The research, led by Haitham Jahrami of Government Hospitals and the Arabian Gulf University in Bahrain, together with colleagues including Waqar Husain, Khaled Trabelsi, Zahra Saif, Achraf Ammar, Halley M. Pontes, and Amir H. Pakpour, recruited 1,134 Arabic-speaking young adults aged 18 to 25 years through social media platforms. Slightly more than half of the participants, 53.4 percent, were female, and the average age was just over nineteen years. This age band is epidemiologically critical: young adults are among the heaviest gamers globally, and systematic reviews and meta-analyses have repeatedly identified adolescents and young adults as the groups at greatest risk for problematic gaming patterns. The Arab world, with its exceptionally youthful population structure, represents a region where robust screening tools for gaming-related harm are urgently needed.

What makes this study unusual is the sheer breadth of analytical techniques applied to a four-item questionnaire. The Gaming Disorder Test, originally developed by Pontes and colleagues to operationalize the WHO framework of gaming disorder, is deliberately brief, which makes it attractive for large-scale surveys but also means that each item carries enormous psychometric weight. The team therefore combined classical test theory, confirmatory factor analysis, measurement invariance testing across gender and age groups, Rasch analysis, latent class analysis, and regularized partial-correlation network analysis. Each method interrogates a different property of the scale, and together they provide a far more complete picture than any single approach could deliver.

The classical psychometric results were reassuring. The Arabic version of the test showed a unidimensional structure, meaning that all four items tap a single underlying construct of gaming disorder severity rather than fragmenting into separate subdomains. Internal consistency was acceptable, with a Cronbach’s alpha of .716, McDonald’s omega of .770, and composite reliability of .776. Confirmatory factor analysis produced adequate fit indices, a finding the authors interpret carefully in light of the model’s very low degrees of freedom. With only four indicators loading onto one factor, fit statistics such as the RMSEA are known to behave erratically, sometimes producing misleadingly poor or misleadingly favorable values, so the researchers contextualized their results accordingly rather than overinterpreting a single number.

Perhaps the most consequential finding for future cross-cultural research is that strict measurement invariance held across both gender and age groups. Measurement invariance is the statistical property that allows researchers to meaningfully compare scores between groups: if a scale measures the construct differently in men and women, or in younger and older respondents, then any observed score differences might reflect measurement artifacts rather than genuine differences in symptom severity. Demonstrating invariance at the strictest level, which constrains not only the factor loadings but also the item intercepts and residual variances, means that total scores from the Arabic Gaming Disorder Test can be compared directly across gender and age within this population, opening the door to valid group comparisons in future epidemiological studies.

Rasch analysis added a further layer of rigor grounded in item response theory. This approach models the probability of endorsing each response category as a function of the respondent’s underlying severity and the item’s difficulty, allowing researchers to verify that the items work together as a coherent measuring instrument. The Rasch results indicated adequate item fit and properly ordered response categories, meaning that participants used the response options in a logically consistent way: those with higher severity were more likely to endorse higher response options on each item. This is a nontrivial property that many translated scales fail to demonstrate, and its confirmation here supports the use of the raw total score as a meaningful interval-level measure of symptom severity.

Latent class analysis then shifted the question from measurement to classification, asking whether distinct subgroups of gamers exist within the sample. The analysis identified two severity classes: a lower-severity group comprising 42.2 percent of participants and a higher-severity group comprising 57.8 percent. The relatively large proportion of participants in the higher-severity class is striking, although the authors are careful to note that the test measures self-reported symptom severity rather than providing a clinical diagnosis. The two-class solution suggests that gaming-related harm in this population is not distributed as a smooth continuum alone but may cluster into qualitatively distinct profiles, a finding with potential implications for how screening and intervention efforts are targeted.

Network analysis, an increasingly popular framework in psychopathology research that treats symptoms as interconnected nodes in a causal system rather than reflections of a single latent variable, offered a hypothesis-generating perspective on the internal architecture of the scale. The analysis suggested that items GDT2 and GDT3 carried the highest centrality, meaning they were most strongly connected to the other symptoms in the network. However, with only four nodes, the network is necessarily sparse, and the authors explicitly frame these findings as preliminary and hypothesis-generating rather than definitive. Central symptoms identified in small networks may become targets for future research into which aspects of disordered gaming are most tightly bound to the overall syndrome.

