Validation of the 12 Item Short form Health Survey in a Sample from Region Central Jutland

In 2010 the Danish regions started a new program of public health surveillance in collaboration with the national and local health authorities using the short form health survey (SF-12) for measuring and reporting on health related quality of life among the Danish adult population. The instrument has not, however, been validated in a Danish setting. The aim of this study was to assess the reliability and validity of the physical component summary (PCS) and the mental component summary (MCS) score of the 12-item short form health survey (SF-12) in a sample from Central Denmark Region. A total of 26,397 persons above the age of 25 were included in the analyses. Reliability was assessed by Cronbach’s α. The validity was assessed using known-groups comparisons and convergent validity. The factor structure was investigated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s α showed high reliability with a score of 0.90 and 0.85 for PCS and MCS respectively. The SF-12 discriminated well with respect to gender, age, educational status and long term illness. Individual items correlated higher with own hypothesized scales than with other scales and summary measures corroborating the convergent validity. The EFA gave a two-factor structure. Irrespective of the chosen rotation method (varimax and oblimin) the items related to PCS loaded on one factor and the items related to MCS loaded on another factor. The factor structure was validated with acceptable model-fit values in CFA. The SF-12 instrument is a reliable and valid measure of health related quality of life among the population of Central Denmark Region.     

Dimensions of mental health: Life satisfaction,positive affect,anxiety and depression

Psychological well-being and psychological distress are often regarded as distinct, if not orthogonal dimensions of mental health. Based on analyses in this paper, we consider the distinction misleading. Four dimensions seem worth measuring in general population surveys: life satisfaction, positive affect, anxiety and depression. Furthermore, one of the well-being dimensions, life satisfaction, is quite strongly correlated with a distress dimension, depression. A person is unlikely to be both satisfied with life and depressed, but may be satisfied and anxious. The paper is based on convergent validity (exploratory and confirmatory factor analyses) and divergent validity assessments of a range of widely used measures, which were included in the Victorian Quality of Life Panel Survey, 1987.     

Measuring Social Isolation in Older Adults: Development and Initial Validation of the Friendship Scale

Although there are many excellent published scales measuring social isolation, there is need for a short, user-friendly, stand alone scale measuring felt social isolation with good psychometric properties. This study reports the development and preliminary validation of a short, user-friendly scale, the Friendship Scale. The six items measure six of the seven important dimensions that contribute to social isolation and its opposite, social connection. The psychometric properties suggest that it has excellent internal structures as assessed by structural equation modelling (CFI = 0.99, RMSEA = 0.02), that it possesses reliability (Cronbach α = 0.83) and discrimination when assessed against two other short social relationship scales. Tests of concurrent discriminant validity suggest it is sensitive to the known correlates of social isolation. Although further work is needed to validate it in other populations, the results of this study suggest researchers may find the Friendship Scale particularly useful in epidemiology, population surveys or in health-related quality of life evaluation studies where a parsimonious measure of felt social support or social isolation is needed.     

Assessing subjective well-being: Progress and opportunities

Subjective well-being (SWB) comprises people's longer-term levels of pleasant affect, lack of unpleasant affect, and life satisfaction. It displays moderately high levels of cross-situational consistency and temporal stability. Self-report measures of SWB show adequate validity, reliability, factor invariance, and sensitivity to change. Despite the success of the measures to date, more sophisticated approaches to defining and measuring SWB are now possible. Affect includes facial, physiological, motivational, behavioral, and cognitive components. Self-reports assess primarily the cognitive component of affect, and thus are unlikely to yield a complete picture of respondents' emotional lives. For example, denial may influence self-reports of SWB more than other components. Additionally, emotions are responses which vary on a number of dimensions such as intensity, suggesting that mean levels of affect as captured by existing measures do not give a complete account of SWB. Advances in cognitive psychology indicate that differences in memory retrieval, mood as information, and scaling processes can influence self-reports of SWB. Finally, theories of communication alert us to the types of information that are likely to be given in self-reports of SWB. These advances from psychology suggest that a multimethod approach to assessing SWB will create a more comprehensive depiction of the phenomenon. Not only will a multifaceted test battery yield more credible data, but inconsistencies between various measurement methods and between the various components of well-being will both help us better understand SWB indictors and group differences in well-being. Knowledge of cognition, personality, and emotion will also aid in the development of sophisticated theoretical definitions of subjective well-being. For example, life satisfaction is theorized to be a judgment that respondents construct based on currently salient information. Finally, it is concluded that measuring negative reactions such as depression or anxiety give an incomplete picture of people's well-being, and that it is imperative to measure life satisfaction and positive emotions as well.     

