Validation of the Warwick-Edinburgh Mental Well-being Scale among nursing students in Slovenia
Corresponding Author
Leona Cilar RN
Assistant PhD student
Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
Correspondence
Leona Cilar, Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000 Maribor, Slovenia.
Email: [email protected]
Search for more papers by this authorMajda Pajnkihar PhD, RN, FAAN
Professor
Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
Search for more papers by this authorGregor Štiglic PhD
Associate Professor
Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
Search for more papers by this authorCorresponding Author
Leona Cilar RN
Assistant PhD student
Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
Correspondence
Leona Cilar, Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000 Maribor, Slovenia.
Email: [email protected]
Search for more papers by this authorMajda Pajnkihar PhD, RN, FAAN
Professor
Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
Search for more papers by this authorGregor Štiglic PhD
Associate Professor
Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
Search for more papers by this authorAbstract
Aim
The aim of this study was to assess the validity of the Warwick-Edinburgh Mental Well-being Scale used for measuring mental well-being.
Background
Nursing students’ mental well-being is often poor due to various academic and personal stressors. Nursing students are involved in clinical practice and are facing birth, death, health, diseases and other stressful situations. They may be exposed to higher levels of stress than students from other study programmes.
Methods
A cross-sectional study was conducted among nursing students in Slovenia. We performed a 6-step analysis of the psychometric properties of the Warwick-Edinburgh Mental Well-being Scale. Moreover, content validity of the scale was assessed.
Results
The scale formed a unidimensional scale with good homogeneity (H < 0.40) and reliability (α = 0.91; β = 0.87; λ = 0.92; ω = 0.91). The confirmatory factor analysis suggested that the WEMWBS was suitable for use as a single scale (RMSEA = 0.085, CFI = 0.907; TLI = 0.891) and measures one construct, mental well-being. I-CVI is acceptable for all 14 items, kappa coefficient was excellent, and S-CVI was assessed as acceptable.
Conclusions
The Slovenian version of the scale achieved good validity and reliability in a sample of nursing students and is recommended for future usage.
Implications for Nursing Management
The validated questionnaire can be used by nurse managers to assess nursing students’ mental well-being during their clinical placement.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interest.
REFERENCES
- Adams, A. M. N., Chamberlain, D., & Giles, T. M. (2019). The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review. Australian Critical Care, 32, 319–329.
- Aldiabat, K. M., Matani, N. A., & Le Navenec, C. L. (2014). Mental health among undergraduate university students: a background paper for administrators, educators and healthcare providers. Universal Journal of Public Health, 2(8), 209–214.
10.13189/ujph.2014.020801 Google Scholar
- Bartlett, M. L., Taylor, H., & Nelson, J. D. (2016). Comparison of mental health characteristics and stress between baccalaureate nursing students and non-nursing students. Journal of Nursing Education, 55(2), 87–90.
- Bartram, D. J., Sinclair, J. M., & Baldwin, D. S. (2013). Further validation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in the UK veterinary profession: Rasch analysis. Quality of Life Research, 22, 379–391.
- Bartram, D. J., Yadegarfar, G., Sinclair, J. M., & Baldwin, D. S. (2011). Validation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) as an overall indicator of population mental health and well-being in the UK veterinary profession. The Veterinary Journal, 187, 397–398.
- Bass, M., Dawkin, M., Muncer, S., Vigurs, S., & Bostock, J. (2016). Validation of Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in a population of people using Secondary Care Mental Health Services. Journal of Mental Health, 25(4), 323–329.
- Beck, C. T., & Gable, R. K. (2001). Ensuring content validity: An illustration of the process. Journal of Nursing Measurement, 9, 201–215.
- Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246.
- Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88, 588–606.
- Boone, W., & Rogan, J. (2005). Rigour in quantitative analysis: The promise of Rasch analysis techniques. African Journal of Research in Mathematics, Science and Technology Education, 9(1), 25–38.
10.1080/10288457.2005.10740574 Google Scholar
- Castellvi, P., Forrero, C. G., Codony, M., Vilagut, G., Brugulat, P., Medina, A., … Alonso, J. (2014). The Spanish version of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is valid for use in the general population. Quality of Life Research, 23, 857–868.
- Cerny, C. A., & Kaiser, H. F. (1977). A study of a measure of sampling adequacy for factor-analytic correlation matrices. Multivariate Behavioral Research, 12(1), 43–47.
