of the Nation Outcomes Scale (HoNOS) in Australian adult psychiatric services. Schizophrenia Research 1998, 29: 9–10. 10.1016/S0920-9964(97)88307-7CrossRef

29.

Adams M, Palmer A, O'Brien JT, Crook W: Health of the Nation Outcome Scales for psychiatry: Are they valid? Journal of Mental Health 2000, 9: 193–198. 10.1080/09638230050009186CrossRef

30.

Brooks R: The reliability and validity of the Health of the Nation Outcome Scales: Validation in relation to patient derived measures. Australian and New Zealand Journal Psychiatry 2000, 34: 504–511. 10.1046/j.1440-1614.2000.00755.x

31.

Issakidis C, Teesson M: Measurement of need for care: A trial of the Camberwell Assessment of Need and the Health of the Nation Outcome Scales. Australian and New Zealand Journal Psychiatry 1999, 33: 754–759. 10.1046/j.1440-1614.1999.00598.xCrossRef

32.

Hunter R, McLean J, Peck D, Pullen I, Greenfield A, McArthur W, Quinn C, Eaglesham J, Hagen S, Norrie J: The Scottish 700 Outcomes Study: A comparative evaluation of the Health of the Nation Outcome Scale (HoNOS), the Avon Mental Health Measure (AVON), and an Idiographic Scale (OPUS) in adult mental health. Journal of Mental Health 2004, 13: 93–105. 10.1080/09638230410001654594CrossRef

33.

Trauer T, Callaly T: Concordance between mentally ill patients and their case managers using the Health of the Nation Outcome Scales (HoNOS). Australasian Psychiatry 2002, 10: 24–28. 10.1046/j.1440-1665.2002.00387.xCrossRef

34.

Slade M, Beck A, Bindman J, Thornicroft G, Wright S: Routine clinical outcome measures for patients with severe mental illness: CANSAS and HoNOS. British Journal of Psychiatry 1999, 174: 404–408.PubMedCrossRef

35.

Salvi G, Leese M, Slade M: Routine use of mental health outcome assessments: Choosing the measure. British Journal of Psychiatry 2005, 186: 146–152. 10.1192/bjp.186.2.146PubMedCrossRef

36.

Craig RJ: Measures for mental health outcomes. British Journal of Psychiatry 2005, 187: 90–91. 10.1192/bjp.187.1.90-aPubMedCrossRef

37.

Bech P, Bille J, Schutze T, Sondergaard S, Wiese M, Waarst S: Health of the Nation Outcome Scales (HoNOS): Implementability, subscale structure and responsiveness in the daily psychiatric hospital routine over the first 18 months. Nordic Journal of Psychiatry 2003, 57: 285–290. 10.1080/08039480310002156PubMedCrossRef

38.

Bonsack C, Borgeat F, Lesage A: Measuring patients' problems severity and outcomes in a psychiatric sector: A field study with the French version of the Health of Nation Outcome Scales (HoNOS-F)/Mesurer la severite des problemes des patients et leur evolution dans un secteur psychiatrique: Une etude sur le terrain du Health of Nation Outcome Scales en francais: (HoNOS-F). Annales Medico-Psychologiques 2002, 160: 483–488. 10.1016/S0003-4487(02)00208-1CrossRef

39.

Gallagher J, Teesson M: Measuring disability, need and outcome in Australian community mental health services. Australian and New Zealand Journal Psychiatry 2000, 34: 850–855. 10.1046/j.1440-1614.2000.00815.xCrossRef

40.

Allan S, McGonagle I: A comparison of HoNOS with the Social Behaviour Schedule in three settings. Journal of Mental Health 1997, 6: 117–124. 10.1080/09638239718888CrossRef

41.

Broadbent M: Reconciling the information needs of clinicians, managers and commissioners: A pilot project. Psychiatric Bulletin 2001, 25: 423–425. 10.1192/pb.25.11.423CrossRef

42.

Schneider J, Wooff D, Carpenter J, Brandon T, McNiven F: Service organisation, service use and costs of community mental health care. Journal of Mental Health Policy and Economics 2002, 5: 79–87.PubMed

43.

Ashaye K, Seneviratna K, Shergill S, Orrell M: Do the Health of the Nation Outcome Scales predict outcome in the elderly mentally ill? A 1-year follow-up study. Journal of Mental Health (UK) 1999, 8: 615–620.CrossRef

44.