Flourishing Across Europe: Application of a New Conceptual Framework for Defining Well-Being

Governments around the world are recognising the importance of measuring subjective well-being as an indicator of progress. But how should well-being be measured? A conceptual framework is offered which equates high well-being with positive mental health. Well-being is seen as lying at the opposite end of a spectrum to the common mental disorders (depression, anxiety). By examining internationally agreed criteria for depression and anxiety (DSM and ICD classifications), and defining the opposite of each symptom, we identify ten features of positive well-being. These combine feeling and functioning, i.e. hedonic and eudaimonic aspects of well-being: competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self esteem, and vitality. An operational definition of flourishing is developed, based on psychometric analysis of indicators of these ten features, using data from a representative sample of 43,000 Europeans. Application of this definition to respondents from the 23 countries which participated in the European Social Survey (Round 3) reveals a four-fold difference in flourishing rate, from 41% in Denmark to less than 10% in Slovakia, Russia and Portugal. There are also striking differences in country profiles across the 10 features. These profiles offer fresh insight into cultural differences in well-being, and indicate which features may provide the most promising targets for policies to improve well-being. Comparison with a life satisfaction measure shows that valuable information would be lost if well-being was measured by life satisfaction. Taken together, our findings reinforce the need to measure subjective well-being as a multi-dimensional construct in future surveys.     

An Index of Child Well-being in the European Union

While the living conditions of children and young people in the European Union have gained increasing recognition across the EU, the well-being of children is not monitored on the European level. Based on a rights-based, multi-dimensional understanding of child well-being we analyse data already available for the EU 25, using series data as well as comparative surveys of children and young people. We compare the performance of EU Member States on eight clusters with 23 domains and 51 indicators and give a picture of children’s overall well-being in the European Union. The clusters are children’s material situation, housing, health, subjective well-being, education, children’s relationships, civic participation and risk and safety.     

Child Well-Being in Advanced Economies in the Late 2000s

This paper aimed at comparing the well-being of children across the most economically advanced countries of the world while discussing the methodological issues involved in comparing children’s well-being across countries. A Child Well-being Index was constructed to rank countries according to their performance in advancing child well-being. The Index used 30 indicators combined into 13 components, again summarised in 5 dimensions for 29 rich countries. Data from various sources were combined to capture aspects of child well-being: material well-being, health, education, behaviour and risks, housing and environment. The scores for the countries on all variables and combinations of variables were discussed in detail. The Child Well-being Index revealed that the Netherlands and the Scandinavian countries (excluding Denmark) did relatively better than the other countries while Romania and the United States performed well below the average. Overall, serious differences existed in child well-being across countries suggesting that in many, improvement could be made in the quality of children’s lives.     

Do Household Heads Speak for the Household? A Research Note

Many recent household surveys include questions about respondents’ subjective well-being. Nearly all of them, however, pose these questions only to the household head. This paper addresses an issue with practical and methodological concerns. Can survey designers ask only household heads and expect them to accurately represent the living conditions of the entire household? Using South Africa’s 1998 October Household Survey (OHS) to estimate econometric models of subjective well-being, this paper finds that the response of household heads is determined largely by factors shared by the entire household – housing, for example – and not on those experienced primarily by the head – individual health status, for example. This suggests that South African household heads are truly reporting household well-being, rather than their individual level of satisfaction. While this result probably cannot be widely generalized, the testing methodology is replicable and could be applied to similarly structured data sets.     

Development and Validation of the Middle Years Development Instrument (MDI): Assessing Children’s Well-Being and Assets across Multiple Contexts

Few instruments provide reliable and valid data on child well-being and contextual assets during middle childhood, using children as informants. The authors developed a population-level, self-report measure of school-aged children’s well-being and assets—the Middle Years Development Instrument (MDI)—and examined its reliability and validity. The MDI was designed to assess child well-being inside and outside of school on five dimensions: (1) Social and emotional development, (2) Connectedness to peers and to adults at school, at home, and in the neighborhood, (3) School experiences, (4) Physical health and well-being, and (5) Constructive use of time after school. This paper describes the theoretical framework, selection of items and scales for the survey, and four studies that were conducted to revise the MDI and examine its psychometric properties. The findings indicate a theoretically predicted factor structure, high internal consistency, and document the convergent and discriminant validity of the MDI scales. The discussion delineates a plan for future validation studies that address further validity questions, such as predictive validity, measurement invariance, and fairness/bias, and provides a brief outlook of how the MDI may be used by practitioners, educators, and decision makers in schools and communities to motivate and inform action in support children’s well-being.     

