Nottingham Health Profile

Abstract

The Nottingham Health Profile (NHP) is a widely utilized generic self-report instrument designed to inventory the perceived health limitations and subjective distress experienced by patients. It serves as a tool to quantify the social and personal effects resulting from illness or chronic conditions. The NHP is structured into two distinct parts. Part I aims to measure the patient’s current experienced health status across six key dimensions of dysfunction and distress. Part II addresses health-related problems specifically concerning the performance of daily activities. The NHP is recognized globally for its simplicity and its ability to capture the subjective dimension of Quality of Life (QoL).

Keywords

Health Status, Quality of Life, Generic Questionnaire, Psychometric instrument, Pain, Mobility, Social Function, Daily Activities, Nottingham Health Profile.

Authors

Hunt SM, McEwen J, McKenna SP (Original 1980); Dutch version: Passchier J, Erdman RAM (1993)

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Purpose

The primary purpose of the Nottingham Health Profile is to provide a standardized, brief, and easily administered measure of perceived health distress and functional limitations. It is intended for use in clinical settings and large-scale epidemiological studies where a rapid assessment of the patient’s subjective experience of illness is required. Unlike purely clinical or physiological measures, the NHP focuses on the individual’s self-assessment of how their health problems interfere with their life.

It is particularly valuable for evaluating the effectiveness of medical interventions, monitoring changes in health status over time, and making comparisons between different patient groups or populations. The NHP’s generic nature allows it to be applied across a wide range of diseases and conditions, providing a common metric for assessing health outcomes.

Construct

The NHP measures the construct of subjective health-related Quality of Life (QoL) through two primary components: experienced distress and functional limitations.

Part I of the instrument consists of 35 items grouped into six distinct subscales, reflecting the main dimensions of distress and dysfunction resulting from poor health:

• Energy Level: Measures feelings of tiredness and lack of energy.
• Pain: Assesses the presence and impact of physical discomfort.
• Emotional Reactions: Covers psychological distress, including anxiety, depression, and irritability.
• Sleep: Measures disturbances in sleep patterns and quality.
• Social Isolation: Reflects the impact of health on social relationships and participation.
• Physical Mobility: Assesses limitations in movement and physical function.

Part II consists of seven items that determine the extent to which health problems interfere with specific aspects of daily living, such as employment, household tasks, and hobbies, thereby assessing general participation and function.

Validity

The NHP has demonstrated robust psychometric properties across numerous international studies, supporting its concurrent and construct validity. Studies confirm that the NHP successfully discriminates between groups known to differ in health status, such as patients with chronic diseases (e.g., rheumatoid arthritis, COPD) versus healthy controls.

The scale’s concurrent validity is established by its moderate to high correlation with other established measures of physical function, pain severity, and psychological well-being. Furthermore, the instrument exhibits sensitivity to change, meaning it is capable of detecting clinically meaningful improvements or deteriorations in a patient’s health following intervention or over the course of a disease.

Reliability

The reliability of the NHP, particularly Part I, is generally strong. Internal consistency, typically assessed using Cronbach’s alpha, consistently exceeds the acceptable threshold of 0.70 for the six subscales, indicating that the items within each dimension measure a unified construct.

Test-retest reliability is also satisfactory, suggesting that the scores are stable over short periods when the patient’s underlying health condition has not changed. This stability makes the NHP a reliable instrument for monitoring chronic conditions where perceived health status is expected to remain consistent in the absence of therapeutic changes.

Factor Analysis

Initial factor analysis performed during the development of the NHP confirmed the theoretical structure of Part I, supporting the division into six distinct, yet related, dimensions of subjective health distress. These analyses helped establish the empirically derived weighting system used in the scoring of the NHP.

The weighting system is a unique feature of the NHP, designed to reflect the severity of each item as perceived by the general population. This approach ensures that items reflecting more severe limitations contribute proportionally more to the overall subscale score, thus enhancing the instrument’s ability to differentiate between mild and severe levels of health impairment.

Instrument

Test Type: Questionnaire (Self-Report)

Format: The NHP consists of two parts, generally totaling 38 items. Items are answered using a simple dichotomous (Yes/No) response format.

Language Available: English (Original), Dutch (Nederlandse versie), and widely translated into numerous other languages globally.

Population Group: Adults, Elderly

Age Group: Typically 18 years and older.

Population Details: Generic instrument applicable across diverse patient populations, including those with acute and chronic illnesses, and general community samples.

Test Methodology: The NHP is typically self-administered, requiring minimal instruction. Scoring involves summing the weighted responses within the six subscales of Part I, yielding scores from 0 (no distress) to 100 (maximum distress) for each dimension.

Keywords

Self-Report, Health Outcomes, Patient-Reported Outcomes (PROs), Chronic Illness, Physical Mobility, Sleep Disturbance, Emotional Distress, Social Participation.

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Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: Not specified in source content.

Correspondence Address: Not specified in source content.

Permissions & Fee and Test Year

The original version of the NHP was published in 1980 by Hunt, McEwen, and McKenna. The official Dutch adaptation was published in 1993 by Passchier and Erdman. The NHP is often considered a non-commercial, public domain instrument, particularly for academic research, though specific permissions may be required depending on the country and intended application.

Reference’s

Hunt SM, McEwen J, McKenna SP. (1980). A quantitative approach to perceived health status. Journal of Epidemiology and Community Health, 34(4), 281-286.

Passchier J, Erdman RAM. (1993). Nederlandse bewerking van de Nottingham Health Profile. Lisse: Swets & Zeitlinger.

The explanatory form (Toelichtingsformulier) for the Dutch version is available here: NHP-form.pdf.

The measurement instrument (Meetinstrument) for the Dutch version is available here: NHP-meetinstr.pdf.

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Items of the Nottingham Health Profile

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific scale items of the Nottingham Health Profile were not provided in the source content. The NHP generally consists of 38 items covering six core dimensions of distress (Part I) and seven areas of functional limitation in daily activities (Part II).