Goldney RD, Fisher LJ, Walmsley SH: The Health of the Nation Outcome Scales in psychiatric hospitalisation: A multicentre study examining outcome and prediction of length of stay. Australian and New Zealand Journal Psychiatry 1998, 32: 199–205.CrossRef

45.

Boot B, Hall W, Andrews G: Disability, outcome and case-mix in acute psychiatric in-patient units. British Journal of Psychiatry 1997, 171: 242–246.PubMedCrossRef

46.

Trauer T, Callaly T, Hantz P, Little J, Shields R, Smith J: Health of the Nation Outcome Scales. Results of the Victorian field trial. British Journal of Psychiatry 1999, 174: 380–388.PubMedCrossRef

47.

Goldney RD, Fisher LJ, Walmsley SH: A pilot study of the Health of the Nation Outcome Scales as a measurement of outcome in a private psychiatric hospital. Australasian Psychiatry 1996, 4: 319–321.CrossRef

48.

Audin K, Margison FR, Clark JM, Barkham M: Value of HoNOS in assessing patient change in NHS psychotherapy and psychological treatment services. British Journal of Psychiatry 2001, 178: 561–566. 10.1192/bjp.178.6.561PubMedCrossRef

49.

Parabiaghi A, Barbato A, D'Avanzo B, Erlicher A, Lora A: Assessing reliable and clinically significant change on the Health of the Nation Outcome Scales: Method for displaying longitudinal data. Australian and New Zealand Journal of Psychiatry 2005, 39: 719–725. 10.1111/j.1440-1614.2005.01656.xPubMedCrossRef

50.

Taylor JR, Wilkinson G: HoNOS v. GP opinion in a shifted out-patient clinic. Psychiatric Bulletin 1997, 21: 483–485.CrossRef

51.

Sharma VK, Wilkinson G, Fear S: Health of the Nation Outcome Scales: A case study in general psychiatry. British Journal of Psychiatry 1999, 174: 395–398.PubMedCrossRef

52.

Stafrace S: Doubts about HoNOS. Australian and New Zealand Journal Psychiatry 2002, 36: 270. 10.1046/j.1440-1614.2002.t01-5-01016.xCrossRef

53.

Stein GS: Usefulness of the Health of the Nation Outcome Scales. British Journal of Psychiatry 1999, 174: 375–377.PubMedCrossRef

54.

Gilbody SM, House AO, Sheldon TA: Psychiatrists in the UK do not use outcomes measures: National survey. British Journal of Psychiatry 2002, 180: 101–103. 10.1192/bjp.180.2.101PubMedCrossRef

55.

Andrews G, Page AC: Outcome measurement, outcome management and monitoring. Australian and New Zealand Journal of Psychiatry 2005, 39: 649–651. 10.1111/j.1440-1614.2005.01648.xPubMedCrossRef

56.

Ashaye O, Mathew G, Dhadphale M: A comparison of older longstay psychiatric and learning disability inpatients using the Health of the Nation Outcome Scales. International Journal of Geriatric Psychiatry 1997, 12: 548–552. 10.1002/(SICI)1099-1166(199705)12:5<548::AID-GPS543>3.0.CO;2-SPubMedCrossRef

57.

Glover GR, Sinclair Smith H: Computerised information systems in English mental health care providers in 1998. Social Psychiatry and Psychiatric Epidemiology 2000, 35: 518–522. 10.1007/s001270050274PubMedCrossRef

58.

James M, Kehoe R: Using the Health of the Nation Outcome Scales in clinical practice. Psychiatric Bulletin 1999, 23: 536–538.CrossRef

59.

Milne D, Reichelt K, Wood EI: Implementing HoNOS: An eight stage approach. Clinical Psychology and Psychotherapy 2001, 8: 106–116. 10.1002/cpp.252CrossRef

60.

Trauer T: The Health of the Nation Outcome Scales in outcome measurement: A critical review. Australasian Psychiatry 1998, 6: 11–14.CrossRef

61.

Harnett PH, Loxton NJ, Sadler T, Hides L, Baldwin A: The Health of the Nation Outcome Scales for Children and Adolescents in an adolescent inpatient sample. Australian and New Zealand Journal of Psychiatry 2005, 39: 129–135. 10.1111/j.1440-1614.2005.01533.xPubMedCrossRef

62.

