Empirical Investigation of SAMHSA’s (Substance Abuse and Mental Health Services Administration) Model of Wellness

The quest to operationalize the construct of wellness has been elusive. Part of the difficulty resides in the way wellness has been conceptualized in the literature, using different non-overlapping models. Another drawback is that many existing models are not based on solid empirical evidence. The current study addressed these limitations by assessing the empirical validity of SAMHSA’s (Substance Abuse and Mental Health Services Administration) model of wellness. We created an instrument to assess wellness based on a thorough review of the literature that serves as the basis of the SAMHSA model that can be used to assess wellness. Findings revealed a refined view of wellness in which the dimension of Community Resources represented the single greatest contribution to wellness in a multidimensional structure. ASSESSMENT OF WELLNESS 3 The traditional view of physical and mental health is that disease and health is fully explained by deviations from the norm of measurable biological or somatic variables (Engel, 1977). Unfortunately, this approach has not proved optimal in understanding many modern health care issues, including mental disorders and other health-related issues with significant behavioral and psychosocial components (Johnson, 2013). Recently, a complementary perspective based on wellness has been introduced. Wellness is defined not simply as the absence of illness or disease but as a comprehensive understanding of multiple components of an individual’s lives (World Health Organization [WHO], 1948). The present study provides empirical evidence for the construct of wellness as it has been defined recently in the literature. Operational definition of wellness Repeated attempts have been made to formalize the concept of wellness. The problem of defining wellness has been made more complex from its usage with other interrelated terms, including wellbeing, quality of life, life satisfaction, happiness, and general satisfaction (Miller & Foster, 2010). All models have been broadly consistent with WHO’s (1948) conception of wellness as a state of complete physical, mental and social wellbeing (Ardell, 1977). Examples include Dunn (1959) who considered wellness to be an integrated way of functioning that maximizes health in the context of the total environment. More recently, Ardell (2005) emphasized the conscious choice to take responsibility for improving the quality of one’s life. Hatfield and Hatfield (1992) recognized the importance of healthy cognitive processes in overall wellbeing. Gatterman and Brimhall (2006) linked an ASSESSMENT OF WELLNESS 4 individual’s capacity to adapt creatively to all aspects of life in reaching an optimal level of functioning. Witmers and Sweeney (1992), and later Myers, Sweeney and Witmer (2000), conceptualized wellness in their own model in terms of five life tasks: spirituality, self-regulation, work, friendship and love. Much of the literature on wellness converges on a holistic perspective. Wellness has been associated with a strong sense of personal identity; a reality oriented perspective; the recognition of a unifying force in one’s life; the ability to manage one’s affairs creatively and maintain a hopeful view; and the capability of inspired, open relationships (Egbert, 1980). Dunn (1977) emphasized the interconnected nature of wellness in mind, body and environment, which exists in dynamic equilibrium. Dunn also acknowledged the fluctuating nature of wellness as people make active choices towards or away from their maximum potential. Yet these holistic definitions, albeit compelling and productive in theorizing about wellness, have fallen short of an operational definition of the construct. Researchers have addressed this limitation by proposing multidimensional or feature-based models of wellness, which view the construct as an assemblage of constituent dimensions. Lafferty (1979), for example, defined wellness as a balanced combination of six dimensions: physical, emotional, social, intellectual, spiritual and purposeful. Greenberg (1985) viewed wellness as an individual’s integration of these dimensions. Hettler (1980) replaced the purposeful dimension with an occupational dimension, emphasizing the importance of awareness of one’s wellness and actively making choices towards optimal living. The multidimensional approach has the advantage of more clearly specifying the component attributes of ASSESSMENT OF WELLNESS 5 the wellness construct. Multidimensional models also emphasize the holistic quality of wellness as the integration of components to assess overall functioning and quality of life. Multiple dimensions allow for the construct of wellness to be holistic or integrative, consistent with the bio-psycho-social framework (Miller & Foster, 2010). However, multidimensional models are nevertheless difficult to operationalize, as they are dynamic and