Thesis Adaptation and validation of the Health Anxiety Inventory (short version) for medical settings, 2023, Colenutt

Source: University of Bath
Date: September 15, 2021.
Online: September 2023

Abstract: https://researchportal.bath.ac.uk/e...linical-psychology-main-research-portfolio-38

Adaptation and validation of the Health Anxiety Inventory (short version) for medical settings -------------------------------------------------------------------------
Jessica Colenutt - Department of Psychology, University of Bath, U.K.

Abstract

Objectives

This study seeks to adapt the 18-item Health Anxiety Inventory - Short Version (SHAI; Salkovskis et al., 2002) for use in medical settings and to evaluate the adapted version's psychometric properties. It reports two studies. The objectives of the first study were to use expert opinion 1) to identify the limitations of the SHAI for administration in medical settings, 2) to formulate adaptations to items for use in medical settings through an iterative process of feedback and modification, and 3) to develop an adapted version of the SHAI for medical settings using an evidence-based consensus. The objective of the second study was to evaluate the psychometric properties of the adapted measure in samples with Multiple Sclerosis (MS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and chronic pain.

Method

In study one, a Delphi study method was used to adapt the SHAI for medical settings. Eight experts with experience of living with a physical health condition and four experts by profession working within physical health were invited to review the SHAI and suggest adaptations through an iterative developmental process. Study two employed a cross-sectional mixed methods questionnaire design. Individuals with MS, ME/CFS and chronic pain were invited to complete a battery of questionnaires via an online survey, and to complete a second survey one week later, allowing for the psychometric properties of the adapted measure to be evaluated.

Results

An evidence-based consensus was reached for an adapted version of the SHAI for medical settings (HAI-M) following study one. Consultation with an expert in the field of health anxiety and a person with personal experience confirmed face validity of the 12-item HAI-M. During study two, 315 participants took part in the online survey of which 80.6% fully completed the HAI-M and 62.86% fully completed the battery of questionnaires. 33.3% completed the follow up questionnaire one week later. All groups rated the HAI-M as more acceptable for assessing their health concerns than the SHAI and no significant differences were found between clinical groups in how they scored on the HAI-M. No significant differences were found between clinical groups in how they scored on the SHAI which was an unexpected finding. The HAI-M demonstrated high internal consistency (.875), good test-retest reliability (.812) and good convergent validity (.801). Divergent validity was also good (.515). The exploratory factor analysis suggests the presence of a 3-factor model and this model is discussed in relation to previous studies reporting the factor structure of the SHAI.

Conclusion

This study provides preliminary evidence for a psychometrically sound health anxiety screening tool for use in medical settings. Recommendations are made for further research.

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Date of Award 15 Sept 2021
Original language English
Awarding Institution

• University of Bath

Supervisor Jo Daniels (Supervisor)

 

What is the point of evaluating health anxiety in a medical setting? I don't think anyone has ever really asked that question. It's simply assumed to be necessary. But what is the expectation, what is to do, if someone actually has health anxiety? That isn't already expected of medical professionals? Or anyone in a job, really. No actual information is even gained. No knowledge derives from this, if anything it distracts and distorts from important things. It has mainly served to reattribute illnesses to imaginary causes for decades, impeding the progress of science while doing massive harm. And easy PhDs, I guess. Which benefits no one.

Because this is something that has been the target of fanatical obsession, and yet I don't think anyone could actually come up with a valid reason to do any of this that isn't either already expected, or utterly trivial. The most basic effort at customer service, expected in any sales job, is more than enough here. Treat people with respect, with decency, listen to their concerns, do not push them, and it'll all be fine. But medicine prides itself in not doing customer service, so instead they perform this elaborate theater that is mainly about compensating for not doing something that is expected in every entry-level job.

A common example would be over vaccinations. Some people aren't anxious about them at all. Some are quite a bit. And yet, what is even the difference in how those should be handled that isn't simple common decency. Give them a bit more time? Otherwise you really just need to be a decent human being capable of the most basic respectful human interaction and it'll be just the same. But how is that any different from managing a ride at an amusement park, where you will find similar valid concerns? Something teenagers manage just fine without any training.

