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

The review, published in eClinicalMedicine by Maria Vedechkina, Prerna Banati, and Valentina Baltag, systematically mapped instruments used to measure adolescent digital technology use across 533 studies published between 2014 and 2025. Conducted under PRISMA-ScR guidelines with a protocol registered on the Open Science Framework, the team searched PubMed, Web of Science, and Scopus using a strategy that combined population terms such as adolescent, teen, and youth with device and media terms and measurement keywords. After removing 711 duplicates from 1,600 records and screening 583 full texts, the authors retained 533 studies spanning more than 20 countries, predominantly in East Asia, North America, and Europe.

The timing matters. Only 120 of the included studies appeared before 2020; the rest were published in the last five years, reflecting the surge of research interest that followed the COVID-19 pandemic, when remote learning and online socialisation deepened adolescents’ reliance on digital platforms. Governments and bodies such as the World Health Organization are increasingly pressed to issue guidance on balancing the risks and benefits of digital engagement, and young people themselves have voiced concerns about technology-facilitated gender-based violence, misinformation, and weak digital safeguards. But sound policy, the authors argue, requires sound measurement first—and that is precisely what is missing.

From the 533 studies, the team identified 135 validated instruments, most of them brief self-report questionnaires of between 4 and 51 items. Just over half of the studies, about 59 percent, used at least one validated instrument, while the remaining 41 percent relied on study-specific, ad hoc questions—often a single item asking how many hours per day an adolescent spends on social media. Strikingly, only two alternative assessment methods were found: passive data collection via a mobile app. Despite the availability of device logs, screen-time tracking, and ecological momentary assessment, the field remains almost entirely dependent on teenagers remembering and honestly reporting their own behaviour, a method known to suffer from recall error and social desirability bias.

What the instruments measure is as revealing as how they measure it. Applying a logic-model framework that distinguishes inputs, processes, outputs, outcomes, and impacts, the reviewers found that duration (79 instruments) and frequency (70) dominated, followed by addiction (47) and problematic use (43). Over two-thirds of the identified tools were explicitly designed to detect pathological or addictive use, borrowing clinical criteria such as withdrawal, tolerance, dependence, and loss of control. Familiar names include the Internet Addiction Test, the Smartphone Addiction Scale, and the Bergen Social Media Addiction Scale. By contrast, fewer than 2 percent of instruments assessed positive dimensions of digital technology use, such as enjoyment, peer bonding, creativity, or skill-building.

The consequences of this risk-heavy orientation are profound. When nearly every tool is built to find dysfunction, the resulting evidence base paints a distorted picture of adolescent digital life—one heavy on deficiency and light on the nuanced middle ground where most use likely falls. Motivations for engagement, such as emotion regulation, identity exploration, or social support, were captured by only about ten instruments. Contextual factors fared worse: parenting practices and family media rules appeared in just four tools, while peer influence and school context were strikingly absent. By overlooking the social and motivational environment, the authors warn, existing measures risk conflating elevated use with harmful use.

Developmental appropriateness emerged as another critical weakness. The reviewers classified most instruments as age-insensitive: they had not been developed or validated specifically for adolescents aged 10 to 19, contained no developmentally specific content such as schoolwork impairment or parental mediation, and lacked age-referenced norms. Only about 12 percent, including the Social Media Disorder Scale, were built and validated specifically for adolescents. Widely used tools such as the Internet Addiction Test were adapted from adult versions with minimal modification, and few incorporated adolescent input during formative work. Generic wording like neglecting responsibilities does little to reflect the realities of teenage life, where peer dynamics, school demands, and family supervision shape how technology is used.

Cross-cultural applicability is similarly thin. Although many instruments have been translated—Chinese, Korean, Spanish, and French were the most common languages—genuine cross-cultural adaptation and validation were rare. Most studies reported translation without content modification or validation across cultural groups, and socioeconomic factors such as device access, digital norms, and urban-rural differences were seldom considered. Roughly 35 percent of the included studies presented data from low- and middle-income countries, but Africa and Latin America were notably underrepresented. The upshot is that instruments are applied globally while remaining tailored to none of the diverse sociocultural settings in which adolescents actually live.

Psychometric quality varied widely. Using an adapted version of the COSMIN guidelines, the team appraised content validity, construct validity, internal consistency, and test-retest reliability. Internal consistency was commonly reported and generally satisfactory, but validity metrics were inconsistent, often limited to exploratory factor analysis or simple correlations. Independent validation studies were scarce, and interpretability and responsiveness were rarely assessed. Only 19 instruments, about 14 percent, earned a strong overall rating, typically through multiple validations and transparent reporting; 14 instruments, about 10 percent, were rated poor, often due to unclear methodology or validation conducted solely by the original developers. The majority, 76 percent, fell in the moderate category.

Perhaps the most fundamental problem is conceptual fragmentation. Definitions of screen time, problematic use, and high usage varied enormously across studies. Some tools defined use as general screen time, others focused on specific platforms, and still others required a clinical threshold on a behavioural scale; some classified adolescents as problematic users based purely on daily hours. Without agreed core constructs or standardised metrics, studies measuring different phenomena under the same label cannot be meaningfully compared or synthesised, stalling cumulative knowledge. The pace of technological change compounds the issue: instruments developed in 2015 contain no questions about TikTok, AI companions, or live-streaming, and almost none captured the commercial dimensions of digital life, such as the ubiquitous targeted advertising of food and beverages to minors.

The review, which forms part of the WHO’s broader effort to inform global policy on adolescent digital health, closes with targeted recommendations. The authors call for holistic instruments co-designed with young people that capture positive, normative, and qualitative dimensions of use, including digital literacy, creativity, and social connection. They urge consensus on core constructs and standardised definitions to enable cross-study comparison, rigorous validation across demographic and cultural groups, and multi-method approaches that combine self-report with passive device logging, wearable sensors, and ecological momentary assessment to reduce recall bias. They also caution researchers against clinging to legacy measures for the sake of comparability at the expense of relevance. Emerging tools such as the Cyber Virtues Scale, the EHealth Literacy Scale, and the Digital Media Use Effects Scales for Adolescents suggest the field may be beginning to broaden, but progress since a 2021 review flagged the same gaps has been minimal. Better measurement, the authors conclude, is not an end in itself but the means to understanding—and ultimately improving—adolescent development in the digital age.

Subject of Research: Measurement instruments for adolescent digital technology use

Article Title: Systematized scoping review of instruments for measuring adolescent digital technology use

Article References: Vedechkina, M., Banati, P., & Baltag, V. (2026). Systematized scoping review of instruments for measuring adolescent digital technology use. eClinicalMedicine, 101, Article 104247. https://doi.org/10.1016/j.eclinm.2026.104247

Image Credits: AI Generated

DOI: 10.1016/j.eclinm.2026.104247

Keywords: adolescent health, digital technology use, screen time, measurement instruments, scoping review, psychometrics, internet addiction, WHO, cross-cultural validation, self-report bias, digital wellbeing, eClinicalMedicine

The PBIAS was first developed by Charlotte Maes, Jolien Trekels, Tracy Tylka, and Laura Vandenbosch in a 2021 study with Belgian adolescents, and it was designed from the ground up to capture positive body image as a multidimensional construct rather than a single feeling of satisfaction. Since then it has been adapted into Portuguese, Persian, and Spanish–Catalan versions, each adaptation serving as a stress test of the scale’s conceptual core. The Turkish version now joins that international family, and the way it was tested offers a textbook demonstration of how modern psychometric validation is supposed to work.

