Population. Adult. Domain. Measures of Self. Type of Measure. Self-report. ICF- Code/s e4. Description. Herth Hope Scale (HHS) is a measure that attempts to. Abstract. Hope is a motivational/cognitive attribute that is theoretically necessary to initiate and sustain action toward goal attainment. The Herth Hope Scale. Hope is a motivational/cognitive attribute that is theoretically necessary to initiate and sustain action toward goal attainment. The Herth Hope Scale (HHS) not.

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Exploratory factor analysis was used to examine the dimensionality of the measure. Bivariate analyses were used to examine construct validity.

The sample had moderately high hope scores. A two-factor structure emerged from the scsle analysis, explaining Satisfaction with social support was positively associated with hertth, supporting convergent validity. Neurocognitive status, illness insight and depression were not associated with hope, indicating discriminant validity. Families impacted by cognitive impairment may maintain hope in the face of a potentially progressive illness, regardless of cognitive status.

The HHI can be utilized as a reliable and valid measure of hope by practitioners providing support to families impacted by cognitive impairment. Hope has been explored as an important construct related to coping and adaptation at times of great loss, uncertainty or suffering Folkman, ; Herth, Understanding what factors may cause difficulties in coping with a diagnosis of mild cognitive impairment MCI or early stage dementia can be beneficial for care providers and the development of effective supports for affected individuals and their care partners CPs.

Previous work has posited that hope is a sccale skill from which therapeutic value can be derived. Scae and Martocchio proposed a theoretical model for hope based on interviews with older adults. The model distinguishes between the constructs of global hope and time-specific hope, both of which are multidimensional with affective, cognitive, behavioral, temporal, and contextual domains. Several ecale have been developed in attempts to measure this proposed framework Herth, ; Snyder et al.

In particular, the Herth Hope Scale Herth, was developed with the intent to measure constructs, such as globalized hope, hope without reliance on interpersonal relationships, relationship engagement and altruism as instilling hope and hope as a means to control emotional and behavioral responses to difficult events or experiences. An abbreviated, item scale was later developed to address the need for a brief, psychometrically validated tool for use in clinical settings Herth, The psychometric properties of the abbreviated scale, the Herth Hope Index HHIhave been investigated in several studies.

While the psychometric properties of the HHI have been established in different populations, these properties have not been explored in families impacted by cognitive impairment. Therefore, the current exploratory investigation aims to establish the reliability and validity of the HHI in a sample of family members impacted by cognitive impairment. Therefore, we utilized exploratory factor analytic methods to examine the factor structure of the HHI. The following hypotheses were tested:.

The primary aim of the parent study was to evaluate a new measurement tool for assessing research participation burden, and was approved by the University of Pittsburgh Institutional Review Board.

Measuring hope among families impacted by cognitive impairment

The primary gain from using a sample pulled from the ADRC is that participants have a very specified and accurate diagnosis established through comprehensive evaluation of cognitive symptoms employing current guidelines for dementia McKhann et al.

Hefth criteria for study participants included: The sample was comprised of 45 individuals with cognitive impairment IWCI and uope care partners CPyielding a total sample of 96 study participants.

The HHI was completed face-to-face with participants as a part of a larger interview battery conducted by trained interviewers, along with questions regarding social support.

All participants provided informed consent prior to any data collection for the parent study.

Abbreviated instrument to measure hope: development and psychometric evaluation.

Chart review data were collected that corresponded most closely in date with when the study battery was administered. Interviews were often held the same day as the ADRC evaluation, or within a year of the patient’s evaluation. The HHI is a item scale measuring generalized hope. Each item is measured on a four-point scale ranging from strongly disagree 1 to strongly agree 4.


Summed scores can range from 12 to 48, with higher scores indicating greater hope. Scoring ranges from 0 to 30 with higher scores indicative of less cognitive impairment. The HRSD Hamilton, is a clinician-rated, item scale that assesses the presence and severity of depressive symptoms for IWCIs, including depressed mood, agitation, insomnia, and weight loss Williams, Eight items are scored on a 5-point scale ranging from not present 0 to severe 4while nine items are scored from absent 0 to frequent 2.

Ratings for each domain are based on the IWCI’s medical and neurological assessment as well as the care partner interview. A higher score indicates greater impairment and scores may range from 0 to 8.

Measuring hope among families impacted by cognitive impairment

One item was used to measure satisfaction with social support for both IWCIs and CPs, independently, with the question: The satisfaction item uses a 4-point scale ranging from not at all 0 to very 3. With 12 items and 96 subjects in the current herhh, the subjects-to-items ratio was 8, which was sufficient to perform the EFA. Herthh accordance with the assumptions of factor analysis, data were screened for multivariate outliers using the Mahalanobis distance method.

No influential outliers were identified. PAF with both oblique and orthogonal rotations were performed, with a specification that extracted factors had eigenvalues greater than one. The Kaiser-Meyer-Olkin KMO; Kaiser, statistic and Bartlett’s test of sphericity Bartlett, were checked to determine the factorability of the correlation matrix.