It's not as if there are things that can be done here. And it's completely obsessive, it's treated as one of the most important thins in the whole world. You can clearly see the obsession over this during the pandemic, how managing people's anxieties, most of them imagined, has only made everything worse by essentially overshadowing everything. It has effectively ruined the whole pandemic because of imagined anxieties, not even real ones.

Medical professionals should spend far less time wondering about patients' anxieties, not bothering with stuff like this, because it clearly serves no actual purpose other than being a cheap exercise in futile box-checking.

 

According to https://www.bythebyreholidays.com/journal/history-of-bath

"Bath" is derived from the Angle Saxon word "bað,”
"Bathan" by the Britons which meant "boiling waters"

A bad cauldron.

 

It sounds like they're surprised there are no differences on the regular instrument but aren't surprised there are no differences on the form adapted for medical settings? I don't get it.

 

First, without seeing the details I can't confirm its effectivenes on being more than 'a nod' to inclusion, but good to see this type of step maybe inferring things heading in the right direction in considering method:

But who were these experts and what actual physical health condition did they have in comparison to the intended experimental sample? Was it at all giving them insight into the lived experience/comparable?

On the other hand the following should be a massive red flag re: what is wrong with your method? (says to me lots of the participants smelled a rat personally):

So what did they actually analyse? ONly the 33% who were happy for whatever it became clear was in those questionnaires to be asked about? Or the answers from ealier ones (and ergo a less self-filtered population) where there is potentially a consent issue - because to me the lack of wanting to do follow-up 1 week later says they felt misled somewhere into filling out those earlier ones. ie a consent issue. The fact these surveys were online makes me even more suspicious it wasn't 'just' travel or energy-related, but that people could see said survey and thought better for example.

So to me those drop-out stats etc makes this seem invalidated surely? at best it is a very niche selection they've filtered down to using their questionnaires to find those who didn't mind said questioning.

What I don't get is the inclusion of MS - due to the classic 'abstract only' I can't see the breakdown as to whether by the end of this there were any MS patients in there or whether they had similar answers or if the areas of difference were interesting flags e.g. for where treatment is the crap and harmful bit for the other codnitions. What agenda did they have by including something they haven't yet convinced anyone is psychosomatic?



Secondly, Indeed, pathologising your own mistreatment and abnormal behaviour which means you cannot be trusted to be safe as 'the problem of the demographic' instead of your own wake-up call time to finally be responsible or accountable for the impact of what you do/don't do. This 'don't listen to patients' goes a bit far doesn't it really when it comes to such huge swathes having to be labelled just so the few don't have to change jobs or personal qualities/approach.

You would be a bit more 'anxious' about your 'symptoms' (or more like 'is this what I have at all, because this sure doesn't work') if those 'in charge' are self-believedly telling you their treatment means you should be feeling improvement and the pain going and gaslighting you as the opposite happens....

I'd be very impressed if this went so far as to have a stage two that looked forensically at the specifics of what caused anxiety (without leading the horse to water/restricting answers to leading questions), and any situation-specifics that could be used to inform problem approaches to/for patients.

Or you can twist the whole thing and try and warp semantics to pretend what you caused is 'the cause' and there is no health condition at all of course....


Thinking about possible methods for e.g. teasing out where 'the treatment' is 'the cause'...
as this paper and the author has inspired me on the subject rather.. as to how this methodology could be expanded to get to the bottom of this 'finding'

Just as an example you'd kind of hope that e.g. with a school system if all/most of the kids under certain teachers or schools ended up with 'anxiety' someone would be looking into the set-up and sending a psychologist in to look at what was being badly done by the teachers and/or organisation. And said individuals being 'clueless' as to why it was impacting pupils that way, as it must be the pupils, you'd hope would wear very thin and reflect badly/give insight as to where the problem lay and treatment was needed.

