Translation and Validation of the Malay Version of the WHO-5 Well-Being Index: Reliability and Validity Evidence from a Sample of Type 2 Diabetes Mellitus Patients

A scoping review of well-being measures: conceptualisation and scales for overall well-being

This study aims to identify the conceptualisation of overall well-being used for well-being assessment through a review of the characteristics and key components and/or dimensions of well-being scales as presented in current literature. Scopus and Web of Science were searched, and thematic analysis was conducted inductively to analyse the identified components within scales, as well as the types of well-being these scales measure. 107 peer-reviewed articles from 2003 to 2022 were included, and 69 well-being scales were identified covering nine areas of well-being. Four final themes were identified as the foundational dimensions of overall well-being: hedonic; eudaimonic; physical health; and generic happiness. Notably, these 69 scales are mainly validated and adopted in the Western context. '4 + N' frameworks of overall well-being are recommended for assessing overall well-being. This review provides researchers with a synthesis of what types of well-being have been measured and which measures have been used to assess these types of well-being for which research participants. Non-Western-based well-being research is called for that incorporates a broader range of research participants and cultural contexts in contributing to a more inclusive understanding of well-being.

Assessing the psychometric properties of the World Health Organization -five well-being index (WHO-5) in Filipino samples amid the COVID-19 pandemic

BACKGROUND

The WHO-5 well-being index is a brief rating scale extensively used to evaluate well-being symptoms. Despite the increasing number of studies validating this instrument across different samples from different countries, its psychometric properties remain unexplored in the Philippine context. Bridging this gap, the present study assessed the psychometric properties of the WHO-5 in Filipinos amid the pandemic.

METHODS

In study one, exploratory structural equation modeling (ESEM) was conducted using a sample of Filipinos (N = 2,521) from the general population and a unidimensional model of well-being was extracted. In study two, confirmatory factor analysis (CFA) was employed to examine the one-factor model in 1,289 Filipino government workers. In study three, nomological validity was examined by performing a mediation analysis using 407 Filipino left-behind emerging adult children with dysfunctionality as mediator, pandemic-related adversities as independent variable, and well-being as the dependent variable.

RESULTS

The results of ESEM and CFA provided support for the WHO-5 one-factor model. Moreover, the negative relationship of well-being to anxiety, depression, and distress lend evidence to the scale's criterion validity. The results of the mediation analysis performed in study three implied that those who experienced pandemic-related adversities tended to have greater dysfunctionality, and in turn, had lower levels of well-being.

CONCLUSIONS

Overall, the findings suggest that the WHO-5 well-being index is a psychometrically sound tool for measuring Filipinos' well-being.

An intervention to determine the effectiveness of the Sanubari optimal health program (OHP) in improving mental well-being among junior doctors in Malaysia: a quasi-experimental study

BACKGROUND

Mental health problems among junior doctors in Malaysia pose a significant concern, as they not only adversely affect their overall well-being but also impact the quality of health services they provide. Therefore, it is important to implement interventions aimed at preserving their mental health. This study aimed to evaluate the effectiveness of the Sanubari Optimal Health Program (OHP) intervention in enhancing the mental well-being of junior doctors in Malaysia.

METHODS

The study utilised a quasi-experimental design involving 204 junior doctors who participated in the intervention. The Sanubari OHP Intervention Package was employed alongside self-administered questionnaires for mental health and well-being assessment. To evaluate the effects over time, repeated measures ANOVA was employed to analyse within-group and between-group changes in various endpoints, as measured at different assessment time points.

RESULTS

The study revealed that self-efficacy and adaptive coping behaviours scores increased over time among the intervention group and decreased among the control group. Yet, depression and anxiety scores decreased significantly over time among the intervention group but not in the control group. No significant differences were observed in well-being and maladaptive coping strategies among the groups.

CONCLUSIONS

This study showed promising results regarding the effectiveness of Sanubari OHP in improving mental well-being among junior doctors.

Measurement Properties and Optimal Cutoff Point of the WHO-5 Among Chinese Healthcare Students

Purpose

The World Health Organization-Five Well-Being Index (WHO-5) is widely used to assess subjective well-being. Nevertheless, measurement invariance and optimal cutoff point of the WHO-5 have not been examined in Chinese samples. We aimed to assess measurement properties of the Chinese version of the WHO-5 (WHO-5-C) among healthcare students.

Patients and Methods

A two-wave longitudinal assessment was conducted among 343 Chinese healthcare students from September to November 2022. Measurement properties of the WHO-5-C were assessed through structural validity using confirmatory factor analysis (CFA), measurement invariance using multigroup CFA (MGCFA) and longitudinal CFA (LCFA), convergent validity using correlation analysis with the Self-Rated Health Questionnaire (SRHQ) and Patient Health Questionnaire-4 (PHQ-4), reliability using internal consistency and test-retest reliability, and optimal cutoff point using receiver operating characteristic (ROC) analysis.

