International Journal of Nursing Studies 51 (2014) 927–933

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International Journal of Nursing Studies

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Development and preliminary testing of the Schizophrenia

Hope Scale, a brief scale to measure hope in people with
schizophrenia
Kwisoon Choe *
Department of Nursing, College of Natural Sciences, Kunsan National University, Gunsan, South Korea

A R T I C L E I N F O A B S T R A C T

Article history: Background: Hope has received attention as a central component of recovery from mental
Received 17 June 2013 illness; however, most instruments measuring hope were developed outside the mental
Received in revised form 30 August 2013 health field. To measure the effects of mental health programs on hope in people with
Accepted 19 October 2013
schizophrenia, a specialized scale is needed.
Objective: This study examined the psychometric properties of the newly developed 9-
Keywords:
item Schizophrenia Hope Scale (SHS-9) designed to measure hope in individuals with
Hope
schizophrenia.
Mental health
Reliability and validity Design: A descriptive survey design.
Scale development Setting: Participants were recruited from three psychiatric hospitals and two community
Schizophrenia mental health centers in South Korea.
Participants: A total of 347 individuals over age 18 with a DSM-IV diagnosis of
schizophrenia, schizoaffective, or schizophrenia spectrum disorders (competent to
provide written informed consent) participated in this study; 149 (94 men, 55 women)
completed a preliminary scale consisting of 40 revised items, and 198 (110 men, 88
women) completed the second scale of 17 items.
Methods: Scale items were first selected from extensive literature reviews and a
qualitative study on hope in people with schizophrenia; the validity and reliability of a
preliminary scale was then evaluated by an expert panel and exploratory factor analysis.
The remaining 9 items forming the Schizophrenia Hope Scale (SHS-9) were evaluated
through confirmatory factor analysis.
Results: The SHS-9 demonstrates promising psychometric integrity. The internal
consistency alpha coefficient was 0.92 with a score range of 0–18 and a mean total
score of 12.06 (SD = 4.96), with higher scores indicating higher levels of hope. Convergent
validity was established by correlating the SHS-9 to the State-Trait Hope Inventory,
r = 0.61 (p < 0.01). Divergent validity with the Beck Hopelessness Scale was also
established, r = 0.55 (p < 0.01). Exploratory and confirmatory factor analysis resulted
in a 1-factor solution, with the essential meaning of hope accounting for 61.77% of the total
item variance.
Conclusion: As hope has been shown to facilitate recovery from mental illness, the
accurate assessment of hope provided by the short, easy-to-use Schizophrenia Hope Scale
(SHS-9) may aid clinicians in improving the quality of life of individuals with
schizophrenia.
ß 2013 Elsevier Ltd. All rights reserved.

* Tel.: +82 10 2569 1750; fax: +82 63 469 1991.

