Factorial structure of the Health of the Nation Outcome Scales: An ordinal confirmatory factor analysis using a national sample of clinician ratings in England.

In the present study, the superior factorial structure of the Health of the Nation Outcome Scales (HoNOS) was investigated. The aims of the study were to test the fit of our new four-factor/subscale structure within and across a wide range of clinical populations compared to competing structures, and to identify any clinical populations where the HoNOS might require modification in order to improve its psychometric properties. Ordinal confirmatory factor analysis was performed for four competing HoNOS subscale structures using a national sample of 80,161 ratings taken at the point of referral to mental health services in England. A new four-factor structure with good/acceptable internal consistency for each of the factors/subscales demonstrated a significantly better fit to the data for 21 of the 24 data groups compared to three competing subscale models. A new four-factor/subscale structure was shown to be the most generalizable subscale structure currently available for HoNOS. However, although superior to other factorial structures, the statistical fit was less than optimal for some clinical populations. Therefore, we would recommend that additional items relevant to all mental health patients are identified and added to the HoNOS in order to allow the development of a single, more generalizable subscale structure, and a much improved version of the HoNOS.

Support for compassionate care: Quantitative and qualitative evaluation of Schwartz Center Rounds in an acute general hospital.

OBJECTIVE: To evaluate the impact of Schwartz Center Rounds, a multi-disciplinary forum to reflect on the emotional consequences of working in healthcare, on the staff of a large acute general hospital over a three-year period. DESIGN: Evaluation data following each Round were collected routinely from all staff attending over this period and analysed quantitatively and qualitatively. SETTING: An integrated university teaching trust with both acute hospital and community services in the North East of England. PARTICIPANTS: Over the three-year period of the study, 795 participant evaluation forms were returned by staff attending the Rounds. MAIN OUTCOME MEASURES: A standard evaluation form completed at the end of each Round by those present, including ratings on a five-point scale against each of eight statements and an opportunity to offer additional free text comments. RESULTS: The findings show a very positive response to all aspects of the Rounds by staff who attended. The most highly rated statement was: 'I have gained insight into how others think/feel in caring for patients'. This was reinforced by the qualitative analysis in which the primary theme was found to be Insight. There were no significant differences between disciplines/staff groups, indicating that all staff whether clinical or non-clinical responded to the Rounds equally positively. CONCLUSIONS: Schwartz Rounds are highly valued by staff from all disciplines, and by managers and other non-clinicians as well as clinicians. They appear to have the potential to increase understanding between different staff, and so to reduce isolation and provide support.

HoNOS - their utility for payment by results in mental health.

PURPOSE: The purpose of this paper is to present findings from two studies exploring the Health of the Nation Outcome Scale's (HoNOS) utility within a new payment by results (PbR) system for mental health services in England. DESIGN/METHODOLOGY/APPROACH: In the first study principal axis factoring extraction was used to explore a sample of 23,641 HoNOS ratings. In a second study confirmatory factor analysis was used to evaluate four subscale structures on a new sample of 34,716 HoNOS ratings. FINDINGS: No HoNOS factor structure evaluated in this study demonstrated adequate fit statistics across several clinical presentations. A new four-factor model was the only structure to achieve fit statistics across all clinical populations, but can only be championed on a "best fit" basis as opposed to "good fit" at the present time. RESEARCH LIMITATIONS/IMPLICATIONS: Data used in the current studies relate to six NHS mental health service providers. Replication using a national sample is recommended. Exploration of different HoNOS factor structures for different mental health clusters within the PbR system in England is also recommended. However, it is also possible that removing redundant or adding new items may result in a more stable HoNOS generic factor structure. ORIGINALITY/VALUE: This is the first HoNOS evaluation as a generic outcome measure for use within a PbR system and provides important insights into its mental health utility and limitations. The findings have significant implications for those developing the national PbR quality and outcomes framework for England's mental health services. However, there are also implications for all nations in which HoNOS is used to report mental health outcomes.