- Child, D. (1990). The essentials of factor analysis ( 2nd ed.). New York: Cassell Educational.
- Cicchetti, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86(2), 127–137.
- Cilar, L., Barr, O., Stiglic, G., & Pajnkihar, M. (2019). Mental well-being among nursing students in Slovenia and Northern Ireland: A survey. Nurse Education in Practice, 39, 130–135.
- Clarke, A., Friede, T., Putz, R., Ashdown, J., Martin, S., Blake, A., … Stewart-Brown, S. (2011). Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Validated for teenage school students in England and Scotland. A mixed methods assessment. BMC Public Health, 11(487), 1–9.
- Clarke, A., Putz, R., Friede, T., Ashdown, J., Adi, Y., Martin, S., … Platt, S. (2010). Warwick-Edinburgh Mental Well-being Scale (WEMWBS) acceptability and validation in English and Scottish secondary school students (The WAVES Project). Edinburgh, UK: NHS Health Scotland.
- Currie, C., Nic Gabhainn, S., Godeau, E., Roberts, C., Smith, R., & Currie, D. (Eds.) (2008). Inequalities in young people’s health: HBSC international report from the 2005/2006 Survey. Copenhagen, Denmark: WHO Regional Office.
- Currie, C., van der Glujis, W., Whitehead, R., Currie, D., Rhodes, G., Neville, F., & Inchley, J. (2015). HBSC (Health Behaviour in School-Aged Children) 2014 Survey in Scotland National Report. St Andrews, UK: University of St Andrews.
- Daniel, W. W. (1999). Biostatistics: A foundation for analysis in the health sciences ( 7th ed.). New York: John Wiley & Sons.
- Davis, L. L. (1992). Instrument review: Getting the most from your panel of experts. Applied Nursing Research, 5, 194–197.
10.1016/S0897-1897(05)80008-4 Google Scholar
- Dearholt, S. (2019). Improving nurse well-being through a mindfulness-based education strategy. Minneapolis, MN: Walden University.
- Dima, A. (2018). Scale validation in applied health research: tutorial for a 6-step R-based psychometrics protocol. Health Psychology and Behavioral Medicine, 6(1), 136–161.
- Dogan, N., & Senturk, S. (2018). Determination of the stress experienced by nursing students’ during nursing education. International Journal of Caring Sciences, 11(2), 896–904.
- Dong, A., Chen, X., Zhu, L., Shi, L., Cai, Y., Shi, B., … Guo, W. (2016). Translation and validation of a Chinese version of the Warwick-Edinburgh Mental Well-being Scale with undergraduate nursing trainees. Journal of Psychiatric and Mental Health Nursing, 23, 554–560.
- Fung, S. (2019). Psychometric evaluation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) with Chinese University Students. Health and Quality of Life Outcomes, 17(46), 1–9.
- Haugland, S., Wold, B., Stevenson, J., Aaroe, L., & Woynarowska, B. (2001). Subjective health complaints in adolescence. A cross-national comparison of prevalence and dimensionality. European Journal of Public Health, 11, 4–10.
- Haver, A., Akerjordet, K., Caputi, P., Furunes, R., & Magee, C. (2015). Measuring mental well-being: A validation of the Short Warwick-Edinburgh Mental Well-Being Scale in Norwegian and Swedish. Scandinavian Journal of Public Health, 43, 721–727.
- Hemker, B. T., Sijtsma, K., & Molenaar, I. W. (1995). Selection of unidimensional scales from a multidimensional item bank in the polytomous Mokken IRT model. Applied Psychological Measurement, 19(4), 337–352.
- Hoffman, S., Rueda, H. A., & Lambert, M. C. (2019). Confirmatory factor analysis of the Warwick-Edinburgh Mental Wellbeing Scale among youth in Mexico. International Social Work, 62(1), 309–315.
- Horn, J. L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30, 179–185.
- Hughton, S., Wood, L., Marais, I., Rosenberg, M., Ferguson, R., & Pettigrew, S. (2017). Positive mental well-being: a validation of a Rasch-derived version of the Warwick-Edinburgh mental well-being scale. Assessment, 24(3), 371–386.
- Ikink, J. G. M., Lamers, S. M., & Bolier, J. M. (2012). De Warwick-Edinburgh Mental Well-being Scale (WEMWBS) als meetinstrument voor mentaal welbevinden in Nederland. Enschede, the Netherlands: Universiteit Twente.