The hopw plot and total variance explained were utilized as guides to assess the viability of the extracted solution. Items loadings greater than. According to Nunnally and Bernsteininternal consistency estimates of. Inter-item hefth and item-total correlations were also inspected. Because data from a gold standard measure of hopefulness were not collected in the parent study, several a priori hypotheses were constructed to supply evidence of construct validity American Educational Research Association, The direction and hop of the correlations were examined to draw conclusions regarding the hypotheses.

All analyses were performed using SPSS The scalw was predominantly white The majority of IWCI were living with a spouse or partner Mini Mental State Exam. Table 2 shows the means and standard deviations for the items of the Herth Hope Index. Most items were negatively skewed toward agreement with each statement, though adequate variability was demonstrated.

A PAF with oblique Promax rotation was first performed and results were examined to assess the appropriateness of the solution. No specific hreth of factors was specified; therefore factors with eigenvalues greater than one were considered viable. The solution revealed three factors with eigenvalues greater than one that explained The eigenvalue of the first factor 5.

The examination of the scree plot indicated that the slope substantially diminished following the first factor plotting. Additionally, the examination of the factor loadings identified one item as cross-loading, that is, the item had a factor loading greater than the specified cut-off of. Next, hhope results of the PAF using orthogonal Varimax rotation were examined. The results were similar to scalw oblique solution, with three factors explaining The slope of the scree plot again substantially diminished following the first factor plotting.

The orthogonal rotation produced four cross-loading items, whereas the solution using oblique rotation produced one cross-loading item. Due to the lower number of cross-loading items and the fact that the oblique rotation accounts for correlated factors, the subsequent analyses were conducted using the oblique approach.

The dimensionality of the HHI structure was still unclear after conducting the PAF without specifying a particular number of factors. Two factors explained Factor loadings from the pattern matrix are reported in Table 2.

In order to substantiate the findings of a two-factor solution, the internal consistency of each factor was computed.

These coefficient estimates are higher than the recommended cut-off of. For IWCIs, neurocognitive status, depression, and insight were not associated with hope total score or subscales, supporting our hypotheses and indicating these scales measure constructs that differ from hope see Table 3.


The purpose of this secondary analysis was to evaluate the reliability and validity of the Herth Hope Index by examining the internal factor structure and by exploring its relationship to scales measuring depression, illness insight, neurocognitive status, and satisfaction with social support.

Study participants reported high levels of global hope, despite their experience with progressive illness. It is therefore important that clinicians explore the hopes of individuals facing cognitive impairment, as this hrrth may aid in setting care goals, even when illness may be progressive and terminal.

This is the first psychometric study to explore the properties of a hope scale utilizing members of families impacted by cognitive impairment. Findings support evidence of internal consistency and construct validity for scores obtained from the HHI.

Additionally, while Promax oblique rotation was use in the current analysis, these previous studies used a Varimax rotation. In the current analysis, Factor 1 seems to cluster around goal orientation e.

Abbreviated instrument to measure hope: development and psychometric evaluation.

The three-factor structure reported by Herth did not play out, possibly due to differences in the context of the population. Differences in item loadings across studies may be attributed to a sample inclusive of individuals facing cognitive impairment; other studies have been comprised of adult outpatients at a primary care clinic Katerndahl et al. Given the differences in factor structures across studies, confirmatory factor analysis might help to clarify the underlying structure of the HHI.

In the current investigation, satisfaction with social support was significantly associated with hope. Social support has been previously considered to comprise one of the factors of the item Herth Hope Scale, but has not been reported to be a component of the abbreviated HHI.

Other work has pointed to the importance of hope in others in instilling hope in the individual Herth, Further examination of the relationship between hope and social support may particularly benefit from more extensive questioning surrounding social support, including what aspects of social support may enhance hope and in turn how this relationship impacts depression.

Depression was not associated with hope in the current study. In relation to a measure of generalized hope, no relationship with depression provides evidence that these scores were measures of two differing constructs.

Insight into illness and cognitive functioning were also not associated with hope.

Previous work has pointed to impaired cognition as being a potential inhibitor of hope Herth,however this finding was put forth by cognitively intact older adults, rather than individuals experiencing cognitive impairment. Awareness may differ by stage of impairment which in turn may correspond with varied levels of hope.

IWCIs may not perceive a continuum of memory decline, even after a diagnosis of cognitive impairment Lingler et al. Those diagnosed with MCI may overestimate their symptoms while persons with dementia tend to underestimate memory impairment, even during mild stages of the disease Kalbe et al.

Along these lines, greater insight and concern about symptom progression in the earliest stages of illness may correspond with lessened hope while in the later stages and when awareness is impaired, hope may be elevated. Individuals with awareness of their illness may then anticipate future care issues and set realistic life goals. Therefore, how these correlations may be conceptualized among individuals with cognitive impairment is likely all the more complex, when considering the impact of progressive memory loss upon coping and insight, and warrants further exploration.

The use of additional measures of insight, including subjective report Clare,may also further tease out the relationship between hope and insight. Our study finding of no association between memory functioning and hope implies that sense of hope may be maintained at any stage of cognitive impairment.