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Understanding and measuring wellbeing
Hone, Lucy Clare
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There is growing interest and application worldwide in the science of wellbeing. Considerable empirical evidence indicating the importance and potential benefits of population wellbeing promotion (such as reducing the burden of mental illness and enhancing employee performance and productivity) provides strong arguments for wellbeing to become part of the governmental and organisational policy agenda. Although health agencies around the world nominally recognise health as more than the absence of disease, and policy documents now make reference to wellbeing promotion, they continue to operate under a deficit model. This thesis investigates the reasons for this disconnect between scientific evidence and real world practice, taking both an international and national perspective. In particular, it focuses on the understanding and measurement of wellbeing, and flourishing, a term commonly used to describe high levels of wellbeing. By examining current conceptualisations and operationalisations of wellbeing (and flourishing), exploring their epidemiology, and evaluating intervention effectiveness research, it gives greater clarity to the questions of what is wellbeing?, how is it measured?, who has wellbeing?, and how can wellbeing be promoted? Knowledge gaps highlighted in the literature and practice give rise to a series of studies that become the starting point for epidemiological research on wellbeing, and flourishing, in New Zealand. Study 1 found that 24% of New Zealand adults were flourishing, providing a baseline measure for future comparison. It also investigated the impact of operational definition on epidemiology: by calculating the prevalence of flourishing according to different operationalisations it found that national flourishing prevalence ranged from 24% to 47% depending on the operationalisation used. The outcomes from this study spawned the next two studies. Study 2 addressed the lack of evidence concerning lay perspectives of wellbeing with qualitative work exploring New Zealand workers’ conceptualisations of wellbeing, highlighting similarities and differences between lay and academic models. New Zealand workers were less likely than academic researchers to consider achievement, engagement, and optimism as important for wellbeing, and considered physical health, work-life balance, and feeling valued as more important instead. Study 3 expanded the limited psychometric evidence supporting key wellbeing measures by demonstrating the validity and reliability of the Flourishing Scale among a nationally representative sample of adult New Zealanders (N = 9,646), and providing population benchmarks. Study 4 contributed additional epidemiological evidence exploring the characteristics and determinants of flourishing among a large sample of New Zealand workers (n = 5,549). One in four New Zealand workers were categorised as flourishing. Being older and married, reporting greater income, financial security, physical health, autonomy, strengths awareness and use, work-life balance, job satisfaction, participation in the Five Ways to Wellbeing, volunteering, and feeling appreciated by others, were all significantly associated with worker flourishing, independent of socio-demographics. Having explored extant conceptual and operational definitions of wellbeing, their psychometric utility, and resultant epidemiology, this thesis switched to focus on interventions. Study 5, an evaluation of intervention effectiveness research using the RE-AIM framework common to public health (Reach, Efficacy, Adoption, Implementation, Maintenance), found substantial limitations within the existing evidence-base concerning limited sample representativeness, and a paucity of evidence regarding intervention maintenance (reported in 16% of the studies) and implementation costs (reported in 2.5% of studies). The large proportion of trials relying on specialist agents (45%) and researchers (30%) for delivery was identified as an additional factor limiting mass-market dissemination of wellbeing interventions in naturalistic contexts. Study 6, a qualitative study exploring New Zealand workers’ self-reported pathways to wellbeing, indicated workers’ awareness of some evidence-based strategies (such as the Five Ways to Wellbeing, practicing gratitude and mindfulness) but greater endorsement of traditional pathways such as exercise (endorsed by 78%), hobbies (41%), healthy eating (35%), and sleep (27%). The body of knowledge comprising these doctoral studies therefore aims to further the understanding and measurement of wellbeing among researchers, policy-makers, and oragnisational decision-makers, equipping them with the necessary evidence and psychometric tools to enable the promotion of population wellbeing to become a reality.