Project HOPEFUL: A PN-RCT With Implementation Science

The Social Provisions Scale (SPS-5) is a 5-item measure used to evaluate a participant's level of social support. It is a shortened version of the 10-item SPS and designed for use in research studies to reduce participant burden while maintaining strong psychometric properties. The SPS is based on a theory of social support developed by Irwin Weiss and uses one positive item to assess the social provisions of Attachment, Guidance, Social Integration, Reliable alliance, and Reassurance of worth. Each item is rated on a 4-point Likert scale, from "Strongly Disagree" to "Strongly Agree". Sample items include, "There is someone I could talk to about important decisions in my life", "I feel part of a group of people who share my attitudes and beliefs", and "There are people I can count on in an emergency." A total score is calculated by summing the responses to the 5 questions. The scores can range from 5 to 20, with higher scores indicating higher levels of perceived social support.

The three-item UCLA Loneliness Scale (Hughes et al., 2004) is a widely used instrument for measuring subjective feelings of loneliness. The scale assesses three core dimensions of loneliness through corresponding items: relational connectedness ("How often do you feel that you lack companionship?"), social connectedness ("How often do you feel left out?"), and self-perceived isolation ("How often do you feel isolated from others?"). Participants respond using a 3-point scale ranging from "hardly ever" to "often." Total scores range from 3 to 9, with higher scores indicating greater loneliness. The scale demonstrates good psychometric properties in middle-aged and older adult populations.

The Patient Health Questionnaire-9 (PHQ-9) is a 9-item measure to assess depressive symptoms in the past 2 weeks (Kroenke et al., 2001). The scale items correspond to the 9 diagnostic criteria for major depressive disorder. Respondents rate the frequency of each symptom on a 4-point scale ranging from "not at all" to "nearly every day." Sample items include "Little interest or pleasure in doing things" and "Poor appetite or overeating." Total scores range from 0 to 27, with higher scores indicating more severe depressive symptoms. The PHQ-9 includes an additional functional impairment item that assesses how much the problems have affected the respondents' daily activities. The scale has shown strong psychometric properties across diverse populations. Among U.S. older adults, the PHQ-9 showed high sensitivity (88%) and specificity (80%) for identifying major depression, as well as the combination of major and minor depression (Phelan et al., 2010).

The Short Form Health Survey (SF-12) is a self-reported outcome measure to assess health-related quality of life. The raw answers from the 12 questions are processed to produce two main, standardized summary scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). We only used the MCS factor in this study as the treatment is targeting mental health. The MCS computed score has a range from 17 to 64 in the analysis and was based on the linear combination of six computed, generated, iterated weights. A low Mental Component Summary (MCS) score indicates poorer self-perceived mental health and lower health-related quality of life.

The Interpersonal Needs Questionnaire (INQ; Van Orden et al., 2012) was used to evaluate thwarted belongingness and perceived burdensomeness through 15 items. An adapted version tailored specifically for older adults was used which includes 3-point Likert scale ranging from 1 (Not at all true for me) to 3 (Very true for me). The instrument includes 2 sets of characteristics: (1) the 9-item Thwarted Belongingness (e.g., "I feel disconnected from other people."); and (2) the 6-item Perceived Burdensomeness (e.g., "I think my death would be a relief to the people in my life."). Six questions from the Thwarted Belongingness subscale were reverse-coded when the overall score across questions was computed due to the nature of those questions. In particular, the total score on the INQ is calculated by summing the questions responses to all items and reversing the appropriate ones. As a result, greater scores on each subscale reflect higher levels of the respective construct being measured.

AIM: The Affect Intensity Measure is a 40-item, self-report questionnaire used in psychology to determine the characteristic strength or weakness with which an individual experiences both positive and negative emotions.4-item instrument measuring the acceptability of an intervention.

Item Scale: Each of the 4 items is rated on a 5-point Likert scale, typically ranging from 1 (Completely Disagree) to 5 (Completely Agree).