Subjective Well-being in a Multicultural Urban Population: Structural, and Multivariate Analyses of the Ontario Health Survey Well-being Scale

The validity of a scale, from the OntarioHealth Survey, measuring the subjective senseof well-being, for a large multiculturalpopulation in Metropolitan Toronto, is examinedthrough principal components analysis withoblique rotation. Four factors are extracted. Factor 1, is a stress and strain factor, andconsists of health worries, feeling exhaustedand worn out, and feeling tense. Factor 2,interpreted as a sense of control, consists ofno health worries, and ability to handlefeelings. Factor 3, interpreted as positiveaffect, consists of having an interesting life,feeling cheerful and light-hearted, feelingloved, feeling relaxed and full of vitality. Factor 4 is interpreted as a despondency factorconsists of feeling lonely, having a boringlife, inability to control feelings and feelinglow. The statistic of multiple discriminantanalysis between the variables, sex, age, andethnic groupings, as independent discriminatingvariables and the four factor scores asdependent variables, is calculated. Theresults show that the observed mean variance inthe well-being factor scores cannot beexplained by the respondents being eitherfemale or male, or being a certain age or bybelonging to specific cultural groupings. These results are discussed in relation toother studies on the dimensions of subjectivewell-being.     

The Dual-Factor Model of Mental Health: A Short-Term Longitudinal Study of School-Related Outcomes

The Dual-Factor Model of Mental Health, proposed by Greenspoon and Sasklofske (Soc Indic Res 54:81–108, 2001), suggested that student mental health should be assessed on a dimension of psychopathology as well as a dimension of subjective well-being (SWB). Greenspoon and Sasklofske (Soc Indic Res 54:81–108, 2001) argued that measuring both psychopathology and SWB allow mental health professionals to have a more complete understanding of the child’s psychological health. The present exploratory study provided a further evaluation of the usefulness of the Dual-Factor model in understanding adolescents’ SWB using both person-centered and variable-centered analyses. Using person-centered analyses, we explored whether group membership revealed differential changes in middle school students’ GPAs as well as emotional, cognitive, and behavioral engagement across a 5-month time period. Furthermore, we used variable-centered analyses to examine whether middle school students’ levels of SWB at Time 1 predicted changes in our criterion variables. Specifically, we assessed whether SWB at Time 1 predicted student school engagement and GPA at Time 2 above and beyond their levels of internalizing and externalizing behaviors at Time 1, levels of student engagement and grades at Time 1, and demographic variables. Results of the person-centered analyses found statistically significant differences across the four groups identified in the Dual-Factor Model for emotional, cognitive and behavioral engagement as well as GPA. The results from the variable-centered analyses suggest subjective well-being to be a significant predictor of emotional, cognitive and behavioral engagement beyond measures of psychopathology. These results provide additional support for use of the Dual-Factor Model.     

Effects of social change on well-being: Boom and bust in a Western Canadian city

Drawing from surveys done over a eight year period, we find some important effects on well-being coming from economic boom and bust in a Western Canadian city. This effect is buffered, however, by the important role that family and friends play for young people and health and non-working activities play for the adjustment of older people. Because of these factors, difficulties in the objective condition of economic downturn has had less impact on the general social well-being of the public than previously reported.     

The Unbalance Penalisation Method for Metrics of Social Progress

This study contributes to the debate on the development of aggregate metrics of societal progress. Summarising societal progress into a single number poses various methodological challenges, including the choice of indicators, normalisation, weighting and aggregation. This paper addresses the issue of aggregation in the case of metrics of well-being and uses as a case study the European Union regional Social Progress Index—EU-SPI—published by the European Commission. The index is an aggregate measure of 55 social and environmental indicators observed for all the European regions grouped into 12 components. In metrics of this type, while complete substitutability among components is rarely acceptable, controlling their level of substitutability is highly desirable. To this aim, we adopt a modified version of the unbalance penalisation approach originally proposed by Casadio Tarabusi and Guarini (Soc Indic Res 112:9–45, 2013). A penalisation is applied to the regions whose performance across the index components is unbalanced, that is when they perform well on some components but worse on others. The penalisation applied by this approach depends on two parameters that, in its original formulation, are generally arbitrarily chosen. We design a data-driven approach allowing for an informed choice of the penalisation parameters. The comparison between the EU-SPI original and penalised scores shows that the penalisation effect is particularly evident for regions with a strongly unbalanced profile across the components. The proposed method allows for adjusting the level of substitutability between components when constructing an aggregate metric, an important functionality especially when measuring societal progress for policy-making.

