{ "abstract": "Adolescents living with HIV (ALHIV) in Eastern and Southern Africa experience challenges around medication adherence, mental health and wellbeing. Although interventions such as Zvandiri aim to strengthen mental health and wellbeing to impact HIV treatment outcomes, available measures often focus on negative outcomes or rely on positive psychology instruments developed in high-income settings. These tools may not adequately capture culturally embedded and relational dimensions of wellbeing. We describe the development of the Zvandiri Character Strength (ZCS) scale and draw methodological lessons for culturally grounded wellbeing measurement. The multi-stage scale-development process (2022–2025) comprised a scoping and systematic review, qualitative discussions, expert panel input, construct and item prioritisation, cognitive interviews, iterative item reduction, and exploratory factor and Rasch analyses. We reduced an initial item bank to a 53-item candidate scale, then to the ZCS 38 (38 items) and finally, the ZCS 25 (25 items), based on quantitative analyses and participant feedback. We subsequently assessed the ZCS 25 using retrospective pretest, post-test and follow-up administration. The review identified conceptually overlapping positive psychological constructs, many of which are measured using instruments developed in high-income settings and not adequately validated for ALHIV in Africa. Qualitative work highlighted connectedness, hope, self-acceptance, self-efficacy, purpose, and flourishing as key. Discussions also highlighted that wellbeing was relational, contextually situated, and often co-occurring with distress. Quantitative testing showed highly positive responses, disordered thresholds, ceiling effects, weak internal structure, and fluctuating retrospective ratings. Participant feedback suggested that positive responses likely reflected affirmations, and were partly linked to social desirability. In conclusion, the ZCS scale did not support a single interpretable total score, but its development offers important methodological lessons. Future measurement should begin with clearer construct definition, response-process validation, domain-level testing and explicit decisions about whether the measure aims to capture lived wellbeing, domain-specific positive outcomes or intervention-relevant change.", "abstract_shown": true, "affiliations": [ "Sexual and Reproductive Health Department, Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe", "Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom", "Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe", "Friendship Bench, Harare, Zimbabwe", "MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom", "Department of Psychology, University of Bath, Somerset, United Kingdom", "Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia", "Zvandiri, Harare, Zimbabwe", "Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom" ], "article_type": "Research Article", "arxiv": null, "author_total": 14, "authors": [ { "affs": [ 0 ], "name": "Webster Mavhu" }, { "affs": [ 1 ], "name": "Jermaine M. Dambi" }, { "affs": [ 2 ], "name": "Victoria Simms" }, { "affs": [ 3 ], "name": "Faith Martin" }, { "affs": [ 4 ], "name": "Joni Lariat" }, { "affs": [ 5 ], "name": "Rufaro Mbundure" }, { "affs": [ 6 ], "name": "Leviticus Makoni" }, { "affs": [ 7 ], "name": "Laura Kafata" }, { "affs": [ 8 ], "name": "Carol Wogrin" }, { "name": "Vivian Chitiyo" }, { "name": "Abigail Mutsinze" }, { "name": "Frances M. Cowan" }, { "name": "Nicola Willis" }, { "name": "Sarah Bernays" } ], "bibtex": "https://research.draconitic.com/paper/3hasm7vmd0698.bib", "cited_by": 0, "doi": "10.1371/journal.pgph.0006845", "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006845", "id": "3hasm7vmd0698", "issns": [ "2767-3375" ], "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006845", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "1803|Psychometric Methodologies and Testing" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Clinical psychology" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Learning" ], [ "plos", "/Biology and life sciences/Neuroscience/Learning and memory/Learning" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Population biology/Population metrics/Death rates" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Clinical psychology" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Learning" ], [ "plos", "/Biology and life sciences/Psychology/Psychometrics" ], [ "plos", "/Medicine and health sciences/Mental health and psychiatry" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/People and places/Population groupings/Age groups/Children/Adolescents" ], [ "plos", "/People and places/Population groupings/Families/Children/Adolescents" ], [ "plos", "/Research and analysis methods/Research assessment/Systematic reviews" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Clinical psychology" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Learning" ], [ "plos", "/Social sciences/Psychology/Psychometrics" ] ], "openalex": "W7214964934", "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0006845&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-30", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/3hasm7vmd0698.ris", "sources": [ { "first_seen": "2026-10-30T12:17:37Z", "native_id": "10.1371/journal.pgph.0006845", "source": "plos", "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006845" } ], "subjects": [ { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "biology", "origin": "plos:neuroscience", "subfield": "neuroscience" }, { "field": "medicine", "origin": "plos:clinical psychology", "subfield": "psychiatry" } ], "title": "Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe", "title_text": "Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:37Z", "url": "https://research.draconitic.com/paper/3hasm7vmd0698", "venue": "PLOS Global Public Health", "versions": [] }