Neurocognition, ecological validity, and daily living in the community for individuals with schizophrenia: a mixed methods study.

The ecological validity of neurocognitive measures concerns translating laboratory-based neuropsychological (NP) findings into relevant predictions about how people will perform in varied real world settings. There have been no studies of the ecological validity of psychosocial or neurocognitive measures in schizophrenia that incorporated direct observation of naturally occurring community behavior. The research questions for this mixed method study were: (1) Are there differences in the daily community functioning of persons with schizophrenia who have high or low cognitive functioning as determined by lab-based assessments? and (2) Can ethnographic methods be used to create descriptions of functioning that are useful for assessing ecological validity? Ten individuals from a larger longitudinal study were randomly selected from two strata that reflected low or high neurocognitive functioning. Individuals completed quantitative measures of psychosocial functioning and were also observed ethnographically for three days by an observer who was blind to their neurocognitive status. A new method developed in this study for characterizing the predominant behavioral living strategies of individuals with schizophrenia found notable differences between high and low NP groups in their community functioning. This study found evidence to support the ecological validity of NP measures and yielded an ethnographically based observational protocol to reliably characterize the predominant individual daily behavioral strategies.