Wellness: A Review of Theory and Measurement for Counselors

Adolescents' Interpretation of the Concept of Wellness: A Qualitative Study

Introduction: This study sought to explore and describe the interpretation which adolescents ascribe to the term wellness at a selected high school in the Western Cape Province of South Africa.

Methods: A qualitative research design was utilized. Nine focus-group discussions were conducted among 58 adolescents. Sample was selected purposefully and collected data was analyzed using open coding.

Results: Findings reflected adolescents’ interpretations of the term wellness in the realm of holistic well-being transcending the nonexistence of illness or sickness in the body. The interpretations given include: healthy living which embrace eating enough nutritious foods, exercising regularly and being actively involved in physical activities; practicing self-care habits such as personal hygiene and grooming; well-being of the mind (psychological, emotional); having a balanced personality and interpersonal processes; being focused and goal directed and spiritual well-being.

Conclusion: It is imperative to consider adolescents’ understandings of wellness when planning, designing, implementing and evaluating adolescent wellness programs.

Measuring Well-Being

Interest in the study of psychological health and well-being has increased significantly in recent decades. A variety of conceptualizations of psychological health have been proposed including hedonic and eudaimonic well-being, quality-of-life, and wellness approaches. Although instruments for measuring constructs associated with each of these approaches have been developed, there has been no comprehensive review of well-being measures. The present literature review was undertaken to identify self-report instruments measuring well-being or closely related constructs (i.e., quality of life and wellness) and critically evaluate them with regard to their conceptual basis and psychometric properties. Through a literature search, we identified 42 instruments that varied significantly in length, psychometric properties, and their conceptualization and operationalization of well-being. Results suggest that there is considerable disagreement regarding how to properly understand and measure well-being. Research and clinical implications are discussed.

Technology-Based Innovations to Foster Personalized Healthy Lifestyles and Well-Being: A Targeted Review

BACKGROUND

New community-based arrangements and novel technologies can empower individuals to be active participants in their health maintenance, enabling people to control and self-regulate their health and wellness and make better health- and lifestyle-related decisions. Mobile sensing technology and health systems responsive to individual profiles combined with cloud computing can expand innovation for new types of interoperable services that are consumer-oriented and community-based. This could fuel a paradigm shift in the way health care can be, or should be, provided and received, while lessening the burden on exhausted health and social care systems.

OBJECTIVE

Our goal is to identify and discuss the main scientific and engineering challenges that need to be successfully addressed in delivering state-of-the-art, ubiquitous eHealth and mHealth services, including citizen-centered wellness management services, and reposition their role and potential within a broader context of diverse sociotechnical drivers, agents, and stakeholders.

METHODS

We review the state-of-the-art relevant to the development and implementation of eHealth and mHealth services in critical domains. We identify and discuss scientific, engineering, and implementation-related challenges that need to be overcome to move research, development, and the market forward.

RESULTS

Several important advances have been identified in the fields of systems for personalized health monitoring, such as smartphone platforms and intelligent ubiquitous services. Sensors embedded in smartphones and clothes are making the unobtrusive recognition of physical activity, behavior, and lifestyle possible, and thus the deployment of platforms for health assistance and citizen empowerment. Similarly, significant advances are observed in the domain of infrastructure supporting services. Still, many technical problems remain to be solved, combined with no less challenging issues related to security, privacy, trust, and organizational dynamics.

CONCLUSIONS

Delivering innovative ubiquitous eHealth and mHealth services, including citizen-centered wellness and lifestyle management services, goes well beyond the development of technical solutions. For the large-scale information and communication technology-supported adoption of healthier lifestyles to take place, crucial innovations are needed in the process of making and deploying usable empowering end-user services that are trusted and user-acceptable. Such innovations require multidomain, multilevel, transdisciplinary work, grounded in theory but driven by citizens' and health care professionals' needs, expectations, and capabilities and matched by business ability to bring innovation to the market.

[Development of a Wellness Index for Workers]

PURPOSE

The purpose of this study was to develop a wellness index for workers (WIW) and examine the validity and reliability of the WIW for assessing workers' wellness.