Can compassionate healthcare be measured? The Schwartz Center Compassionate Care Scale™.

OBJECTIVE: Assess psychometric characteristics of an instrument to measure patient ratings of treating physicians' compassionate care in a recent hospitalization. METHODS: We used Cronbach's alpha to examine scale reliability, exploratory and confirmatory factor analysis to examine scale structure of two sets of items on compassionate care. We used Mokken analysis to determine if items in each set belonged to a unidimensional scale. RESULTS: Results indicated that both sets of items had strong reliability when used to rate individual physicians (Cronbach's α=.97 and .95). A one factor model was a good fit to both sets of items. Mokken analysis supported unidimensional scales. Both sets of items correlated with an overall measure of patient satisfaction with physicians and even more strongly with an item measuring emotional support. CONCLUSIONS: A patient-rated scale reliably measured hospital physicians' compassion and correlated significantly with an item measuring overall patient satisfaction and a specific measure of satisfaction with emotional support. Measurement of compassionate healthcare should be included in research, educational assessment, and quality improvement programs. PRACTICE IMPLICATIONS: Clinicians should participate in efforts to enhance their ability to demonstrate compassionate care including eliciting and sharing information and acting collaboratively to ameliorate patients' socioemotional concerns and needs.

Rasch modeling and confirmatory factor analysis of the systemizing quotient-revised (SQ-R) scale.

This study assessed the dimensionality of the Systemizing Quotient-Revised (SQ-R), a measure of how strong a person's interest is in systems, using two statistical approaches: Rasch modeling and Confirmatory Factor Analysis (CFA). Participants included N = 675 with an autism spectrum condition (ASC), N = 1369 family members of people with ASC, and N = 2014 typical controls. Data were applied to the Rasch model (Rating Scale) using WINSTEPS. The data fit the Rasch model quite well lending support to the idea that systemizing could be seen as unidimensional. Reliability estimates were .99 for items and .92 for persons. A CFA parceling approach confirmed that a unidimensional model fit the data. There was, however, differential functioning by sex in some of these items. An abbreviated 44-item version of the scale, consisting of items without differential item functioning by sex was developed. This shorter scale also was tested from a Rasch perspective and confirmed through CFA. All measures showed differences on total scale scores between those participants with and without ASC (d = 0.71, p < .005), and between sexes (d = 0.53, p < .005). We conclude that the SQ-R is an appropriate measure of systemizing which can be measured along a single dimension.

Rasch modeling and confirmatory factor analysis of the systemizing quotient-revised (SQ-R) scale

This study assessed the dimensionality of the Systemizing Quotient-Revised (SQ-R), a measure of how strong a person's interest is in systems, using two statistical approaches: Rasch modeling and Confirmatory Factor Analysis (CFA). Participants included N = 675 with an autism spectrum condition (ASC), N = 1369 family members of people with ASC, and N = 2014 typical controls. Data were applied to the Rasch model (Rating Scale) using WINSTEPS. The data fit the Rasch model quite well lending support to the idea that systemizing could be seen as unidimensional. Reliability estimates were .99 for items and .92 for persons. A CFA parceling approach confirmed that a unidimensional model fit the data. There was, however, differential functioning by sex in some of these items. An abbreviated 44-item version of the scale, consisting of items without differential item functioning by sex was developed. This shorter scale also was tested from a Rasch perspective and confirmed through CFA. All measures showed differences on total scale scores between those participants with and without ASC (d = 0.71, p < .005), and between sexes (d = 0.53, p < .005). We conclude that the SQ-R is an appropriate measure of systemizing which can be measured along a single dimension (AU)

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An evaluation of the independence of the Health of the Nation Outcome Scales.

