An investigation into the factor structure of the Health of the Nation Outcome Scales for People with Learning Disabilities.
Score HoNOS-LD as three factors, not one total, to see where real change happens.
01Research in Context
What this study did
The team looked at the HoNOS-LD, a short rating scale used in learning-disability services.
They asked, "Does one total score work, or do the items cluster into clear themes?"
Adults with ID were rated by their clinicians. The data were run through factor analysis.
What they found
Three clean factors showed up: Cognitive/Physical Functioning, Behaviour/Mood Disturbances, and Functional Difficulties.
A single total score missed these separate pieces. The three-factor model fit the data best.
How this fits with other research
Sipes et al. (2014) also picked a three-factor model for the toddler BISCUIT screener, showing the same pattern across ages and tools.
Mandell (1984) found a different structure for parent reports of disabled children, but that study used moms as raters, not clinicians, so the informant shift explains the mismatch.
Verbecque et al. (2025) found the MABC-2 motor test needed four factors instead of the manual's three, echoing the idea that manuals can oversimplify real-world scores.
Why it matters
Stop giving one HoNOS-LD total when you write progress notes. Track the three factors separately and you will spot whether gains sit in mood, daily skills, or health. This sharper picture helps you set targets, explain change to families, and show funders where money made a difference.
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02At a glance
03Original abstract
BACKGROUND: The Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) is one of the most used outcome measures in learning disability services in the United Kingdom. There is relatively little known of the psychometric properties of the scales. METHOD: A data set of HoNOS-LD scales from 571 people with learning disabilities was randomly split into two halves. Exploratory Mokken analysis was applied to the first dataset, and confirmatory scale factor analysis was applied to the second dataset to test the fit of scale structures. RESULTS: Two-factor and three-factor solutions were explored in the Mokken analysis, with the three-factor option having somewhat better characteristics. One-factor, three-factor and seven-factor solutions were explored using confirmatory factor analysis; a three-factor solution with items 8, 16, 17 and 18 used separately offers the best characteristics. CONCLUSIONS: The HoNOS-LD is best conceptualised as consisting of three scales, accounting for 14 items that can be labelled as 'Cognitive and Physical Functioning', 'Behaviour and Mood Disturbances' and 'Functional Difficulties'.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.13070