Results

The WHO-5-C demonstrated satisfactory structural validity with comparative fit index (CFI) of 0.968 at baseline and 0.980 at follow-up, and adequate measurement invariance in different sociodemographic variables at baseline (gender, age, major, home location, being only child, monthly household income, part-time job, physical exercise, hobby, frequency of visiting home, and stress coping strategy) (CFI changes [ΔCFI] = -0.009-0.003) and over a week (ΔCFI = -0.006-0.000). The WHO-5-C also had good internal consistency (Cronbach's α = 0.907-0.934; McDonald's ω = 0.908-0.935) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.803). Convergent validity was supported by moderate correlations of the WHO-5-C with the SRHQ and PHQ-4. The optimal cutoff point of the WHO-5-C was found to be 50, with an area under the ROC curve of 0.882 at baseline data, with sensitivity of 0.803 and specificity of 0.762 at follow-up.

Conclusion

The WHO-5-C demonstrated adequate measurement properties, especially concerning cross-sectional and longitudinal measurement invariance, with a recommended optimal cutoff point of ≥ 50 for assessing adequate level of psychological well-being in healthcare students.

Validation of Chinese version of the 5-item WHO well-being index in type 2 diabetes mellitus patients

BACKGROUND

For better disease management and improved prognosis, early identification of co-morbid depression in diabetic patients is warranted. the WHO-5 well-being index (WHO-5) has been used to screen for depression in diabetic patients, and its Chinese version (WHO-5-C) has been validated. However, its psychometric properties remain to be further validated in the type 2 diabetes patient population. The aim of our study was to examine the reliability and validity of the WHO-5-C in patients with type 2 diabetes mellitus.

METHODS

The cross-sectional study was conducted on 200 patients from July 2014 to March 2015. All patients should complete the WHO-5-C, the Patient Health Questionnaire-9 (PHQ-9), the 20-item Problem Areas in Diabetes Scale (PAID-20), the Mini International Neuropsychiatric Interview (M.I.N.I), and Hamilton Rating Scale for Depression (HAM-D). Internal consistency of WHO-5 was revealed by Cronbach's alpha, and constructive validity by confirmatory factor analysis (CFA). Relationship with PHQ-9, HAM-D, and PAID-20 was examined for concurrent validity, and ROC analysis was performed for criterion validity.

RESULTS

The WHO-5-C presented satisfactory reliability (Cronbach's alpha = 0.88). CFA confirmed the unidimensional factor structure of WHO-5-C. The WHO-5-C had significant negative correlation with HAM-D (r = -0.610), PHQ-9 (r = -0.694) and PAID-20 (r = -0.466), confirming good concurrent validity. Using M.I.N.I as the gold standard, the cut-off value of WHO-5-C was 42, with a sensitivity of 0.83 and specificity of 0.75.

CONCLUSION

The WHO-5-C holds satisfactory reliability and validity that is suitable for depression screening in type 2 diabetes patients as a short and convenient instrument.

The 4-item family resilience scale: psychometric evaluation and measurement invariance of the malay version in adolescents and young adults

BACKGROUND

The original Family Resilience Scale (FRS) is a reliable tool to assess family resilience. However, the FRS is based on the United States and parental context. Thus, the usefulness of the FRS for the adolescent and young adult population in Asian countries, particularly Malaysia remains unknown. This study translated the FRS into the Malay language and validated it on Malaysian adolescents and young adults to identify its potential as a self-report tool to assess the resilience level of their family.

METHODS

A total of 351 participants (Mage = 19.75, SDage = 3.29) were recruited in the study using purposive sampling. Confirmatory factor analysis was conducted to examine the factorial structure of the Family Resilience Scale-Malay (FRS-Malay) and measurement invariance between adolescents and young adults. Then, the scale's reliability was investigated using Cronbach's alpha, McDonald's omega coefficients, and composite reliability index. Finally, we examined the discriminant validity of the FRS-Malay by correlating its score with individual resilience score and examined the incremental validity of the scale using hierarchical multiple regression analysis to test if family resilience can explain individual well-being levels beyond and above individual resilience.

RESULTS

The findings of the confirmatory factor analysis suggest that a single-factor model is supported for both age groups. Furthermore, the scale exhibited scalar invariance between adolescents and young adults. The scale also exhibited good reliability, as the value of Cronbach's alpha, McDonald omega coefficients, and composite reliability index were above 0.80. Additionally, the Pearson correlation analysis showed a positive correlation between the FRS-Malay and individual resilience scores, which supports the discriminant validity of the scale. Similarly, the incremental validity of the scale is also supported. Specifically, family resilience had a positive correlation with well-being, even after controlling for individual resilience in the regression analysis.