METHODS

The developmental process for the instrument included construction of a conceptual framework based on a wellness model, generation of initial items, verification of content validity, preliminary study, extraction of final items, and psychometric testing. Content validity was verified by 4 experts from occupational health nursing and wellness disciplines. The construct validity, convergent validity and discriminant validity were examined with confirmatory factor analysis. The reliability was examined with Cronbach's alpha. The participants were 494 workers from two workplaces.

RESULTS

Eighteen items were selected for the final scale, and the results of the confirmatory factor analysis supported a five-factor model of wellness with acceptable model fit, and factors named as physical · emotional · social · intellectual · occupational wellness. The convergent and discriminant validity were also supported. The Cronbach's alpha coefficient was .91.

CONCLUSION

The results indicate that the WIW is a valid and reliable instrument to comprehensively assess workers' wellness, and to provide basic directions for developing workplace wellness program.

Promoting Health and Wellness: Implications for Physical Therapist Practice

The leading cause of morbidity and mortality in the United States is chronic, or noncommunicable, diseases. The impact of chronic diseases on health and wellness can be significantly altered by individual health and behavior choices or modifications. Furthermore, the burden of chronic disease goes beyond health and the health care system and may influence an individual's wellness. The purposes of this article are: (1) to provide a basis for understanding the terms "health" and "wellness," (2) to identify the knowledge and skills physical therapists need to address behaviors that promote health and wellness and treat and protect against chronic disease, and (3) to discuss barriers and opportunities associated with integrating the promotion of health and wellness into physical therapist practice.

Establishing the Psychometric Properties of the Comprehensive Ethos Towards Wellness Questionnaire in a Norwegian Population

AIM

to replicate and establish the psychometric properties of the 74-item comprehensive Ethos Towards Wellness Questionnaire in a healthy Norwegian population in terms of content and construct validity as well as homogeneity and stability reliability.

METHOD

A questionnaire with a methodological and developmental design was sent on two occasions to 214 healthy middle-aged participants and processed in two phases.

RESULTS

The three life context and the ethos indexes at ordinal scale level showed an overall satisfactory construct validity (communalities > 0.30, factor loadings > 0.30, and factor total variance > 50%). On two occasions 4 weeks apart, reliability in terms of homogeneity (Cronbach's α > .70) and stability (intraclass correlation coefficient > 0.70) were also considered satisfactory for the same four indexes.

CONCLUSIONS

This newly developed and possibly only questionnaire that focuses on "grasping the big human picture," based on both philosophical reasoning and empirical recommendations of wellness, was found to be valid and reliable in the screening and follow-up of wellness and ethos in a healthy Norwegian population.

Structural Validation of the Holistic Wellness Assessment

The Holistic Wellness Assessment (HWA) is a relatively new assessment instrument based on an emergent transdisciplinary model of wellness. This study validated the factor structure identified via exploratory factor analysis (EFA), assessed test–retest reliability, and investigated concurrent validity of the HWA in three separate samples. The hypothesized eight-factor structure was validated via confirmatory factor analysis (CFA), individually for each factor and overall in a multifactor analysis. Test–retest reliability estimates over a 1- to 3-week interval were appropriate for this assessment type. Concurrent validity estimates indicated that the HWA measures were similar, but not redundant, to wellness constructs found in other wellness instruments, specifically the TestWell® and Wellness Evaluation of Lifestyle, Version S (WEL-S). As young adults are exposed to a broader base of wellness in educational and related contexts, the use of the wellness assessments such as the HWA can identify areas of personal need for balance and healthy choice making.

Consumption of organic and functional food. A matter of well-being and health?