The study recruited 448 adolescents between the ages of 12 and 18, with an average age of about 14 years and a sample that was 54.2 percent girls. That age window matters. Adolescence is precisely the period when body image concerns tend to emerge and consolidate, and longitudinal research has shown that body dissatisfaction in these years can persist into young adulthood. Turkish adolescents face particular pressures: prior research cited in the paper documents body image dissatisfaction among Turkish schoolchildren and its impact on body esteem, alongside rising social appearance anxiety and its links to reduced motivation for physical activity. A validated positive body image measure gives Turkish researchers, school counselors, and clinicians a tool that measures the constructive side of the equation, not just the deficits.

The technical heart of the study lies in how the authors compared competing structural models of the scale. Confirmatory factor analysis, or CFA, is the traditional workhorse here: the researcher specifies in advance that fifteen items should load onto four distinct factors, and the analysis tests how well that rigid structure reproduces the observed correlations among items. But CFA has a known weakness. It forces each item to load onto only its assigned factor and treats any cross-loading as noise, which can inflate correlations between factors and distort the apparent structure of a questionnaire. Enter exploratory structural equation modeling, or ESEM, a more forgiving framework introduced by Tihomir Asparouhov and Bengt Muthén in 2009 that allows items to load on all factors simultaneously, reflecting the messy reality of how people actually answer psychological questions.

Urfa and Yildiz ran both analyses and compared the original four-factor structure against alternative three-factor solutions. The result was decisive: the original 15-item, four-factor model fit the Turkish data best under both CFA and ESEM. In other words, the conceptual map drawn up in Belgium, in which positive body image among adolescents comprises distinct but related dimensions, transfers cleanly to Turkish adolescents without needing to be redrawn. That kind of structural stability across languages is rare enough in psychology that it deserves attention, particularly for a construct as culturally loaded as the body.

Validity was tested from multiple angles. Convergent validity asks whether a scale correlates with other measures it theoretically should, and here the authors examined relationships between the PBIAS and two well-established constructs: body esteem, measured with an instrument adapted into Turkish in prior work, and body surveillance, the tendency to view oneself from an observer’s perspective that sits at the core of objectification theory. The pattern of correlations behaved as theory predicts, with positive body image tracking positively with body esteem and negatively with body surveillance. The authors also computed the average variance extracted and composite reliability, two indices that quantify how much of the variance in a set of items reflects the underlying construct rather than measurement error, and both supported the claim that the Turkish PBIAS measures what it claims to measure.

Reliability received equally rigorous treatment. Cronbach’s alpha, the most widely used index of internal consistency, and composite reliability coefficients both provided strong evidence that the items within each subscale hang together coherently. For practitioners, this matters enormously: a scale that produces unstable scores cannot support individual assessment, program evaluation, or clinical decision-making, no matter how elegant its theory. The Turkish PBIAS now meets the psychometric bar for applied use.

Perhaps the most consequential analysis, however, concerned measurement invariance. Invariance testing asks a deceptively simple question: does the scale measure the same thing in different groups? The authors tested whether the factor structure, the item loadings, and the item intercepts held across relevant subgroups, following the conventional sequential approach established by Cheung and Rensvold and refined by Fang Chen, in which fit is tracked as equality constraints are progressively imposed. When invariance holds, group differences in scores can be interpreted as genuine differences in the construct. When it fails, apparent differences may be statistical artifacts. The finding of measurement invariance for the Turkish PBIAS means researchers can meaningfully compare boys and girls, or younger and older adolescents, without worrying that the yardstick itself changes between groups. It also opens the door to cross-cultural comparisons with the Belgian, Portuguese, Persian, and Spanish–Catalan versions, since a common metric is the precondition for any such comparison to be interpretable.

The broader significance of this work sits within a larger movement in body image science. Researchers such as Tracy Tylka and Nicholas Wood-Barcalow have argued that positive body image is not simply the absence of negative body image but a distinct construct with its own features: body appreciation, functionality awareness, body acceptance, and protective filtering of appearance information. Recent large-scale research has even linked positive body image to life satisfaction across dozens of nations, suggesting the construct has genuine predictive reach. Meanwhile, systematic reviews of body image interventions in boys and in youth generally show growing evidence that these positive dimensions can be cultivated, making reliable measurement of them a practical priority for schools and clinics alike. Every validated adaptation expands the geography of that research program.

The Turkish adaptation also fills a documented national gap. Studies cited by the authors show that body image dissatisfaction among Turkish children and adolescents affects body esteem, and that social appearance anxiety shapes adolescents’ engagement in physical activity. Until now, however, Turkish-language instruments focused overwhelmingly on negative body image. The PBIAS gives Turkish-speaking researchers a multidimensional positive measure that has already proven its portability across four other languages and cultures, and its demonstrated invariance makes it a candidate for inclusion in international comparative studies of adolescent wellbeing. The authors report no funding and no competing interests, ethical approval was obtained from the FMV Işık University Ethics Committee, and informed consent was secured from participants and their parents. The data are available from the corresponding author upon reasonable request. For a field increasingly convinced that building resilience requires measuring strengths and not just deficits, a psychometrically sound Turkish PBIAS is a small instrument with outsized implications.

Subject of Research: Cross-cultural adaptation and psychometric validation of the Positive Body Image among Adolescents Scale in Turkish adolescents

Article Title: Adaptation, validation and measurement invariance of the positive body image among adolescents scale in Turkish adolescents

Article References: Urfa, O., & Yildiz, T. (2026). Adaptation, validation and measurement invariance of the positive body image among adolescents scale in Turkish adolescents. Current Psychology, 45(17), Article 1457. https://doi.org/10.1007/s12144-026-10022-x

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10022-x

Keywords: positive body image, adolescents, PBIAS, psychometrics, measurement invariance, confirmatory factor analysis, ESEM, Turkish adaptation, body esteem, body surveillance, cross-cultural validation, Current Psychology

The study, led by Aamer Aldbyani of Shandong Xiehe University together with colleagues in Jordan, Egypt, Saudi Arabia, and Yemen, was designed as a cross-sectional psychometric validation. The researchers translated the scale into Arabic, submitted it to expert review, culturally adapted the wording, and formally assessed content validity before deploying it to students in Egypt, Saudi Arabia, Yemen, and Jordan. The final analytic sample comprised 1,252 university students, a size large enough to subject the instrument to the full battery of modern statistical scrutiny: confirmatory factor analysis, reliability estimation, tests of discriminant and criterion-related validity, and, perhaps most importantly for a multilingual instrument, measurement invariance testing across national samples.

The Digital Mindfulness Scale rests on a three-factor structure, measuring three distinct but related dimensions of mindful technology engagement. The first is Intention, the degree to which a person deliberately chooses when and how to use digital tools rather than reaching for them reflexively. The second is Attention, the capacity to remain present and focused during digital activity instead of drifting into fragmented, distracted browsing. The third is Attitude, a non-judgmental and accepting orientation toward one’s own digital experiences, including the ability to notice urges to check a phone without automatically obeying them. Together, the three subscales paint a portrait of someone who uses technology consciously rather than being used by it, a quality that researchers increasingly see as central to digital wellbeing.

Confirmatory factor analysis provided strong support for that three-factor architecture in the Arabic data. The model produced a chi-square of 190 with 87 degrees of freedom, yielding a ratio of chi-square to degrees of freedom of 2.184, comfortably within conventional thresholds. The comparative fit index reached 0.959 and the Tucker-Lewis index 0.951, both above the 0.95 benchmark typically considered evidence of good fit. The root mean square error of approximation came in at 0.043, with a 90 percent confidence interval of 0.035 to 0.052, and the standardized root mean square residual was 0.038. In plain terms, the pattern of answers given by Arabic-speaking students matched the structure the scale was built to measure, suggesting that the psychological concept of digital mindfulness translates coherently into Arabic rather than dissolving into something culture-specific and unrecognizable.

