Investigating qualitative and quantitative validity of PSYCHLOPS: a novel Patient Reported Outcome Measure in a pilot study of primary care management of insomnia

Main Article Content

Zowie Davy
Casey Quinn
Fiona Togher
Helen Wilson
A Niroshan Siriwardena


Rationale, Aims and Objectives PSYCHLOPS (‘Psychological Outcome Profiles’) is an idiographic patient reported outcome measure that attempts to evaluate therapeutic progress. We aimed to assess the validity of PSYCHLOPS within a study of insomnia. Methods We investigated reliability, content, criterion and construct validity of PSYCHLOPS as part of a cluster randomized pilot study. Other measures used included the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Beck Depression Inventory and sleep diaries. We administered PSYCHLOPS in a study seeking to educate primary care clinicians to deliver problem focused and patient centred therapy for insomnia with adults. The instrument was administered in intervention and control primary care sites. Sixty two participants measuring five and above on the PSQI were included in the study. Results The qualitative analysis showed expected responses for sleep problems. We found a positive correlation between PSYCHLOPS and ISI, but not between PSYCHLOPS and PSQI, suggesting partial criterion validity with regards to insomnia impact. We found a positive correlation between PSYCHLOPS and BDI supporting construct validity. However, these validity results rested on a number of assumptions insofar as patients who offered complex free text responses would have to rate their experiences at the beginning, mid way and end of therapy respectively, in order for the tool to create a significant score. This would be difficult for patients to do, which undermines the tool’s validity. Conclusion PSYCHLOPS demonstrated aspects of validity supporting further circumspect use and evaluation in practice. A combined qualitative and quantitative analysis added important dimensions to the assessment of validity for this tool. Nonetheless, idiographic measures like PSYCHLOPS provide a much needed patient voice to research and clinical outcome measures.

Article Details

Regular Articles
Author Biographies

Zowie Davy, University of Lincoln

Lecturer in Community HealthPhD

Casey Quinn, University of Nottingham


Fiona Togher, University of Lincoln

Research AssistantBSc

Helen Wilson, United Lincolnshire Hospitals NHS Trust


A Niroshan Siriwardena, University of Lincoln

Professor of primary and Prehospital CarePhD


Devine, E. B., Hakim, Z., Green, J. (2005) A systematic review of patient-reported outcome instruments measuring sleep dysfunction in adults. Pharmacoeconomics, 23, 889-912.

Bastien, C.H., Vallieres, A., Morin, C.M. (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297-307.

Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman, S.R., Kupfer, D.J. (1989) The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.

Williams, S.J., Sleep and Health: Sociological reflections on the dormant society. Health 2002; 6(2): 173-200.

Kyle, S.D., Espie, C.A., Morgan, K. (2010) “… Not Just a Minor Thing, It Is Something Major, Which Stops You From Functioning Daily”: Quality of Life and Daytime Functioning in Insomnia. Behavioral Sleep Medicine, 8, 123-140.

Robinson, S.I., Ashworth, M., Shepherd, M., Evans, C. (2006) In their own words: a narrative-based classification of clients' problems on an idiographic outcome measure for talking therapy in primary care. Primary Care Mental Health, 4, 165-173.

Singleton, N., Bumpstead, R., O’Brien, M., Lee, A., Meltzer, H. (2001) Psychiatric morbidity among adults living in private households. London: The Stationary Office.

Morphy, H., Dunn, K.M., Lewis, M., Boardman, H.F., Croft, P.R. (2007) Epidemiology of Insomnia: a Longitudinal Study in a UK Population. Sleep, 30(3), 274-280.

Taylor, D.J., Lichstein, K.L., Weinstock, J., Sanford, S., Temple, J.R. (2007) A Pilot Study of Cognitive-Behavioral Therapy of Insomnia in People with Mild Depression. Behavior Therapy, 38(1), 49-57.

Ford, D.E., Kamerow, D.B. (1989) Epidemiological study of sleep disturbances and psychiatric disturbances. JAMA, 5(262), 1479-1484.

Hayward, R., Jordan, K.P., Croft, P. (2010) Healthcare use in adults with insomnia: a longitudinal study. British Journal of General Practice, 60, 334-340.

Ozminkowski, R.J., Wang, S., Walsh, J.K. (2007) The direct and indirect costs of untreated insomnia in adults in the United States. Sleep, 30, 263-273.

Siriwardena, A.N., Qureshi, M.Z., Dyas, J.V., Middleton, H., Ørner, R. (2008) Magic bullets for insomnia? Patients' use and experiences of newer (Z drugs) versus older (benzodiazepine) hypnotics for sleep problems in primary care. British Journal of General Practice, 58, 417-422.

Glass, J., Lanctôt, K.L., Herrmann, N., Sproule, B.A., Busto, U.E. (2005) Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331(7526), 1169.

Buscemi, N., Vandermeer, B., Friesen, C., Bialy, L., Tubman, M., Ospina, M., Klassen, T., Witmans, M. (2007) The Efficacy and Safety of Drug Treatments for Chronic Insomnia in Adults: A Meta-analysis of RCTs. Journal of General Internal Medicine, 22(9), 1335-1350.

