Health of the nation outcome scales evaluation in a community setting population

Purpose To explore the internal structure of the Health of the Nation Outcome Scales (HoNOS-12), proposing a shorter one-dimensional version for routine use in community- oriented Mental Heath services. Methods A validation study involving four Mental Health Departments, located in the Province of Milan (Italy). Eligible patients were outpatients and residential inpatients rated on three occasions during the year 2009, with a range of mental illnesses and diagnoses. Methodologically, we use both exploratory factor analysis (EFA) with holdout validation and Rasch approaches and parallel analysis. Results EFA, Rasch analysis and parallel analysis demonstrate a large violation of unidimensionality. Both EFA (training sample) and Rasch analyses yield convergent results, generating the same unidimensional abbreviated version of the HoNOS-12, resulting in a six-item scale (HoNOS-6) which demonstrates unidimensionality, good item fit, a solid factor structure (strong loadings and communalities) and acceptable model fit, evaluated using confirmatory factor analysis on a validation sample. Conclusions The HoNOS-12 does not measure a single, underlying construct of mental health status. Nevertheless, the instrument can be utilized in a reduced version (HoNOS- 6), as a clinically acceptable outcome scale (measuring self-perceived clinical and social needs for community support, rather than global mental disorder) for routine use in a community setting population. © Springer Science+Business Media B.V. 2012.