Nottingham Health Profile (NHP)

Abstract

The Nottingham Health Profile (NHP) is a widely recognized generic measure designed to assess the Subjective Health Status of individuals. Developed in the UK in the early 1980s, it focuses on quantifying the negative impact of health problems on daily life and emotional well-being. The NHP is intended to provide a straightforward, subjective assessment of distress and disability, making it highly applicable in clinical, public health, and Epidemiology studies where quick and sensitive measurements of health outcomes are required. The instrument is structured into two main parts, covering six defined dimensions of distress and the effects of health on key areas of social and personal functioning.

Keywords

Nottingham Health Profile, NHP, Subjective Health Status, Health Measurement, Quality of Life, Psychometrics, Health Outcomes, Disability, Pain, Sleep, Social Isolation, Emotional Reactions.

Authors

S.M. Hunt, J. McEwen, S.P. McKenna.

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Purpose

The primary purpose of the Nottingham Health Profile (NHP) is to serve as a practical and fast-acting Psychological Scale for measuring perceived health status. It was specifically developed to be highly responsive to changes in health resulting from illness or intervention, making it a valuable tool for evaluating the efficacy of medical treatments, rehabilitation programs, and public health initiatives in terms of patient-reported outcomes.

The NHP uniquely focuses on the negative dimensions of health, specifically measuring the distress, pain, and disability experienced by the individual. By quantifying the perceived limitations imposed by health issues across various domains, it provides clinicians and researchers with a standardized metric for comparison, often used to assess the burden of disease in various populations.

Construct

The NHP measures the construct of **subjective ill-health** or **perceived health status**, emphasizing how health problems disrupt an individual’s normal life and cause distress. It is fundamentally an assessment of suffering and functional limitation, derived from statements describing perceived health problems that are common in illness. The scale does not measure positive health attributes.

Part I of the instrument is designed around six distinct dimensions of perceived distress, covering both physical and emotional impairment. Part II assesses the impact of the current health state on seven key areas of daily functioning, reflecting the practical consequences of reduced health status on social, occupational, and personal roles. The instrument utilizes a binary (Yes/No) response format, reflecting the presence or absence of a specific health problem or limitation.

Validity

The Validity of the NHP has been rigorously established through numerous international studies. **Construct Validity** is supported by evidence showing that NHP scores correlate appropriately with objective clinical measures of disease severity and known functional limitations. For example, validation studies involving patients with chronic conditions, such as Osteoarthrosis, demonstrated that NHP scores accurately reflected the degree of functional impairment experienced by these patient groups.

Furthermore, the NHP has demonstrated strong **Discriminant Validity** by successfully differentiating between populations known to possess varying levels of health status (e.g., healthy controls versus patient cohorts). Its sensitivity to change over time (longitudinal validity) reinforces its utility as a valid outcome measure in clinical trials designed to track recovery or deterioration following medical interventions.

Reliability

The NHP exhibits strong internal consistency and test-retest Reliability. Studies conducted across diverse patient populations, including those managing chronic illnesses, have consistently reported high internal consistency (measured using Cronbach’s alpha) for the six dimensions composing Part I of the scale. This suggests that the items within each dimension are measuring the same underlying construct.

Test-retest reliability is a critical feature for instruments used in longitudinal monitoring and evaluation. Research has confirmed that the NHP provides stable results over short periods, provided that the individual’s underlying health status remains consistent. This stability ensures that any score changes observed over time are likely attributable to genuine changes in the patient’s perceived health status rather than random measurement error.

Factor Analysis

The structural foundation of the NHP was established using a rigorous scaling methodology, specifically Thurstone scaling, which assigned weights to items based on perceived severity, differentiating the NHP from simple summative scales. Subsequent factor analyses confirm the multidimensional structure of the instrument.

Part I consistently loads onto six distinct, though sometimes interrelated, factors: Energy Level (EL), Pain (P), Emotional Reactions (ER), Sleep (S), Social Isolation (SI), and Physical Abilities (PA). These factors represent specific domains of subjective distress. Part II, which addresses the impact on specific daily roles (e.g., work, social life), typically stands as a separate, complementary domain, reflecting the external consequences of the internal health state measured by Part I.

Instrument

Test Type: Generic Health Status Measure / Subjective Health Indicator

Format: Self-administered questionnaire utilizing a binary response format (“Yes” or “No”). It contains 45 items divided into two sections.

Language Available: Widely translated and validated in numerous languages globally, including English, French, Spanish, German, Dutch, Italian, and Persian, facilitating international comparisons in health research.

Population Group: Applicable to the general population, various clinical patient groups, and cohorts undergoing health interventions or rehabilitation.

Age Group: Typically utilized for adults (16 years and older) who possess the cognitive capacity for accurate self-reporting of their health status.

Population Details: Has seen extensive use in primary care settings, specialized chronic disease management (e.g., rheumatology, oncology), and large-scale public health surveys to monitor population health trends.

Test Methodology: The NHP is scored by summing the weighted “Yes” responses for each dimension in Part I (or often simply summing unweighted items for clinical brevity) and summing “Yes” responses in Part II. Scores are typically standardized to a range of 0 (no problems) to 100 (maximum problems), where higher scores indicate worse perceived health status and greater distress/disability. The full instrument can be found in PDF format at the following links:

• The original PDF can be downloaded here: www.a4ebm.org/sites/default/files/Measuring Health.pdf
• An additional resource is available here: http://reseauconceptuel.umontreal.ca/rid=1J1WXGYDK-CPP19Z-1ZQY/Nottingham.pdf

Keywords

Health profile, Quality of Life assessment, Subjective distress, Functional status, Health outcomes research, Thurstone scaling, Epidemiology, Clinical assessment.

