Assessing mental well-being in a Sinhala speaking Sri Lankan population: validation of the WHO-5 well-being index

B P R Perera,A Caldera,R Jayasuriya,A R Wickremasinghe

doi:10.1186/s12955-020-01532-8

B P R Perera, A Caldera + Show 2 more

Open Access

https://doi.org/10.1186/s12955-020-01532-8

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Abstract

PurposeThe WHO-5 well-being index is a widely used, short rating scale that measures subjective well-being. We translated the WHO-5 index into Sinhala and tested its psychometric properties including measurement invariance among diverse groups in a community sample in Sri Lanka.MethodsThe sample of 267 persons aged between 16 and 75 years was recruited from a semi-urban area. 219 completed a paper-based questionnaire and 48 responded to an online survey. Construct validity was tested for factorial validity (Confirmatory Factor Analysis -CFA), convergent validity and known group validity. Composite reliability for congeneric measures and test-retest reliability were also tested. Multi-group CFA (MG-CFA) was used to test measurement invariance.ResultsThe translated Sinhala version demonstrated good content and face validity. Internal consistency reliability of the five items had a Cronbach’s alpha of 0.85 and test-retest reliability over 2 weeks was satisfactory (Pearson r = 0.72, p < 0.001, ICC = 0.82). Confirmatory factor analysis supported factorial validity with a {chi}_5^2 =4.99 (p = 0.28), a RMSEA of 0.03 (90% C.I. =0.00–0.10), a SRMR of 0.02, a TLI of 0.99 and a CFI of 0.99; factor loadings were between 0.55 and 0.89. Measurement invariance was acceptable for configural, metric and scalar invariance for gender.WHO-5 scores were significantly negatively correlated with the Patient Health Questionnaire (PHQ-9) (Pearson’s r = − 0.45, p < 0.001) scores and the Kessler Psychological Distress Scale (K10) scores (Pearson’s r = − 0.56, p < 0.001).ConclusionThe Sinhala translation of WHO-5 well-being index has shown acceptable psychometric properties and can be used for assessing mental well-being in the community in Sri Lanka. Further testing of the measure with larger and diverse (including different ethnic/cultural) groups are indicated to test measurement invariance of the measure.

Highlights

The World Health Organization-5 (WHO-5) well-being index was developed in response to the need of an instrument to measure subjective well-being which reflects a single dimension with high clinical face validity [1]
Participants and recruitment A community sample was recruited by contacting households in a sub-division of a district demarcated for population health services, called a Medical Officer of Health (MOH) area, in a semi-urban setting in the western province of Sri Lanka
In the final sample of 267 participants, the mean age was 34.1 years (SD 13.5 years; range 17 to 73 years), 72% were females and 96% were Sinhalese (4% were Tamils and Muslims who were conversant in Sinhala)

Summary

Introduction

The World Health Organization-5 (WHO-5) well-being index was developed in response to the need of an instrument to measure subjective well-being which reflects a single dimension with high clinical face validity [1]. WHO-5 was derived from WHO-10 which has its origin from a 28-item rating scale that was used in a multi-centre study in eight European countries [2]. The validity of the WHO-5 has been tested in different countries and settings, but predominantly in high income settings in the west and Japan [4,5,6,7,8,9,10,11,12,13,14] as a robust outcome measure of well-being [4, 6, 8, 9, 15, 16]. The aim of this study was to assess the psychometric properties of a translation of the WHO-5 well-being index into Sinhala in Sri Lanka, a South Asian country

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