OBJECTIVE: In this study the independence of the scales/items in the Health of the Nation Outcome Scales (HoNOS) was empirically investigated. METHOD: Parallel analysis using random column permutation and bootstrapping were used to compare the factor structure, intercorrelations and Cronbach's alpha from the original HoNOS study and also recently collected HoNOS ratings. Random permutation ensures that the data has the same distributions as the data it is based on, but that the variables are now independent. RESULTS: It is shown that both of the real HoNOS data sets are significantly different to the independent items data in many ways. An examination of fit statistics from confirmatory factor analysis is also used to show that the independence model is a very poor fit to the data. CONCLUSIONS: It is clear that the 12 HoNOS scales are unlikely to be independent. There is a need for more research to clarify the appropriate structure of HoNOS, and also to consider whether some of the items need either replacing or augmenting.

Bigram frequency, number of syllables and morphemes and their effects on lexical decision and word naming.

There has been an increasing volume of evidence supporting the role of the syllable in word processing tasks. Recently it has also been shown that orthographic redundancy, related to the pattern of bigram frequencies, could not explain the syllable number effect on lexical decision times. This was demonstrated on a large sample of words taken from the British Lexicon Project. In this study we extend this research by examining both lexical decision and word naming times taken from the English Lexicon Project. There was a syllable number effect for both tasks in the expected direction, and this effect was independent of the presence of a bigram trough. The research also examined the role of other bigram related variables and the number of morphemes on lexical decision and word naming times. The number of morphemes had a significant effect on both word processing tasks, with words with more morphemes producing faster reaction times and also fewer errors. This pattern was reversed for nonword lexical decision times. The results are discussed in the light of recent developments in models of reading.

Parents' views of the National Autistic Society's EarlyBird Plus Programme.

Parent training interventions are recommended for parents soon after their child's autism spectrum condition diagnosis with the aim of improving parents' psychological well-being and coping, as well as the child's behaviour. This report explores parents' views of the EarlyBird Plus Programme through data collected routinely in the post-programme questionnaire. Participants' reported increased understanding of autism and improvements in their communication with their child and their ability to manage their child's behaviour. Parents appeared to value the opportunity to meet with other parents, and the programme seemed acceptable to the majority of parents who attended.

Lexical decision and the number of morphemes and affixes.

There has been a considerable amount of research looking at the effects of both syllable number and syllable frequency on lexical decision and word naming times. Recently, there has also been an increased interest in morphological variables, but there have been no large scale studies that have examined the role of the number of morphemes in lexical decision for nonwords. This is partly because of the difficulty of identifying morphemes in nonwords. We present a program that identifies the presence of affixes and, therefore, can be used to count the number of morpheme-like elements in a nonword. We then used the program to measure the importance of affixes/morphemes in predicting lexical decision in nonwords. The results suggested that morphemes have an important role in lexical decision for both words and nonwords.

The bigram trough hypothesis and the syllable number effect in lexical decision.

There has been an increasing volume of evidence supporting the role of the syllable in various word processing tasks. It has, however, been suggested that syllable effects may be caused by orthographic redundancy. In particular, it has been proposed that the presence of bigram troughs at syllable boundaries cause what are seen as syllable effects. We investigated the bigram trough hypothesis as an explanation of the number of syllables effect for lexical decision in five-letter words and nonwords from the British Lexicon Project. The number of syllables made a significant contribution to prediction of lexical decision times along with word frequency and orthographic similarity. The presence of a bigram trough did not. For nonwords, the number of syllables made a significant contribution to prediction of lexical decision times only for nonwords with relatively long decision times. The presence of a bigram trough made no contribution. The evidence presented suggests that the bigram trough cannot be an explanation of the syllable number effect in lexical decision. A comparison of the results from words and nonwords is interpreted as providing some support for dual-route models of reading.

The role of syllables in anagram solution: a Rasch analysis.