Health is an important motivation for the consumption of both organic and functional foods. The aim of this study was to clarify to what extent the consumption of organic and functional foods are characterized by a healthier lifestyle and a higher level of well-being. Moreover, the influence of social desirability on the respondents' response behavior was of interest and was also analyzed. Well-being and health was measured in a sample of 555 German consumers at two levels: the cognitive-emotional and the behavioral level. The results show that although health is an important aspect for both functional food and organic food consumption, these two forms of consumption were influenced by different understandings of health: organic food consumption is influenced by an overall holistic healthy lifestyle including a healthy diet and sport, while functional food consumption is characterized by small "adjustments" to lifestyle to enhance health and to increase psychological well-being. An overlap between the consumption of organic and functional food was also observed. This study provides information which enables a better characterization of the consumption of functional food and organic food in terms of well-being and health.

Adult total wellness: group differences based on sitting time and physical activity level

Background

An increasing body of evidence associates a high level of sitting time with poor health outcomes. The benefits of moderate to vigorous-intensity physical activities to various aspects of health are now well documented; however, individuals may engage in moderate-intensity physical activity for at least 30 minutes on five or more days of the week and still exhibit a high level of sitting time. This purpose of this study was to examine differences in total wellness among adults relative to high/low levels of sitting time combined with insufficient/sufficient physical activity (PA). The construct of total wellness incorporates a holistic approach to the body, mind and spirit components of life, an approach which may be more encompassing than some definitions of health.

Methods

Data were obtained from 226 adult respondents (27 ± 6 years), including 116 (51%) males and 110 (49%) females. Total PA and total sitting time were assessed with the International Physical Activity Questionnaire (IPAQ) (short-version). The Wellness Evaluation of Lifestyle Inventory was used to assess total wellness. An analysis of covariance (ANCOVA) was utilised to assess the effects of the sitting time/physical activity group on total wellness. A covariate was included to partial out the effects of age, sex and work status (student or employed). Cross-tabulations were used to show associations between the IPAQ derived high/low levels of sitting time with insufficient/sufficient PA and the three total wellness groups (i.e. high level of wellness, moderate wellness and wellness development needed).

Results

The majority of the participants were located in the high total sitting time and sufficient PA group. There were statistical differences among the IPAQ groups for total wellness [F (2,220) = 32.5 (p <0.001)]. A Chi-square test revealed a significant difference in the distribution of the IPAQ categories within the classification of wellness [χ² (N = 226) = 54.5, p < .001]. One-hundred percent (100%) of participants who self-rated as high total sitting time/insufficient PA were found in the wellness development needed group. In contrast, 72% of participants who were located in the low total sitting time/sufficient PA group were situated in the moderate wellness group.

Conclusion

Many participants who meet the physical activity guidelines, in this sample, sit for longer periods of time than the median Australian sitting time. An understanding of the effects of the enhanced PA and reduced sitting time on total wellness can add to the development of public health initiatives.

Creating a culture of wellness: conversations, curriculum, concrete resources, and control

Burnout and depression across the career life cycle of healthcare providers are increasing at alarming rates. We need to devote our resources and efforts to bolster the next generation of healthcare providers who have the capacity for resiliency and well-being--the antidote to burnout and depression. A handful of organizations have implemented general wellness programs to combat burnout but there are surprisingly few documented, well-researched interventions to build resiliency. Wellness provides an alternative framework to approach the epidemic rates of burnout and depersonalization within the healthcare profession. In this article we describe our rationale for developing a culture of wellness among primary care physicians along with the specific activities and initiatives for creating a culture of wellness throughout medical educational training. Examples of the four core components of a residency wellness program-concrete resources, positive conversations, curriculum, and control-are described with regard to our Family Medicine Residency. A brief description of early efforts to empirically examine the impact of the wellness initiative across systemwide residency programs (Family Medicine and other programs) is described.

The prediction of subjective wellness among the old-old: implications for the "fourth-age" conception

OBJECTIVES

As the "fourth-age" conception suggests that the adaptability of psychosocial capabilities is disrupted at old-old age due to failures in maintaining balanced functions, this study examines the predictability of subjective wellness outcomes by factual dysfunction markers of health among old-old people across 12 years.

METHOD

Participants were self-respondents in a 3-wave survey that sampled the older (age 75-94) Jewish population in Israel. Wave 1 (N = 1,369, mean age = 83.5) preceded Wave 2 (N = 687, mean age = 85.4) by 4 years and Wave 3 (N = 164, mean age = 91.6) by 12 years.

