Assessing the relationships people have with their voices : Developing the V-HEARS

Leveridge, Dani and Fletcher, Ian and Morris, Rohan (2026) Assessing the relationships people have with their voices : Developing the V-HEARS. PhD thesis, Lancaster University.

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Abstract

This thesis comprises of a systematic literature review, an empirical paper, and a critical appraisal. The purpose of this research is to address the gap in assessing relational approaches to hearing voices, by critically examining existing outcome measurement practices and contributing to the development and evaluation of a lived-experience-informed outcome measure for voice hearing. The systematic literature review examines the development of patient-reported outcome measures (PROMs) designed to assess experiences associated with a diagnosis of a Schizophrenia Spectrum Disorder (SSD). The review focuses on the extent to which lived experience perspectives are incorporated into measure development and conceptual framing. Findings indicate that most measures prioritise validating psychometric properties, with limited attention to experiential validity or service user involvement, and little use of inductive processes. It concludes by providing a rationale for the development of measures rooted in the understandings of people with lived experience. The second section reports an empirical paper describing the development and preliminary validation of a new outcome measure assessing the relationship between voice hearers and their voices (V-HEARS). The research followed best-practice guidance for PROM development and comprised three stages: item refinement based on relevance and distinctiveness, cognitive interviewing to assess comprehension, acceptability and emotional burden, and an initial psychometric evaluation. Findings suggest that the measure is acceptable to participants, captures aspects of experience not routinely assessed by existing PROMs, and demonstrates promising preliminary psychometric properties. The third section offers a critical appraisal of the literature review and empirical research. This appraisal evaluates methodological strengths and limitations, with particular attention to construct validity, experiential validity, ethical considerations, and researcher reflexivity. Broader structural tensions related to lived experience involvement, doctoral research constraints, and outcome measurement practices within mental health services are explored. Implications for clinical practice, future research, and clinical psychology training are discussed.