E-mail address: choe1201@hanmail.net

0020-7489/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijnurstu.2013.10.018
928 K. Choe / International Journal of Nursing Studies 51 (2014) 927–933
What is already known about the topic?
 Hope is viewed as a facilitating factor in recovery and
rehabilitation from mental illness.
 Even though 32 hope scales have been developed, there
are few valid and reliable tools for measuring hope in
people with severe mental illness.
What this paper adds
 A valid and reliable hope scale was developed for people
with schizophrenia; its properties include essential
meanings of hope from their perspective.
 This study produced a concise, easy-to-use 9-item
instrument, the Schizophrenia Hope Scale (SHS-9) that
could be of great value in measuring the effectiveness of
nursing interventions on hope in mental health treat-
ment settings.
1. Introduction
Hope is considered to be an important factor in
recovering from mental illness (Van Gestel-Timmermans
et al., 2010) and is believed to improve the quality of life
of people with schizophrenia (Hasson-Ohayon et al.,
2009). However, it has been reported that people with
schizophrenia have significantly less hope than the
general population (Landeen and Seeman, 2000; Land-
een et al., 2000). The diagnosis of schizophrenia,
implying a life-time of psychosis and hospitalization,
is certainly a cause for despair and loss of hope among
people with this illness (Littrell et al., 1996). Recently,
insight into mental illness, internalized stigma, and
depression were also considered to be a cause of
hopelessness in people with schizophrenia (Ehrlich-
Ben Or et al., 2013; Sharaf et al., 2012).
Given that hope is important to people with schizo-
phrenia, various interventions to support it have been
implemented in psychiatric settings (Cheavens et al.,
2006; Schrank et al., 2012a). However, when conducting a
study of hope, clinicians or nursing researchers unfortu-
nately face the difficulty of identifying an appropriate
hope scale to assess their patients with schizophrenia.
Today, even though 32 hope scales have been identified
across various disciplines and applications (Schrank et al.,
2008), few valid and reliable tools exist for measuring
hope in people with severe mental illnesses (Schrank et
al., 2012b).
Attributes of hope are complex and multidimension-
al; thus, the emphasis on each attribute in hope scales
would differ according to the situation and the context
of the target population. One reason to insist upon the
development of a hope instrument specific to people
with schizophrenia is that hope reflects personal
experience. For example, hope in persons with terminal
cancer is related to ameliorating physical symptoms
such as pain at the end of life (McClement and
Chochinov, 2008), while individuals with psychiatric
disorders hope for an untroubled life, the restoration of
family relationships, and close interpersonal relationships
(Noh et al., 2008). Hope in people with schizophrenia has
more emotional and spiritual meanings, that is, meaning in
life, happiness, anticipation of a better future, and the energy
to live (Noh et al., 2008).
The Snyder Hope Scale, Herth Hope Index, and Miller
Hope Scale are the most frequently used with psychiatric
patients. Although these tools are reported to have good
reliability and validity, none have been validated for
people with severe mental illness (Schrank et al.,
2012b). Moreover, these three tools overlap considerably
and focus on each attribute separately (Schrank et al.,
2012b). The Snyder Hope Scale adopted a more narrow
definition of hope as the mainly motivational concept of
goal orientation. Consequently, it focuses on cognitive
appraisals of the ability to generate the means to achieve
goals, and excludes other possible emotional and
spiritual aspects of hope (Schrank et al., 2012b). The
Herth Hope Index (Herth, 1991) was developed to assess
hope in elderly patients with cancer and their families
during the last phases of the disease. It is likely that
the nature of hope differs between people with cancer
who face impending death and those with mental
illness who continue to be concerned with daily life.
The Miller Hope Scale (Miller and Powers, 1988) was
based on critical elements of hope revealed in a
comprehensive literature review and an exploratory
study of hope in survivors of critical illness. Although the
definition of hope in the Miller Hope Scale is more
comprehensive than that in the Snyder and Herth
instruments, this scale still focuses on hope in persons
who survived a critical physical rather than mental
illness. Furthermore, it is unfeasible for people with
mental illness due to its high number of items (Schrank
et al., 2012b). Accordingly, the use of existing scales to
measure hope in people with schizophrenia may result
in a misunderstanding of hope in this population
because it is not certain that these scales accurately
measure the properties of hope specific to individuals
with mental disorders.
Therefore, there is a clear need for a high-quality
instrument to measure hope in people with schizophre-
nia. This instrument could serve as a valuable measure-
ment of hope in the context of evidence-based empirical
research in the mental health field as well as an effective
clinical assessment of recovery. This study aimed to
develop a valid and reliable instrument to measure hope
consisting of essential meanings of hope from the
perspective of people with schizophrenia. Therefore,
the specific research question is as follows: what is the
reliability and validity of the newly developed measure-
ment of hope in people with schizophrenia?
2. Methods
2.1. Design
A descriptive survey design was used to develop an
instrument to measure hope in people with schizophrenia.