     

Does the recording of parallel activities in Time Use Diaries affect the way people report their main activities?

It is widely recognised that studies based ontime diaries form the most valid and reliabledata source concerning peoples' timeallocation, but it is also documented thatvarious designs give somewhat divergentresults. Usually both main activities andpossible parallel activities are captured intime diaries. Much research has been undertakento evaluate various aspects of the design ofsuch surveys, but there has been littlesystematic investigation on the possibleeffects of recording parallel activities on theway people report their main activities. Asmost analyses focus mainly on primaryactivities, validity in this area is of utmostimportance. Utilising the Norwegian Time UseStudy from 1990–1991 we discuss in this paper if,and possibly how, the registration of secondaryactivities influences the picture we get ofpeople's main activities. Also the role of theexamples presented to participants isinspected. Our findings indicate that therecording of parallel activities does affectthe way people report their main activities.Especially indistinct and fuzzy activities likechildcare, socialising and television viewingseem to be sensitive, but effects differ forwomen and men. Undoubtedly, information onsecondary activities is needed in order tofully reflect people's time patterns, but it isimportant that guidelines for diary keeping andexamples presented to participants aredeveloped carefully so that information onprimary activities is not distorted.     

Midwives’ self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey

BackgroundLittle is known about midwives’ knowledge and skills to assess and promote maternal health literacy.AimsTo test the reliability and validity of a new tool to assess midwives’ health literacy knowledge, skills and attitudes.MethodsUsing a cross-sectional design, midwives were recruited through professional and social media networks. The online survey included demographic and professional questions and a new measure on midwives’ health literacy knowledge, skills and attitudes. Convergent validity was assessed using ten items from the Caring Assessment Scale. Perceived barriers to promoting maternal health literacy were sought.FindingsThree hundred and seven participants completed the survey. A two-factor solution accounted for 41% of variance and resulted in 14 items, including all attitude items, being removed. Cronbach’s alpha reliability was acceptable (Skills = .76; Knowledge = .66). Convergent validity was established. Most midwives (77.1%, n = 221) reported giving limited attention to formally assessing women’s health literacy. Between 30 to 60% of midwives never or only sometimes used specific techniques to promote maternal health literacy. Most (75%, n = 201) had not received education about health literacy.Discussion and ConclusionsThe new Transforming Maternity Care Collaborative Health Literacy tool was valid and reliable. Few midwives formally assessed or promoted women’s health literacy. Midwives require education about maternal health literacy assessment and promotion to ensure women understand information being conveyed. A large national survey of midwives using the new tool is recommended.     

Gender Convergence in the American Heritage Time use Study (AHTUS)

The present study explored the short-term temporal characteristics of subjective well-being (SWB) and its potential correlates. Specifically, we examined the intra-individual variability and the trajectories of SWB and its components life satisfaction, positive, and negative affect. Over a two-week period, 27 participants (78% university students, 85% females, mean age of 29 years) provided SWB data every other day. Before and after this period, participants completed several questionnaires assessing personality and environmental variables, as well as several open-ended questions. The results provide evidence that participants experienced a significant amount of intra-individual variability in their SWB and its components. Furthermore, inter-individual differences in the intra-individual variability were related to several of the personality and environmental variables, as well as to participant’s age. Results of multiple regression analyses indicated that deliberation (one facet of the Big Five dimension conscientiousness), social support, and age accounted for 58% of the total variance of intra-individual variability in SWB. In contrast, the slopes of the individual trajectories of SWB were on average statistically non-significantly different from zero. These results emphasize that information is gained by looking at both the patterns and the intra-individual variability over time: The individual trajectories of the participants on average appeared to be stable, but intra-individual variability of SWB was meaningfully related to several of the variables.     

