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

Piolanti, Antonio, Waller, Franziska, Kunovski, Ivo, Shenderovich, Yulia ORCID: https://orcid.org/0000-0002-0254-3397, Mueller, Janina, Wienand, Dennis, Simon, Judit, Heinrichs, Nina, Sampathkumar, Swetha, Moore, Graham ORCID: https://orcid.org/0000-0002-6136-3978 and Foran, Heather 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 10.1186/s40359-026-05624-w

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Abstract

Background The World Health Organization Five Well-Being Index (WHO-5) is a widely used, open-access measure of subjective well-being. However, evidence on its psychometric properties among young adolescents participating in preventive interventions in low- and middle-income countries remains limited. This study aims to evaluate the structural validity and cross-country measurement invariance of the WHO-5 among young adolescents participating in a prevention program in Southeastern Europe. Methods Data were drawn from the baseline assessment of the FLOURISH Phase 2 trial, including 653 adolescents aged 10–14 years recruited with their caregivers as part of a family-focused program in Moldova and North Macedonia. The WHO-5 was administered using culturally adapted versions in local languages. Confirmatory factor analysis tested the one-factor, five-item model in the overall sample and separately in each country. Model fit was evaluated using the RMSEA, CFI, TLI and SRMR. Multi-group ordinal confirmatory factor analysis assessed configural, threshold, metric and scalar invariance across countries. Internal consistency was estimated using McDonald’s ω. Results The one-factor, five-item model showed appropriate fit in the overall sample, 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. Measurement invariance analyses supported configural, threshold, metric and scalar invariance. Conclusions The WHO-5 demonstrated good internal consistency, a unidimensional structure and cross-country measurement invariance among young adolescents participating in a prevention program in Moldova and North Macedonia. These findings support the use of the WHO-5 for assessing and comparing adolescent well-being across these settings and contribute to the validation of open-access, cross-culturally adapted instruments for well-being monitoring in middle-income and prevention contexts.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Social Sciences (Includes Criminology and Education) Schools > School of Social and Spatial Sciences Research Institutes & Centres > Centre For Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Publisher:	BioMed Central
ISSN:	2050-7283
Date of First Compliant Deposit:	1 October 2026
Date of Acceptance:	15 September 2026
Last Modified:	01 Oct 2026 09:45
URI:	https://orca.cardiff.ac.uk/id/eprint/189924

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