Reliability results were similarly reassuring. The three subscales posted Cronbach’s alpha values of 0.776 for Intention, 0.781 for Attention, and 0.760 for Attitude, with McDonald’s omega coefficients of 0.778, 0.781, and 0.761 respectively, all indicating acceptable internal consistency for a research instrument. Composite reliability estimates ranged from 0.776 to 0.779, reinforcing the conclusion that each subscale measures its target dimension consistently across items. One statistical caveat did surface: average variance extracted, or AVE, ranged from 0.410 to 0.414, falling below the conventional 0.50 cutoff that signals strong internal convergent evidence. The authors were candid about this limitation, noting that the items within each subscale share somewhat less variance with one another than strict standards would prefer, even though the constructs themselves proved reliable in practice.

Discriminant validity, the requirement that the three dimensions remain statistically distinguishable from one another rather than collapsing into a single blurry factor, was supported. Heterotrait-monotrait ratios, known as HTMT values, ranged from 0.393 to 0.510, sitting below the thresholds at which researchers begin to worry that two supposedly separate constructs are indistinguishable in practice. This matters because a scale whose subscales overlap too heavily cannot tell a researcher whether intentional engagement, attentive engagement, or accepting attitudes are driving an outcome. With these results in hand, future studies can ask which specific component of digital mindfulness predicts healthier phone habits, rather than treating the whole construct as an undifferentiated block.

The most headline-worthy findings concern criterion-related validity, the test of whether the scale correlates with real-world outcomes it should plausibly relate to. Students who scored higher on digital mindfulness reported greater digital life balance, with a correlation of r = 0.335, a moderate positive association indicating that mindful engagement goes hand in hand with a healthier equilibrium between online and offline life. Conversely, digital mindfulness scores were negatively associated with problematic smartphone use, with r = -0.283, meaning students who used their devices more mindfully were less likely to report the compulsive checking, loss of control, and life interference that characterize problematic smartphone behavior. These correlations align with what the broader mindfulness literature would predict, lending the new Arabic scale immediate practical credibility.

Perhaps the study’s most technically impressive achievement was demonstrating measurement invariance across the four country samples. Configural invariance, the baseline requirement that the scale’s factor structure holds in each country, was supported, as were metric invariance, meaning the items relate to their factors with equal strength across groups, scalar invariance, meaning comparisons of mean scores are meaningful, and strict invariance, the most demanding level, which additionally requires that measurement error behaves identically across countries. In practical terms, this means researchers can legitimately compare average digital mindfulness scores between Egyptian, Saudi, Yemeni, and Jordanian students without worrying that differences reflect quirks of translation or response style rather than genuine psychological differences. For a region whose universities are producing enormous volumes of digital behavior research, that cross-cultural guarantee is a valuable piece of scientific infrastructure.

The authors are careful about the boundaries of their claims. External convergent validity, the demonstration that the Arabic scale correlates with established measures of general mindfulness or closely related constructs, was not directly examined, and they recommend that future validation work incorporate such benchmarks. The AVE shortfall likewise suggests the scale is ready for research use but should be interpreted with standard psychometric caution. The study was funded by Umm Al-Qura University in Saudi Arabia under grant 26UQU4331015GSSR02, received ethical approval from the Research Ethics Committee of Shandong Xiehe University with local institutional consultation in the participating countries, and was conducted in accordance with the Declaration of Helsinki. The article was published open access on 14 October 2026, with the accepted manuscript shared early to speed access to the peer-reviewed findings.

Why does this matter beyond the psychometrics? Problematic smartphone use among university students has been linked in numerous studies to poorer sleep, lower academic performance, and elevated anxiety, and interventions built on mindfulness principles have shown promise in English-language contexts. Until now, Arabic-speaking researchers lacked a rigorously validated tool to assess digital mindfulness in their own populations, forcing reliance on translated instruments of unverified quality. A scale that is reliable, structurally sound, and invariant across four national contexts opens the door to cross-cultural studies of digital wellbeing spanning the Arab world and beyond, to screening programs that identify students at risk of compulsive phone use, and to intervention trials that can measure whether mindfulness training actually shifts the attitudes and habits that keep screens from crowding out real life. The smartphone is not going away; instruments like this one are how science learns to live with it wisely.

Subject of Research: Arabic-language psychometric validation of the Digital Mindfulness Scale and its links to digital life balance and problematic smartphone use among Arab university students

Article Title: Arabic validation of the Digital Mindfulness Scale among Arab university students: associations with digital life balance and problematic smartphone use

Article References: Aldbyani, A., Ayasrah, M. N., Zayed, A. M., Al-Harbi, M. F. O., & Almansoub, H. A. M. M. (2026). Arabic validation of the Digital Mindfulness Scale among Arab university students: associations with digital life balance and problematic smartphone use. BMC Psychology. https://doi.org/10.1186/s40359-026-05790-x

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05790-x

Keywords: digital mindfulness, psychometrics, scale validation, smartphone use, university students, Arabic, cross-cultural psychology, measurement invariance, digital life balance, confirmatory factor analysis, BMC Psychology, digital wellbeing

The research, led by Angélica María Londoño-Moreno of Universidad del Valle in Cali, Colombia, together with colleagues at the University of Granada in Spain and Universidade Salgado de Oliveira in Brazil, set out to solve a persistent problem in the psychology of aging and work. Most validated measures of retirement decision-making were developed in wealthy countries with mature pension systems, and researchers have long questioned whether such instruments can be meaningfully applied in Latin America, where informal employment, lower pension coverage, and different family structures shape the end of working life. The IDA was originally developed in Brazil, and this study represents its first formal cultural adaptation and validation in two additional Ibero-American countries.

The study involved 415 participants in Colombia and 622 in Spain. The researchers followed established guidelines for the cross-cultural adaptation of assessment instruments, translating and culturally adjusting the questionnaire so that its items would resonate with workers in each country. The inventory measures four distinct orientations toward the retirement decision: anticipating retirement, which reflects a desire to leave work earlier than the legal age; retiring at the legal time, which captures the intention to exit exactly when the pension system allows; bridge employment, which describes plans to move into lighter or different work after leaving a main career; and continuing to work full-time, which represents the intention to remain in the labor force beyond retirement age.

To test whether this four-factor structure held up statistically, the team used confirmatory factor analysis with the WLSMV estimator, a robust weighted least squares approach suited to ordinal questionnaire data. The results were encouraging but nuanced. In Spain, the 13-item, four-factor model showed excellent fit to the data, with a comparative fit index of 0.978 and a standardized root mean square residual of 0.049, both well within accepted thresholds. In Colombia, the fit was more marginal, with a comparative fit index of 0.919 and a standardized root mean square residual of 0.098, and the combined sample produced an elevated root mean square error of approximation of 0.112. These figures indicate that the inventory’s core structure travels across cultures, but that some items behave slightly differently in the Colombian context, likely reflecting the greater heterogeneity of that country’s labor market.

A central question in cross-cultural psychology is whether an instrument measures the same constructs in the same way in different groups, a property known as measurement invariance. Without invariance, comparing scores between countries is statistically meaningless. Using converging fit criteria, the researchers found that measurement invariance across Colombia and Spain was supported, with one caveat: partial metric invariance was localized in a single loading on the bridge employment factor. In practical terms, this means that most of the inventory’s items function equivalently in both countries, but one item about post-retirement work arrangements is interpreted somewhat differently by Colombian and Spanish respondents. Gender invariance was also confirmed in the total sample and in Spain, while the Colombian sample showed metric invariance across gender, suggesting the instrument can be used to compare men and women within each country.