To establish criterion validity, the researchers examined correlations between Gaming Disorder Test scores and symptoms of depression, anxiety, and stress measured with the DASS-21, a widely used brief instrument. Total scores showed small but statistically significant associations with psychiatric distress symptoms. This pattern is consistent with the broader literature, including meta-analytic work linking internet gaming disorder with depressive symptoms, and with studies showing that gaming-related impairment is meaningfully, if modestly, related to general psychological distress. The modest effect sizes also reinforce an important conceptual point: gaming disorder is not simply a proxy for general distress but a distinct pattern of behavior with its own measurement logic.

The authors conclude that the Arabic Gaming Disorder Test demonstrates sound psychometric properties and cross-group comparability, supporting its use as a screening tool for self-reported gaming disorder symptom severity among Arabic-speaking young adults. They are equally clear about its limits: a brief self-report screen cannot substitute for a structured clinical assessment, and a positive screen should prompt, not replace, a comprehensive diagnostic evaluation. With validated versions of the test now available in Chinese, Persian, Spanish, Polish, and other languages, this Arabic translation fills a significant gap for a linguistic community spanning more than twenty countries. For researchers and public health officials across the Arab world, the study provides a psychometrically defensible instrument at precisely the moment when concerns about gaming-related harm among youth are intensifying globally, and it sets a methodological benchmark, combining classical, Rasch, latent class, and network approaches, that future validation studies of brief behavioral addiction measures will be hard-pressed to match.

Subject of Research: Psychometric validation of the Arabic version of the Gaming Disorder Test in Arabic-speaking young adults

Article Title: Translation and Validation of the Gaming Disorder Test in an Online Sample of Arabic-Speaking Young Adults: Evidence from Classical Psychometrics, Rasch Analysis, Latent Class Analysis, and Network Analysis

Article References: Jahrami, H., Husain, W., Trabelsi, K., Saif, Z., Ammar, A., Pontes, H. M., & Pakpour, A. H. (2026). Translation and Validation of the Gaming Disorder Test in an Online Sample of Arabic-Speaking Young Adults: Evidence from Classical Psychometrics, Rasch Analysis, Latent Class Analysis, and Network Analysis. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-026-01742-z

Image Credits: AI Generated

DOI: 10.1007/s11469-026-01742-z

Keywords: gaming disorder, Gaming Disorder Test, psychometrics, Arabic validation, Rasch analysis, latent class analysis, network analysis, measurement invariance, young adults, ICD-11, DASS-21, behavioral addiction

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 Assessment of Work Performance, or AWP, was originally developed in Sweden and has now been translated into ten languages, with Finnish being the most recent addition. Unlike interview-based instruments, the AWP relies on direct observation. An occupational therapist watches a client carry out a real or simulated work task and rates fourteen distinct observable skills on a four-point scale, from incompetent to competent performance. These skills fall into three domains: motor skills such as mobility, coordination, and strength; process skills such as time management, planning, and adaptation; and communication and interaction skills such as social contact and information exchange. Crucially, the instrument is not tied to any particular diagnosis. Because it measures the interaction between person and environment, it can be applied to clients with mental health conditions, musculoskeletal problems, or any other work-related challenge, in genuine workplaces or constructed assessment settings.

In the new study, a team led by Jennie Nyman of Metropolia University of Applied Sciences, together with colleagues at Linköping University in Sweden, put the Finnish translation, the AWP-FI, through a demanding statistical technique known as Rasch analysis. Seventeen occupational therapists across Finland, all trained in a one-day session and two follow-up meetings, collected ninety-four assessments as part of their routine clinical work. The clients ranged from 18 to 60 years of age, and a majority of those with reported diagnoses had mental or behavioural disorders. Most assessments were conducted through direct observation, and the overwhelming majority, 84 percent, took place in simulated settings, with tasks such as book binding, household chores, and arranging and indexing magazines standing in for real jobs.

