Health Opinion Survey (HOS) – 27 items

Abstract

The Health Opinion Survey (HOS), developed by Semmence in 1969, is a concise 27-item instrument primarily designed for use as a psychiatric screening tool in non-specialized clinical settings, such as general practice. It aims to quickly assess the presence and frequency of various physical and psychological symptoms that may be indicative of underlying psychological distress or somatic complaints. The HOS is noted for its straightforward scoring mechanism, making it practical for rapid administration and initial evaluation of patients presenting with non-specific health concerns.

Keywords

Health Opinion Survey, HOS, Psychiatric screening, Somatic complaints, Nervousness, General practice, Psychological distress, Health behaviors.

Authors

Semmence, A. M.

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Purpose

The primary purpose of the Health Opinion Survey is to serve as an efficient and accessible instrument for the early detection and screening of psychiatric morbidity, particularly within general medical settings. It allows clinicians to identify patients exhibiting a higher burden of somatic and psychological symptoms that warrant further investigation or referral.

By quantifying the frequency of common health troubles and nervous symptoms, the HOS helps distinguish between general health concerns and those potentially rooted in emotional or stress-related factors. Its use is particularly valuable in primary care where time constraints necessitate rapid, yet effective, screening tools for common mental health issues.

Construct

The HOS measures a broad construct encompassing general health perception, the manifestation of physical symptoms often associated with stress (somatization), and explicit indices of nervousness and anxiety. Items probe areas such as autonomic nervous system arousal (e.g., trembling, sweating, heart palpitations), sleep disturbances, gastrointestinal issues, and general psychological instability (e.g., feeling close to a nervous breakdown).

The instrument is fundamentally designed to capture the subjective experience of poor health and neurotic tendencies, providing a cumulative score that reflects the respondent’s level of perceived health trouble and psychological burden.

Validity

Detailed information regarding specific, modern psychometric testing is often limited in historical instruments like the HOS. However, its continued use and citation in academic literature imply foundational levels of utility and criterion validity for detecting distress. Studies validating the HOS typically correlate its scores with clinical diagnoses or established mental health inventories, demonstrating its ability to discriminate between clinically healthy individuals and those experiencing significant psychological symptoms.

The instrument’s content validity is strong, as its items directly address common symptoms reported by patients presenting with anxiety, depression, and somatoform disorders in medical settings.

Reliability

The reliability of the HOS, particularly in its original context, was generally considered adequate for a brief screening measure used in general practice. High internal consistency is expected among the items reflecting nervousness and somatic complaints, given their common clustering in presentations of general anxiety and neuroticism.

While the brevity of the 27-item scale is a strength for clinical application, it necessitates robust internal consistency to ensure that the cumulative score accurately reflects a stable underlying trait of psychological morbidity.

Factor Analysis

While the HOS is often utilized as a single-factor measure, yielding a single continuous score representing overall psychological distress or morbidity, early exploratory analyses suggested potential underlying components related to specific symptom clusters. These sub-factors often include dimensions such as Somatic Symptoms (physical complaints) and Anxiety/Nervousness (emotional and autonomic arousal symptoms).

In practice, researchers using the HOS typically sum the scores to derive a single, continuous measure of overall psychological burden, prioritizing its function as a general screening tool rather than a diagnostic instrument for specific disorders.

Instrument

Test Type: Self-report Questionnaire / Psychiatric Screening Instrument

Format: 27 items, primarily utilizing 3-point and 4-point Likert-style response options.

Language Available: English (Original)

Population Group: Adults in general population or primary care settings.

Age Group: Typically utilized with adult populations (18+).

Population Details: Originally validated and utilized extensively within the context of British general practice settings.

Test Methodology: Respondents indicate the frequency or presence of various physical and emotional symptoms. Scoring involves assigning weights (0, 1, 2, or 3) to responses, where higher weights correspond to greater symptom frequency or severity. The total raw score reflects the level of distress.

Keywords

Somatization, Neuroticism, Primary care assessment, Health screening, General Practitioners, Symptom frequency.

