Psychometric properties of Arabic-translated-related quality of life scales for people with parkinson disease: a scoping review.

BACKGROUND: Parkinson's disease (PD) substantially contributes to poor functional outcomes, loss in productivity, and poor health-related quality of life (HRQoL). Despite the existence of various scales, there is a notable gap in existing HRQoL reviews with regard to the availability of Arabic validated scales. As a response to this gap, the aim of our scoping review is to identify validated scales, focusing on their psychometric validation procedures, to contribute valuable insights to the understanding of HRQoL among the Arabic-speaking people with PD. METHODS: A scoping review was conducted at the end of December 2022, using the Medline and Embase databases. The focus of this review was on examining the psychometric properties and validation procedures of included scales. Articles were included in the full-text screening process if they focused on people with PD of any age, included a scale measuring HRQoL in Arabic, and were written in English, French, or Arabic. RESULTS: After applying inclusion/exclusion criteria, 10 studies were selected to analyze HRQoL scales validated in people with PD. However, the PDQ-39 is the only HRQol PD specific scales validated in the Arabic language. Five studies validated in people with PD were identified in the context of instrument validation (3 generic, 1 specific validated in 2 studies). CONCLUSION: There are several HRQoL measurement scales for people with PD. However, only one specific HRQoL instrument has been validated in Arabic for people with PD. For the remaining instruments identified they were just used in people with PD without being validated in this population.

Sexual Coercion and Harassment of Students with Disabilities in a Public University in Ghana.

There is limited literature on sexual coercion/harassment of university students with disabilities, hence we, explored this phenomenon in Ghana, using a sequential explanatory-mixed method design that involved 119 (62 males and 57 females) students with various disabilities in the quantitative study and 12 (7 females and 5 males) students in the qualitative phase using questionnaire and interview guide for data collection respectively. We found that participants were not aware of the university's sexual coercion/harassment policy nor involved in its formulation/dissemination. Persistently asking for sexual relationships, pressurized for outings, attempted/forced kissing, being sexually looked at, engaging in uncomfortable sexual conversations, and sexually provocative touch were common. The main perpetrators of these acts included physically able people (24.4%), colleagues with disabilities (14.3%), and Lecturers/Administrative staff (10.9%). We recommend policies and programs' strengthening to protect students with disabilities from such unwarranted acts.

Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana.

Introduction: Although the relationship between subjective social status and depression in university students has been well-established, this association could be seen as a spurious one. Previous studies have shown that key variables like financial resources and age could play key roles in explaining the variances in social status and mental health outcomes. In this research, we assessed the complex interrelationships between subjective social status, financial resources at their disposal and depressive symptoms among university students within their young and middle adulthood stages. Methods: A cross-sectional survey was conducted in a university in Ghana to sample 1134 university students through accidental sampling. The McArthur Scale and WHO-5 Well-being measure were used for the data collection. Results: The results revealed that higher levels of subjective social status were associated with lower levels of depression. It was further found that the interaction between students' pocket money and age played unique roles in the relationship between subjective social status and depression. Conclusion: The study findings call on stakeholders in education to explore funding opportunities and to examine ways of empowering parents (financially) to adequately support the students. Health educationists and promoters, including psychologists, school counsellors and parents could compliment these efforts by helping to train and empower students through self-regulation or management skills to help improve their well-being. Continuous efforts are required to improve the financial status and mental health of students.

Assessing the dimensionality of the sense of coherence scale (SOC-L9) using Ghanaian university students: Guarding against the method effect.

