DIALOG Scale for Mental Health Services
DIALOG Scale for Mental Health Services overview
Creator and Context
DIALOG is an 11 item patient reported measure of satisfaction with life and with treatment, designed to be completed inside the clinical appointment rather than around it.
It was developed by Stefan Priebe, Rosemarie McCabe and colleagues at Queen Mary University of London and East London NHS Foundation Trust, and introduced in a cluster randomised trial published in 2007.
As DIALOG+, the scale sits inside a structured, solution focused conversation, and it is that conversation which carries the evidence.
Presenting Conditions
DIALOG covers eleven domains in two groups.
Eight life domains, which together give a subjective quality of life score: mental health, physical health, job situation, accommodation, leisure activities, relationship with partner or family, friendships, and personal safety.
Three treatment aspects, which together give a treatment satisfaction score: medication, practical help, and meetings with professionals.
Administration
Administered within the clinical meeting, on a tablet, phone or paper. Each domain is rated from 1 (totally dissatisfied) to 7 (totally satisfied), with 4 as the neutral midpoint. After each rating, the person is asked whether they want more help in that area.
In DIALOG+, a maximum of three domains are then worked through using a four step approach: understanding, looking forward, exploring options and agreeing actions.
Desired Audience
Adults using mental health services. It was developed with people with psychosis and is now used across NHS mental health services more broadly.
DIALOG is unusual because it changes the appointment rather than sitting alongside it. The person says what they are dissatisfied with and where they want help, and the conversation is then structured around their answer. That is why the trial evidence shows better quality of life and fewer unmet needs, and it is why collecting the ratings without the conversation misses the point entirely.
Considerations
DIALOG is not an alliance measure. It measures satisfaction with life domains and with treatment. Grouping it with alliance instruments would be inaccurate.
The evidence base is for DIALOG+, the structured conversation. Passively collecting the eleven ratings does not reproduce the trial effect.
There is no clinical cut off beyond the neutral midpoint of 4.
The routine care benchmark data come from a single NHS trust and are not a general population norm.
How to score the DIALOG Scale for Mental Health Services
Conducting the assessment
The person rates each of the eleven domains from 1 to 7, and answers a yes or no question about whether they want more help in that area.
Interpretation
The mean of the eight life domains gives a subjective quality of life score. The mean of the three treatment aspects gives a treatment satisfaction score. Both sit on the 1 to 7 scale.
Scores below 4 reflect explicit dissatisfaction. Scores above 4 reflect explicit satisfaction. A score of 4 is the neutral midpoint.
Every individual item is meaningful in its own right, which is a deliberate design feature.
Clinical Considerations
Use it inside the appointment, not before it. The value is in the conversation it structures.
Let the person choose which domains to work on, even if they are not the lowest scoring ones.
Review the agreed actions at the start of the next appointment. Without that, it is just a satisfaction survey.
DIALOG Scale for Mental Health Services use cases
Structuring routine mental health appointments around what the person actually wants help with
Measuring subjective quality of life and treatment satisfaction together
Patient reported outcome and experience reporting for commissioners
Research in community mental health
Category
Feedback
Research Summary
Priebe, S., McCabe, R., Bullenkamp, J., et al. (2007). Structured patient clinician communication and 1 year outcome in community mental healthcare: Cluster randomised controlled trial. British Journal of Psychiatry, 191(5), 420 to 426.
Priebe, S., Kelley, L., Omer, S., et al. (2015). The effectiveness of a patient centred assessment with a solution focused approach (DIALOG+) for patients with psychosis. Psychotherapy and Psychosomatics, 84(5), 304 to 313.
Mosler, F., Priebe, S., & Bird, V. (2020). Routine measurement of satisfaction with life and treatment aspects in mental health patients: The DIALOG scale in East London. BMC Health Services Research, 20, 1020.
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