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Authors

Author ORCID Identifier: Information Not Available in Source

Affiliation Email addresses: Information Not Available in Source

Correspondence Address: Information Not Available in Source

Permissions & Fee and Test Year

The Health Opinion Survey was first published in 1969. Due to its age and common academic usage, it is often treated as being in the public domain or freely available for non-commercial research purposes, though researchers should verify permissions with the original publisher (Journal of the Royal College of General Practitioners) or its current representative. No specific fee structure is typically associated with its use in academic research.

Test Year: 1969.

Reference’s

• Semmence‚ A. M.‚ (1969). The health opinion survey A psychiatric screening instrument. Journal of the Royal College of General Practitioners‚ 18(89): 344–348.
• The instrument and scoring details are available via NCBI PubMed Central.

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Items of the Health Opinion Survey (HOS) – 27 items

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

1. Do you have any particular physical or health trouble at present? Yes‚ No‚ Undecided
2. Do your hands ever tremble enough to bother you? Often‚ Sometimes‚ Never
3. Are you ever troubled by your hands or feet sweating so that they feel damp and clammy? Often‚ Sometimes‚ Never
4. Have you ever felt you were going to have a nervous breakdown? Often‚ Sometimes Never‚ Once or twice
5. Have you ever been bothered by your heart beating hard? Often‚ Sometimes‚ Never
6. Do you tend to feel tired in the mornings? Often‚ Sometimes‚ Never
7. Do you have any trouble in getting to sleep and staying asleep? Often‚ Sometimes‚ Never
8. How often are you bothered by ha‎ving an upset stomach? Nearly all the time‚ Not very much‚ Pretty often Never
9. Are you ever bothered by nightmares? (Dreams which frighten you or upset you?) Many times‚ A few times‚ Never
10. Do your arms or legs go to sleep rather easily? Often‚ Sometimes‚ Never
11. Have you ever been troubled by ‘cold sweats’? Often‚ A few times‚ Never
12. Do you feel you are bothered by all sorts (different kinds) of ailments in different parts of your body? Often‚ Sometimes‚ Never
13. Do you smoke? A lot‚ Some‚ Not at all
14. Are you troubled by sick headaches? Often‚ Sometimes‚ Never
15. Do you ever have loss of appetite? Often‚ Sometimes‚ Never
16. Do you ever have a bad taste in your mouth? Often‚ Sometimes‚ Never
17. Does your food ever seem tasteless and hard to swallow? Often‚ Sometimes‚ Never
18. Do you feel it is necessary to take vitamin pills for your health? Often‚ Sometimes‚ Never
19. Do you depend on patent medicines? Often‚ Sometimes‚ Never
20. Do you feel that you are more apt to catch contagious diseases than most people? Yes‚ No‚ Undecided
21. Has ill health affected the amount of work you do? Often‚ Sometimes‚ Never
22. Do you ever take weak turns? Often‚ Sometimes‚ Never
23. Have you ever had spells of dizziness? Often‚ Sometimes‚ Never
24. Do you tend to lose weight when you have important things bothering you? Often‚ Sometimes‚ Never
25. Are you bothered by nervousness? Often‚ Sometimes‚ Never
26. Have you ever been bothered by shortness of breath when you were not exercising or working hard? Often‚ Sometimes‚ Never
27. For the most part‚ do you feel healthy enough to carry out the things that you would like to do? Often‚ Sometimes‚ Never

Scoring Information

The scoring methodology for the Health Opinion Survey is based on assigning numerical values to the response options, with higher scores reflecting greater symptom frequency or psychological distress.

Standard Three-Point Questions (25 items):

• No‚ Never‚ Not at all (0 points)
• Sometimes‚ Undecided (1 point)
• Yes‚ Often‚ A lot (2 points)

Four-Point Questions (Questions 4 and 8 only):

• Never (0 points)
• Once or twice‚ Not very much (1 point)
• Sometimes‚ Pretty often (2 points)
• Often‚ Nearly all the time (3 points)