Toggle Main Menu Toggle Search

Open Access padlockePrints

Review and update of the Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD)

Lookup NU author(s): Dr Barry Ingham



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© The Author(s) 2023. Background: The Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD) is an 18-item measure which provides a structured and standardized approach to rating various clinical and psychosocial outcomes and has been in use nationally since 2002. Aims: To revise and improve the HoNOS-LD’s utility in contemporary intellectual disability (ID) services whilst retaining its original objectives and five-point severity ratings. Method: ID clinicians were invited to complete an online survey, rating each item on the existing measure for being fit for purpose, identifying issues and suggesting improvements based on their experience of using the HoNOS-LD in practice. Scales were then assessed and revised sequentially; survey responses were used to inform discussion and revisions to the HoNOS-LD by the Advisory Board. Results: A total of 75 individuals replied. Respondents had used HoNOS-LD for an average of 8.0 years (S.D. 5.28 years) and 88% found the scale to be useful in their practice. On average, respondents used HoNOS-LD ratings to inform care 42.4% of the time (S.D. 33.5%). For each scale there was a significant negative correlation between the percentage of positive/very positive respondent ratings and the number of changes proposed. Common changes included simplifying terms, reducing ambiguity and replacing anachronistic language. Conclusion: The changes outlined in this paper are based on the advisory group’s expert consensus. These changes are intended to improve reliability and validity but now need empirical testing as well as review by service users.

Publication metadata

Author(s): Painter J, Adams N, Ingham B, James M, Majid M, Roy A, Shankar R, Smith M

Publication type: Article

Publication status: Published

Journal: International Journal of Social Psychiatry

Year: 2023

Volume: 69

Issue: 7

Pages: 1807-1813

Online publication date: 17/05/2023

Acceptance date: 02/04/2018

Date deposited: 27/06/2023

ISSN (print): 0020-7640

ISSN (electronic): 1741-2854

Publisher: Sage Publications Ltd


DOI: 10.1177/00207640231175773


Altmetrics provided by Altmetric