The reliability and validity of the Health of the Nation Outcome Scales: validation in relation to patient derived measures

Objective: The Health of Nation Outcome Scales (HoNOS) was developed to assess mental health outcomes. The aim of the studies is to examine the psychometric properties, reliability and validity of the HoNOS. Method: Three studies were conducted within St John of God Hospitals in New South Wales, Australia. They examined the reliability and the validity of the HoNOS. The first study examined the interrater reliability of the HoNOS, before and after staff training in the use of the HoNOS. The second study examined the validity of the HoNOS with the Symptom Checklist 90 Revised (SCL90-R) and the third study examined the validity of the HoNOS with the Short-Form 36 (SF-36). Results: The first study showed an improvement in the interrater reliability (IRR) of the HoNOS due to training. However, a generally unsatisfactory IRR (range 0.50-0.65) was achieved. The second study found no correlation between the SCL90-R and the HoNOS on admission (r = 0.04) and discharge (r = 0.06). The third study found no significant correlation between the Mental Component Score of the SF-36 and the HoNOS on admission (r = -0.033) nor on discharge (r = -0.104). Conclusions: The HoNOS has at best moderate interrater reliabilities. Further, the validity of the HoNOS is under question, that is, it does not correlate with a major measure of mental health symptoms, nor with a major measure of health status. As such, it is concluded that the psychometric properties of the HoNOS do not warrant its use as a routine measure.