This study was conducted in three phases: instrument
development (phase 1), piloting scale (phase 2), and final
Schizophrenia Hope Scale (phase 3).
 K. Choe / International Journal of Nursing Studies 51 (2014) 927–933
2.2. Participants and ethical considerations
Patients were recruited from three psychiatric hospi-
tals and two community mental health centers in South
Korea. Inclusion criteria were a DSM-IV diagnosis of
schizophrenia, schizoaffective or schizophrenia spectrum
disorders, above 18 years of age, and competency to
provide written informed consent. This research was
reviewed and approved by the Institutional Review Board
of Kunsan National University Bioethics Committee. All
participants voluntarily consented to participate. All
procedures were carried out in accordance with The Code
of Ethics of the World Medical Association (Declaration of
Helsinki).
A total of 347 individuals participated in this study; 149
(94 men, 55 women) completed a preliminary scale
consisting of 40 revised items and 198 (110 men, 88
women) completed the second scale of 17 items.
2.3. Validating instruments
Since the Beck Hopelessness Scale and the State-Trait
Hope Inventory were used in studies of hope in psychiatric
populations, these scales were chosen in this study.
2.3.1. Beck Hopelessness Scale
The Beck Hopelessness Scale (Beck et al., 1974) is a 20-
item questionnaire that asks participants to endorse
statements as true or false as applied to them in order
to measure negative thinking about the future. Individual
items are summed; total scores can range from 0 to 20,
with higher scores indicating higher levels of hopelessness.
A Korean-language version of the Beck Hopelessness Scale
was used, the psychometric soundness of which was
established by Shin et al. (1990). The average score for
participants in this sample was 6.44 (SD = 4.28), and the
internal consistency alpha coefficient was 0.82.
2.3.2. State-Trait Hope Inventory
The State-Trait Hope Inventory, developed based on a
comprehensive literature review (Farran et al., 1995),
consists of two identical 20-item 5-point Likert scales that
measure the state and trait dimensions of hope. Total
scores can range from 20 to 100, with higher scores
indicating higher levels of hopefulness. A Korean-language
version of this inventory was used, the psychometric
soundness of which was established by the authors of this
study. The average score for this sample was 67.99
(SD = 11.80), and the internal consistency alpha coefficient
was 0.85.
2.4. Data collection
Data collection was conducted by self-reported ques-
tionnaires administered face-to-face with participants.
For reliable data collection, the author met with the
patients to explain the purpose and procedures of this
study. In the event that a patient could not read the
questionnaires due to blurred vision, the author adminis-
tered the scales verbally and recorded the patient’s
responses.
929
2.5. Data analysis
Statistical analyses were performed using SPSS version
17.0 and AMOS programs. Descriptive statistics were
calculated to summarize the sample characteristics and
the subjects’ responses on the questionnaires. An explor-
atory factor analysis and a confirmatory factor analysis
were performed to evaluate the construct validity of the
Schizophrenia Hope Scale. The scale’s internal consistency
was established using Cronbach’s alpha and Pearson’s
correlation coefficients were calculated to examine the
relationships among the three scales; Schizophrenia Hope
Scale-9 (SHS-9); Beck Hopelessness Scale, and State-Trait
Hope Inventory. For all analyses, p < .05 was considered
statistically significant.
3. Results
3.1. Instrument development (phase 1)
Forty items were selected for the scale from concept
clarification research (Choe et al., 2005), a qualitative
study (Noh et al., 2008), and an extensive literature review
on hope in people with schizophrenia. An expert panel of
professionals with extensive experience (over 10 years)
working with people with schizophrenia was assembled,
consisting of four psychiatric head nurses and one
psychiatrist. These professionals address the issue of hope
with their patients, and have specifically interviewed them
on the subject. The panel evaluated content validity,
assigning each item a rating ranging from 0 (not
appropriate) to 2 (very appropriate). The average score
was above 1 (appropriate) for each of the 40 items; all items
were included in the first preliminary scale. Following a
pilot study of 15 patients, some wording was changed to
aid readability.
3.2. Piloting the scale (phase 2)
3.2.1. Reliability and validity of the first preliminary scale (40
items)
A preliminary scale consisting of the 40 revised items
was administered to 149 persons with schizophrenia (94
men, 55 women). The sample size appropriate to validate
an instrument under development is at least four times the
expected number of total items on the final instrument
(Nunnally and Bernstein, 1994). The expected total
number of items of the hope instrument in this study
was less than 20; thus, a sample size of 149 people was
considered to be appropriate. Each item was rated on a 3-
point Likert scale (0: disagree; 1: agree; 2: strongly agree),
yielding a final score range of 0–80. The 3-point Likert scale
is a simple but discriminate assessment tool that considers
the cognitive abilities of persons with schizophrenia.
Correlations between items and total scale score ranged
from 0.486 to 0.806. Principal factor analysis to evaluate
construct validity revealed five factors with an eigenvalue
above one. The factor loadings of all 40 items were above
0.4. Cronbach’s alpha for the preliminary scale was 0.97,
and for the five factors as follows: Factor I (the essential
930 K. Choe / International Journal of Nursing Studies 51 (2014) 927–933

