Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe
9 affiliations
- 1Sexual and Reproductive Health Department, Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- 2Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- 3Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- 4Friendship Bench, Harare, Zimbabwe
- 5MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- 6Department of Psychology, University of Bath, Somerset, United Kingdom
- 7Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
- 8Zvandiri, Harare, Zimbabwe
- 9Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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.
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BibTeX
@article{mavhu2026rethinking,
title = {{Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe}},
author = {Webster Mavhu and Jermaine M. Dambi and Victoria Simms and Faith Martin and Joni Lariat and Rufaro Mbundure and Leviticus Makoni and Laura Kafata and Carol Wogrin and Vivian Chitiyo and Abigail Mutsinze and Frances M. Cowan and Nicola Willis and Sarah Bernays},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0006845},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006845},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Rethinking wellbeing measurement: Learning from a scale development study with adolescents living with HIV in Zimbabwe
AU - Webster Mavhu
AU - Jermaine M. Dambi
AU - Victoria Simms
AU - Faith Martin
AU - Joni Lariat
AU - Rufaro Mbundure
AU - Leviticus Makoni
AU - Laura Kafata
AU - Carol Wogrin
AU - Vivian Chitiyo
AU - Abigail Mutsinze
AU - Frances M. Cowan
AU - Nicola Willis
AU - Sarah Bernays
PY - 2026
DA - 2026/09/30
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0006845
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006845
AB - 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.
SN - 2767-3375
ER -