- Kaiser, H. (1974). An index of factor simplicity. Psychometrika, 39, 31–36.
- Kammann, R., & Flett, R. (1983). Affectometer 2: A scale to measure current level of general happiness. Australian Journal of Psychology, 35, 259–265.
- Karaca, A., Yidirim, N., Cangur, S., Acikgoz, F., & Akkus, D. (2019). Relationship between mental health of nursing students and coping, self-esteem and social support. Nurse Education Today, 76, 44–50.
- Kean, J., Brodke, D. S., Biber, J., & Gross, P. (2018). An introduction to item response theory and rasch analysis of the eating assessment tool (EAT-10). Brain Impairment, 19(1), 91–102.
- Kim, S., Jung, H.-Y., Na, K.-S., Lee, S. I., Kim, S.-G., Lee, A. R., & Cho, J. T. (2014). A validation study of the Korean version of Warwick-Edinburgh mental well-being scale. Journal of Korean Neuropsychiatric Association, 53(4), 237–245.
10.4306/jknpa.2014.53.4.237 Google Scholar
- Lang, G., & Bachinger, A. (2017). Validation of the German Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in a community-based sample of adults in Austria: A bi-factor modelling approach. Journal of Public Health, 25, 135–346.
- Latif, R. A., & Nor, M. Z. M. (2019). Stressors and coping strategies during clinical practice among diploma nursing students. The Malaysian Journal of Medical Sciences, 26(2), 88–98.
- Lindell, M. K., & Brandt, C. J. (1999). Assessing interrater agreement on the job relevance of a test: A comparison of the CVI, T, rWG(J), and r*WG(J) indexes. Journal of Applied Psychology, 84, 640–647.
- Linton, M., Dieppe, P., & Medina-Lara, A. (2016). Review of 99 self-report measures for assessing wellbeing in adults: exploring dimensions of well-being and developments over time. British Medical Journal Open, 6(7), e010641.
- Lloyd, K., & Devine, P. (2012). Psychometric properties of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in Northern Ireland. Journal of Mental Health, 21(3), 257–263.
- Lopez, M. A., Gabilondo, A., Codony, M., Garcia-Forero, C., Vilagut, G., Castellvi, P., … Alonso, J. (2013). Adaptation into Spanish of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and preliminary validation in a student sample. Quality of Life Research, 22, 1099–1104.
- Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35, 382–385.
- MacKean, G. (2011). Mental health and well-being in postsecondary education settings: a literature and environmental scan to support planning and action in Canada. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.737.6978&rep=rep1&type=pdf
- Mair, P., & Hatzinger, R. (2007). Extended Rasch modeling: The eRm package for the application of IRT models in R. Journal of Statistical Software, 20(9), 1–20.
- Martuza, V. R. (1977). Applying norm-referenced and criterion-referenced measurement in education. Boston, MA: Allyn & Bacon.
- McKay, M. T., & Andretta, J. R. (2017). Evidence for the psychometric validity, internal consistency and measurement invariance of Warwick Edinburgh Mental Well-being Scale scores in Scottish and Irish adolescents. Psychiatry Research, 255, 382–386.
- Polit, D. F., & Beck, C. T. (2004). Nursing research: Principles and methods ( 7th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.
- Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what’s being reported? Critique and recommendations. Research in Nursing & Health, 29, 489–497.
- Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice ( 9th ed.). Philadelphia, PA: Wolters Kluwer, Lippincott Williams & Wilkins.
- Polit, D. F., Beck, C. T., & Owen, S. V. (2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30(4), 459–467.
- R Development Core Team (2005). A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing.
- Ravens-Sieberer, U., Erhart, M., Torsheim, T., Hetland, J., Freeman, J., Danielson, M., … the HBSC Positive Health Group (2008). An international scoring system for self-reported health complaints in adolescents. European Journal of Public Health, 18(3), 294–299.
- Revelle, W. (2017). Psych: Procedures for psychological, psychometric, and personality research [Online]. Retrieved from https://CRAN.R-project.org/package=psych
- Revelle, W., & Rocklin, T. (1979). Very simple structure: An alternative procedure for estimating the optimal number of interpretable factors. Multivariate Behavioral Research, 14, 403–414.
