An exploratory factor analysis of HONOS-LD scales
| Pages | 33-44 |
| DOI | https://doi.org/10.1108/AMHID-05-2019-0013 |
| Date | 23 January 2020 |
| Published date | 23 January 2020 |
| Author | Rai Turton |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
An exploratory factor analysis of
HONOS-LD scales
Rai Turton
Abstract
Purpose –The purpose of this study is to identify clinically meaningful groups of Health of the Nation
Scales Learning Disabilities(HONOS-LD) single-item scales that might be used as shortscales that are
more reliable than single-item scale scores and morefocused than the sum of scale scores. The single-
item scales are likely to be unreliablein many applications. The sum of scale scores is a heterogeneous
measure that is not a good representative of any specific difficulties that people who have intellectual
disabilities may have and the effects of interventions on any specific difficulties may be masked by
fluctuationsin the ratings of other scales.
Design/methodology/approach –A total of 2,109 pseudonymised completeHONOS-LD ratings were
factor-analysedusing principal factor extractionand oblimin rotation. Three-, four- and five-factorrotated
patternswere examined.
Findings –Three factors that each have three or more strong loadings (|0.50|) were identified that
jointly included 11 single-item scales: one representing problems with cognitive competencies, one
representingdepressive phenomena or other mood problemsand one representing problems with social
competencies. A weaker factor that represents behaviour that challenges services is indicated; it
includes five single-item scales. Both the cognitive competencies and social competencies groups of
items were also reported in a previous study by Skelly and D’Antonio (2008) and may be stable. The
present study’s factor representing behavioural difficulty has some similarity to Skelly and D’Antonio’s
‘‘functional behaviourand attachment disturbance’’ group. In other respects, the presentstudy and the
previousstudy differ.
Research limitations/implications –The outcomes of these factor analysesindicate that some of the
single-item scalescan be combined into groups. However, the specific groupsfound in this study must
be regarded as possibly unstablebecause of the likelihood of weak inter-rater reliability in HONOS-LD
data and differences between this analysis and Skelly and D’Antonio’s. Further research is needed to
supportor modify them.
Practical implications –The cognitive competence and social competence groups of items may be
used as subscales if they are convenient. The groups representing mood and behavioural problems
shouldbe supported by further research beforebeing used.
Originality/value –This is the secondpublished factor analysis of the HONOS-LD andincludes a much
larger dataset than the first. It has some similarities to and differencesfrom the first and is a further step in
the processof identifying useful groupings of HONOS-LDsingle-item scales.
Keywords Exploratory factor analysis, Principal components analysis,
Health of the nation outcome scales learning disabilities, HONOS-LD, Scale scores, Subscales
Paper type Research paper
Introduction
The Health of the Nation Outcome Scalesfor People with Learning Disabilities (HONOS-LD)
is an adaptation of the Health of the Nation Outcome Scales (HONOS) (Roy et al.,2002). It
is a bundle of 18 single-item scales (six more than the HONOS) and can be scored as 22
scales because Scale 3 includes 5 scales that can be individually scored and recorded.
HONOS and HONOS-LD scales are rated for severity of impact on a five-point scale: 0 =
“no problem” and 1-4 rate increasing levels of severity (Wing et al.,1998;Roy et al.,2002).
Rai Turton is based at
Learning Disabilities,
Hertfordshire Partnership
University NHS Foundation
Trust, Radlett, UK.
Received 5 May 2019
Revised 8 November 2019
2 December 2019
Accepted 10 December 2019
DOI 10.1108/AMHID-05-2019-0013 VOL. 14 NO. 2 2020, pp. 33-44, ©Emerald Publishing Limited, ISSN 2044-1282 jADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES jPAGE 33
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