Background: The dimensionality of the sense of coherence (SOC-L9) scale has been in contention due to the varied factor structure revealed in the literature. In this study, we assessed the dimensionality of the SOC-L9 scale using Ghanaian university students while guarding against the method effect. The study also examined the gender measurement invariance of the scale. Methods: This research conveniently sampled 1062 students who responded to the SOC-L9 scale with negative items reversed to positive items. A larger proportion of the participants were male students (n = 769, 72.4 %), with 293(27.6 %) being female students. The youngest participant was 18 years old, whereas the oldest was 42 years old. Following all validation studies protocols, four distinct confirmatory factor analysis models were fitted and compared (i.e., unidimensional, three-factor first-order, three-factor second-order and bifactor models). Results: The initial model comparison revealed that the bifactor CFA model [CFI = 0.958, SRMR = 0.036, AIC = 21231.35, BIC = 21370.45] was superior to the unidimensional [CFI = 0.914, SRMR = 0.046, AIC = 26280.67, BIC = 26414.8] and 3-factor models [CFI = 0.932, SRMR = 0.040, AIC = 26221.67, BIC = 26370.71]. Upon further probing, it was discovered that SOC-L9 functions best as a unidimensional scale for the university student population. Gender measurement invariance was established for configural invariance [CFI = 0.986, SRMR = 0.044], metric invariance [CFI = 0.894, SRMR = 0.051] and scalar invariance [CFI = 0.983, SRMR = 0.047]. Conclusion: The SOC-L9 scale has a nested structure with the various sub-scales interacting to produce a summary total observed score. The structure of the SOC-L9 requires scholars to treat the scale as a unidimensional scale rather than a multidimensional one. This latent structure was found to be consistent with male and female university students.

Stress-related experiences and intentions to quit studies among female married postgraduate distance education students in Ghana.

BACKGROUND: Although postgraduate studies have been shown to be associated with stressful experiences, students reading programmes through the distance and e-learning mode experience greater levels of stress due to several reasons. These stressful encounters might be heightened in female married postgraduates on distance education programmes due to other family-work-related engagements. This study investigated the stress-related experiences and intentions to quit studies among female married students on a distance education programme in Ghana. METHODS: Using a sequential explanatory mixed-methods design, 164 married postgraduate distance education students were sampled to participate by responding to a questionnaire. Follow-up interviews were conducted with 10 participants to offer insight into the quantitative findings. Quantitative data were analysed using descriptive statistics, including frequency and percentages, while the qualitative data were thematically analysed. RESULTS: Stress was prevalent among the female married distance education students, with the majority having intentions of quitting their studies. The stressors identified ranged from personal (i.e., work and family demands) to institutional ones (i.e., academic load, unresolved complaints and high financial demands from the programme). CONCLUSIONS: Key findings suggest that female married postgraduate distance education students perform multiple roles as full-time employees with family and academic demands that can negatively impact their health and academic work. Implications and recommendations of the findings are discussed.

Modeling unit non-response and validity of online teaching evaluation in higher education using generalizability theory approach.

Introduction: Unit non-response is a common phenomenon in online teaching evaluation in higher education institutions. However, little is known about the relationship between the rates of unit non-response and the quality of online teaching evaluation exercise. This study explored the incidence of unit non-response and how this phenomenon relates to the reliability of students' responses to online teaching evaluation. Methods: Adopting the generalizability theory approach, students' evaluation of teaching data from a university in Ghana was analyzed by conducting both generalizability study (G-study)- and decision study (D-study) analyses. Results: The results revealed that unit non-response among students was predominant in online teaching evaluation exercise. The study demonstrated that higher rates of non-response among students were associated with high levels of measurement errors and low reliability of responses. Discussion: The findings of this study have implications for the accuracy of online evaluation data obtained for decision-making in higher education contexts. The study calls on higher education administrators to embark on sensitization and awareness campaigns that target students on the need to actively participate in the appraisal of teaching at the university to address the issue of unit non-response.

Moderation modelling of COVID-19 digital health literacy and sense of coherence across subjective social class and age among university students in Ghana.

BACKGROUND: The study assessed the moderation modelling of digital health literacy and sense of coherence across subjective social class and age among university students in Ghana during the COVID-19 pandemic. METHODS: A total of 1160 students were conveniently sampled from two universities namely, the University of Education, Winneba and University of Cape Coast, using the descriptive cross-sectional survey design. Preliminary analysis was performed using descriptive statistics, whilst multivariate multiple regression and moderation analyses (Haye's Model) were employed to analyze the main data. RESULTS: The study revealed that COVID-19 digital health literacy is directly and positively associated with sense of coherence among university students. Further, higher subjective social class positively and strongly moderated the relationship between COVID-19 digital health literacy and sense of coherence among university students. Additionally, the relationship between COVID-19 digital health literacy and sense of coherence was indirectly prominent among relatively older university students than younger ones. CONCLUSIONS: The findings have implications for university management/authorities and public health agencies to organize effective orientation and self-management training programmes for university students.

Effectiveness of Video Modeling in Improving Technical Skills in Young Novice Basketball Players: A Quasi-Experimental Study.

