Development and psychometric evaluation of a Chinese version of auditory hallucination risk assessment scale in patients with a diagnosis of schizophrenia.

AIMS AND OBJECTIVES: To develop a Chinese version of Auditory Hallucination Risk Assessment Scale and evaluate its psychometric properties. BACKGROUND: Auditory hallucination, a common symptom in schizophrenia, has the potential to cause harm to patients and the people around them. However, there has been a paucity of suitable instrument developed in Asian region that can comprehensively and reliably assess its risk and inform interventions. DESIGN: This study involved 2 stages, the development of the Auditory Hallucination Risk Assessment Scale (AHRAS) and testing the psychometric properties of AHRAS. We followed STROBE guidelines in reporting the study. METHODS: Auditory Hallucination Risk Assessment Scale items were developed based on Symptom Management Theory, systematic literature review and findings of a qualitative study on the experience of auditory hallucinations. The items were evaluated by content validity. Auditory Hallucination Risk Assessment Scale was then tested for construct validity, concurrent validity, predictive validity, internal consistency and test-retest reliability in a convenience sample of 156 patients with a diagnosis of schizophrenia. RESULTS: The final version of AHRAS has nine items. Two factors were extracted from AHRAS, which explained 57.74% of the total variance. The score of AHRAS was strongly correlated with that of the Psychotic Symptom Rating Scales-Auditory Hallucinations. The area under the curve was 0.90 for the overall AHRAS score. Sensitivity (86.5%) and specificity (80.0%) were maximal for a mean overall AHRAS score of 13.5, suggesting that this is an appropriate threshold for differentiation. Cronbach's alpha coefficient for internal consistency was 0.82, and intra-class correlation coefficient for test-retest reliability was 0.84. CONCLUSIONS: Auditory Hallucination Risk Assessment Scale has good reliability and validity. It can be used in clinical settings in China and beyond to assess the risk of auditory hallucinations. RELEVANCE TO CLINICAL PRACTICE: Auditory Hallucination Risk Assessment Scale can serve as a tool for nurses and other healthcare professionals to identify patients with high-risk auditory hallucinations, monitor the changes of risk and inform nursing interventions.