To examine whether the inventory actually measures something meaningful, the researchers tested its relationships with an external measure, the Brief Scale of Reasons to Continue Working in Retirement, known as the EMCTA-r. The pattern of correlations followed theoretical expectations with striking precision. The two exit-oriented factors, anticipating retirement and retiring at the legal time, correlated negatively with reasons to continue working, while the two continuity-oriented factors, bridge employment and continuing to work full-time, correlated positively. In other words, workers who want to leave early report fewer motives for staying on the job, and workers who plan to keep working report more of them. This coherent pattern provides strong evidence of convergent validity for the adapted instrument.

Yet beneath this shared structure, the two countries revealed a fascinating divergence. In Spain, the exit and continuity dimensions of the retirement decision behaved as bipolar opposites, with a Spearman correlation of negative 0.65 between them. Spanish workers who lean toward leaving work also tend, quite strongly, to reject continuing to work, as if the decision were a single continuum with retirement at one end and continued employment at the other. In Colombia, by contrast, the two dimensions were statistically independent. A Colombian worker can simultaneously express a desire to retire and an intention to pursue bridge employment or continued work, treating these not as contradictory options but as complementary possibilities. This structural difference, the authors suggest, reflects the different economic pressures and labor market flexibility that characterize the two nations.

Group comparisons reinforced this cultural contrast. Mann-Whitney U tests, a non-parametric method appropriate for ordinal data, showed significantly higher scores on the exit factors in Spain and significantly higher scores on the continuity factors in Colombia. Spanish workers, embedded in a mature pension system with relatively predictable benefits, appear more oriented toward a clean break from work at the legally defined moment. Colombian workers, facing a pension system in transition, including the recent Law 2381 of 2024 that established a new Comprehensive Social Protection System for old age, show stronger orientations toward remaining economically active, whether through bridge jobs or full-time work beyond traditional retirement age.

The study also provided evidence of criterion validity, particularly in Colombia. Scores on the anticipating retirement factor correlated negatively with the age at which workers said they hoped to retire, with a Spearman coefficient of negative 0.40, and the retiring at the legal time factor showed an even stronger negative correlation of negative 0.43. Employment sector was also meaningfully associated with decision profiles in the Colombian sample, with a substantial effect size for the anticipating retirement factor, measured at epsilon squared of 0.17. In Spain, these associations were weaker, which the researchers interpret as consistent with a more homogeneous retirement structure in which the timing and form of exit are more standardized across occupational groups.

The implications reach beyond psychometrics. Populations across Latin America and Europe are aging rapidly, and policymakers increasingly need reliable tools to understand when and why older workers plan to leave the labor force. An instrument that captures four distinct decision orientations, and that has now been shown to function across culturally distinct Spanish-speaking countries, offers researchers and practitioners a common vocabulary for studying retirement transitions. The team has made the anonymized data, analytic methods, and study materials openly available through the Open Science Foundation in line with FAIR principles, allowing other researchers to scrutinize and extend the work. As bridge employment and phased exits from work become more common worldwide, understanding how workers in different cultures weigh exit against continuity may prove essential for designing pension policies and career support programs that meet people where they actually are in their decision-making about the end of working life.

Subject of Research: Cross-cultural adaptation and validation of the Retirement Decision Inventory in Colombia and Spain

Article Title: Retirement decision inventory in Colombia and Spain: cultural adaptation and validation study

Article References: Londoño-Moreno, A. M., Belalcázar, M., Díaz-Bambula, F., Rubio, L. R., Dumitrache, C. G., Gabardo-Martins, L. M., & França, L. H. D. F. P. (2026). Retirement decision inventory in Colombia and Spain: cultural adaptation and validation study. Current Psychology, 45(17), Article 1467. https://doi.org/10.1007/s12144-026-10024-9

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10024-9

Keywords: retirement decision, psychometrics, cross-cultural validation, confirmatory factor analysis, measurement invariance, bridge employment, Colombia, Spain, aging workforce, pension systems, Current Psychology, occupational psychology

The research team, led by Sam Salek of the University of Hertfordshire together with Jeffrey Johns, Faraz M. Ali and Andrew Y. Finlay of Cardiff University, along with colleagues in Norway and Germany, analyzed data from 3,408 dermatology outpatients recruited across 13 European countries: Belgium, Denmark, France, Germany, Hungary, Italy, the Netherlands, Norway, Poland, Russia, Spain, Turkey and the United Kingdom. The dataset originated in a large multicenter cross-sectional study in which 250 consecutive adult patients were enrolled at each participating clinic. Every patient completed the DLQI in their own validated national language version, alongside the generic EQ-5D-3L health questionnaire and a physician-assessed severity rating. Crucially, the analysis included only patients with complete DLQI responses, eliminating missing-data ambiguity from the statistical models.

The central technical question was one of measurement invariance, the psychometric property that determines whether an instrument measures the same underlying construct in the same way across different groups. The researchers applied a hierarchical testing framework using multiple-group confirmatory factor analysis, or MGCFA. At the first level, configural invariance asks whether the same factor structure holds in every country, meaning respondents everywhere conceptualize the construct similarly. At the second level, metric invariance tests whether factor loadings, the strengths of the relationships between individual items and the latent quality-of-life factor, are equal across groups. Only if those hold does scalar invariance, equality of item thresholds, come into play, and it is scalar invariance that licenses direct comparison of mean scores between countries. Each successive level imposes stricter constraints, and each was tested against established fit criteria from the COSMIN consensus framework.

The first major finding was that the DLQI behaves as essentially unidimensional in every one of the 13 language versions. Confirmatory factor analysis using a single-factor model produced unscaled comparative fit index and Tucker-Lewis index values above 0.97 in all countries, comfortably exceeding the COSMIN threshold of 0.95. This matters because unidimensionality is the fundamental precondition for summing ten items into one interpretable number. If the items tapped several unrelated constructs, the total score would be statistically unstable and conceptually ambiguous. The team used polychoric correlations, which are designed for ordinal Likert-type data rather than the continuous, normally distributed data assumed by Pearson correlation, and found all inter-item correlations above 0.42 with none exceeding 0.85, ruling out both weak relationships and item redundancy. Contemporary measurement science accepts that perfectly unidimensional health measures are essentially nonexistent; what is required is a dominant general factor strong enough that the composite score behaves like a measure of one construct, and the DLQI cleared that bar in every country.

The multigroup analysis then delivered the study’s most consequential result. Configural invariance held across the 12 countries included in the MGCFA models, confirming that all translations conceptualize the same construct. Metric invariance also held, with equality of factor loadings demonstrated within the fit-change thresholds recommended by measurement methodologist F.F. Chen, meaning the items are equally related to the latent factor everywhere. But full scalar invariance was not achieved: the drop in CFI of 0.03 and rise in RMSEA of 0.023 exceeded the accepted limits of 0.01 and 0.015 respectively. In practical terms, this means that directly comparing average DLQI scores between countries is not statistically supported by the current evidence, even though the instrument measures the same construct everywhere.