meaning of hope), 0.96; Factor II (what hope is for), 0.93;
Factor III (support systems for hope), 0.81; Factor IV
(spiritual dimensions of hope), 0.84; and Factor V (not
classified), 0.18. Factor I of the preliminary scale measured
the fundamental meaning of hope and included 17 items.
The eigenvalue of Factor I was 19.956 and accounted for
48.9% of the total item variance.
3.2.2. Reliability and validity of the second preliminary scale
(17 items)
The second preliminary hope scale consisted of the 17
items included in Factor I (the essential meaning of hope).
This second preliminary scale was completed by 198
persons with schizophrenia (110 men, 88 women) who had
not completed the first preliminary scale. Rasch analysis
showed that the mean square infit and outfit statistic of all
17 items ranged between 0.5 and 1.5; thus, exploratory
factor analysis could be performed for the 17 items.
As a result of exploratory factor analysis, factors with
eigenvalues greater than one were extracted. Maximum
likelihood factor analysis with oblimin rotation resulted in
a 1-factor solution. Items with factor loadings greater than
0.60 and communalities greater than 0.50 were selected,
but the validity of three items (6, 14, and 15) was low;
these items were deleted. For the remaining 14 items, the
Kaiser–Meyer–Olkin (KMO) measure of sampling adequa-
cy was 0.936; a minimum KMO score of 0.50 is considered
acceptable to reliably use factor analysis. To examine the
correlation between the items, Bartlett’s test of sphericity
(BTS) was conducted. The BTS score was 2077.880
(p < 0.001), indicating that the correlation matrix between
the variables is not the unit matrix and that factor analysis
is appropriate for the variables. A total of 57.1% of the
variance was explained by the 1-factor solution. Cron-
bach’s alpha coefficient for Factor I was 0.94. All
participants completed the 17-item second preliminary
version of the Schizophrenia Hope Scale and two validating
instruments, the Beck Hopelessness Scale and the State-
Trait Hope Inventory.
3.3. The final Schizophrenia Hope Scale (phase 3)
To select the most valid and reliable items, confirmato-
ry factor analysis was performed for the 14 items of the
second preliminary scale. Goodness-of-fit was improved
by deleting five items (5, 8, 13, 16, and 17), leaving nine
items in the final version, the Schizophrenia Hope Scale
(SHS-9). The results of exploratory factor analysis of the
second preliminary hope scale and the final SHS-9 are
displayed in Table 1.
The Schizophrenia Hope Scale (SHS-9) is a 9-item scale
in 3-point Likert format (0: disagree; 1: agree; 2: strongly
agree). The range of possible scores is 0–18, with higher
scores indicating higher levels of hope. The final Schizo-
phrenia Hope Scale was administered to 198 people with a
DSM-IV diagnosis of schizophrenia, schizoaffective, or
schizophrenia spectrum disorders. Participants’ character-
istics are presented in Table 2. Participants were 22–67
years old, with a mean age of 43.44 (SD = 8.21), and a mean
duration of illness of 12.54 years (SD = 8.66). The average
score for this sample was 12.06 (SD = 4.96), with an
internal consistency alpha coefficient of 0.92. The alpha
coefficients decreased when any of the items were deleted,
indicating that the SHS-9 is a reliable instrument. The nine
items of the SHS-9 are presented in Table 1.
Convergent validity was evaluated by comparing the
scores of the Schizophrenia Hope Scale (SHS-9) with the
State-Trait Hope Inventory. Pearson’s correlations between
the two instruments indicated a moderate positive
correlation, r = 0.61 (p < 0.01), supporting the convergent
validity of the Schizophrenia Hope Scale (Table 3).
Divergent validity of the Schizophrenia Hope Scale
(SHS-9) was measured by Pearson’s correlations between
the Schizophrenia Hope Scale and the Beck Hopelessness

