Herth Hope Index (HHI)

What is the Herth Hope Index (HHI)?

The Herth Hope Index (HHI) is a scale developed by Kaye Herth to measure hope in adults (Herth, 1992). It has been widely used in patients facing chronic, life-threatening, mental health, and cancer-related conditions. The HHI consists of three subscales:

1. Inner sense of temporality and future (cognitive-temporal): The belief in the possibility of positive outcomes in the near or distant future.
2. Inner positive readiness and expectancy (affective-behavioral): Confidence and action towards achieving desired outcomes.
3. Interconnectedness with self and others (affiliative-contextual): Awareness of personal connections with others and a higher spiritual force.

The HHI is used in clinical settings, particularly in chronic health conditions, mental health recovery and active cancer treatment, making it a valuable tool for healthcare professionals like psychologists, counsellors and oncologists.

The HHI has undergone thorough psychometric evaluation including exploratory factor analysis and confirmatory factor analysis to validate its psychometric properties and factor structure, as well as its varying factor structures across different samples, proving it to be a valid and reliable instrument for measuring hope (Chan et al., 2012). Rimaponti et. al (2012) also found that the HHI has a Cronbach's alpha of 0.84 and test-retest reliability of 0.64 (95% CI 0.51; 0.76).

The index also shows strong internal consistency, meaning that it reliably measures hope across different patient demographic and clinical characteristics. Further research has explored the Herth Hope Index's effectiveness across diverse populations, leading to the development of internationally translated and validated versions that maintain the tool's reliability and cultural relevance (Nikoloudi et al., 2021).

How does our Herth Hope Index template work?

Here's how to use our Hearth Hope Index template:

Step 1: Access the template

You can access and download our printable Herth Hope Index template by either clicking the “Use Template” or “Download” button above or searching “Herth Hope Index” in Carepatron's template library on our website or app.

Step 2: Introduce the HHI to the patient

Explain to the patient that the HHI is a tool used to measure their level of hope. Reassure them that the assessment is confidential and designed to gain a better understanding of their emotional and psychological well-being, which will help in providing the best care and support.

Step 3: Administer the HHI

Provide the patient with the HHI either in print or digitally. Instruct them to read each statement and mark their response based on their current feelings. Encourage honest and spontaneous responses to ensure an accurate assessment of their hope levels.

Step 4: Score the HHI

After the patient completes the scale, total their responses. Higher scores indicate higher levels of hope. Instructions on how to score the scale can be found in the template as well as below under 'Scoring'.

Step 5: Use the HHI to inform clinical decision-making

Use the patient's HHI results to guide your clinical decisions. The scores can help identify areas where they may need more support and help shape individualized care plans and interventions. The results may also inform decisions about referrals to mental health or spiritual care services.

Scoring and interpretation

The Herth Hope Index is scored by adding up the responses from all 12 items. The 12-item questionnaire is rated on a 4-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree), providing a total score between 12 and 48. The three subscales - temporality and future, positive readiness, and interconnectedness with others - capture different dimensions of hope.

Higher scores indicate greater levels of hope. Lower scores may signal a need for additional psychological support or intervention.

Next steps

After scoring the HHI, it's helpful to the patient's responses to identify personally significant areas where hope is strong or may need support. Discussing the significant of hope in a patient's life and exploring these themes can make the session more personally meaningful.

If clients wish to delve further into specific areas of their score, it is a reasonable request to allow additional time or follow-up sessions to fully address any emerging needs. This process helps ensure that treatment plans are individualized and supportive, aligning with the client's unique perspective and values.

References

Chan, K. S., Li, H. C., Chan, S. W., & Lopez, V. (2012). Herth hope index: psychometric testing of the Chinese version. Journal of advanced nursing, 68(9), 2079–2085. https://doi.org/10.1111/j.1365-2648.2011.05887.x

Herth K. (1992). Abbreviated instrument to measure hope: development and psychometric evaluation. Journal of advanced nursing, 17(10), 1251–1259. https://doi.org/10.1111/j.1365-2648.1992.tb01843.x

Nikoloudi, M., Tsilika, E., Parpa, E., Kostopoulou, S., Tentolouris, A., Psarros, C., Alexandra, M., & Mystakidou, K. (2021). Herth Hope Index: A Psychometric Evaluation Study within a Sample of Greek Patients with Cancer. Indian journal of palliative care, 27(3), 367–374. https://doi.org/10.25259/IJPC_364_20

Ripamonti, C. I., Buonaccorso, L., Maruelli, A., Bandieri, E., Boldini, S., Pessi, M. A., Chiesi, F., & Miccinesi, G. (2012). Hope herth index (HHI): A validation study in italian patients with solid and hematological malignancies on active cancer treatment. Tumori Journal, 98(3), 385–392. https://doi.org/10.1177/030089161209800317