WHO-5 shows structural validity and cross-country measurement invariance among 10- to 14-year-olds in Moldova and North Macedonia

The abstract of a baseline psychometric study reports that the five-item World Health Organization Five Well-Being Index (WHO-5) had a unidimensional structure, good internal consistency and measurement invariance across Moldova and North Macedonia among 653 adolescents aged 10–14 years participating in a family-focused prevention program. The findings provide evidence about the measurement properties of culturally adapted WHO-5 versions in these two program settings, but the analysis did not test whether the prevention program improved well-being.

Researchers used baseline data from the FLOURISH Phase 2 trial. Participants were recruited with their caregivers in Moldova and North Macedonia, and the WHO-5 was administered in local languages using culturally adapted versions. Confirmatory factor analysis tested a one-factor, five-item model in the combined sample and separately in each country. Model fit was evaluated with CFI, TLI, RMSEA and SRMR. Multi-group ordinal confirmatory factor analysis assessed configural, threshold, metric and scalar invariance across the countries, while McDonald’s ω estimated internal consistency.

The one-factor model showed appropriate fit in the combined sample, with CFI = 0.995, TLI = 0.990, RMSEA = 0.069 and SRMR = 0.019. Country-specific analyses also supported the one-factor structure. Standardized factor loadings ranged from 0.698 to 0.811, and residual variances ranged from 0.343 to 0.513. McDonald’s ω was 0.84. The cross-country analyses supported configural, threshold, metric and scalar invariance.

Based on the abstract, these results support using the WHO-5 to assess and compare adolescent well-being within the two program settings and add evidence for the validation of an open-access, culturally adapted instrument in middle-income and prevention contexts. The findings are limited to the study population, age range, program setting and baseline psychometric scope. Results from these two countries do not by themselves establish the measure’s validity in other adolescent populations, countries or intervention contexts, nor do they demonstrate preventive-program effects. The supplied evidence comes from the abstract of an open-access BMC Psychology article published as an early-access version that is subject to further edits, so this report is limited to the methods, estimates and conclusions stated in the abstract.

Subject of Research: Psychometric validation of the WHO-5 among adolescents in Moldova and North Macedonia

Article Title: Structural validity and measurement invariance of the WHO-5 Well-Being Index among young adolescents in a family-focused prevention context in Southeastern Europe

Article References: Piolanti, A., Waller, F., Kunovski, I., Shenderovich, Y., Mueller, J., Wienand, D., Simon, J., Heinrichs, N., Sampathkumar, S., Moore, G., & Foran, H. M. (2026). Structural validity and measurement invariance of the WHO-5 Well-Being Index among young adolescents in a family-focused prevention context in Southeastern Europe. BMC Psychology. https://doi.org/10.1186/s40359-026-05624-w

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05624-w

Keywords: WHO-5, adolescent well-being, measurement invariance, confirmatory factor analysis, Moldova, North Macedonia, psychometrics, FLOURISH trial, cross-cultural validation, Structural, validity, measurement