Calculation: The final score is the mean (average) of the four individual item scores.

Interpretation: Higher average scores indicate greater perceived acceptability of the intervention among the respondents.

IAM: The Intervention Appropriateness Measure (IAM) is a 4-item survey used in implementation science to assess the perceived suitability or relevance of a healthcare intervention or implementation strategy.

Item Scale: Each of the 4 items is rated on a 5-point Likert scale, typically ranging from 1 (Completely Disagree) to 5 (Completely Agree).

Average Item Rating: To find the average for a specific item, sum the scores from all respondents and divide by the total number of respondents.

Aggregate Score: To calculate the overall IAM score for an individual or group, take the mean (average) of the four items.

Interpretation: Higher average scores indicate that stakeholders perceive the intervention as more appropriate, fitting, or relevant to their specific setting or population.

FIM: The Functional Independence Measure (FIM) is a standardized assessment tool used primarily in rehabilitation to measure a patient's level of disability and the amount of assistance they require for daily activities.

Item Scale: Each of the 4 items is rated on a 5-point Likert scale, typically ranging from 1 (Completely Disagree) to 5 (Completely Agree).

Final Score: Sum the scores of all 4 items and divide by 4 to get the individual respondent's mean score.

Interpretation: Higher scores (closer to 5) indicate that the intervention is perceived as more feasible, "doable," or "possible". There are currently no established "cut-off" scores; results are typically compared across different time points or groups.

SUS: The system Usability Scale is a 10-item measure of digital intervention usability. Items are scored on a 5-item Likert scale (Strongly Disagree-Strongly Agree).

Convert these raw ratings into a "score contribution" for each item:

Odd-numbered items (1, 3, 5, 7, 9): Subtract 1 from the raw user response (i.e. X-1) Even-numbered items (2, 4, 6, 8, 10): Subtract the raw user response from 5 (i.e. 5-X) Result: Every item will now have a value between 0 and 4.

Aggregate Calculation: Sum the Scores: Add all 10 converted item scores together. This will result in a total between 0 and 40. Then multiply this sum by 2.5. This step scales the total from a 40-point maximum to a 100-point maximum.

Interpretation of Results: The final SUS score is a measure of perceived usability, not a percentage. Generally, the following benchmarks apply: Score < 51: Often considered "poor" or "unaccepta

The Household Food Security Survey Module (HFSSM) is the primary, validated survey tool used to measure the prevalence and severity of food insecurity in the United States and other countries like Canada.

The Household Food Security Survey Module (HFSSM) is scored by calculating a raw score based on the number of affirmative responses to its questions. This raw score is then used to classify households into specific food security categories.

0 affirmative responses = High Food Security 1-2 affirmative responses = Marginal Food Security 3-5 affirmative responses = Low Food Security 6-10 affirmative responses = Very Low Food Security

The 4-item Session Rating Scale is a therapeutic practice measure that treatment recipients complete after receiving treatment. This allows trained helpers to make real-time adjustments to improve treatment effectiveness and prevent dropout. Participants marked their responses on a Likert-Scale, ranging from 0 to 10, representing: (a) the quality of the therapeutic relationship, (b) agreement on goals and topics, (c) the relevance and fit of the treatment provider's approach, and (d) the overall effectiveness of the treatment dosage. The scores for each domain were summed to generate a total possible score of 40. A total score below 36 or a score below 9 on any single item is a potential indicator of concern, which should prompt the therapist to discuss the issue openly with the client and make necessary adjustments to the session's direction or approach.

The Consolidated Framework for Implementation Research (CFIR) Interview Guide Tool is an online, interactive resource that helps users build a customized semi-structured interview guide based on the five domains and associated constructs of the CFIR. This tool does not produce a single "score" like a standard survey. Instead, it is a qualitative tool used to identify determinants (barriers and facilitators) that are then rated using a specific valence and magnitude system.