Rasch analysis is a form of modern psychometrics that converts ordinal rating-scale data into interval-level measurements. The method estimates two quantities simultaneously: the ability of each person and the difficulty of each item, placing both on a common scale. If the data behave as the model expects, the instrument can be said to measure a single coherent underlying trait, in this case work performance, in a way that is fair and comparable across individuals. The researchers structured their evaluation around three questions drawn from established psychometric guidance: whether the scale’s difficulty range matched the abilities of the sample, whether a reliable measurement scale had been constructed, and whether the individuals in the sample were being measured reliably and meaningfully.

The headline result was encouraging. The AWP-FI showed an overall fit to the Rasch model, with a non-significant chi-square test indicating that observed responses aligned well with model expectations. Individual items performed within acceptable statistical limits, and, importantly, no item behaved differently for different groups. Tests for differential item functioning, which detect whether an item is biased, for example by being harder for women than for men at the same underlying ability level, came back clean across gender, across direct versus participatory observation, and across simulated versus genuine work tasks. This stability suggests the Finnish instrument can be used confidently with men and women alike, in real workplaces or assessment laboratories, and whether the therapist watches from the side or joins the work activity as a participant.

The analysis was not without complications. Five of the fourteen items showed disordered thresholds, meaning that adjacent response categories were not being used in a consistent, ordered way. In practice, the middle rating of the four-point scale was rarely the most probable response for those items, likely because the observed clients clustered at similar performance levels and the full range of the scale was seldom used. The researchers collapsed the affected categories and reran the analysis, a standard corrective procedure, but they caution that any permanent change to the rating scale should wait for confirmation in larger and more varied samples.

Two deeper issues also emerged. First, targeting was suboptimal: the mean person location of 1.6 sat well above the item mean of zero, and the item difficulty range, spanning roughly from minus 1.3 to 0.9 on the logit scale, was narrow. In plain terms, the clients assessed were generally more capable than the hardest items could measure, leaving the scale without items at the demanding end of the work-performance continuum. The authors attribute this largely to the tasks chosen: most assessments used simulated, non-work-specific activities with relatively low demands. Their clinical recommendation is that assessors think carefully about task selection, since the nature and demands of the chosen task directly shape what the assessment can reveal. Adding harder items could widen the measure, but the authors urge caution, because new items must remain faithful to the instrument’s theoretical foundation in the Model of Human Occupation, and expanding item counts carries its own psychometric risks.

Second, the analysis flagged local dependency among items and indications of multidimensionality. Twenty-four of ninety-one residual correlations exceeded the statistical cut-off, and these correlations clustered neatly within the three AWP domains, suggesting that items within a domain share information beyond what the single underlying trait of work performance can explain. When the researchers compared person estimates derived from different domains, between 11 and 17 percent of respondents fell outside the range expected for a truly unidimensional scale, well above the 5 percent benchmark. Notably, this finding diverges from an earlier evaluation of the Swedish original, which found no multidimensionality. The authors suggest the clinical impact may be minimal, since the domain structure reflects the deliberate theoretical architecture of the Model of Human Occupation, but they recommend that future studies with larger samples apply multidimensional or testlet-based Rasch approaches to confirm the pattern.

On the reliability front, the news was solid. The person-separation index reached 0.83, comfortably above the 0.8 benchmark, indicating the scale can distinguish roughly three clinically meaningful groups of clients. Only four participants, about 4 percent, showed erratic response patterns outside acceptable fit limits, meaning nearly everyone was measured in a statistically coherent way. Taken together, the results provide an initial validation of the AWP-FI and support its use as a valid and reliable observational tool for assessing work performance in Finland, where the Finnish Institute for Health and Welfare has explicitly called for more reliable and valid vocational assessment practices. Used alongside the interview-based Worker Role Interview, whose Finnish version passed a similar evaluation in 2023, the AWP-FI can contribute to the kind of holistic, multi-source assessment that sickness insurance and vocational rehabilitation systems increasingly demand.