The validity of measures of self-reported well-being

Using a new analytic approach, construct validity estimates are developed for proposed social indicators of self-reported well-being. Two separate investigations are reported: the first involves data on six aspects of well-being each assessed by six methods from 222 adults in one geographic area; the second, a partial replication and extension, involves a more limited set of indicators measured on a sample of 1297 respondents representative of all American adults. The results provide evidence that perceptions of well-being can be measured by single questionnaire or interview items using any of four formats with validities in the range of 0.7 to 0.8 and with correlated method effects contributing less than 10% of the total variance. Two other formats, however, were markedly less valid. These findings are important in view of past criticisms of ‘subjective’ social indicators as lacking in validity, and the findings can guide current efforts to develop new ways to assess the quality of life. Methodologically, the article illustrates the feasibility and utility of deriving parameter estimates of structural equation models of multimethod-multitrait data using Joreskog's LISREL algorithm. The possibility of deriving validity estimates in this way, even when the data include correlated errors, opens new and important opportunities to precisely assess the amount of error variance in much social science data.     

Society’s (Virtually) Time-Free Transition into the Digital Age

Three early studies of the impact of IT on American society suggested that it was having a negative impact on social life, as well as mass media use. This article reviews the results from two large multiyear US national surveys that have been monitoring social change in US daily life with high response rates: (1) the 1974–2012 General Social Survey (GSS; with more than 55,000 adult respondents aged 18+) and (2) the 2003–2011 American Time-Use Survey (ATUS; with more than 100,000 such respondents). The GSS has collected time-estimate data on particular social and media activities, while the ATUS surveys have collected complete 24-h diary accounts across a single day. Our analysis is conducted on two levels to determine whether various social/media activities have changed (1) at the aggregate societal level as new IT have diffused over the last 20 years and (2) among individuals who use these new media more. In both surveys, there seems little if any significant impact of these new media on social/media time, even though they had become the predominant source of information and social contact by 2004. GSS respondents in general have not reported lower levels of social or media contact since the 1990s, and while those GSS respondents who spent more time on the Internet did report fewer social visits with relatives, they reported more visits with friends, compared to those who do not use the Internet. The main difference between users and nonusers in the ATUS was with time at paid work, and that was only partially explained by higher Internet use by teens and on days off from work. For reading and certain other behaviors, Internet use was sometimes associated with increased use in these surveys. Moreover, no consistent decline in either social or media activities was found in either survey across this period of Internet diffusion, much in line with the earlier national studies. At the same time, it seems clear that not only the ATUS but diary studies in other countries are failing to capture the significant social impact of IT on the rest of life in the new digital age.     

Satisfaction Ratings of QOLPAV: Psychometric Properties Based on the Graded Response Model

A scale measuring quality of life (QOL) is important in adolescent research. Using the graded response model (GRM), this study evaluates the psychometric properties of the satisfaction ratings of the Quality of Life Profile Adolescent Version (QOLPAV). Data for 1,392 adolescents were used to check IRT assumptions such as unidimensionality and local item dependence (LID). The goodness of fit of the GRM to the data and the item characteristic curves were evaluated. The reliability and validity analyses included item/test information, Cronbach’s α, and convergent and discriminant validity. Differential item functioning (DIF) procedures were also performed to detect item bias. The results provide evidence that the items sufficiently measured one single dimension. Few pairs of questions were flagged as LID due to content or wording similarity. Five items did not fit the GRM, and 4 were low in item discrimination. The findings also suggest that the assessment had appropriate reliability and validity. The DIF impact on the assessment score was considered minor. Because QOLPAV includes a respondent’s perceived importance of various life aspects, a short form that only considers important life aspects in the overall QOL estimation for each respondent becomes feasible within the framework of IRT. Future studies focusing on the development of a QOL overall index using the items from QOLPAV are recommended.     

The Influence of Environment and Personality on the Affective and Cognitive Component of Subjective Well-being

Subjective well-being (SWB) has two components: affective well-being (AWB) and cognitive well-being (CWB). The present study demonstrated that AWB and CWB have are influenced by different factors in a nationally representative sample in Germany (N = 1053). Neuroticism was a stronger predictor of AWB than CWB. Unemployment and regional differences between the East and West of Germany were stronger predictors of CWB than AWB. In addition, the study demonstrated that shared evaluative biases in personality and SWB ratings inflate estimates of the effect size of personality. After controlling for this bias, the effects of environmental factors (unemployment, regional differences) on CWB were stronger than the effects of personality (neuroticism). The results demonstrate that AWB and CWB are distinct components of SWB and that research findings for one component may not generalize to the other component. The results also raise important questions about the weighing of the two components in the creation of subjective social indicators.