open to interpretation. The current study aimed to define wellness more clearly by better specifying its constituent dimensions using an empirical-based psychometric approach. Existing measures of wellness The process of developing a valid instrument involves several steps. Usually, a theoretical model of a construct – here, wellness – is formalized by the creation of a set of items that collectively represent the construct. Statistical data reduction techniques, such as factor analysis or principal components analysis, are then performed on the items from a target population. The reliability and factor structure of items is used to assess the internal integrity of the model. Several existing wellness models have been subjected to this approach (Adams et al., 1997, Hettler, 1980; Myers, Luecht & Sweeney, 2004; Renger et al., 2000). Some notable measures are discussed below: (1) Hettler’s (1980) Life Assessment Questionnaire (LAQ). The LAQ is a 100item instrument derived from a six-dimensional (social, spiritual, physical, intellectual, emotional, and occupational) model of wellness. Psychometric investigations of this scale in a college-aged sample by Palombi (1992) and ASSESSMENT OF WELLNESS 6 DeStefano and Richardson (1992) found low test-retest reliability. Palombi (1992) reported low to moderate correlations among the total and subscale scores. (2) Hettler’s (1980) model also is the basis of TestWell, a 100-item wellness measure developed by the National Wellness Institute (1992). TestWell contains 100 items scored on a 5-point Likert Scale. Owen (1999) reported that the scale has high reliability on test-retest, subscale as well as total scale conditions. (3) The Perceived Wellness Model (PWS; Adams et. al., 1997) is a multidimensional measure of perceived wellness in social, spiritual, physical, intellectual, emotional and psychological domains. The scale contains 36 items, six on each of the six dimensions. The PWS showed convergent validity with related instruments (e.g., instruments measuring wellbeing, social support and self-esteem). However, internal reliability of the PWS is low; only four of the six subscales demonstrated adequate consistency. Further, Harari et al., (2005) found no evidence supporting the multidimensional structure of the PWS scale. (4) The Optimal Living Profile (OLP; Renger et al., 2000) is a 135 item questionnaire tapping six dimensions of wellness (i.e., emotional, spiritual, physical, social, intellectual and environmental). Although Renger et al., (2000) reported adequate reliability and validity of the scale, independent psychometric analysis of OLP is needed. (5) The Wellness Evaluation of Life Inventory (WEL; Myers, Luecht & Sweeney, 2004) is derived from a model that conceptualizes wellness in terms of five life tasks (Witmer & Sweeney, 1992; Myers, Sweeney, & Witmer, 2000): spirituality, self-regulation, work, friendship, and love. The scale includes twelve ASSESSMENT OF WELLNESS 7 sub-life tasks that together comprise the Wheel of Wellness: sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self-care, stress management, gender identity and cultural identity. Psychometric analyses in a large, diverse sample suggest adequate test-retest reliability, high internal consistency, and strong convergent and divergent validity. Unfortunately, the scale and its underlying model stand apart as distinct from current theorizing in the wellness literature. (6) Travis (1981) developed the Wellness Inventory (WI), which includes 120 items covering 12 dimensions: self-responsibility and love, breathing, sensing, eating, moving, feeling, thinking, playing and working, communication, sex, finding meaning and transcending. Eight of the 12 dimensions reveal high internal consistency (Palombi, 1992). Yet Palombi (1992) warned that the instrument might be measuring a unidimensional construct. To be sure, the wellness measures discussed here have advanced the research and applications of wellness. However, they all share a similar set of limitations. First, the wide disparities that exist among various models and definitions of wellness (see Operational definition of wellness) also plague the instruments that measure wellness. The lack of a gold standard definition of wellness leads to development of instruments that measure different, nonoverlapping aspects of wellness (Rachele, Washington, Cuddihy, Barwais, & McPhail, 2013). Second, most of the instruments are limited to use within small research teams with little clinical application and little independent empirical scrutiny from the larger scientific community. Third, the current instruments have resisted a ASSESSMENT OF WELLNESS 8 cyclical process of review and refinement. Instead, extant instruments measure wellness using a locally favored multidimensional model and proceed without rigorous investigation to evaluate, improve, or provide further support for the original structure. Adams et al.’s (1997), for example, criticized creators