Measuring health worker psychological Well-Being: A validation of the WHO-5 Well-Being Index across ten sub-Saharan African countries

Background Health worker mental health and psychological well-being is receiving much research attention, particularly since the SARS-CoV-2 pandemic. However, in many countries, particularly in low- and middle-income ones, validity evidence on commonly used tools to measure mental health and psychological well-being is direly lacking. Against this background, our study generated evidence on the factorial validity and measurement invariance of the WHO-5 Well-being Index for health workers in ten sub-Saharan African countries. Methods We used secondary data from a total of 9060 health workers across the ten countries; Confirmatory Factor Analysis (CFA) with the standard set of fit indices for factorial validity testing; and multi-group CFA to test for measurement invariance across country, gender, and age groups. Results Results suggest good factorial validity as well as measurement invariance for gender and age group (above and below 40 years). In contrast, we did not find full measurement invariance for country. Conclusions Based on our findings, we conclude that the WHO-5 is well-suited to measure health worker well-being across a diverse range of sub-Saharan African countries, likely generalizing to others. Our findings suggest that scores can be meaningfully compared across genders and age groups, but not across countries. In cross-country research with the WHO-5, we therefore recommend strong caution and ideally context-specific validation work prior to comparing scores across countries.