title: Mokken analysis of the Health of the Nation Outcome Scales in acute inpatient and community samples.
abstract: OBJECTIVE
  The structure and scoring of the Health of the Nation Outcome Scales (HoNOS) has been open to debate. Most studies have relied on factor analytic approaches to investigate HoNOS structure. Our aim is to investigate HoNOS using methods from item response theory.
  
  
  METHODS
  Completed HoNOS forms from patients receiving mental health treatment in the community and also inpatients were subjected to Mokken analysis, which is a non-parametric form of item response theory. Confirmatory factor analysis was then used to investigate these scales.
  
  
  RESULTS
  Two scales with the same items were found in both samples; however, the inpatient sample scored higher on both scales. The first scale contained three items (10, 11, 12) from the social scale, and the other was related to depression (2, 7, 8). Confirmatory factor analysis showed that a two scale structure had better fit statistics than other suggested structures.
  
  
  CONCLUSIONS
  HoNOS might best be conceived as two scales measuring aspects of social adjustment and depression.
authors.affiliation: Academic Director, Department of Clinical Psychology, Teesside University, Middlesbrough, UK s.muncer@tees.ac.uk.
authors.forename: Steven
authors.initials: S
authors.lastname: Muncer
authors.affiliation: Consultant Clinical Psychologist, Tees Esk and Wear Valley NHS Foundation Trust, Middlesbrough, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Bass
authors.affiliation: Assistant Psychologist, Tees Esk and Wear Valley NHS Foundation Trust, Middlesbrough, UK.
authors.forename: Matt
authors.initials: M
authors.lastname: Dawkin
mesh_terms: D003863:Depression / Q000453:epidemiology*; D004739:England; D005163:Factor Analysis, Statistical; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000458:organization & administration; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012917:Social Adjustment
keywords: HoNOS; Mokken; confirmatory factor analysis