Introduction
Globally, chronic illness and unhealthy lifestyle behaviors continue to rise among adult individuals1. Therefore, it becomes necessary to create awareness and social cognition in health/wellness patterns2 and continue further research in this issue considering multidimensional scores3,4 in order to better address shared decision making approaches in social interactions and in achieving one’s goals5.
Additionally, Rossi et al.6 has just conducted the Italian adaptation of a brief Resilience Scale for Adults, highlighting the relevance of such tools in non-clinical populations and offering a useful precedent for the present study.
Since nurses should promote the health and wellness of individuals, they are directed by many nursing theories, such as the Theory of Self-Care7, Health Promotion Model8, and the Theory of Integrative Nurse Coaching (TINC)9 to address challenges in lifestyle choices in chronic diseases. In this specific field, the nurse coach role was improved between nursing and change theories care10, including This role spans the spectrum of nursing, incorporating coaching skills in all areas of nursing. Thus, an integrative assessment becomes essential, as the IHWA which assesses the nurse coach role and (self) awareness through reflection and respective self-care11.
The latest theory supports that nurses have an additional education in coaching interventions to support health promotion thanks to an emphasis on healthy lifestyle improvements, which promotes the development of the Integrative Health and Wellness Assessment™ Tool12.
The IHWA tool was validated for this aim and a consequential need to develop a shorter form, also.
The IHWA was created 2011, thanks to a self-evaluation instrument first created by Lynn Keegan and Barbara Dossey13 that considered the Theory of Integral Nursing14, and the TINC15. The beginning self-assessment instrument contained six sub dimensions of wellness: Physical, Mental, Emotions, Spirit, Relationships, and Choices16,17 and was ameliorated over the past 23 years, thanks to constructive feedbacks by experts in holistic nursing. In 2010, with the beginning of the nurse coach professional role, the practice of nurse coaching evolved with Nurse Coach scope and core competencies of practice using the ae evaluation instrument as a guide for practice. After reviewing several instruments, self-help programs, and content experts, the e tool included an integrative approach to self-assessment within the TINC. With the increased interest internationally, the necessity to promote healthy lifestyles supports the opportunity to validate the new tool in other languages. In this regard, the IHWA short form aims to create awareness and assess the individual’s self-reflection development, empowering patients and supporting the nurse-client relationship. Additionally, the recent Turkish adaptation of the IHWA by İnkaya et al.18 demonstrated the tool’s cross-cultural adaptability and underscores the importance of expanding its use in non-English-speaking contexts.
Holistic Nursing
Holistic care is a complex concept which defies a precise definition19. Holistic care provides an indepth understanding of patients and their various needs for care and has important consequences in healthcare systems and has been referred to as the heart of the science of nursing20,21. Holistic care can contribute to patients’ satisfaction with healthcare and help them to accept and assume selfresponsibility22. It will also result in a better understanding of the effects of illnesses on patients’ responses and their true needs23. During an illness, complex psychological, social and cultural needs disturb a patient’s balance24, and adversely affect his/her ability to carry out every day activities25. Holistic care, by addressing patients’ physical, emotional, social and spiritual needs, restores their balances and enables them to deal with their illnesses, consequently improving their lives26.
There is compelling evidence that most nurses who have been educated within a biomedical allopathic focus, are not familiar with the concept of holistic care - or at best, have a semischolarly understanding of it27. This often leads them to neglect holistic care22,27 and to consider only one aspect of the patients’ needs - the physical aspect. Using only the medical model is not only insufficient to restore health but also exposes patients to serious threats, prolongs hospitalization and increases treatment costs28. In many countries, such as the United Kingdom28, Australia29, and Iran30, caring conditions are inappropriate. Many aspects of patients’ needs are forgotten, and patients’ dignity is often neglected30.
Theoretical Framework
The power of touch and connection to patients that goes beyond the physical is at the heart of nursing care. Being in gear that is protective, yet woefully wanting in terms of providing the opportunity for the human touch that shows care, has made an impact on nurses’ feelings about the value of their care. Pervasive stories have been reported of nursing feeling profoundly inadequate in helping dying patients go through this transition in the absence of the kind of loving care31.
Defining health can be difficult32. The Institute of Medicine33 observed that health is more than the absence of disease and injury. Nursing has long shared this holistic point of view. The IOM33 utilizes the concept of “positive health” along four components: a healthy body, high-quality personal relationships, a sense of purpose in life, and resilience to stress, trauma, and change. The World Health Organization (WHO) defines health as physical, mental, and social well-being34. Both of these definitions include the concept of social health as being an essential factor. The theories of social determinates of health suggest that in addition to these defined components of health, the relationship between the components is critical35.
Objectives
In Italy, there is not any validated instrument to assess integrative health and wellness. Therefore, the present manuscript aimed to:
- validate the Italian version of the IHWA_V2_2022 questionnaire;
- explore psychometric characteristics of the IHWA_V2_2022 in a sample of Italian individuals;
- investigate if the integrative health was differently perceived among participants according to gender and age.
Materials and methods
Participants
A representative sample of Italians was recruited online. The questionnaire was spread and administered on-line, thanks to Instagram and Facebook pages by inviting them to participate in the present study.
Sample size
According to the National Institute of Statistics36 in January 2023 the Italian population amounted to 58,997,201.
The sample size was assessed by applying Miller and Brewer’s formula37 at the 95% the confidence interval, n = N/(1+N(α)2). Where, n represented the desired sample size, N the target population and α the level of statistical significance of 0.05 and 1 was a constant.
Therefore, the sample size assessment was:
The assessed sample size of 400 was increased by 30% to 520 to ensure that sample size was not lost during data collection, since literature reported an answer rate nearly 60%-65%38.