(1) Objective: This is a quasi-experimental study that investigated the effect of four weeks of training sessions using video modeling (VM) on individual and collective technical skills in young novice basketball players. (2) Method: 20 players were equally assigned to either a control group (CG, n = 10; 12 ± 0.7 years) or a video modeling group (VMG, n = 10; 12.5 ± 0.5 years; visualizing videos before each session) were assessed before and after the four-week training period using the Basketball Skill Test of the American Alliance for Health, Physical Education, Recreation and Dance for individual techniques and three vs. three small-sided games for collective aspects. (3) Results: For the passing test, VMG induced higher performance than CG (p = 0.021; d = 0.87). For offensive balls post-intervention, higher values were recorded for VMG compared to CG (p = 0.003; d = 1.81). In addition, the number of attack balls index post-intervention was higher for VMG compared to CG (p = 0.001; d = 0.28). For losing the ball, VMG induced lower values than CG after the training intervention (p < 0.001; d = -3.23). The efficiency index was higher post-training compared to pre-training for VMG (p = 0.013; d = 1.24). (4) Conclusion: The study highlighted the importance of using video modeling as an effective strategy to improve technical skills and collective performance in novice young basketball players.

Modelling the associations between academic engagement, study process and grit on academic achievement of physical education and sport university students.

OBJECTIVE: The present study examined the impact of academic engagement, study processes, and grit on the academic achievement of physical education and sport university students. METHODS: An internet-based survey recruited 459 university students aged 19-25 years (M = 21 ± 1.3) in physical education and sports (PES) to fill out questionnaires on Physical Education-Study Process Questionnaire (PE-SPQ), Physical Education-Grit (PE-Grit), academic engagement (A-USEI), and Grade Point Average (GPA). A path analysis was carried out to understand variable relationships. RESULTS: Data from each variable exhibited symmetrical and normal distribution, as indicated by the skewness and kurtosis values. The model's fit indices showed sufficient Comparative Fit Index (CFI = 0.92), Tucker-Lewis Index (TLI = 0.90), Goodness of Fit Index (GFI = 0.99) and Normed Fit Index (NFI = 0.90) and showed acceptable levels. The results indicated a statistically significant positive impact of engagement (ß = 0.299, p < 0.001) and study processes (ß = 0.397, p < 0.001) on academic achievement. However, the effect of grit on achievement was non-significant. CONCLUSIONS: Academic engagement as well as study processes are two important factors predicting academic achievement while grit seems to be not a major predictor. Hence, physical education and sport faculty and university administrators should prioritize student engagement as a determinant of academic outcomes by reforming or redesigning physical education and sport curriculum modules that can facilitate engagement.

Subjective social status and well-being of adolescents and young adults in Ghanaian schools: conditional process analysis.

BACKGROUND: With the growing concern and interest in the mental health and well-being of adolescents and young adults (AYAs) including those in schools, many studies have explored the bivariate relationship between subjective social status (SSS) and AYAs' subjective well-being (SWB). Acknowledging the spurious nature of this relationship, we assessed the relationship between SSS and SWB of AYAs in schools within Northern Ghana, focusing on the conditional indirect effect of monetary resource (MR) and sense of coherence (SoC). METHODS: We utilised a cross-sectional descriptive design to survey 1096 senior high school students from two regions in Ghana's Northern zone through a stratified sampling method. A questionnaire consisting of a number of calibrated standardized measures was used for the data collection. The data were processed using SPSS and PROCESS Macro and analysed using Hayes' conditional process analysis. RESULTS: The results revealed that students' MR significantly moderated the relationships between SSS and SoC as well as SSS and SWB. A significant moderated mediation effect of MR and SoC on the relationship between SSS and SWB was found. Particularly, AYAs who reported higher levels of MRl, SSS and SoC reported a better SWB. CONCLUSION: The findings underscore the relevance of providing sufficient financial support for students in secondary schools in Ghana; thus, highlighting the sheer relevance of economic capital as a leading factor for better well-being. The findings also place much emphasis on building students' personal coping mechanisms as a key variable in explaining how the students' SSS and MR translate into having positive mental health outcomes.

A cross-sectional study of university students' pocket money variance and its relationship with digital health literacy and subjective well-being in Ghana.