Table 1
Exploratory factor analysis of the preliminary hope scale and the final Schizophrenia Hope Scale (SHS-9).

Items Model 1 Model 2 Final Model

Factor loading h2 Factor loading h2 Factor loading h2

Q1 There is a better future ahead of me. .713 .508 .718 .516 .736 .541
Q2 I will be happy in the future. .790 .624 .804 .646 .835 .698
Q3 I am getting better every day. .736 .541 .744 .554 .770 .593
Q4 My future is bright. .751 .563 .765 .586 .775 .600
Q5 I set my goals and try to achieve them. .728 .530 .743 .552
Q6 I have a lot of time to experience life. .582 .329
Q7 I am excited about my life now. .826 .682 .823 .677 .834 .695
Q8 I have a strong will to live. .711 .506 .710 .503
Q9 I plan my future. .777 .603 .778 .605 .769 .591
Q10 I am confident about my life. .779 .607 .778 .605 .794 .631
Q11 I am confident about my future. .795 .632 .796 .634 .810 .656
Q12 My life is meaningful. .742 .551 .740 .548 .744 .553
Q13 I have a dream. .714 .509 .715 .611
Q14 I now live with passion and strength. .668 .446
Q15 If I overcome difficult situations, my life will be better. .634 .402
Q16 I overcome sadness and frustration. .726 .527 .729 .532
Q17 I feel confident about myself. .722 .521 .723 .532

Eigenvalue 9.092 7.883 5.559

% Of variance 53.483 57.095 61.766
Cronbach’s a .973 .942 .922

h2: index of communality coefficients.

 K. Choe / International Journal of Nursing Studies 51 (2014) 927–933 931

Table 2 Construct validity of the Schizophrenia Hope Scale was

Sample characteristics (N = 198).
confirmed by principal component analysis with extrac-
Variables n (%) tion and direct oblimin rotation. Maximum likelihood
Gender factor analysis with oblimin rotation resulted in a 1-factor
Male 110 (55.6) solution. One factor consisting of nine items with
Female 88 (44.4) eigenvalues > 1 was extracted; it accounted for 61.77%
M (SD) of the total item variance.
Age (years) 43.44 (8.21)
The results of the confirmatory factor analysis for the
Duration of illness (years) 12.54 (8.66)
Marital status Schizophrenia Hope Scale were acceptable. The x2 value
Never married 112 (58.0) was significant (x2 = 88.662, p < .001), and the compara-
Married 32 (16.6) tive fit index, normal fit index, goodness-of-fit index, and
Separated 16 (8.3)
root mean square residual were 0.941, 0.919, 0.908, and
Divorced 25 (13.0)
Widowed 8 (4.1) 0.021, respectively, indicating that the structure of the
Education Schizophrenia Hope Scale accurately represents the data
Never attended 2 (1.0) for hope. The standardized estimates of the items ranged
Elementary school 17 (8.7) from 0.49 to 0.66 (Fig. 1).
Middle school 24 (12.2)
High school 89 (45.4)
College 59 (30.1) 4. Discussion
Graduate school 5 (2.6)
Religion This study was conducted to develop an instrument to
Protestant 106 (54.1)
measure hope in people with schizophrenia; the Schizo-
Catholic 18 (9.2)
Buddhist 24 (12.2) phrenia Hope Scale (SHS-9) was thus created. As the scale
Other 16 (8.1) was developed based on a concept clarification, the
None 32 (16.3) findings of qualitative researches, and literature reviews
M: mean; SD: standard deviation. on hope in people with schizophrenia, this tool is unique in
that it includes the meaning of hope from the perspective
Scale. Results indicated a moderate negative correlation of this population. As a result of this study, reliability and
between the two scales, r = 0.548 (p < 0.01), confirming validity of the newly developed Schizophrenia Hope Scale
the divergent validity of the Schizophrenia Hope Scale have been established. In the first phase, the researcher
(Table 3). developed a hope instrument consisting of 40 items. Then,

Table 3
Correlations among the instruments (N = 198).