The study’s limitations are candidly acknowledged. The sample of ninety-four assessments is modest, the DIF analysis suffered from very unequal group sizes, with simulated tasks dominating at 84 percent, which raises the risk that genuine item bias could have gone undetected, and the narrow spread of client performance likely constrained several of the analyses. The authors therefore frame this as a first step rather than a final verdict, recommending further testing with larger and more diverse samples to resolve the local dependency and targeting issues. For clinicians, the practical message is immediate and actionable: the AWP-FI works, but its usefulness depends on choosing work tasks demanding enough to reveal the full range of a client’s capability, and on remembering that the fourteen observed skills are organised into three theoretically distinct domains that should inform, not obscure, the interpretation of results.

Subject of Research: Psychometric validation of the Finnish version of the Assessment of Work Performance using Rasch analysis

Article Title: Psychometric evaluation of the Finnish version of the Assessment of Work Performance (AWP-FI)

Article References: Nyman, J., Sandqvist, J., Pihlava, J., Ekbladh, E., & Yngve, M. (2025). Psychometric evaluation of the Finnish version of the Assessment of Work Performance (AWP-FI). Scandinavian Journal of Occupational Therapy, 32(1), Article 2555182. https://doi.org/10.1080/11038128.2025.2555182

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2555182

Keywords: psychometrics, Rasch analysis, occupational therapy, work ability, vocational rehabilitation, AWP-FI, construct validity, differential item functioning, Model of Human Occupation, Finland, assessment tools, work performance

Occupational balance is a deceptively simple concept with deep roots in occupational therapy, the health profession concerned with helping people engage in the everyday activities, or occupations, that give life structure and meaning. Swedish researchers Petra Wagman and Carita Håkansson, both co-authors of the new study, defined it in earlier work as an individual’s perception of having the right amount of occupations and the right variation between them. Crucially, the definition is subjective: there is no universal formula dictating how time should be divided among self-care, work, leisure, and sleep. What matters is whether each person feels their mix of activities is sufficient and varied enough. Occupational imbalance arises when someone feels they are doing too little, too much, or lacking variety, and research consistently links this perception to well-being, quality of life, and mental health.

People with depression face particular obstacles in achieving this balance. Symptoms such as low mood, lack of interest and energy, and difficulties with decision-making, concentration, and memory reduce the capacity to perform personal care, household tasks, and social or productive activities. Many individuals scale back the roles they take on, withdrawing from chores, employment, and family responsibilities. Over time, depression can shift daily patterns toward sleeping and resting at the expense of active pursuits, further narrowing the variety of occupations. Prior research suggests that people with depression achieve occupational balance when they feel they have varied things to do, the right amount to do, satisfaction with how their time is spent, and a good mix of energizing and draining activities. Measuring where a patient stands on this spectrum is therefore essential for designing effective, individualized interventions, which is precisely why a validated assessment tool matters.

The instrument at the heart of the new study is the OBQ11, an eleven-item self-report questionnaire developed in Sweden and refined through Rasch analysis, a modern psychometric technique. Respondents rate each statement, such as having just enough to do during a regular week or balancing obligatory and voluntary occupations, on a four-point Likert scale from completely disagree to completely agree, yielding total scores from 0 to 33, with higher scores indicating better occupational balance. The questionnaire takes less than fifteen minutes to complete, making it practical for clinical use. It has already been translated into Spanish, Norwegian, Turkish, Arabic, Persian, and Danish, but until now no version existed for Chinese-speaking populations, and no tool had been found suitable for people in Taiwan.

Translating a psychological questionnaire is far more demanding than swapping words between languages, and the Taiwanese team followed a rigorous, standardized procedure. Two bilingual occupational therapists produced a forward translation into traditional Chinese, while a bilingual translator supported by a professional English editor handled the back translation. The first author then reconciled the two versions and corresponded directly with the OBQ11 developers to confirm accuracy. Some items proved stubborn: two required back translation twice, and one needed four rounds before the meaning aligned with the original. This iterative process, repeated across multiple reviews, ensured that each translated item preserved the intent of the Swedish source rather than merely its surface wording.