Background: Mental health concerns of university students are gaining more attention since the emergence of the coronavirus disease. Consequently, scholars in education, health and psychology-related fields have attributed the dwindling subjective well-being (SWB) of students to their low levels of digital health literacy (DHL). However, little attention has been paid to an important variable like pocket money (PM) which might serve as a buffer against reduced levels of SWB. In this study, we explored the dynamics of PM and its linkage with DHL and SWB among university students in Ghana. Methods: With a cross-sectional design, a convenient sample of 1160 students was obtained from the University of Education, Winneba, Ghana. The COVID-DHL and WHO-5 Well-being instruments were used for the data collection for a 2 months period (February-March, 2021). Chi-square test, multivariate regression, simple linear regression, and PROCESS mediation analyses were performed with the use of SPSS software version 25. Results: The study found that while most of the students were financially supported by their parents (n = 715, 61.6%), a larger proportion of them reported that their PM was either less sufficient or not sufficient (n = 550; 76.9%). Findings revealed a positive relationship between PM and SWB (B = -36.419, p < 0.001; B = -13.146, p = 0.012; B = -10.930, p = 0.043), with this relationship mediated by DHL (B = -1.139, confidence interval [CI] [-2.073, -0.263] vs. -2.300, CI [-4.290, -0.532] vs. -8.366, CI [-14.863, -1.908]). Conclusions: Students with little to insufficient PM were vulnerable to mental health problems, although this could be buffered by the high DHL levels. In practical terms, not only should the PM of university students be increased, but the sources of PM should be complemented since the sufficiency level of PM was associated with the source of finance. More importantly, parents should be empowered through job creation so that sufficient levels of PM can be provided to university students.

Assessing secondary school students' digital health literacy, information searching behaviours, and satisfaction with online COVID-19 information in Northern Ghana.

Available evidence suggests that managing the complexities of health information and the behaviours associated with information search call for adequate digital health literacy (DHL). Students' ability to judge the relevance of health-related information largely affects their level of satisfaction with the information. The study assessed DHL, information searching behaviours, and the link between DHL and COVID-19 information. The cross-sectional study utilised the multi-stage sampling technique in the selection of 1392 secondary school students in the Northern Region of Ghana. A DHL questionnaire was used to survey the students. The students displayed inadequate level of DHL concerning the relevance of online information. Predictably, most of them had not searched for information in the past four weeks prior to the data collection. Search engine portals, websites of public bodies, and news portals were the predominant platforms used for information search. Majority of the participants reported not being satisfied with the information they found on the internet about coronavirus. A significant association between DHL levels and utilization of COVID-19 information platforms was identified, such that students who showed high levels of DHL used platforms which had reviewed/professional content compared to those with low levels of DHL. Advanced DHL may serve as a disincentive to the consumption of information from sources which are not credible. There is an urgent call for collaboration among the ministries/agencies responsible for education and health, telecommunication networks, and civil society organisations for interventions aimed at integrating DHL in schools..

Item and rater variabilities in students' evaluation of teaching in a university in Ghana: application of Many-Facet Rasch Model.

This research examined the item and rater variabilities in students' evaluation of teaching and courses exercise at the University of Cape Coast (UCC) through the lenses of the Many-Facet Rasch Model (MFRM). The study covered students during the 2019/2020 academic year in the selected university, analysing secondary data obtained from the Directorate of Academic Planning and Quality Assurance, UCC (DAPQA-UCC). The data were analysed by conducting partial credit MFRM analyses. It was found that the sources of measurement errors in the student evaluation exercise included halo effect, non-functional item structure, inconsistent students' ratings, rater leniency, and non-functional rating scale. It was concluded that data from students' appraisal of lecturers' teaching should be used with caution. It was recommended that DAPQA-UCC and the university management should train students on the evaluation of teaching, as well as review the existing evaluation form for appraising courses and teaching by subjecting the instrument to rigorous validation procedures.

Reproducibility of the brief religious coping inventory with African athletes' sample using ordinal factor analytical approach.