Possible range of scores Range M  SD Correlations

SHS-9 BHOP STHI

SHS-9 0–18 0–18 12.06  4.96 1.0

BHOP 0–20 1–19 6.44  4.28 .548* 1.0
STHI 20–100 38–100 67.99  11.80 .606* .755* 1.0

SHS-9: Schizophrenia Hope Scale-9; BHOP: Beck Hopelessness Scale; STHI: State-Trait Hope Inventory; M: mean; SD: standard deviation.
* p < 0.01

Fig. 1. CFA Model for the SHS-9 standardizied estimates.

932 K. Choe / International Journal of Nursing Studies 51 (2014) 927–933
content validity was ensured through expert-review and
patient feedback.
In the second phase, principal factor analysis to
evaluate construct validity revealed five factors with an
eigenvalue above 1, and the factor loadings of all 40 items
were above 0.4. Internal consistency was very high
(a = 0.97). The preliminary scale composed of 40 items
on five factors became 17 items on one factor. Among the
five factors, only 17 items on Factor I (the essential
meaning of hope) were included in the next phase because
13 items on Factor II (what hope is for) and 3 items on
Factor III (support systems for hope) addressed theoreti-
cally different elements in the dynamics of hope. Factor IV
(spiritual dimensions of hope) was also excluded because
its items referenced faith in God, prayers to God, and so on.
These items would limit its use in nonreligious individuals.
The two items on Factor V (‘‘I can overcome difficulties
well’’ ‘‘I want to be free’’) were also removed due to very
low internal consistency (a = 0.18). As a result of explor-
atory factor analysis of the second preliminary scale (17
items), a 1-factor solution was confirmed and three items
with low validity were removed. For the remaining 14
items, KMO and BTS scores were acceptable for factor
analysis, and a total of 57.1% of the variance was explained
by the 1-factor solution. Internal consistency for Factor I
was very high (a = 0.94).
In the last phase, through exploratory and confirmatory
factor analyses, eight items were removed from the total
17 items on Factor I step by step; finally, construct validity
and internal consistency of the final model of the SHS-9 (9
items) were tested. Cronbach’s alpha was 0.92 for the SHS-
9, indicating good reliability. One factor was extracted, and
the variance explained 61.77% of the total scale. Conver-
gent validity was demonstrated by correlating the final
SHS-9 to the State-Trait Hope Inventory (r = 0.61). Diver-
gent validity with a negative correlation of the SHS-9 to the
Beck Hopelessness Scale (r = 0.55) also supported the
construct validity of the SHS-9. These two scales were
chosen because they had been used in previous studies of
hope in psychiatric populations.
The eight deleted items included ‘‘I set my goals and try
to achieve them’’ (Q5) and ‘‘I have a dream’’ (Q13) were
removed, showing a major difference between the Snyder
Hope Scale and the Schizophrenia Hope Scale (SHS-9). The
components of the Snyder Hope Scale (Snyder et al., 1991)
are goal-oriented, while the components of the final SHS-9
focus more on the emotional and spiritual aspects of hope.
The remaining nine items of the SHS-9 address the
emotional meaning of hope (‘‘better’’ (Q1, Q3), ‘‘happy’’
(Q2), ‘‘bright’’ (Q4), ‘‘excited’’ (Q7), and ‘‘confident’’ (Q10,
Q11)), and the spiritual meaning of hope (‘‘my life is
meaningful’’ (Q12)). Although ‘‘I plan my future’’ (Q9) is
included in the final model, this is more general than
concrete strategies to achieve goals, compared to the
Snyder Hope Scale.
The essential meaning of hope in the remaining nine
items is defined as positive expectations for the future,
confidence in life and the future, and meaning in life. In the
Miller Hope Scale (Miller and Powers, 1988), hope is
characterized by looking forward to a good future and the
expectation of a positive outcome. In the Herth Hope Index
(Herth, 1991), future orientation and positive expectancy
are similar to the positive expectation component of the
Schizophrenia Hope Scale. Future reference is an inevitable
aspect of hope. Interestingly, renewing a sense of
possibility or positive expectations for the future is one
of the definitions of social recovery in people with
schizophrenia (Hopper, 2007).
Among the items of the SHS-9, ‘‘confidence in life and
the future’’ (Q10, Q11) was revealed as an important
property of hope for people with schizophrenia. However,
‘‘I feel confident about myself’’ (Q17) was not included in
the final model. Hopeful participants in this study felt
confident about life and their futures, but they did not feel
confident in themselves. ‘‘I have a strong will to live’’ (Q8)
and ‘‘I now live with passion and strength.’’ (Q14) were also
excluded. Low confidence and lack of will may reflect their
low self-esteem. For this reason, two items on overcoming
difficulties (Q15, Q16) may be deleted.
Meaning in life is a key element of hope, although only
one item on meaningful life remained in the final model of
the SHS-9. The Miller Hope Scale (Miller & Powers, 1988)
also describes purpose and meaning in life as critical
elements of hope. Hope is intimately connected with
questions of meaning and values (Fitzgerald, 1979).
Qualitative studies of hope in people with mental disorders
have revealed that determinants of hope revolve around
meaning in life (Schrank et al., 2012a). The search for
meaning is a primary force in human life (Fitzgerald, 1979).
Thus, people with schizophrenia who have hope live life
with energy. Recapturing meaning in life is an essential
element in the process of recovery from severe mental
illness (Ehrlich-Ben Or et al., 2013).
In summary, the essential meaning of hope in the SHS-9
consisted of positive expectations for the future, confi-
dence in life and the future, and meaning in life. These
three meanings of hope are the very core elements of the
concept of hope for people with schizophrenia. Of course,
these three elements of hope may not be different from
those for people without mental illness; however, until
now there have been few hope scales that combine these
three core elements in a single instrument.
Finally, there are some limitations associated with this
study. The test-retest reliability of the scale was not
validated; this will need to be analyzed in a future study.
Further testing of this Schizophrenia Hope Scale (SHS-9)
across diverse study populations would help to validate its
use in other regions.
5. Conclusion
The Schizophrenia Hope Scale is a new self-report
instrument with adequate psychometric properties to
measure hope in persons living with schizophrenia. This
scale is significant for representing the subjective meaning
of hope from the perspective of people with schizophrenia
and for allowing simpler quantification of the construct of
hope in this population. Moreover, the Schizophrenia Hope
Scale facilitates further exploration of the antecedents and
correlates of hope in people with schizophrenia and
provides a sound basis for future research on hope in this
population.
 K. Choe / International Journal of Nursing Studies 51 (2014) 927–933 933