Cultural nuance surfaced most vividly in the expert review phase. Ten occupational therapy experts from across Taiwan, with an average of thirteen years of clinical experience, initially rated the translated items below the accepted thresholds for content validity, flagging ambiguous wording, difficult phrasing, and a missing instruction about the recall period. In response, the team refined item 1, clarifying that just enough things means an appropriate amount of activity, neither too little nor too much, and adjusted item 3 to indicate that it concerns doing some of the things a person genuinely wants. Item 9, which addresses balancing obligatory and voluntary occupations, required extensive discussion because the distinction itself is culturally loaded. The researchers noted that in Sweden people commonly separate activities they want to do, such as leisure, from activities they must do, such as work and caregiving, whereas in Taiwan obligations may align with personal desires and thus bring satisfaction. Parenthetical explanations of responsibility and voluntary were added, and after revision the expert-level content validity indices reached acceptable values, with item-level scores between 0.8 and 1.0 and a scale-level average of 0.93.

The validation then moved to the people who would actually use the questionnaire. Ten participants with depressive disorder completed cognitive debriefing interviews, confirming that they understood the items, and a larger sample of 161 adults with depressive disorder, recruited from two psychiatric outpatient clinics in central Taiwan, completed the finalized OBQ11-C. Participants averaged 39.2 years of age, were predominantly female, and had developed psychiatric disorders at an average age of 31.2 years. Of these, 131 returned a second completed questionnaire by mail within seven to fourteen days, allowing the team to assess stability over time. The results were striking: the intraclass correlation coefficient, a measure of test-retest reliability, reached 0.94, indicating excellent agreement between the two administrations, while Cronbach’s alpha, a gauge of internal consistency, stood at 0.90, and corrected item-total correlations ranged from 0.49 to 0.77, all comfortably above accepted standards.

Beyond classical test theory, the researchers applied Rasch analysis, a mathematical framework that converts person ability and item difficulty into a common unit called the logit and tests whether a questionnaire measures a single underlying construct. The analysis supported the four-point rating scale, confirmed that all items fit the model, and demonstrated unidimensionality, meaning the eleven items all tap the same construct of occupational balance. Item separation was 3.95 with item reliability of 0.94, and person separation was 2.87 with person reliability of 0.89, indicating the scale distinguishes both item difficulty levels and individual differences effectively. Principal component analysis of residuals explained 53.6 percent of the variance, and no floor or ceiling effects emerged, meaning the scale works across the full range of occupational balance levels.

Perhaps the most intriguing findings came from comparing item difficulty rankings across the Chinese, Swedish, Norwegian, and Danish versions. Some patterns held everywhere: item 3, concerning time for doing things one wants, consistently ranked among the easiest, while item 10, balancing energy-giving and energy-taking activities, and item 7, satisfaction with how time is spent, ranked among the hardest. But other items shifted dramatically between versions, by more than three ranking positions. In the Chinese version, the hardest item concerned balancing physical, social, mental, and restful occupations, plausibly reflecting the daily struggles of people with depression in managing chores, social interaction, and self-care. In the original Swedish version, balancing work, home, family, leisure, rest, and sleep posed the greatest difficulty, while Norwegian students found obligatory versus voluntary balance hardest, and Danish workers struggled with having sufficient time for obligatory tasks. These differences underscore that occupational balance is a personal, culturally situated perception shaped by age, health status, and life context.

The study has limitations the authors acknowledge: participants were adults aged 20 to 66 recruited from outpatient clinics in central Taiwan with relatively homogeneous characteristics, and properties such as criterion validity, differential item functioning, and minimal clinically important difference remain to be examined. Even so, the OBQ11-C now stands as the first validated tool of its kind for Chinese-speaking individuals with depression in Taiwan, giving clinicians a foundation for building individualized, occupation-based assessment and intervention programs. For a condition that affects one in twenty adults worldwide and reshapes the texture of everyday life, the ability to measure something as intimate as whether one’s days feel balanced, varied, and sufficient is a quiet but meaningful advance, one that may help therapists meet patients where they actually live.