Brann P: Routine Outcome Measurement in Child/Adolescent Mental Health: HoNOSCA - Valid Enough? Feasible Enough? Melbourne, Monash University;

63.

Brann P, Coleman G, Luk E: Routine outcome measurement in a child and adolescent mental health service: An evaluation of HoNOSCA. Australian and New Zealand Journal of Psychiatry 2001, 35: 370–376. 10.1046/j.1440-1614.2001.00890.xPubMedCrossRef

64.

Yates P, Garralda ME, Higginson I: Paddington Complexity Scale and Health of the Nation Outcome Scales for Children and Adolescents. British Journal of Psychiatry 1999, 174: 417–423.PubMedCrossRef

65.

Bilenberg N: Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): Results of a Danish field trial. European Child and Adolescent Psychiatry 2003, 12: 298–302. 10.1007/s00787-003-0343-1PubMedCrossRef

66.

Gowers S, Levine W, Bailey-Rogers S, Shore A, Burhouse E: Use of a routine, self-report outcome measure (HoNOSCA-SR) in two adolescent mental services. British Journal of Psychiatry 2002, 180: 266–269. 10.1192/bjp.180.3.266PubMedCrossRef

67.

Manderson J, McCune N: The use of HoNOSCA in a child and adolescent mental health service. Irish Journal of Psychological Medicine 2003, 20: 52–55.

68.

Garralda ME, Yates P, Higginson I: Child and adolescent mental health service use. HoNOSCA as an outcome measure. British Journal of Psychiatry 2000, 177: 52–58. 10.1192/bjp.177.1.52PubMedCrossRef

69.

Garralda E, Yates P: HoNOSCA: Uses and limitations. Child Psychology and Psychiatry Review 2000, 5: 131–132. 10.1017/S1360641700002306CrossRef

70.

Burns A, Beevor A, Lelliott P, Wing J, Blakey A, Orrell M, Mulinga J, Hadden S: Health of the Nation Outcome Scales for elderly people (HoNOS 65+). British Journal of Psychiatry 1999, 174: 424–427.PubMedCrossRef

71.

Allen L, Bala S, Carthew R, Daley S, Doyle E, Driscoll P, Grey B, Macdonald A: Experience and application of HoNOS65+. Psychiatric Bulletin 1999, 23: 203–206.CrossRef

72.

Macdonald AJ: HoNOS 65+ glossary. British Journal of Psychiatry 1999, 175: 192.PubMedCrossRef

73.

College Research Unit: HoNOS 65+: A Tabulated Glossary for Use with HoNOS65+ (Version 3). London, Royal College of Psychiatrists; 2002.

74.

Mozley CG, Huxley P, Sutcliffe C, Bagley H, Burns A, Challis D, Cordingley L: 'Not knowing where I am doesn't mean I don't know what I like': Cognitive impairment and quality of life responses in elderly people. International Journal of Geriatric Psychiatry 1999, 14: 776–783. 10.1002/(SICI)1099-1166(199909)14:9<776::AID-GPS13>3.0.CO;2-CPubMedCrossRef

75.

Spear J, Chawla S, O'Reilly M, Rock D: Does the HoNOS 65+ meet the criteria for a clinical outcome indicator for mental health services for older people? International Journal of Geriatric Psychiatry 2002, 17: 226–230. 10.1002/gps.592PubMedCrossRef

76.

Bagley H, Cordingley L, Burns A, Mozley CG, Sutcliffe C, Challis D, Huxley P: Recognition of depression by staff in nursing and residential homes. Journal of Clinical Nursing 2000, 9: 445–450. 10.1046/j.1365-2702.2000.00390.xPubMedCrossRef

77.

Reilly S, Challis D, Burns A, Hughes J: The use of assessment scales in Old Age Psychiatry Services in England and Northern Ireland. Aging Mental Health 2004, 8: 249–255. 10.1080/13607860410001669787PubMedCrossRef

78.

Macdonald AJD: The usefulness of aggregate routine clinical outcomes data: The example of HoNOS65+. Journal of Mental Health (UK) 2002, 11: 645–656. 10.1080/09638230020023CrossRef

Title: A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures
Authors: Jane E Pirkis
Philip M Burgess
Pia K Kirk
Sarity Dodson
Tim J Coombs
Michelle K Williamson
Publication date: 01-12-2005
Publisher: BioMed Central
Published in: Health and Quality of Life Outcomes / Issue 1/2005
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/1477-7525-3-76

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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