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Littrell, K.H., Herth, K.A., Hinte, L.E., 1996. The experience of hope in
wrong answer. Respond to all items, but do not spend too adults with schizophrenia. Psychiatric Rehabilitation Journal 19 (4)
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Disagree Agree Strongly
Noh, C., Choe, K., Yang, B., 2008. Hope from the perspective of people
Agree
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1. There is a better future ahead 69–77.
of me. Nunnally, J.C., Bernstein, I., 1994. Psychometric theory, 3rd ed. McGraw-
2. I will be happy in the future. Hill Humanities, New York.
3. I am getting better every day. Schrank, B., Bird, V., Rudnick, A., Slade, M., 2012. Determinants, self-
management strategies and interventions for hope in people with
4. My future is bright.
mental disorders: systematic search and narrative review. Social
5. I am excited about my life now.
Science and Medicine 74, 554–564.
6. I plan my future. Schrank, B., Stanghellini, G., Slade, M., 2008. Hope in psychiatry: a review
7. I am confident about my life. of the literature. Acta Psychiatrica Scandinavica 118, 421–433.
8. I am confident about my future. Schrank, B., Woppmann, A., Hay, G.A., Sibitz, I., Zehetmayer, S., Lauber, C.,
9. My life is meaningful. 2012. Validation of the Integrative Hope Scale in people with psy-
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