The development of a 'CORE' for health settings

At present there is no outcome measure suitable for use across different health conditions seen within Clinical Health Psychology (CHP) settings which satisfactorily capture the main aspects relevant to service user outcomes. Several types of measure have previously been developed according to different assumptions about what and how best to measure outcomes. Measures may broadly be divided into symptom-focussed, theory-driven or pragmatically approached. Considering these in the context of psychological theories and the Recovery Approach suggests that superordinate concepts, such as distress; psychological mechanisms; satisfaction with functioning; the therapeutic alliance; and concepts such as hope, supportive relationships, empowerment and finding meaning, are relevant to CHP outcomes. The aim of this study was to begin to develop a global outcome measure for use in CHP. Consensus was sought regarding the most relevant concepts to measure by conducting a literature review and clinician interviews. Concepts were formed into items using a set of principles to ensure they were accessible and relevant to a broad range of service users. This item pool was refined, both conceptually and linguistically, using clinician feedback over three iterations of an online Delphi survey. Qualitative data was analysed thematically. Elicited themes were compared to those concepts thought to be relevant to CHP outcomes immediately before the Delphi study, in order to provide a quality control check on their relevance. Some consensus was reached by the end of the Delphi study, which provides partial support for the hypothesis that rather than each condition having its own unique psychological profile, concepts are shared across conditions. The lack of complete agreement may have been due to differences in service users’ presentations, differences in concepts identified by clinician participants, or different interpretations of the language used to convey concepts. Whilst item construction may have been biased by subjective judgement, the Delphi methodology likely mitigated the effect of this on the final item pool. Recommendations are offered for how this pilot outcome measure may be developed into a final version.