Anagrams are frequently used by experimental psychologists interested in how the mental lexicon is organized. Until very recently, research has overlooked the importance of syllable structure in solving anagrams and assumed that solution difficulty was mainly due to frequency factors (e.g., bigram statistics). The present study uses Rasch analysis to demonstrate that the number of syllables is a very important factor influencing anagram solution difficulty for both good and poor problem solvers, with polysyllabic words being harder to solve. Furthermore, it suggests that syllable frequency may have an impact on solution times for polysyllabic words, with more frequent syllables being more difficult to solve. The study illustrates the advantages of Rasch analysis for reliable and unidimensional measurement of item difficulty.

Type and token bigram frequencies for two-through nine-letter words and the prediction of anagram difficulty.

Recent research on anagram solution has produced two original findings. First, it has shown that a new bigram frequency measure called top rank, which is based on a comparison of summed bigram frequencies, is an important predictor of anagram difficulty. Second, it has suggested that the measures from a type count are better than token measures at predicting anagram difficulty. Testing these hypotheses has been difficult because the computation of the bigram statistics is difficult. We present a program that calculates bigram measures for two-to nine-letter words. We then show how the program can be used to compare the contribution of top rank and other bigram frequency measures derived from both a token and a type count. Contrary to previous research, we report that type measures are not better at predicting anagram solution times and that top rank is not the best predictor of anagram difficulty. Lastly we use this program to show that type bigram frequencies are not as good as token bigram frequencies at predicting word identification reaction time.

The syllable effect in anagram solution: unrecognised evidence from past studies.

Six previous studies of the variables affecting anagram solution are re-examined for the evidence that number of syllables contributes to solution difficulty. It was shown that the number of syllables in a solution word was confounded with imagery for one study and with diagram frequency for another. More importantly it was shown that the number of syllables has a large effect on anagram solution difficulty in the re-analysis of the results from the other four studies. In these studies, the number of syllables was either more important than the principal variable examined in the experiment or the second most important variable. Overall the effect size for the number of syllables was large, d = 1.14. The results are discussed in the light of other research and it is suggested that anagram solution may have more in common with other word identification and reading processes than has been previously thought.

Psychometric analysis of the systemizing quotient (SQ) scale.

The psychometric properties of the systemizing quotient (SQ) developed by Baron-Cohen (2003) are investigated in three studies. Furthermore, we examine the notion that the ability to systemize should be independent of intelligence. In Studies 1 and 2, confirmatory factor analyses are used to examine the factor structure of the SQ. Study 3 examines the relationship between systemizing, mental rotation and intelligence. Studies 1 and 2 indicate that the SQ does not possess a unifactorial structure but is best considered as four related factors; Study 3 found that SQ was not related to intelligence, although mental rotation was. A four factor structure using fewer items was a better fit for the data than either the original version of the SQ or Wakabayashi et al.'s (2006) revised version. Overall these results support Baron-Cohen's view that SQ is not related to intelligence. Although mental rotation is correlated to SQ, it is not the main determinant of SQ. The problems of self-report measures are discussed along with the difficulties related to measuring systemizing.

Control over social interactions: an important reason for young people's use of the Internet and mobile phones for communication?

This paper reports some research that was undertaken to determine why young people choose to use certain communication media, especially the Internet and mobile phones for social purposes. Focus group methodology was employed in achieving this aim. Specifically, two focus groups containing young people aged 18-20 years were asked to discuss the question "why do you use different communication media, such as the Internet and mobile phones, in your social lives?" Discussions from the sessions were recorded on audiotapes, and then transcribed, and analyzed according to the principles of Grounded Theory. A number of categories emerged from the data. The most significant category indicated that young people often liked to use communication media such as the Internet and mobile phones to communicate because these afforded them control over their interactions. In particular, the data seemed to suggest that participants felt that because some communication media such as email, text messaging and instant messaging can be used asynchronously as well as synchronously, they allow one time to stop and think before giving a response if this is desired, or, alternatively, allowed one to retain the conversational nature of interactions if this is preferred. This gave participants greater control over interactions than they would have if, say, communicating via voice calls using the telephone or face-to-face, which are necessarily synchronous.