There was, however, a partial rescue. By relaxing the equality constraint on a single threshold of DLQI item 7, which concerns treatment difficulties, the researchers achieved partial scalar invariance. The culprit threshold was clearly identifiable: modification indices flagged it with a chi-squared value of 39.7 and a p-value below 0.0001, and plots of thresholds by country revealed that Russia and Turkey were outliers for that specific item parameter. This pattern is far from unusual in cross-national psychometrics. The authors note that a study of the Satisfaction With Life Scale across 65 nations achieved configural and metric but not full scalar invariance, that the Quality of Life Enjoyment and Satisfaction Questionnaire showed 12 of 14 items non-invariant across ten countries, and that a systematic review of 75 studies using personality measures found none achieved scalar or strict invariance across cultural groups. Against that backdrop, the DLQI’s near-miss is a strong performance.

The study also confronted a well-known statistical subtlety. The weighted least squares mean and variance adjusted estimator, or WLSMV, used because DLQI data are ordinal and skewed with floor effects, is known to inflate the root mean square error of approximation, particularly in multigroup settings with sparse response categories. The scaled RMSEA of 0.089 in the baseline model looked alarming, but an alternative unweighted least squares estimator produced a value of 0.061, within acceptable limits. Similarly, elevated standardized root mean square residuals in France, Turkey and Belgium were traced to skewed data and sparse response categories rather than genuine model failure. France, which contributed only 107 patients and had no responses in two response categories of the final item, was excluded from the multigroup models for technical reasons. These methodological caveats illustrate why modern psychometric validation demands more than a glance at a single fit index.

Beyond the invariance testing, the study confirmed that the DLQI does what clinicians actually need it to do: distinguish patients of different disease severity. Known-group analysis using the Jonckheere-Terpstra non-parametric test, which detects ordered trends across groups, showed significant differentiation of DLQI scores by physician-assessed severity in every single country, with most comparisons significant at p less than 0.001. Spearman correlations between DLQI scores and the EQ-5D-3L dimensions, including mobility, self-care, usual activities, pain and anxiety-depression, were all significant and in the expected directions, with the strongest associations around 0.4. Mean DLQI scores ranged from 3.46 in Belgium to 10.69 in Poland, reflecting genuine differences in the disease mix across clinics, from psoriasis and acne to venous ulcers, non-melanoma skin cancer and hidradenitis suppurativa, rather than measurement artifacts.

The upshot for international dermatology research is nuanced but constructive. The DLQI can be trusted to measure the same quality-of-life construct across these 13 European languages, and within any country its scores are valid and clinically meaningful. Researchers planning multinational trials, however, should be cautious about pooling or directly comparing mean scores across countries without accounting for the demonstrated threshold non-invariance, and the authors point toward Bayesian approximate invariance methods, alignment techniques and item-level differential item functioning analyses as promising next steps. The team also cautions that European findings may not generalize to Asian, Middle Eastern or African cultural contexts, and that historical records of cognitive debriefing for some translations are incomplete. For an instrument that has shaped treatment thresholds, guideline decisions and drug trial endpoints for three decades, this study provides the kind of forensic self-examination that few patient-reported measures have undergone, and it largely vindicates the questionnaire’s global role while drawing a precise boundary around where cross-country score comparisons can and cannot be trusted.

Subject of Research: Cross-cultural measurement equivalence and psychometric validation of the Dermatology Life Quality Index across 13 European countries

Article Title: Equivalence of measurement properties of the Dermatology Life Quality Index (DLQI) across 13 European countries

Article References: Salek, S., Johns, J., Ali, F. M., Dalgard, F. J., Kupfer, J., & Finlay, A. Y. (2026). Equivalence of measurement properties of the Dermatology Life Quality Index (DLQI) across 13 European countries. Archives of Dermatological Research, 318(1), Article 518. https://doi.org/10.1007/s00403-026-04877-0

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04877-0

Keywords: Dermatology Life Quality Index, DLQI, measurement invariance, psychometrics, confirmatory factor analysis, patient-reported outcomes, quality of life, dermatology, cross-cultural validation, unidimensionality, MGCFA, Europe

The instrument in question is the Big Five Aspect Scales short version, known as the BFAS-40. The original Big Five Aspect Scales, developed by Colin DeYoung and colleagues, grew out of the observation that each Big Five domain splits into two aspects: for example, extraversion divides into enthusiasm and assertiveness, while neuroticism splits into withdrawal and volatility. These aspects sit between the broad domains and the even narrower facets measured by instruments such as the NEO Personality Inventory, and they have proven useful for linking personality to psychopathology, political ideology, and well-being. The BFAS-40, developed by Gallagher, Stevenor, Samo, and McAbee, condensed the original longer scales into just four items per aspect, aiming to preserve psychometric strength while cutting completion time dramatically.

Translating a questionnaire is not simply a matter of swapping words. Personality items often rely on idioms, subtle emotional vocabulary, and response conventions that do not map neatly across languages. Italian researchers have a long history of adapting personality measures, going back to factor-analytic work on the NEO inventories in the 1990s and 2000s, but each new instrument must be validated on its own terms. A team led by Chloe Lau of the University of Toronto and Francesco Bruno of Universitas Mercatorum in Rome, together with Francesca Chiesi of the University of Florence and Lena Quilty of the Centre for Addiction and Mental Health, took on that task for the BFAS-40, testing the translated scale in a community sample of 662 Italian-speaking adults.

The methodological heart of the study is its use of multidimensional item response theory, or MIRT, a modern statistical framework that models how each individual item functions across levels of the underlying trait. Unlike classical test theory, which focuses on total scores, item response theory estimates parameters for every question: how well it discriminates between people with different trait levels, and where its response thresholds fall along the trait continuum. Because the ten personality aspects are correlated and each item is written to tap one aspect within a broader domain, the researchers fit confirmatory multidimensional models rather than treating each aspect in isolation. This approach allowed them to test whether the hypothesized two-aspect structure actually held within each of the five Big Five domains in the Italian data.

The results were encouraging. Across all ten aspects, the confirmatory MIRT models showed acceptable to strong factor loadings and discrimination parameters, with response thresholds that were well ordered, meaning the answer options functioned as intended along the trait scale. Bayesian fit statistics told a consistent story: standardized root mean square residual values ranged from 0.045 to 0.063, root mean square error of approximation values from 0.032 to 0.045, and comparative and Tucker-Lewis fit indices ranged from 0.950 to 0.975. In conventional terms, these numbers indicate acceptable to strong model fit, supporting the structural validity of the two-factor solutions within each domain. In plain language, the Italian items grouped themselves into the same ten aspects that theory predicted, without needing to be reshuffled or discarded.

Reliability, the consistency with which the items measure each aspect, was assessed using Bayesian methods rather than traditional point estimates alone. The resulting estimates ranged from low to excellent across the ten aspects, a spread that is not unusual for very short scales. With only four items per aspect, some aspects inevitably show weaker internal consistency than others, and the authors are transparent about this variability. The Bayesian framework is particularly well suited to this kind of evaluation because it produces full distributions of the reliability estimates rather than single numbers, giving researchers a more honest picture of the precision of the measurement in a sample of this size.

Validity was then tested against external criteria. The Italian BFAS-40 was administered alongside the Big Five Inventory short form, allowing the researchers to check whether the new scale’s domain scores converged with an established measure of the same constructs. They also examined associations with indices of well-being and with measures of depression, anxiety, and stress drawn from the DASS-21. The pattern of correlations supported both convergent and discriminant validity: aspects related to negative emotionality, such as withdrawal and volatility, correlated with distress measures in the expected directions, while aspects tied to positive engagement aligned with well-being scores. This network of expected relationships suggests the translated items are measuring the same psychological substance as their English originals, not merely producing superficially similar responses.

