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

Nongnong Yang; Haiyan Ma; Mengyi Huang; Esther Yuet Ying Lau; Daniel Yee Tak Fong; Meng Wang; Pengqiao Wang; Siyi Xu; Jiale Xu; Chen Jiang; Yi Luo; Runtang Meng

doi:10.2147/PRBM.S437219

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

Psychol Res Behav Manag. 2023 Dec 22:16:5141-5158. doi: 10.2147/PRBM.S437219. eCollection 2023.

Authors

Nongnong Yang^#¹, Haiyan Ma^{1

2}, Mengyi Huang^#¹, Esther Yuet Ying Lau^{3

4

5}, Daniel Yee Tak Fong⁶, Meng Wang⁷, Pengqiao Wang¹, Siyi Xu⁸, Jiale Xu¹, Chen Jiang¹, Yi Luo⁹, Runtang Meng^#^{1

2}

Affiliations

¹ School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China.
² Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, People's Republic of China.
³ Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, Hong Kong, People's Republic of China.
⁴ Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, People's Republic of China.
⁵ Centre for Religious and Spirituality Education, The Education University of Hong Kong, Hong Kong, People's Republic of China.
⁶ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
⁷ Ophthalmology Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, People's Republic of China.
⁸ School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China.
⁹ School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China.

^# Contributed equally.

Abstract

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.

Keywords: WHO-5 Well-Being Index; diagnostic performance; healthcare students; measurement properties; observational longitudinal design; subjective well-being.

Grants and funding

This study was supported by the Medical Research Fund of Zhejiang Province, Grant No. 2023RC073 and the Research Initiation Fund of Hangzhou Normal University, Grant No. RWSK20201003.