Validation of the Finnish Health Improvement Profile (HIP) with patients with severe mental illness

Abstract

Background: Physical health among people with severe mental illness (SMI) is a global concern. However, many people with SMI do not receive regular comprehensive health checks. There is currently no validated physical health check instrument systematically used in Finnish mental health services. Therefore, this study aims to validate and establish the potential clinical utility of the translated Health Improvement Profile (HIP) tool for Finnish patients with SMI and compare differences in physical health risk items across genders. Methods: The content validity of the two-way translated Finnish HIP (HIP-F) was evaluated by five nurses and four patients with SMI using cognitive debriefing (to assess the clarity and relevance of each item and the recommended actions of the HIP tool). The potential clinical utility was assessed using a pilot test involving 47 patients. The prevalence of red-flagged (risk) items in the whole sample, across female and male participants, and the frequencies of any type of missing item response were calculated and analysed using descriptive statistics. A chi-square test was used to determine differences in frequencies of red-flagged items across genders. Results: Based on the cognitive debriefing, the HIP-F was found to have moderate content validity regarding the clarity and relevance of the items and recommended actions (the average scale level content validity index, S-CVI/ Ave, 0.74). In the pilot test, some missing item responses were identified, but in the sample, nurses identified 399 areas of health and health behaviour risks (mean 8.6 per patient) using the HIP-F. The most frequently red-flagged items were body mass index (BMI) and waist circumference (83.0%), smoking status (48.9%) and lipid levels (46.8%). Female patients had a higher frequency of red-flagged items than males in BMI (92.6% vs. 70.0%, p = 0.04) and waist circumference (96.3% vs. 65.0%, p = 0.01). Conclusions: The results demonstrate that the Finnish HIP has moderate content validity and preliminary clinical utility for evaluating the physical health and health behaviours of people with SMI. The HIP-F findings help to signpost evidence-based interventions for identified areas of concern. Additional nurse training may be necessary to realise the potential clinical utility of the tool in Finland.

The Health Improvement Profile for people with severe mental illness: Feasibility of a secondary analysis to make international comparisons

“…These encouraging initial findings provide the foundations for future, appropriately powered multi-site epidemiological studies of the HIP, which may help to more establish clusters of physical health promotion need and inform policies and practice. Our findings build on those of previous HIP studies that have established that culturally/contextually modified versions of the HIP have good acceptability and face validity in a variety of countries, for example, Finland (Werkkala et al, 2020), Thailand (Meepring et al, 2018), Australia (Brown et al, 2020;Jones et al, 2016) and Hong…”

“…The physical health screening tool administered in the current study, the Health Improvement Profile (HIP), is based on guidelines for health screening in those with SMI and is intended to be used by nurses and other health professionals to produce an individualized physical health risk profile. The HIP was originally developed by White and colleagues in the UK; subsequently, it has been adapted for use in Hong Kong (Bressington et al, 2014(Bressington et al, , 2016, Thailand (Meepring et al, 2018), Finland (Werkkala et al, 2020) and the USA (Bos, 2018) Given the insufficient physical health screening rates and poor medical outcomes in people with SMI (Reilly et al, 2013), it is important to clarify how a standardized approach may facilitate screening and help to directly compare physical health promotion needs (Doherty & Gaughran, 2014;Happell et al, 2015;Vasudev et al, 2010) in a different international settings. However, to date there have been no studies that have contrasted physical health profiles of patients with SMI in different countries using the same screening tool.…”

“…Face validity and clinical utility has been demonstrated in the United Kingdom (Shuel et al, 2010;White et al, 2009). Testing in Hong Kong, China (Bressington et al, 2014(Bressington et al, , 2016(Bressington et al, , 2018, Thailand (Meepring et al, 2018;Thongsai et al, 2016), Finland (Werkkala et al, 2020) and the UK (Shuel et al, 2010) found that the tool had good clinical utility. Additionally, the HIP has been implemented as standard of care in health systems internationally including Australia (Brown et al, 2020).…”

Effects of a web-based education for community mental health case managers on physical healthcare for clients with severe mental illness

“…In the same vein, in this study, mental health case managers significantly changed their physical health management attitudes before and after participating in the web-based education program. This means that the checklist items contributed to the recognition of mental health case managers as contents that should be checked for physical health management of mentally ill patients [18] .…”

“…Based on this, it provides guidelines for practitioners to check the physical health of those mentally ill by providing community mental health case managers with the items to check for mentally ill people, the normal range of physical health values and precautions for physical health management. In addition, it makes it possible to check the overall health without omission [18] . Therefore, by distributing the checklist developed in this study to mental health case management practitioners, it is expected that it will be helpful in promoting the physical health of chronic mental illness patients.…”