RESULTS

The dysfunction markers (comorbidity, medication consumption, doctor's visits, and difficulties in activities of daily living [ADL]) predicted subjective wellness by relating to an increase in depressive symptoms, as well as to a decrease in life evaluation and self-rated health, beyond adjustment for sociodemographics. However, in most cases, an interaction finding indicated that dysfunction markers were weaker predictors of age-related change in subjective wellness among older participants.

DISCUSSION

At old-old age, the results point to reduced predictability of subjective wellness by factual dysfunction. This finding supports the fourth-age model. Still, researchers should consider an alternative interpretation, by which increasing independence between factual and subjective indicators is protective, rather than debilitating, among old-old people.

Holistic Wellness Assessment for Young Adults

Purpose: The purpose of this study was to develop the Holistic Wellness Assessment (HWA) that incorporates conventional dimensions of wellness with a new dimension of wellness influencing young adults: financial wellness that is psychometrically sound and developmentally appropriate. Design of the study: The study design to establish the initial psychometrics of the HWA was the single-group design. The cross-sectional nature of this design allowed for the postclassification of the participants into different demographic groups facilitating comparisons of the instrument’s derived subscales. Method: From 5,075 university students, 2,090 participants completed an online 285-item HWA and 2,086 respondents provided demographic information. Results: Exploratory factor analysis of the HWA revealed eight dimensions: Self-Regard, Self-Awareness and Responsibility, Sustainability, Relational, Risk Prevention, Spirituality, Physical Health, and Health Care Maintenance. Findings: Four of the eight factors were consistent with existing models of wellness. Three new dimensions of wellness— Self-Regard, Self-Awareness and Responsibility, and Sustainability—emerged from the comprehensive item set that included financial wellness and will set the stage for the development and expansion of wellness models and theories. Conclusion: Initial psychometric analysis suggests that this instrument may prove useful in the young adult population for measuring wellness awareness curriculum and behavior change outcomes.

Wellness in older adults: a concept analysis

PURPOSE

The purpose of this analysis is to examine the concept of wellness within the context of older adulthood. Identifying characteristics of wellness will clarify and develop conceptual strengths and limitations, providing a step toward evaluating its relevance in older adults and increasing utility in geriatric nursing.

ORGANIZING FRAMEWORK

Rodger's evolutionary perspective.

METHODS

Computer and manual searches were conducted of articles in the English language from 1950 to 2010, addressing wellness across the life span or among older adult populations. An inductive analysis of articles produced descriptive themes.

FINDINGS

A historical time line traced the evolution of the wellness concept and its operationalization. Wellness has evolved from a little used concept to one commonly applied across many industries. Antecedents, attributes, and consequences of wellness are described. Concepts related to wellness are also identified.

CONCLUSIONS

This concept analysis adds clarity to wellness in older adults. The state of wellness development as a concept in geriatric nursing is moving from conceptualization to use and testing in nursing theory and interventions. Increased knowledge of wellness will enable geriatric nurses to discover the strengths of older adults thereby promoting their ongoing growth and development while simultaneously guiding care for their changing and diverse health.

Benefits and mechanisms of recovery among peer providers with psychiatric illnesses

Providing peer support to individuals with psychiatric disabilities has emerged as a promising modality of mental health services. These services are delivered by individuals who experience mental illnesses themselves. The purpose of this study was to explore how working as a peer provider can enhance personal recovery. The study was conducted with 31 peer providers employed in a variety of mental health agencies. Data were collected through face-to-face semistructured interviews and analyzed using a grounded theory approach. Qualitative analysis revealed a wide range of recovery benefits for the peer providers. The benefits span across five wellness domains: foundational, emotional, spiritual, social, and occupational. In addition, analysis revealed five role-related and five work-environment-related mechanisms of beneficial impact. The role of sharing one's personal story is highlighted as contributing to positively reauthoring one's self-narrative. Implications for peer training, job development, and workplace supports are discussed.