Subject of Research: Validation of the Chinese version of the Occupational Balance Questionnaire 11 for assessing occupational balance in people with depression

Article Title: Psychometric properties of the Occupational Balance Questionnaire 11-Chinese version

Article References: Chen, Y.-L., Su, P.-C., Ko, W.-T., Hsieh, M.-H., Ju, P.-C., Chan, Y.-T., Wagman, P., & Håkansson, C. (2025). Psychometric properties of the Occupational Balance Questionnaire 11-Chinese version. Scandinavian Journal of Occupational Therapy, 32(1), Article 2559893. https://doi.org/10.1080/11038128.2025.2559893

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2559893

Keywords: occupational balance, Occupational Balance Questionnaire, depression, psychometrics, Rasch analysis, reliability, validity, occupational therapy, Taiwan, questionnaire translation, mental health, content validity

The problem the researchers set out to solve is surprisingly basic. Mindfulness research has exploded over the past two decades, with hundreds of trials showing benefits for mental health and well-being in both clinical and non-clinical populations. Yet the overwhelming majority of studies have measured practice quantity, such as how many minutes or sessions participants completed, while treating practice quality as an unmeasured black box. Existing mindfulness questionnaires capture related but different constructs, including trait mindfulness, which reflects a person’s general disposition, and state mindfulness, which captures momentary awareness during practice. Others assess adherence to practice schedules or mechanisms like equanimity. None, according to the authors, had ever been built to assess the quality of the practices themselves, even though evidence suggests that quality, not just duration, may drive outcomes, particularly for novice meditators who have not yet learned to hold attention steadily.

Drawing on Buddhist psychology and modern clinical practice, the team focused on the two practices they describe as the fundamental pillars of mindfulness meditation: concentration, known in the Pali tradition as śamatha, and insight, known as vipassanā. In śamatha practice, the meditator rests attention on a single object, typically the sensation of breath at the nostrils, training the executive functions of sustaining attention, inhibiting the habitual pull toward thoughts, and shifting attention back without frustration. In vipassanā practice, the meditator opens awareness to whatever arises, observing body sensations, emotions and thoughts as impermanent, impersonal phenomena. The researchers deliberately excluded loving-kindness practice from the initial instrument, noting that classical taxonomies classify it as an affective-directed method distinct from the cognitive-directed śamatha and vipassanā practices taught in the earliest Buddhist sources.

The MMPQS was designed to be completed immediately after a meditation session, capturing the practice while it remains fresh. Each of the two scales began with ten items rated on a seven-point Likert scale ranging from not at all true to completely true. Item development drew on traditional meditation manuals and the clinical teaching sequence of MiCBT, and items were refined through an iterative consensus process among experienced meditation teachers on the research team. Concentration items probe the ability to stay focused and to refocus quickly after distraction, with examples such as being able to return to the breath after thoughts or images intervene. Insight items assess the capacity to feel a range of sensations in the body, to perceive experience with objectivity and distance, and to avoid reacting to physical, emotional or mental events, mapping directly onto the interoceptive awareness, equanimity and impermanence components of vipassanā.

What distinguishes this study methodologically is its use of Rasch analysis, a psychometric approach that many readers will find both technical and quietly revolutionary. Traditional scoring of questionnaires assumes that Likert-scale responses behave like interval data, so that the difference between scores of 25 and 26 means the same as the difference between 29 and 30. In reality, ordinal ratings rarely satisfy this assumption, introducing measurement error into every downstream analysis. Rasch models explicitly acknowledge the ordinal nature of the data and provide a mathematically principled conversion from raw summed scores to interval-level estimates on a logit scale. The researchers provide conversion tables so that clinicians and researchers can transform raw MMPQS scores without additional software, enabling precise detection of change over time and meaningful comparisons across groups and studies.