Background: Previous studies have revealed that religious coping strategy is common among athletes due to the stressful experiences before and during competitions as part of the mental preparations they go through, the uncertainty of sporting outcomes, and other organizational issues they encounter. This research assessed the reproducibility of the Brief Religious Coping (RCOPE) instrument in an African setting using athletes' samples from different countries. Particularly, the research sought to assess the (1) factor structure of Brief RCOPE with an African sample, (2) construct validity of the RCOPE measure, and (3) measurement invariance of the RCOPE instrument based on gender and nationality. Methods: The study surveyed a convenient sample of 300 athletes, including 164 male and 136 female athletes, from 3 African countries (Benin, Ghana, and Nigeria) who participated in the 2018 West African University Games. The Brief RCOPE instrument was administered to the athletes for validation purposes before the competition. Exploratory and confirmatory factor analyses were conducted using the ordinal factor analytic approach. Results: This validation study confirmed the two-factor dimension (positive and negative religious coping) of the Brief RCOPE measure. Further, all items for each of the dimensions of the inventory contributed significantly to the measure of the Brief RCOPE domains. The positive and negative religious coping dimensions contributed more than half of the variance of their respective indicators. Measurement invariance across gender and nationality was confirmed. Conclusion: Sufficient evidence was gathered to support the interpretation and use of the Brief RCOPE measure. Coaches and sports psychologists could adopt the Brief RCOPE measure to understand the mental or thought patterns of religious athletes based on existential concerns or stress accrued from impending competitions to inform appropriate religious coping interventions. This notwithstanding, the Minimum Clinical Important Difference (MCID) of the Brief RCOPE should be further investigated to enhance the utility of the instrument for use in intervention-based studies.

Gender Risk Perception and Coping Mechanisms among Ghanaian University Students during the COVID-19 Pandemic.

Recent research has shown that gender is an important driver of the risk of mortality and morbidity rates for people with COVID-19, with case fatality rates being higher for women than men. Despite this pattern, research is sparse on gender risk perception and potential coping mechanisms. This study examined the role gender plays in the relationship between COVID-19 risk perception and coping mechanisms among university students. Through the adoption of traditional and online surveys, 859 students from two public universities in Ghana were conveniently selected to respond to the survey instrument. The results from the multivariate regression analysis revealed that COVID-19 risk perception was positively related to active coping. The outcome of the moderation analysis showed that while males were more likely than females to adopt active and emotional support coping with heightened risk perception, a contrary outcome was observed for behaviour disengagement. This result is an indication that female students are likely to be overwhelmed with a high level of risk perception and easily give up trying to adopt effective strategies to reduce the effect of the COVID-19 pandemic situation. The findings highlight the need for different forms of intervention for male and female students for dealing with the effect of COVID-19.

Examining the underlying latent structure of the sports emotion questionnaire: Insights from the bifactor multidimensional item response theory.

Background: Despite the widespread use of the sports emotion questionnaire (SEQ) in several studies, it is surprising that only a few have explicitly tested the validity and utility of the instrument in non-western populations. Besides, the issue of dimensionality and the latent structure of the instrument remain inconclusive given that several authors have revealed different factor structures across diverse populations. The central concern is whether the items on the various dimensions, proposed for the original SEQ, offer adequate information to their respective expected subscale or otherwise. This study assessed the underlying latent structure of the SEQ using confirmatory and bifactor multidimensional item response (MIRT) models. Methods: Through a well-designed validation study 300 athletes from three West African countries, participating in the 2018 West African University Games were surveyed to respond to the SEQ. The data were analyzed using first, a 5-factor confirmatory factor analysis (CFA) via the MIRT model and second, a bifactor MIRT analysis. Results: The results revealed that items on the SEQ were fairly good in measuring the construct under the respective domains of the instrument. However, the outcome of the bifactor model showed that the majority of the items on the SEQ explained common variance in relation to the general factor other than the specific domains (5-dimensions). Conclusion: Findings of the bifactor model question whether the sub-dimensions of the SEQ are needed since most of the items on the SEQ explained larger variances in the general factor than any of the five domains. It is concluded that instruments like SEQ should be scored for a general factor and not as sub-dimensions. Further investigations are encouraged by scholars within the area to probe the dimensionality of the SEQ.

Psychometric properties of the cultural mix coping inventory for stressful situations using physical education teachers: a multidimensional item response theory analysis.