The equivalent here might be to look at rates vs the provider of the ME/CFS treatment - and of course including anyone referred whether they chose to attend or not (see below re: the 'environmental reach/other aspects to environment') - as a league table of which clinics and areas seem to end up with pwme having the most 'mental health problems' to then probe down as to what specifically is the issue?

OR
I had a friend who worked in a large distribution organisation. She told me that when a sales team underperformed or there were interpersonal issues with the boss the approach was as follows:
- take the team with issues and the 'top-performing team' in the same functional area and swap bosses
- if the previously underperforming team continues to underperform and the 'previously top-performing team' begins to have issues under the new boss then the issue is probably the team
- if the vice versa (underperfoming team starts to improve, previously top-performing starts to have issues under new boss) the issue is the boss.

Which would be your classic pilot/swap to see if the old paradigm of 'false beliefs' and old treatments etc. still being an underlying issue in staff could play a part.

The inclusion of the MS condition here would have been fascinating for this reason, if there are clinics with a more pragmatic approach that didn't include telling the patients their condition was health anxiety, false beliefs etc. I don't know whether there are eg HCP staff from said MS clinics who could potentially take on a pilot using only the new ME/CFS guideline info and definition of the condition to provide e.g. good OT support and reaslistic health advice and monitoring and see if there are differences? Would the vice versa (MS people going to old style CFS treatment staff) either be ethical or something that would even be done?

These two things above seem normal and logical as approaches from normal people actually wanting to find out the genuine issue, rather than manufacture the answer they believe in.


BUT of course. It is all a bit different for ME/CFS to do similar given there are still no guarantees of people not being under he hand of the same regime, nevermind being sure there is a new leaf, enlightenment and change in personal qualities even in different areas. And also weird that for the few clinics that might have a good biomed approach the picture has been fogged by the feedback from new patients who might be diagnosed under unspecific criteria meaning at best mild CFS sometimes just 'PPS' get treatment focusing on getting them to parrot 'how satisfied they are' (but then maybe the treatment works for them/that? so we'd have an inversion).

So there could indeed be a common mix-up of those who have comorbidity (and benefit from the more 'psyching' bits of certain programmes) or perhaps went into the condition with higher anxiety vs situational factors which could indeed be possible to separate with very clever cross-sectional design. So there might be some 'emthods clues' here that could give inspiration to how to control for certain historically-caused issues we see in feedback etc. being 'complicated'.

Add in the fact the 'overall environment' being made hostile by said actors is still closed-down and continuing so thereby ensuring relationships are gerrymandered the opposite to what normally would happen from those with good intentions for mental or physical health of those with serious chronic debilitating biomedical illness.

Which I guess is also why we've had the proliferation strategy in building kingdoms and making sure proteges are trained in or asked to 'buy-into' the strange techniques, methods and ideologies to follow them. Other people's (who might ask questions or cause ructions) career and reputation has to depend on it too.

So I imagine any 'pilot' would basically need to be expansive, look at the 'wider situation' (including GP --> specialist, employer, relationships and so on being overhauled) otherwise you have a 'tentacle issue'?

I noticed, was it @Lidia Thompson mentioned a previous experience in an area of Scotland that was comparatively well constructed due to e.g. a GP there having experienced ME themselves? I don't know the details but was interesting in thinking whether this presents some form of microcosm for case study?

And I'm sure there might be a few areas where there is vice versa 'better than normal medical care' but it can't tentacle the treatment around the pwme enough to extend to other services/relationships/employer to the same levels. Combined these differences onto a scale and we probably have some sort of genuinely useful framework for looking into the impact of the BPSm approach vs unnecessary health anxiety?

 

Do we know the number of people with each condition ?

I wonder if the drop at follow up questionnaire was even across conditions ?

 

This was before my time, but here are some links from the ME Association regarding the ME/CFS service which was subsequently set up in Fife, Scotland.

https://meassociation.org.uk/measpecialist/nhs-fife/
https://meassociation.org.uk/2018/0...uks-top-national-nursing-awards-12-june-2018/

This was written around June 2018.