The Rasch analysis itself was an iterative winnowing process. Data came from 368 clinical participants at two psychology clinic sites, all diagnosed with at least one comorbid mental health condition and most seeking help for anxiety disorders. Participants completed the Concentration scale after concentration practices and the Insight scale after insight practices on two measurement occasions, with combined samples of 414 and 313 observations respectively. On the Concentration scale, items measuring things like feeling that time passed quickly or feeling motivated and engaged proved to be double-barreled, vague or peripheral to the construct, while two nearly identical refocusing items created local dependency. Removing these and combining two remaining dependent item pairs as testlets yielded a clean six-item scale with high reliability, person separation index values between 0.89 and 0.94, and strict unidimensionality.

The Insight scale presented a different pattern of problems. Its initial items all fit the Rasch model, but the scale failed tests of unidimensionality, and one item showed differential item functioning by age, meaning it behaved differently for younger and older respondents. Through successive rounds of analysis, redundant and double-barreled items were removed until a six-item version emerged that preserved full coverage of the insight construct: two items for interoceptive awareness, two for equanimity, and two for awareness of impermanence and non-self. Neither final scale showed differential item functioning for age, gender, prior meditation experience or time of measurement, indicating that the instruments perform equivalently across these groups and that changes in scores over the course of treatment reflect genuine improvements in practice quality rather than shifting item behavior.

Validity testing delivered results that the authors describe as consistent with their hypotheses. Both scales showed small to moderate correlations in the expected directions with measures of equanimity, depression, anxiety, stress, awareness, kindness, life satisfaction and self-efficacy for meditation, supporting construct and divergent validity. More striking were the predictive findings. Concentration practice quality significantly predicted lower levels of depression, anxiety and stress, though not life satisfaction. Insight practice quality predicted reduced symptoms and, uniquely, increased life satisfaction. The authors suggest the difference may reflect the sequential structure of the therapy: concentration training begins in week two and is practiced for only a week or two before insight practices are introduced, possibly too brief a window for patients to feel meaningful gains in life satisfaction so early in treatment. Scores on both scales also rose significantly from the first to the second measurement occasion, consistent with the idea that practice quality improves with continued training.

For clinicians and teachers, the appeal of the MMPQS lies in its practicality. Because the scales are short and administered immediately after practice, they can serve as feedback tools, helping novice meditators understand the skills their practice is meant to cultivate, tracking their progress session by session, and flagging specific difficulties, whether sustaining attention or holding equanimity in the face of unpleasant sensations, that may warrant extra guidance. A participant scoring 25 on the raw Concentration scale, for example, converts to an interval score of 22.11, while a score of 30 converts to 25.10, with equal intervals between converted scores now representing genuine equal units of the underlying ability rather than arbitrary ordinal steps.

The authors are careful about the limits of their findings. The validation sample was culturally homogeneous, predominantly White Australian adults treated within a single therapy program, and the iterative, partly data-driven item selection could have capitalized on chance characteristics of this particular sample, so confirmation in independent samples is needed before the six-item solutions are treated as final. Detailed practice frequency and duration data were not collected, and the temporal lag between concentration and insight training introduces a confound into the predictive analyses. Future work will extend the MMPQS to non-clinical populations, culturally diverse samples, other mindfulness-based programs, and eventually a loving-kindness subscale. Still, the study marks a turning point: for the first time, researchers can measure not just whether people meditate, but whether they meditate well, opening a path toward understanding precisely how the quality of attention, equanimity and insight translates into relief from suffering.

Subject of Research: Development and validation of scales measuring the quality of mindfulness meditation practices using Rasch analysis

Article Title: Development and Validation of the Mindfulness Meditation Practice Quality Scales (MMPQS) in a Clinical Population Using Rasch Analysis

Article References: Strohmaier, S., Cayoun, B. A., Shires, A. G., Medvedev, O. N., & Krägeloh, C. U. (2026). Development and Validation of the Mindfulness Meditation Practice Quality Scales (MMPQS) in a Clinical Population Using Rasch Analysis. Mindfulness. https://doi.org/10.1007/s12671-026-02990-9

Image Credits: AI Generated

DOI: 10.1007/s12671-026-02990-9

Keywords: mindfulness, meditation, Rasch analysis, psychometrics, MMPQS, clinical psychology, Mindfulness-integrated Cognitive Behavior Therapy, concentration meditation, insight meditation, mental health, measurement, equanimity