The incidence of the COVID-19 pandemic heightened the levels of stress of not only students but for teachers, particularly physical education (PE) teachers. The reference to PE teachers is due to their role in engaging students in practical in-person lessons after the resumption of school. Previous literature has revealed that PE teachers exhibit significantly increased levels of anxiety, fear, tension and uncertainty that they could contract the virus during these lessons. Given this scenario, there is a growing need for identifying a suitable coping scale which can accurately measure coping strategies employed these teachers. This research assessed the psychometric properties of the 16-item coping inventory using a multidimensional item response theory approach. The study surveyed 484 PE teachers through the convenience sampling technique, after which the cultural mix coping instrument was administered to them. The findings of this study confirmed the 4-factor structure of the coping measure which is consistent with the original measure. Results further revealed that a modified 14-item compared to the original 16-item coping inventory was optimal in measuring coping strategies among PE teachers. The study concluded that the 14-item cultural mix coping inventory was appropriate, applicable and reproducible to the PE teachers' population.

Re-assessing the Psychometric Properties of Stress Appraisal Measure in Ghana Using Multidimensional Graded Response Model.

Despite the widespread use of the stress appraisal measure questionnaire in sport psychology literature, information on the psychometric properties of this survey instrument across different cultures and samples is still lacking. This study sought to validate the stress appraisal measure among male football players in the Ghana's Premier League using the multidimensional item response theory. The descriptive cross-sectional survey design was adopted to recruit 424 footballers from the 2020/2021 Ghana Premier League season using the census approach. The 28-item Stress Appraisal Measure was used to assess six (6) appraisal mechanisms under primary and secondary cognitive appraisals. The ordered polytomous item response theory was used for analyzing the data. The study found that although some items were problematic, the majority of them were found to have good item parameters, effective scale option functioning, and provided adequate empirical information in the measurement of stress appraisal. This research concluded that the stress appraisal measure has promising applicability among male footballers who participated in the premier league in Ghana. Future researchers are encouraged to re-validate the stress appraisal measure with a different sample to contribute to the understanding of the applicability of the instrument in non-western populations.

COVID-19 Pandemic and Teachers' Classroom Safety Perception, Anxiety and Coping Strategies during Instructional Delivery.

Several professionals, including teachers, have been engrossed in fear of the worst happening due to COVID-19 and the rapidly evolving nature of the virus affecting the perception of safety in any working environment. This study examined teachers' perception of classroom safety, anxiety, and coping strategies during instructional delivery in senior high schools in Ghana. Adopting the cross-sectional survey design with a quantitative approach, a convenient sample of 174 senior high school teachers in the Cape Coast Metropolis completed a questionnaire. Data were analyzed using descriptive analysis, analysis of variance, and multiple linear regression. The findings showed that teachers perceived their classroom environment as unsafe during instructional delivery amidst COVID-19 and reported modest to extreme levels of anxiety. Further, teachers with a high level of COVID-19 anxiety were found to utilize active coping strategies to manage stressful situations. The reported unsafe working environment in schools during pandemic times highlights the critical role of supportive working environments for teachers' mental and psychological wellness. School counseling psychologists, school welfare officers, and school health coordinators should collaborate to implement interventions (e.g., social emotional learning; resilience strategies) that promote the wellbeing of teachers and a safe working environment.

Validation of the WHO-5 Well-Being Scale among Adolescents in Ghana: Evidence-Based Assessment of the Internal and External Structure of the Measure.

The WHO-5 well-being measure happens to be one of the most renowned measures of subjective well-being across the globe. Although the instrument has been calibrated in different countries, its psychometric properties and applicability in Africa, especially in Ghana, are not known. In this study, the WHO-5 well-being scale was validated among adolescents in Ghana by assessing the validity evidence of the measure based on the internal and external structure. In particular, the study examined the (1) dimensionality of the WHO-5 well-being scale, (2) quality of the items (including the scale functioning) for the measure, and (3) criterion validity of the well-being measure. Using a survey approach, 997 adolescents were recruited in secondary schools across the northern belt of Ghana. The study found a one-factor structure of the scale, which supports the factor solution of the original measure. The items were found to be of high quality, except for one item. The WHO-5 well-being measure was found to have sufficient evidence regarding convergent and divergent validity. The outcome of this validation study provides support for the validity and reliability of the WHO-5 well-being scale's utility and use among adolescents in Ghana. The study encourages further validation studies to be conducted in Ghana to widen the reproducibility of the WHO-5 well-being measure.