Morin, C.M., Bootzin, R.R., Buysse, D.J., Edinger, J.D., Espie, C.A., Lichstein, K.L. (2006) Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004). Sleep, 29, 1398-1414.

Smith, M.T., Huang, M.I., Manber, R. (2005) Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review, 25(5), 559-592.

Department of Health. (2008) Improving Access to Psychological Therapies (IAPT): Commissioning Toolkit. London: Department of Health.

McKinstry, B., Wilson, P., Espie, C. (2008) Non-pharmacological management of chronic insomnia in primary care. British Journal of General Practice, 58(547), 79-80.

Ashworth, M., Robinson, S.I., Evans, C., Shepherd, M., Conolly, A., Rowlands, G. (2007) What does and idiographic measure (PSYCHLOPS) tell us about the spectrum of psychological issues and scores on a nomothetic measure (CORE-OM)? Primary Care and Community Psychiatry, 12(1), 7-16.

Czachowskia, S., Seed, P., Schofield, P., Ashworth, M. (Unpublished) Measuring Psychological Change During Brief Cognitive Behaviour Therapy in Primary Care: A Polish Study Using ‘PSYCHLOPS’.

Siriwardena, A.N., Apekey, T., Tilling, M., Harrison, A., Dyas, J., Middleton, H., Ørner, R., Sach, T., Dewey, M., Qureshi, Z. (2009) Effectiveness and cost-effectiveness of an educational intervention for practice teams to deliver problem focused therapy for insomnia: rationale and design of a pilot cluster randomised trial. BMC Family Practice, 10(1), 9.

Johns, M.W. (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 14(6), 540-545.

Salkind, M.R. (1969) Beck depression inventory in general practice. J R Coll Gen Pract, 18(88), 267-271.

Kind, P., Hardman, G., Macran, S. (1999) UK population norms for EQ-5D. York: University of York, Centre for Health Economics, (CHE discussion paper).

Reis, H.T., Judd, C.M. (2000) Handbook of research methods in social and personality psychology. New York: Cambridge University Press.

Berg, B.L. (1989) Qualitative research methods for the social sciences. New York: Allyn and Bacon.

Strauss, A., Corbin, J. (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques. newbury Park: Sage.

Anastasi, A., Urbina, S. (1997) Psychological testing, 7th ed. Upper Saddle River: Prentice Hall.

Kendall, M.G. (1938) A new measure of rank correlation. Biometrika, 30, 81-93.

Streiner, D.L., Norman, G.R. (2008) Health measurement scales: a practical guide to their development and use, 4th ed. Oxford: Oxford University Press.

Staner, L. (2010) Comorbidity of insomnia and depression. Sleep Med Rev, 14(1), 35-46.

Barkham, M., Mellor-Clark, J., Connell, J., Cahill, J. (2006). A core approach to practice-based evidence: A brief history of the origins and applications of the CORE-OM and CORE System. Counselling and Psychotherapy Research, 6(1), 3-15.

Ashworth, M., Evans, C., Clement, S. (2009) Measuring psychological outcomes after cognitive behaviour therapy in primary care: a comparison between a new patient-generated measure “PSYCHLOPS” (Psychological Outcome Profiles) and “HADS” (Hospital Anxiety and Depression Scale). Journal of Mental Health, 18(2), 169-177.

Ashworth, M., Robinson, S.I., Godfrey, E., Shepherd, M., Evans, C., Seed, P., Parmentier, H., Tylee, A. (2005) Measuring mental health outcomes in primary care: the psychometric properties of a new patient-generated outcome measure, 'PSYCHLOPS' ('psychological outcome profiles'). Primary Care Mental Health, 3(4), 261-270.

Chesson, A., Hartse, K., Anderson, W.M., Davila, D., Johnson, S., Littner, M., Wise, M., Rafecas, J. (2000) Practice parameters for evaluation of chronic insomnia. Sleep, 23, 1-5.

Hammersley, M. (1987) Some Notes on the Terms ‘Validity’ and ‘Reliability’. British Educational Research Journal, 13(1), 73 - 82.

Whittemore. R., Chase, S.K., Mandle, C.L. Validity in Qualitative Research. Qualitative Health Research, 11(4), 522-537.

Wainwright, D. (1997) Can Sociological Research Be Qualitative, Critical and Valid? The Qualitative Report.

Pyett, P.M. (2003) Validation of Qualitative Research in the “Real World”. Qualitative Health Research, 13(8), 1170-1179.

Rolfe, G. (2006) Validity, trustworthiness, and rigour: quality and the idea of qualitative research. Journal of Advanced Nursing, 53(3), 304-310.

Hannes, K., Lockwood, C., Pearson, A. (2010) A Comparative Analysis of Three Online Appraisal Instruments' Ability to Assess Validity in Qualitative Research. Qualitative Health Research, 20(12), 1736-1743.

Marshall, S., Haywood, K., Fitzpatrick, R. (2006) Impact of patient-reported outcome measures on routine practice: a structured review. Journal of Evaluation in Clinical Practice, 12(5), 559-568.