Investigating the component structure of the Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD)
McCabe, Joanne
McCabe, Joanne
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Affiliation
Sheffield Hallam University; Central and Northwest London NHS Foundation Trust; University Hospital Coventry and Warwickshire; Coventry and Warwickshire Partnership Trust; Cornwall Partnership NHS Foundation Trust; University of Plymouth Peninsula School of Medicine
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Publication date
2025-03
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Abstract
Background: Outcome measurement is increasingly recognised as a vital element of high-quality service provision, but practice remains variable in the field of intellectual disabilities. The Health of the National Outcome Scales for people with Learning Disabilities (HoNOS-LD) is a widely used Clinician Reported Outcome Measure in the UK and beyond. Over its 20-year lifespan, its psychometric properties have been frequently investigated. Multiple dimensionality reduction analyses have been published, each proposing a different latent structure.
Aim: To analyse a set of HoNOS-LD ratings to test its internal consistency, to identify the optimal number of latent variables, and to propose the items that group together in each domain.
Methods: A Principal Component Analysis of 169 HoNOS-LD ratings was performed to produce an initial model. The component loadings for each HoNOS-LD item were then examined, allowing the model to be adjusted to ensure the optimal balance of statistical robustness and clinical face-validity.
Results: HoNOS-LD's internal consistency (18 items) was 'acceptable' (Cronbach's alpha = 0.797). On excluding three items that had no bivariate correlations with the other 15 items internal consistency rose to 'good' (Cronbach's alpha = 0.828). The final, four-component solution, using the 15 items possessed good internal reliability.
Conclusion: HONOS-LD statistical properties compared favourably to the other published latent structures and adheres to the tool's rating guidance. The four-component solution offers an acceptable balance of statistical robustness and clinical face validity. It provides advantages over other models in terms of internal consistency and/or viability for use at a national level in the UK.
Citation
Painter J, Purandare K, McCabe J, Roy A, Shankar R. Investigating the component structure of the Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD). Int J Soc Psychiatry. 2025 Mar 12:207640251323819. doi: 10.1177/00207640251323819. Epub ahead of print. PMID: 40071659.
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Article