Perhaps the most internationally significant part of the study is its cross-cultural comparison. The researchers compared item functioning between the Italian sample and a Canadian sample of 347 participants, using differential item functioning analysis, a technique that detects whether an item behaves differently for people from different groups after accounting for their trait levels. Of the 40 items, 39 showed no evidence of differential functioning between Italian and Canadian respondents. Only a single Agreeableness item was flagged. This near-perfect record is remarkable for a translated personality measure and suggests that the Italian adaptation achieved what psychometricians call measurement equivalence, the property that allows scores to be compared meaningfully across cultures rather than within each country alone.

The one flagged item is worth noting rather than dismissing. Agreeableness, which splits into compassion and politeness, is the aspect most closely tied to social values and interpersonal norms, domains where cultural expectations differ most between countries. An item that functions differently across cultures does not necessarily indicate a translation error; it may reflect genuine cultural variation in how agreeable behavior is expressed or interpreted. For researchers planning cross-cultural studies, the practical implication is that 39 of the 40 Italian items can be used in direct comparison with Canadian data, while the flagged Agreeableness item should be interpreted with caution in such analyses.

The study arrives at a moment when demand for brief, validated personality measures is accelerating. Short scales are increasingly used in electronic health records, large online panels, and studies that follow thousands of people over time, where every additional minute of questionnaire length translates into dropout. Recent work has extended the BFAS-40 to German, French, and Italian samples, and the present study adds a level of statistical scrutiny, multidimensional item response modeling with Bayesian estimation and formal cross-cultural DIF testing, that goes beyond typical translation checks. For Italian-speaking researchers and clinicians, the BFAS-40 now offers a theoretically grounded, efficient tool that captures the ten aspects of the Big Five in a fraction of the time of the original instruments. For the broader field, it demonstrates that careful psychometric engineering can make even a nuanced hierarchical model of personality travel across languages without losing its shape, a small but meaningful step toward personality science that speaks with one measurement language worldwide.

Subject of Research: Cross-cultural psychometric validation of the Italian BFAS-40 personality questionnaire using multidimensional item response theory

Article Title: The Italian adaptation of the big five aspects scale short version (BFAS-40): a multidimensional item response theory model and cross-cultural validation study

Article References: Lau, C., Bruno, F., Chiesi, F., & Quilty, L. C. (2026). The Italian adaptation of the big five aspects scale short version (BFAS-40): a multidimensional item response theory model and cross-cultural validation study. Current Psychology, 45(18), Article 1508. https://doi.org/10.1007/s12144-026-09982-x

Image Credits: AI Generated

DOI: 10.1007/s12144-026-09982-x

Keywords: personality psychology, Big Five, BFAS-40, psychometrics, item response theory, cross-cultural validation, Italian adaptation, reliability, validity, differential item functioning, Bayesian analysis, psychological assessment

The review, conducted by Xiao-xiao Li, Zhen-peng Huang, and Kong-jin Quan of the Faculty of Nursing at Guangxi University of Chinese Medicine, casts a wide net. The team searched eight English- and Chinese-language databases from their inception through October 2025, screening 10,818 records. From that mountain of literature, 34 studies met the inclusion criteria, covering the development, evaluation, or cross-cultural validation of instruments intended to detect somatic symptom disorder or closely related constructs. The work follows the PRISMA-ScR reporting guidelines, the accepted standard for scoping reviews, and the authors independently mapped each instrument’s content against a prespecified framework derived from the DSM-5.

That framework is where the technical heart of the review lies. The DSM-5 definition of somatic symptom disorder rests on two pillars. Criterion A requires the presence of one or more somatic symptoms that are distressing or disruptive to daily life. Criterion B captures the psychological and behavioral response to those symptoms, broken into three components: disproportionate thoughts about their seriousness, persistently high anxiety about health or symptoms, and excessive time and energy devoted to symptoms. Under the older DSM-IV framework, the diagnosis of somatoform disorders hinged largely on unexplained symptoms; the 2013 revision shifted the emphasis toward how patients think, feel, and behave in relation to symptoms, regardless of whether a medical explanation exists. Any screening tool built before that shift, or built for a different purpose, may therefore be measuring something subtly but importantly different.

When Li and colleagues mapped the nineteen instruments against these criteria, the mismatch became stark. Ten instruments covered Criterion A only, meaning they quantify somatic symptom burden but say nothing about the maladaptive thoughts, anxiety, and behavioral investment that define the disorder. Four covered Criterion B only, probing the psychological response without establishing that distressing symptoms are present. Five instruments covered both Criteria A and B, and only those, the authors argue, align closely enough with the DSM-5 construct to serve as genuine screening tools for the disorder. Criterion C, which concerns the persistence of symptoms, and the final diagnostic confirmation, remain outside the reach of any brief questionnaire and require clinical assessment.

The instrument landscape the review assembles reads like a history of somatic symptom measurement. Legacy tools such as the Patient Health Questionnaire-15, the Somatic Symptom Scale-8, the Screening for Somatoform Symptoms-7, the Symptom Checklist-90, and the Whiteley Index in its revised seven- and eight-item forms were all built to count or characterize physical complaints, or to capture health anxiety, under pre-DSM-5 constructs. Newer, disorder-specific measures include the Somatic Symptom Disorder-B Criteria Scale, known as SSD-12, which was purpose-built to assess the Criterion B psychological features, and instruments such as the Somatic Symptoms Experiences Questionnaire and the Somatic Symptom Scale-China that emerged more recently in response to the revised diagnosis. The SSD-12 stands out in the evidence base: of the six instruments that underwent any cross-cultural validation, the majority of that work concentrated on the SSD-12, which has been translated and tested in numerous languages and clinical populations.

Psychometric evidence varied widely across the 34 studies. The review summarized internal consistency, test-retest reliability, and structural validity, with factor analytic work employing exploratory and confirmatory factor analysis and reporting fit indices such as the comparative fit index, the Tucker-Lewis index, the root mean square error of approximation, and the standardized root mean square residual. Some instruments showed strong and replicable factor structures; others were evaluated only in single studies, in narrow populations, or with methods that would not meet contemporary standards such as item response theory. The authors note that only eight of the nineteen instruments had any evidence of criterion validity or diagnostic validity, typically expressed as sensitivity, specificity, or the area under the receiver operating characteristic curve against a structured clinical interview such as the SCID-5 Research Version. For the remaining instruments, clinicians and researchers are essentially trusting face validity.

This gap matters in practice. A physician using a Criterion A-only tool, such as a symptom-count checklist, may correctly identify a patient burdened by physical complaints but cannot distinguish a patient with somatic symptom disorder from one with a well-understood medical illness that happens to be painful or fatiguing. Conversely, a Criterion B-only measure may flag pathological health anxiety in someone whose physical symptoms are minimal, a presentation the DSM-5 definition would not capture. The review’s central strategic conclusion is that instruments spanning both criteria are the ones most closely aligned with true screening for the disorder, while everything downstream, including attention to Criterion C and the exclusion of better alternative explanations, belongs in the clinical interview. Screening, in other words, can open the door, but only a clinician can walk through it.

The cross-cultural findings carry particular weight for global mental health. Somatic presentation of psychological distress is common in many cultures, and instruments developed in German, Dutch, or English-speaking settings embed assumptions about how patients conceptualize their bodies and their worries. The review found that only six instruments had undergone cross-cultural validation at all, and that the evidence was heavily concentrated on the SSD-12, with Chinese-language adaptations, including the Somatic Symptom Scale-China, forming a notable share of the literature. The inclusion of Chinese-language databases such as CNKI reflects a deliberate effort by the authors to capture validation work that Western reviews have often overlooked. Even so, the authors conclude that further DSM-5-based diagnostic accuracy studies and cross-cultural validations are needed in intended populations and real clinical settings, rather than in the student and convenience samples that dominate psychometric research.

