Professor Graham Meadows ¹, Catharine McNab ¹
¹ Monash University
Project completion year
The Perceived Need for Care Questionnaire (PNCQ) is a fully structured questionnaire measure of perceived need for mental health care. It was first administered as part of the Australian National Survey of Mental Health and Wellbeing survey targeting high prevalence disorders such as depression and anxiety. It is a brief and simple measure in its computer assisted form, typically taking less than two minutes to administer. The paper form of the PNCQ, in contrast, is a 17-page instrument and requires considerable training in administering; its routine use in primary care settings is therefore inappropriate.
Beyond Blue commissioned the development of a brief version of the PNCQ for routine use in primary care research and service delivery, with a particular focus on levels of met and unmet need and barriers to care. The development phase involved trialling of a substantial series of draft versions, and discussion of these in development with GPs, mental health care professionals, and consumers of primary mental health care.
The resulting instrument, the General-practice Users Perceived-need Inventory (GUPI), is a single-page self-report paper and pencil measure, which was further examined for reliability and validity in 122 people attending general practice in north-western Melbourne, 83 of whom were also followed up longitudinally.
Participant feedback suggests that the GUPI has good ‘consumer validity’; participants overwhelmingly found the questionnaire easy to understand and complete, and generally found it useful and potentially helpful in communicating concerns. Higher scores on items associated with adverse mental health experience were associated with perceived need on the GUPI, suggesting that perceived need as measured with the GUPI is associated with poorer general health, and a greater level of disability due to both physical and emotional difficulties.
Reliability was less well supported than validity. This however does not necessarily undermine the utility of the instrument; use of the GUPI may in fact reduce perceived need itself by allowing an opportunity for reassurance or the meeting of need within a GP consultation subsequent to its administration. A reliability study in a general population setting without the intervention of the GP consultation might be more appropriate for the true estimation of reliability.
These data suggest that reducing the GUPI to three ‘psychological/psychiatric need’ items (ie, the first three items) would allow the retention of psychometric properties, while creating a measure that is even more brief and simple to administer and complete. In this form, the GUPI goes a substantial way towards meeting the stated evaluative criteria. These findings and the instrument itself have been published in a peer reviewed paper.
McNab, C. & Meadows, G. (2005) The General-practice Users' Perceived-need Inventory ('GUPI'): a brief general practice tool to assist in bringing mental healthcare needs to professional attention. Primary Care Mental Health, 3, 93-101.
Implications for policy and practice
On the basis of these findings, the continued use and further evaluation of the GUPI is supported, including the use of the GUPI short form where extreme brevity is desirable. The GUPI is a brief and valid measure of perceived need for mental health care, suitable for use in general practice waiting rooms. Its use provides a rapid and accurate picture of potential mental health needs and, as such, would be useful for general practitioners in identifying mental health problems.
The PNCQ has become an influential instrument in psychiatric epidemiology, being included in major surveys internationally and having been translated into at least three other languages. The GUPI has also attracted interest from overseas users. It has already been included in other primary care studies here in Australia that are now moving towards reporting stage. Recent publications from other sources are supporting the utility of this general approach to screening and the GUPI has demonstrably good properties for this use. It is expected that the reporting of these various studies will further contribute to our understanding of good practice in primary mental health care and the instrument itself is readily available for GPs to add to the range of useful screening and monitoring instrumentation.
The GUPI is freely available on the website of the Southern Synergy research group along with supporting material and references. Permission for use in research or clinical settings is freely granted.