Health Opinion Survey (HOS)

Abstract

The Health Opinion Survey (HOS) is a foundational psychometric instrument developed primarily for use in epidemiological studies and community surveys. Its core function is to estimate the prevalence and severity of non-specific psychological distress, often characterized as psychoneurotic disorders, within general populations rather than clinical settings. Comprising 20 items, the HOS covers a range of symptoms, including somatic complaints, anxiety, and general malaise. Since its introduction by Macmillan in 1957, the HOS has served as a widely referenced, brief screening tool for mental health status in community mental health research.

Keywords

Health Opinion Survey (HOS), psychological distress, psychoneurotic symptoms, epidemiological screening, mental health assessment, self-report scale, somatic symptoms, community surveys.

Authors

A. M. Macmillan

Purpose

The primary purpose of the Health Opinion Survey (HOS) is to provide a reliable and efficient technique for estimating the prevalence of psychoneurotic and related types of disorder within community settings. It was designed specifically for large-scale public health and epidemiological research where quick, non-intrusive screening is necessary to identify individuals at risk or to measure the overall mental health burden of a population.

The scale serves as a general index of psychological morbidity, allowing researchers to track changes in mental well-being over time or compare distress levels across different demographic groups. It is frequently employed as a baseline measure in longitudinal studies concerning health outcomes and stress exposure.

Construct

The HOS measures a broad construct of general psychological distress and minor psychiatric morbidity, often categorized historically as non-specific psychoneurosis. This construct encompasses various indicators of poor functioning, including both psychological and physical manifestations of stress and anxiety.

The items tap into several dimensions that contribute to the overall distress score. These include affective symptoms (e.g., nervousness, feeling close to a nervous breakdown), sleep disturbances, and a significant number of somatic symptoms (e.g., loss of appetite, upset stomach, dizziness, heart beating hard). The summation of these items yields an index reflecting the respondent’s subjective experience of being bothered by these health and nervous complaints.

Validity

Studies investigating the HOS have generally supported its criterion validity, showing significant correlations between high HOS scores and clinical diagnoses of psychiatric distress, particularly in non-hospitalized populations. Macmillan’s original work established the HOS as an effective proxy for estimating clinical prevalence in the community.

However, questions regarding its precise dimensionality have been raised. Tousignant, Denis, and Lachapelle (1974) and Butler and Jones (1979) conducted comprehensive analyses, noting that while the scale performs adequately as a measure of general morbidity, its factor structure often suggests multiple underlying factors, such as “Anxiety/Affective Distress” and “Somatic Complaints,” rather than a single, perfectly unified construct.

Reliability

The HOS has demonstrated acceptable levels of internal consistency, which is crucial for a screening instrument used to summate diverse symptoms into a single score. Research has typically reported acceptable Cronbach’s alpha coefficients, confirming that the items consistently measure the underlying construct of general distress.

Furthermore, the scale exhibits reasonable test-retest reliability, suggesting stability in measurements when administered over short periods. This stability supports its use in longitudinal studies where consistent measurement of baseline psychological status is required.

Factor Analysis

Early assumptions treated the HOS as largely unidimensional, reflecting a single underlying factor of psychoneurotic distress. However, subsequent factor analyses have presented mixed findings. Butler and Jones (1979) specifically explored the dimensionality of the HOS, suggesting that while a general distress factor explains a significant portion of the variance, a multi-factor solution often provides a better fit for the data.

These findings indicate that the 20 items cluster around distinct areas, such as physical symptoms, anxiety/tension, and potentially general functioning impairment. Despite the evidence for multidimensionality, the scale remains widely used as a single, cumulative score for general psychiatric screening due to its brevity and effectiveness in identifying high-risk individuals.

Instrument

Test Type: Self-report screening questionnaire for psychological morbidity.

Format: 20 items, typically utilizing a 3-point response scale (1=hardly ever, 2=sometimes, or 3=often). Item 16 is reverse-coded to prevent response bias.

Language Available: Primarily English, though translations have been used in various international epidemiological studies.

Population Group: General population, non-clinical samples.

Age Group: Adults (typically 18 years and older).

Population Details: Suitable for diverse community settings where rapid assessment of mental health status is required.

Test Methodology: The scale is usually self-administered and requires minimal time (approximately 5-10 minutes) to complete. Scoring involves summing the responses, with higher scores indicating greater psychological distress.

Keywords

Psychiatric screening, mental morbidity, distress measure, Macmillan, psychoneurosis, self-report inventory, community health, psychological assessment.

Authors

Author ORCID Identifier: N/A (Information not readily available for A. M. Macmillan)

Affiliation Email addresses: N/A (Information not readily available)

Correspondence Address: N/A (Information not readily available)

Permissions & Fee and Test Year

The Health Opinion Survey (HOS) was first published in 1957 by A. M. Macmillan. Due to its age and widespread use in academic and public health research, the instrument is generally considered to be in the public domain for non-commercial academic use, though researchers should always verify specific usage policies.

The original PDF of the scale and related measurement information can be downloaded here: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf and also here: http://www.unc.edu/depts/sph/longscan/pages/measures/Baseline/Health%20Opnion%20Survey.pdf.

Reference’s

• Macmillan‚ A. M. (1957). The Health Opinion Survey: Technique for estimating prevalence of psychoneurotic and related types of disorder in communities. Psychological Reports‚ 3: 325-339.
• Semmence‚ A. M.‚ (1969). The health opinion survey A psychiatric screening instrument. J R Coll Gen Pract‚ 18(89): 344–348.
• Tousignant‚ Michel.‚ Denis‚ Guy. and Lachapelle‚ Rejean. (1974). Some Considerations Concerning the Validity and Use of the Health Opinion Survey. Journal of Health and Social Behavior‚ 15(3): 241-252.
• Butler‚ M. C.‚ & Jones‚ A. P. (1979). The Health Opinion Survey reconsidered: Dimensionality‚ reliability‚ and validity. Journal of Clinical Psychology‚ 35(3)‚ 554-559.
• McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS.

Items of the Health Opinion Survey (HOS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way. Responses are typically rated 1 (hardly ever)‚ 2 (sometimes)‚ or 3 (often). Item 16 is reverse-coded.

1. Do you have loss of appetite?
2. How often are you bothered by having an upset stomach?
3. Has any ill health affected the amount of work you do?
4. Have you ever felt that you were going to have a nervous breakdown?
5. Are you ever troubled by your hands sweating so that they feel damp and clammy?
6. Do you feel that you are bothered by all sorts (different kinds) of ailments in different parts of your body?
7. Do you ever have any trouble in getting to sleep and staying asleep?
8. Do your hands ever tremble enough to bother you?
9. Do you have any particular physical or health trouble?
10. Do you ever take weak turns?
11. Are you ever bothered by having nightmares? (Dreams that frighten or upset you very much?)
12. Do you smoke a lot?
13. Have you ever had spells of dizziness?
14. Have you ever been bothered by your heart beating hard?
15. Do you tend to lose weight when you have important things bothering you?
16. Are you ever bothered by nervousness?
17. Have you ever been bothered by shortness of breath when you were not exercising or working hard?
18. Do you tend to feel tired in the mornings?
19. For the most part‚ do you feel healthy enough to carry out the things that you would like to do?
20. Have you ever been troubled by “cold sweats”? (NOT a hot-sweat—you feel a chill‚ but you are sweating at the same time.)