For clinicians, the practical takeaway is to know what the questionnaire in the waiting room is actually measuring. A brief symptom checklist may be an excellent triage tool for symptom burden and treatment monitoring, but it is not a somatic symptom disorder screen. Instruments that explicitly assess both the presence of distressing symptoms and the disproportionate thoughts, anxiety, and time investment surrounding them offer the closest available approximation to the DSM-5 construct, and the SSD-12 currently carries the strongest and most internationally replicated evidence base. For researchers, the review identifies clear priorities: head-to-head diagnostic accuracy studies against structured clinical interviews, validation in primary care and medical settings where these patients actually present, and rigorous translation and adaptation work for the many languages and health systems where no validated tool exists.

The broader significance of the review extends beyond one diagnosis. It is a case study in what happens when diagnostic criteria change faster than measurement science. The DSM-5 redefined somatic symptom disorder around a psychological-behavioral response to symptoms, yet sixteen of the nineteen available instruments were designed for adjacent constructs under older frameworks, from health anxiety to unexplained symptom counts. Until the measurement toolkit catches up, the review suggests, the field will continue to rely on instruments that illuminate parts of the disorder while leaving its defining features in shadow, and the diagnosis will remain as challenging to detect in routine practice as it has been to define in the taxonomy.

Subject of Research: Development, validation, and cross-cultural adaptation of screening instruments for somatic symptom disorder

Article Title: Screening instruments for somatic symptom disorder: a scoping review of development, validation, and cross-cultural adaptation

Article References: Li, X.-X., Huang, Z.-P., & Quan, K.-J. (2026). Screening instruments for somatic symptom disorder: a scoping review of development, validation, and cross-cultural adaptation. BMC Psychology. https://doi.org/10.1186/s40359-026-05691-z

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05691-z

Keywords: somatic symptom disorder, DSM-5, screening instruments, psychometrics, SSD-12, scoping review, cross-cultural validation, diagnostic accuracy, somatic symptoms, clinical assessment, questionnaires, BMC Psychology

The research team set out to build a wellbeing scale from the ground up, designed specifically for adolescents living with HIV in Eastern and Southern Africa. The motivation was straightforward. Most existing instruments either dwell on negative outcomes such as depression and anxiety, or they borrow from the positive psychology literature, where questionnaires were developed and validated in high-income countries among populations whose cultural assumptions about happiness, selfhood and success differ profoundly from those of rural and urban Zimbabwe. Concepts like self-esteem, life satisfaction and personal growth are not universal constants; they are shaped by family structures, religious belief, community expectations and the lived experience of a chronic, stigmatized infection. A questionnaire that assumes an individualistic, self-focused notion of wellbeing may simply fail to register what matters most to a fifteen-year-old in Harare.

Between 2022 and 2025, the researchers ran a multi-stage scale development process that would satisfy most textbook checklists. They began with a scoping review and a systematic review of the literature, mapping the crowded landscape of positive psychological constructs and the instruments used to measure them. They then conducted qualitative discussions with adolescents living with HIV, solicited input from an expert panel, prioritized constructs and candidate items, and ran cognitive interviews to check whether young people actually understood the questions as intended. Iterative item reduction followed, using exploratory factor analysis and Rasch analysis, two statistical techniques that test whether a set of questions hangs together as a coherent measurement instrument and whether the response options function as designed. The process whittled an initial item bank down to a 53-item candidate scale, then to a 38-item version, and finally to a 25-item instrument called the Zvandiri Character Strength scale, or ZCS 25.

The qualitative work produced findings that should reshape how anyone thinks about adolescent wellbeing in this setting. When young people talked about what made life good, they emphasized connectedness to others, hope for the future, self-acceptance, self-efficacy, a sense of purpose, and flourishing. Crucially, wellbeing emerged as relational and contextually situated rather than a private, internal state. Being well meant being embedded in supportive relationships, being able to contribute to one’s community, and having one’s identity as a young person living with HIV met with acceptance rather than shame. The discussions also revealed something that Western positive psychology instruments rarely accommodate: wellbeing and distress often co-occurred in the same person at the same time. A teenager could feel hopeful about her future while simultaneously grieving a parent or worrying about disclosure of her status.

Then came the quantitative testing, and this is where the study becomes genuinely instructive, because the results refused to cooperate with the researchers’ hopes. When the ZCS 25 was administered retrospectively before an intervention, immediately after, and at follow-up, the responses were overwhelmingly positive. So positive, in fact, that the data showed ceiling effects, with most participants clustering at the top of the response scales, leaving no room to detect improvement. Rasch analysis revealed disordered thresholds, meaning that adjacent response categories such as somewhat agree and strongly agree did not function as distinct levels of the underlying trait. The internal structure of the scale was weak, with items failing to group into the theoretically expected domains. Retrospective ratings fluctuated in puzzling ways across administrations.

The most illuminating explanation came not from the statistics but from the participants themselves. In feedback sessions, adolescents suggested that their glowing responses likely reflected affirmations, a kind of positive self-statement that carries social and psychological value in its own right, and that social desirability had shaped at least some of their answers. In a context where support groups celebrate resilience and where admitting struggle to a researcher or peer counselor can feel like a betrayal of the community’s ethos of hope, answering positively is not necessarily deception. It may be a meaningful social act. For measurement science, this is a profound complication: the very act of asking about wellbeing can invite a performance of wellbeing, and the boundary between genuine flourishing and aspirational self-presentation is not one that a Likert scale can easily draw.

The bottom line, stated with rare honesty in the published paper, is that the ZCS scale did not support a single interpretable total score. Adding up the 25 items and reporting a wellbeing number would have been statistically indefensible. Many research teams, under pressure to demonstrate impact to funders, would have been tempted to report the totals anyway. The authors instead treated the failure as the finding, arguing that the development process itself generated the most valuable lessons. This is an unusual and commendable stance in a field where null or messy results are routinely buried, and it transforms the study from a failed instrument into a methodological case study with implications far beyond Zimbabwe.

So what should the field do differently? The authors lay out a set of prescriptions that amount to a more humble and more rigorous approach to cross-cultural measurement. Future efforts should begin with a clearer construct definition, specifying exactly what aspect of wellbeing is being targeted before a single item is written. Response-process validation, checking how participants actually interpret and formulate their answers, deserves far more attention than it typically receives, because the cognitive interviews in this study foreshadowed many of the statistical problems that emerged later. Domain-level testing, evaluating each dimension of wellbeing separately rather than chasing a single grand total, would respect the multidimensional and sometimes contradictory nature of adolescent mental life. And researchers should make an explicit decision about the purpose of the measure: is it meant to capture lived wellbeing as adolescents experience it, to assess domain-specific positive outcomes, or to detect change attributable to an intervention? These are different goals that may require different instruments.

The wider stakes are considerable. Global funders increasingly demand mental health outcome data from HIV programs, and positive psychology instruments developed in the United States or Europe are being deployed across sub-Saharan Africa with limited validation. If those instruments produce ceiling effects and social desirability bias in the very populations they are meant to serve, programs may appear to have no effect, or worse, effects may be fabricated by measurement artifacts. The Zimbabwe study does not offer a ready-made scale, but it offers something arguably more valuable: a demonstration that rigorous, participatory measurement development can fail informatively, and that listening to adolescents about what wellbeing means to them is not a preliminary courtesy but the scientific foundation on which any valid instrument must rest. For the millions of young people living with HIV, getting this right is not an academic exercise; it determines which services get funded, which interventions scale, and whose flourishing is finally counted.

