The reliability of the community version of the MRC Needs for Care Assessment

Psychol Med. 1996 Mar;26(2):237-43. doi: 10.1017/s0033291700034632.

Abstract

One hundred and nine adults were screened in the community using the abridged version of the CIDI (CIDIS). The subjects comprised DSM-III-R current cases (N = 48), lifetime cases (N = 31) and non-cases (N = 30). The interviews with the 109 subjects were conducted by one of two pairs of clinicians and videotaped. Each interviewer-pair included a psychiatrist and a clinical psychologist. They rated the community version of the Needs for Care (NFCAS-C) by consensus. The other pair of judges then viewed the video and rated the NFCAS-C independently. The agreement on overall needs was excellent (kappa = 0.75), and very good for four of the seven specific sections (from kappa = 0.61 to 0.81). One section could not be rated because of low prevalence, and agreement was less good for the remaining two sections. Agreement was good on specific interventions (medication, kappa = 0.60; specific psychotherapy, kappa = 0.55), but poor on non-specific interventions. The majority of disagreements were due to differences in clinical judgement rather than to technical errors. A new instruction manual has been produced and should help training as well as stabilizing reliability. In devising reliable and valid instruments based on clinical judgement, a balance must be achieved between enhancing reliability with more precise rules and constraining clinical judgement so tightly that validity is lost.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Community Mental Health Services / statistics & numerical data*
  • Female
  • Health Services Needs and Demand / statistics & numerical data*
  • Humans
  • Male
  • Mass Screening / statistics & numerical data
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology*
  • Mental Disorders / rehabilitation
  • Middle Aged
  • Observer Variation
  • Patient Care Team / statistics & numerical data
  • Personality Assessment / statistics & numerical data*
  • Psychometrics
  • Quebec / epidemiology
  • Reproducibility of Results