CONCLUSIONS

The FRS-Malay has demonstrated good reliability and validity. The scale measures the same construct of family resilience across adolescents and young adults, making it suitable for comparisons. Therefore, this unidimensional tool is appropriate for self-reporting their perceived level of family resilience. It is also useful for studying the development and fluctuation of family resilience in the Malaysian context.

The relationship between patient empowerment and related constructs, affective symptoms and quality of life in patients with type 2 diabetes: a systematic review and meta-analysis

Introduction

The aim of this systematic review is to assess the relationship between patient empowerment and other empowerment-related constructs, and affective symptoms and quality of life in patients with type 2 diabetes.

Methods

A systematic review of the literature was conducted, according to the PRISMA guidelines. Studies addressing adult patients with type 2 diabetes and reporting the association between empowerment-related constructs and subjective measures of anxiety, depression and distress, as well as self-reported quality of life were included. The following electronic databases were consulted from inception to July 2022: Medline, Embase, PsycINFO, and Cochrane Library. The methodological quality of the included studies was analyzed using validated tools adapted to each study design. Meta-analyses of correlations were performed using an inverse variance restricted maximum likelihood random-effects.

Results

The initial search yielded 2463 references and seventy-one studies were finally included. We found a weak-to-moderate inverse association between patient empowerment-related constructs and both anxiety (r = -0.22) and depression (r = -0.29). Moreover, empowerment-related constructs were moderately negatively correlated with distress (r = -0.31) and moderately positively correlated with general quality of life (r = 0.32). Small associations between empowerment-related constructs and both mental (r = 0.23) and physical quality of life (r = 0.13) were also reported.

Discussion

This evidence is mostly from cross-sectional studies. High-quality prospective studies are needed not only to better understand the role of patient empowerment but to assess causal associations. The results of the study highlight the importance of patient empowerment and other empowerment-related constructs such as self-efficacy or perceived control in diabetes care. Thus, they should be considered in the design, development and implementation of effective interventions and policies aimed at improving psychosocial outcomes in patients with type 2 diabetes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192429, identifier CRD42020192429.

Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the COVID-19 Pandemic: A Cross-Sectional Study in Three Countries

Nurses' well-being has been increasingly recognised due to the ongoing pandemic. However, no validation scales measuring nurses' well-being currently exist. Thus, we aimed to validate the WHO-5 Well-Being Index (WHO-5) in a sample of nurses. A cross-sectional multinational study was conducted, and a total of 678 nurses who worked during the COVID-19 pandemic in Spain (36.9%), Chile (40.0%) and Norway (23.1%) participated in this study. The nurses completed the WHO-5, the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2) and three questions about the quality of life (QoL). The WHO-5 demonstrated good reliability and validity in the three countries. Cronbach's alphas ranged from 0.81 to 0.90. High correlations were found between the WHO-5 and the psychological well-being dimension of QoL, and negative correlations between the WHO-5 and PHQ-2. The unidimensional scale structure was confirmed in all the countries, explaining more than 68% of the variance. The item response theory likelihood ratio model did not show discernible differences in the WHO-5 across the countries. To conclude, the WHO-5 is a psychometrically sound scale for measuring nurses' well-being during a pandemic. The scale showed strong construct validity for cross-cultural comparisons; however, more research is required with larger sample sizes.

Validation of the WHO-5 Well-Being Scale among Adolescents in Ghana: Evidence-Based Assessment of the Internal and External Structure of the Measure

The WHO-5 well-being measure happens to be one of the most renowned measures of subjective well-being across the globe. Although the instrument has been calibrated in different countries, its psychometric properties and applicability in Africa, especially in Ghana, are not known. In this study, the WHO-5 well-being scale was validated among adolescents in Ghana by assessing the validity evidence of the measure based on the internal and external structure. In particular, the study examined the (1) dimensionality of the WHO-5 well-being scale, (2) quality of the items (including the scale functioning) for the measure, and (3) criterion validity of the well-being measure. Using a survey approach, 997 adolescents were recruited in secondary schools across the northern belt of Ghana. The study found a one-factor structure of the scale, which supports the factor solution of the original measure. The items were found to be of high quality, except for one item. The WHO-5 well-being measure was found to have sufficient evidence regarding convergent and divergent validity. The outcome of this validation study provides support for the validity and reliability of the WHO-5 well-being scale's utility and use among adolescents in Ghana. The study encourages further validation studies to be conducted in Ghana to widen the reproducibility of the WHO-5 well-being measure.