Subject of Research: Development and psychometric evaluation of a culturally grounded wellbeing scale for adolescents living with HIV in Zimbabwe

Article Title: Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe

Article References: Mavhu, W., Dambi, J. M., Simms, V., Martin, F., Lariat, J., Mbundure, R., Makoni, L., Kafata, L., Wogrin, C., Chitiyo, V., Mutsinze, A., Cowan, F. M., Willis, N., & Bernays, S. (2026). Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe. PLOS Global Public Health, 6(9), e0006845. https://doi.org/10.1371/journal.pgph.0006845

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0006845

Keywords: adolescent health, HIV, wellbeing measurement, Zimbabwe, psychometrics, scale development, global mental health, positive psychology, Rasch analysis, social desirability, Zvandiri, cross-cultural validation

The rationale for the work is straightforward. Falls in hospital can lead to fractures, head injuries, prolonged admissions, loss of patient confidence, and substantial additional costs for health systems. Older adults and patients with certain conditions are particularly vulnerable, but any inpatient can be at risk depending on medication, mobility, and environment. Because nurses spend more continuous time with patients than any other professional group, their knowledge of risk factors, their attitudes toward prevention, and their day-to-day preventive practices are central to whether a hospital’s fall-prevention program succeeds or fails. Instruments that measure these three dimensions together, in the language nurses actually use at the bedside, are therefore a practical necessity rather than an academic luxury.

To build the questionnaire, the researchers drew on three complementary sources: a review of the published literature on fall prevention, existing validated fall-prevention instruments, and clinical guidelines for inpatient safety. From this foundation they assembled an initial pool of 33 items distributed across three domains: knowledge of falls and their prevention, attitudes toward fall-prevention practice, and self-reported preventive measures that nurses carry out in their routine work. This combination of sources is standard practice in instrument development, because it ensures that the items reflect both the scientific consensus on what prevents falls and the practical realities of nursing care, rather than the assumptions of a single author or committee.

The validation process then proceeded in carefully staged steps. Content validity was evaluated by a panel of 10 experts, who judged whether each item was relevant, clear, and representative of the domain it was intended to measure. Face validity was assessed by 30 nurses, who reviewed the draft items for readability and comprehensibility from the perspective of the people who would ultimately complete the survey. This two-layered qualitative screening is critical: an item that experts consider technically correct may still confuse respondents, and an item that reads well may still miss an important concept. Only after this refinement did the team move to the statistical phase of validation.

Construct validity, the question of whether the questionnaire actually measures the three theoretical domains it claims to measure, was tested using two complementary forms of factor analysis on independent samples of 200 registered nurses each. Exploratory Factor Analysis on the first sample allowed the underlying structure of the items to emerge from the data without imposing a predetermined model. The results supported the intended three-domain structure, with the knowledge, attitude, and preventive-measure domains explaining 48.7 percent, 61.3 percent, and 68.5 percent of their respective item variance. These percentages indicate that each cluster of items hangs together coherently around a single underlying construct, a fundamental requirement for a questionnaire that will produce interpretable domain scores.

The second sample was reserved for Confirmatory Factor Analysis, a stricter statistical test in which the researchers specify the three-domain model in advance and ask how well the observed data fit it. The final model, trimmed to 20 items, showed a satisfactory fit across all the conventional indices: a chi-square to degrees-of-freedom ratio of 1.46, a Comparative Fit Index of 0.96, a Tucker-Lewis Index of 0.95, a root mean square error of approximation of 0.07, and a standardized root mean square residual of 0.03. Values close to or above 0.95 for the fit indices, an RMSEA below 0.08, and an SRMR below 0.08 are generally regarded as evidence of good model fit, so the KAP-PMF comfortably meets accepted psychometric standards.

Reliability, the consistency with which the questionnaire measures what it measures, was assessed using three statistics. Cronbach’s alpha, the most widely cited measure of internal consistency, ranged from 0.78 to 0.86 across the three domains, above the commonly accepted threshold of 0.70. Composite Reliability, which is less sensitive to the number of items in a scale, ranged from 0.79 to 0.95. Average Variance Extracted, which quantifies how much of the variance in the items is captured by the underlying construct rather than by measurement error, ranged from 0.50 to 0.67, meeting or approaching the conventional benchmark of 0.50. Together these figures indicate that the shortened 20-item instrument retains dependable measurement properties despite the substantial reduction from the original 33 items.

That reduction itself is worth noting. The final instrument comprises just 4 knowledge items, 6 attitude items, and 10 preventive-measure items. Shorter questionnaires impose less burden on busy clinical staff, reduce respondent fatigue, and are more likely to be adopted in routine audits, training evaluations, and hospital quality-improvement programs. In resource-conscious healthcare systems, a validated 20-item tool that can be completed in a few minutes is far more practical than a sprawling survey, and the evidence that the trimmed version still fits the three-domain model and performs reliably suggests the researchers made defensible choices about which items carried the most informational weight.

The study was carried out among registered nurses at Hospital Pakar Universiti Sains Malaysia, a teaching hospital in Kelantan, and was approved by the Universiti Sains Malaysia Human Research Ethics Committee with written informed consent obtained from all respondents. It was funded by the Hospital Pakar USM Research Incentive Grant. The authors describe the evidence as preliminary, which is an appropriate caveat: the validation was conducted in a single institution, and further testing in other Malaysian hospitals, in different nursing specialties, and ideally with longitudinal designs linking questionnaire scores to actual fall rates would strengthen the case for broader use. Cross-cultural adaptation of health instruments is notoriously difficult, and a tool validated in one setting may behave differently where patient populations, staffing patterns, or fall-prevention protocols differ.

Even with those caveats, the significance of the work extends beyond one hospital in Kelantan. Malaysia’s healthcare workforce is multilingual, and much of bedside communication happens in Malay, so a validated Malay instrument removes a subtle but real source of measurement error that arises when nurses answer questions framed in a second language. The KAP-PMF also provides a template for other countries and languages where fall-prevention research has been constrained by the absence of locally validated tools. For hospital administrators, the questionnaire offers a way to identify specific gaps in knowledge or attitude that can be targeted by training, and to evaluate whether educational interventions actually shift nursing practice. For researchers, it adds a psychometrically sound instrument to a field where measurement quality often lags behind clinical ambition. As hospitals worldwide confront aging populations and rising expectations for patient safety, tools like this one, built rigorously and tested statistically, are the quiet infrastructure on which safer care depends.

Subject of Research: Development and psychometric validation of a Malay-language questionnaire assessing nurses' knowledge, attitudes, and preventive practices in hospital fall prevention

Article Title: Development and validation of a Malay questionnaire on nurses’ knowledge, attitudes, and practices in fall prevention in a teaching hospital in Kelantan: a cross-sectional study

Article References: Wahi, N., Ibrahim, M. I., Hairon, S. M., Yusoff, M., Abdullah, S. A., Zainun, R. M., & Ab Aziz, M. Z. (2026). Development and validation of a Malay questionnaire on nurses’ knowledge, attitudes, and practices in fall prevention in a teaching hospital in Kelantan: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05372-7

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05372-7

Keywords: fall prevention, nursing, questionnaire validation, psychometrics, patient safety, Malaysia, confirmatory factor analysis, exploratory factor analysis, Cronbach's alpha, cross-cultural validation, teaching hospital, nursing research