- Ringdal, R., Bradley Eilertsen, M. E., Nissen Bjørnsen, H., Espnes, G. A., & Moksnes, U. K. (2017). Validation of two versions of the Warwick-Edinburgh mental well-being scale among Norwegian adolescents. Scandinavian Journal of Public Health, 46(7), 718–725.
- Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36.
- Santos, J. J. A., Da Costa, T. A., Guilherme, J. H., Da Silva, W. C., Abentroth, L. R. L., Krebs, J. A., & Sotoriva, P. (2015). Adaptation and cross-cultural validation of the Brazilian version of the Warwick-Edinburgh mental well-being scale. Revista da Associacao Medica Brasileria, 61(3), 209–214.
- Sclove, L. S. (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika, 52, 333–343.
- Sijtsma, K., Emons, W. H. M., Bouwmeester, S., Nyklicek, I., & Roorda, L. D. (2008). Nonparametric IRT analysis of quality-of-life scales and its application to the world health organization quality-of-life scale (WHOQOL-Bref). Quality of Life Research, 17, 275–290.
- Singh, K., & Raina, M. (2019). Demographic correlates and validation of PERMA and WEMWBS scales in Indian adolescents. Child Indicators Research, 13(4), 1175–1186.
- Smith, O. R. F., Alves, D. E., Knapstad, M., Haug, E., & Aarø, L. E. (2017). Measuring mental well-being in Norway: validation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). BMC Psychiatry, 17(182), 1–9.
- Smith, S., Schutte, L., Wissing, M., & Cromhout, A. (2018). Validation of the Short Warwick-Edinburgh Mental Well-being Scale in a South African adult group. Vanderbijlpark, South Africa: North-West University.
- Steiger, J. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioral Research, 25, 173–180.
- Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J., & Weich, S. (2009). Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): A Rasch analysis using data from the Scottish Health Education Population Survey. Health and Quality of Life Outcomes, 7(15), 1–8.
- Stiglic, G., & Cilar, L. (2019). Replication data for: Validation of the Warwick-Edinburgh mental well-being scale (WEMWBS) among university student population in Slovenia. Retrieved from 10.7910/DVN/UBRRHG. Harvard Dataverse.
- Stiglic, G., Watson, R., & Cilar, L. (2019). R you ready? Using the R programme for statistical analysis and graphics. Research in Nursing & Health, 42(6), 494–499.
- Stochl, J., Jones, P. B., & Croudace, T. J. (2012). Mokken scale analysis of mental health and well-being questionnaire item responses: A non-parametric IRT method in empirical research for applied health researchers. BMC Medical Research Methodology, 12(74), 1–16.
- Taggart, F., Friede, T., Weich, S., Clarke, A., Johnson, M., & Stewart-Brown, S. (2013). Cross cultural evaluation of the Warwick-Edinburgh mental well-being scale (WEMWBS) –a mixed methods study. Health and Quality of Life Outcomes, 11(27), 1–12.
- Taggart, F., Stewart-Brown, S., & Parkinson, J. (2015). Warwick-Edinburgh Mental Well-being Scale (WEMWBS): user guide – version 2. Edinburgh, UK: NHS Health Scotland.
- Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., … Stewart-Brown, S. (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes, 5(63), 1–13.
- Trousselard, M., Steiler, D., Dutheil, F., Claverie, D., Canini, F., Fenouillet, F., … Franck, N. (2016). Validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in French psychiatric and general populations. Psychiatry Research, 245, 282–290.
- Tucker, L. R., & Lewis, C. A. (1973). Reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1–10.
- Van der Ark, L. A. (2007). Mokken Scale Analysis in R. Journal of Statistical Software, 20(11), 1–19.
- Velicer, W. F. (1976). Determining the number of components from the matrix of partial correlations. Psychometrika, 31, 321–327.
- Waltz, C. F., Strickland, O. L., & Lenz, E. R. (2005). Measurement in nursing and health research ( 3rd ed.). New York: Springer Publishing.
- Waqas, A., Ahmad, W., Haddad, M., Taggart, F., Muhammas, Z., Bukhari, M. H., … Ejaz, S. (2015). Measuring the well-being of health care professionals in the Punjab: a psychometric evaluation of the Warwick–Edinburgh Mental Well-being Scale in a Pakistani population. PeerJ, 3, e1264.
- Wynd, C. A., Schmidt, B., & Schaefer, M. A. (2003). Two quantitative approaches for estimating content validity. Western Journal of Nursing Research, 25, 508–518.