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Authors

Author ORCID Identifier: Information not provided in source material.

Affiliation Email addresses: Information not provided in source material.

Correspondence Address: Correspondence regarding the instrument is typically directed towards the copyright holders, Galen Research and Consultancy, Manchester, England.

Permissions & Fee and Test Year

The Nottingham Health Profile (NHP) was initially developed and published in 1980 and 1981. The instrument is protected by copyright. Use of the NHP, particularly for commercial applications or large-scale academic research, generally requires formal permission and may involve licensing fees. These permissions are managed by the copyright holders, Galen Research and Consultancy.

Test Year: Initial publication and validation studies occurred in 1980 and 1981.

Reference’s

The following key publications document the development, validation, and application of the Nottingham Health Profile:

• Hunt, S.M., McEwen, J. (1980). The development of a subjective health indicator. Sociol Health Illn, 2:231–246.
• Hunt, S.M., McKenna, S.P., McEwen, J., et al. (1980). A quantitative approach to perceived health status: a validation study. Journal of Epidemiology & Community Health. 34 (4):281–286.
• Hunt, S.M., McKenna, S.P., McEwen, J., et al. (1981). The Nottingham Health Profile: subjective health status and medical consultations Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 15 (3):221–229.
• Hunt, S.M., McKenna, S.P., Williams, J. (1981). Reliability of a population survey tool for measuring perceived health problems: a study of patients with osteoarthrosis. J Epidemiol Community Health, 35:297–300.
• Hunt, S.M., McEwen, J., McKenna, S.P. (1985). Measuring health status: a new tool for clinicians and epidemiologists. The Journal of the Royal College of General Practitioners. 35 (273):185–188.
• Hunt, S.M., McEwen, J., McKenna, S.P., et al. (1984). Subjective health assessments and the perceived outcome of minor surgery. J Psychosom Res, 28:105–114.
• Hunt, S.M., McKenna, S.P., McEwen, J. (1989). The Nottingham Health Profile: user’s manual. Rev ed. [Manuscript] Manchester, England.
• Hunt, S.M., McKenna, S.P. (1991). The Nottingham Health Profile user’s manual, revised. Manchester: Galen Research and Consultancy, 1991.
• European guide to the Nottingham Health Profile. Montpellier: The European Group for the Quality of Life and Health Measurement, 1992.
• Dehdari, T., Hashemifard, T., Heidarnia, A., Kazemnejad, A., (2005). The longitudinal effect of health education on health-related quality of life in patients with coronary artery bypass surgery. Fac of Health, Tarbiat Modarres University, 15:41-46.
• McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS.

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Items of the Nottingham Health Profile (NHP)

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

The NHP consists of 45 items divided into two parts. Part I assesses six dimensions of distress (Energy Level, Pain, Emotional Reactions, Sleep, Social Isolation, Physical Abilities), and Part II assesses seven areas of daily life affected by health.

• Part I: Dimensions of Distress and Disability

1. I’m tired all the time
2. I have pain at night
3. Things are getting me down
4. I have unbearable pain
5. I take tablets to help me sleep
6. I’ve forgotten what it’s like to enjoy myself
7. I’m feeling on edge
8. I find it painful to change position
9. I feel lonely
10. I can only walk about indoors
11. I find it hard to bend
12. Everything is an effort
13. I’m waking up in the early hours of the morning
14. I’m unable to walk at all
15. I’m finding it hard to make contact with people
16. The days seem to drag
17. I have trouble getting up and down stairs and steps
18. I find it hard to reach for things
19. I’m in pain when I walk
20. I lose my temper easily these days
21. I feel there is nobody I am close to
22. I like awake for most of the night
23. I feel as if I’m losing control
24. I’m in pain when I’m standing
25. I find it hard to dress myself
26. I soon run out of energy
27. I find it hard to stand for long (e.g., at the kitchen sink, waiting for a bus)
28. I’m in constant pain
29. It takes me a long time to get to sleep
30. I feel I am a burden to people
31. Worry is keeping me awake at night
32. I feel that life is not worth living
33. I sleep badly at night
34. I’m finding it hard to get on with people
35. I need help to walk about outside (e.g., a walking aid or someone to support me)
36. I’m in pain when going up and down stairs or steps
37. I wake up feeling depressed
38. I’m in pain when I’m sitting

• Part II: Impact of Health on Daily Life

Is your present state of health causing problems with your. . .

39. Job or work? (That is, paid employment)
40. Looking after the home? (Examples: cleaning and cooking, repairs, odd jobs around the home, etc.)
41. Social life? (Examples: going out, seeing friends, going to the pub, etc.)
42. Home life? (That is: relationships with other people in your home)
43. Sex life?
44. Interests and hobbies? (Examples: sports, arts and crafts, do-it-yourself, etc.)
45. Holidays? (Examples: summer or winter holidays, weekends away, etc.)

Dimension Key for Part I:

• EL = Energy Level (items 1, 12, 26)
• P = Pain (items 2, 4, 8, 19, 24, 28, 36, 38)
• ER = Emotional Reactions (items 3, 6, 7, 16, 20, 23, 31, 32, 37)
• S = Sleep (items 5, 13, 22, 29, 33)
• SI = Social Isolation (items 9, 15, 21, 30, 34)
• PA = Physical Abilities (items 10, 11, 14, 17, 18, 25, 27, 35)