However, this was a convenience sampling, which carried inherent limitations in terms of generalizability39.
Translation and cross-cultural adaptation
The translation procedure followed in this study adhered to the guidelines for translating, adapting, and validating instruments or scales for cross-cultural research as outlined by Sousa et al.40. Prior to start the translation process, we obtained permission from the International Nurse Coach Association41. All authors involved in this study had a proficient and certified level of English language. Then, the IHWA_V2_2022- Italian version11 version was confirmed by 5 experts who answered to the “Survey Instrument Validation Rating Scale”42 by judging the maximum level of agreement in all the proposed items indicating the degree of agreement in each item of the questionnaire, and if they were appropriately translated.
The Questionnaire
The questionnaire was created online thanks to the Google Forms function, and then, a link was spread through various Instagram and Facebook social pages to reach the higher number of participants. The questionnaire consisted of three main sections.
The first section collected demographic data including sex (female, male or not answered) and age (until 30 years, 31-40 years, 41-50 years, 51-60 years, over 61 years).
For the second part of the questionnaire, the translation of the IHWA_V2_2022 included statements reflecting on participant’s present way of life, feelings and personal habits. The questionnaire included a total of 36 items to which the participant should indicate the engagement frequency. For each item a Likert scale was proposed in which 1 stand for “never”, 2 for “rarely”, 3 for “occasionally”, 4 for “frequently” and 5 for “always”. The original version included a total of five sub dimensions, such as: life satisfaction, relationships, spiritual, mental, emotional, physical/exercise, physical/nutrition, physical/weight, environmental, health responsibility. By summing each item included in each sub dimension, a total score was assessed which was divided for the maximum value reachable for each sub dimension and then, a different level for each addressing area was identified, including:
“My readiness to change” area, which included the following stated levels, such as: 1 for “in 1 year”, 2 for “within 6 months”, 3 for “next month”, 4 for “in two weeks”, 5 for “now”;
“Priority making change” area, which included the following stated levels: 1 for “never a priority”, 2 “very low priority”, 3 “medium priority”, 4 “priority”, or 5 “highest priority”;
“Confidence in my ability to do it” which included levels: 1 for “not at all confident”, 2 “not very confident”, 3 “somewhat confident”, 4 “confident”, 5 “very confident”.
Finally, one open answer was proposed, in which participants were invited to list 3 potential changes to improve their own lifestyle within the next 3 months.
Data analysis
Sex and age were considered as categorical variables and presented as frequencies and percentages. Internal consistency of the IHWA-V2-2022 was also assessed, by considering: mean ± standard deviation for each item, item-to-item Pearson correlation and α-Cronbach by considering the total IHWA_V2_2022 without the item considered, as also indicated the Turkish validation study18. Then, construct validity and the factor structure of the data were investigated thanks to Varimax rotation with the Kaiser-Meyer-Olkin (KMO) index and Bartlett’s test of sphericity. KMO values higher than 0.40 were considered acceptable, and a significant Bartlett’s test of sphericity (p < 0.001) indicated strong evidence of a factor structure. The Varimax rotation was preferred based on the literature supporting its use in confirmatory factor analysis. Loading factors of ≥ 0.30 were considered significant indicators of important factors.
The reliability of the “IHWA-V2-2022” scale, including internal consistency, absolute stability, and relative stability, was assessed. Internal consistency was evaluated using coefficient alpha (α) for the total data collection as well as for each sub dimension assessed. The intraclass correlation coefficient (ICC) was used to evaluate the stability of the IHWA_V2_2022 values. Then, to assess any differences in IHWA_V2_2022 sub dimensions according to demographic characteristics collected, such as sex and age, ANOVA tests were performed. All p-values assessed were considered as: p < 0.05 as weak evidence, p < 0.01 as strong evidence, and p < 0.001 as very strong evidence.
Ethical considerations
Informed consents was mandatory to continue reading as well as answering the questionnaire.
According to COPE43, the questionnaire was anonymous. At the first part of the questionnaire a clear statement was presented in order to give all possible information of the purpose of the study to participants. Additionally, the questionnaire was performed in accordance with the principles of the Italian data protection authority (DPA). It was highlighted that participation was free. Participants, who gave the informed consent, could complete the questionnaire. In relation to competencies and functions of the Italian Ethical Committee (EC)44, the EC expressed opinions on the following types of studies: protocols of clinical drug trials, observational clinical trials, clinical trials with medical devices, or protocols for therapeutic use of investigational drugs outside clinical trials or for biomedical, psycho-educational, social or other research involving human subjects humans; epidemiological, evaluative and medico-social research projects that require the collection of data personal data or with environmental ethics implications; patient information sheets and informed consent forms; ethical-scientific, methodological and economic aspects of experimental research protocols or amendments; qualification of investigators for the purpose of conducting the proposed research as well as the ethical and scientific aspects of the same.
Since the present study aimed to validate an Italian version of a questionnaire on the general population, without investigating the above mentioned fields of research, the EC opinion was not applicable in its request.
Results
A total of 960 participants voluntarily agreed to participate in the present study. Of these, 695 (72.4%) were females and 265 (27.6%) were males. Additionally, 326 (34%) aged until 30 years, 309 (32.2%) aged between 31-40 years, 191 (19.9%) aged between 41-50 years, 125 (9%) aged between 51-60 years and 9 (0.9%) aged over 61 years.
Internal consistency analysis showed significant items to the total IHWA_V2_2022 score correlations and also high α-Cronbach values (Tab. I).
Both the Kaiser-Meyer-Olkin (KMO) value of sampling adequacy and the Bartlett’s test of sphericity showed that the data were suitable for factor analysis (Tab. II). However, the reported KMO value (0.561) was relatively low. While still acceptable, this value fell below optimal thresholds, potentially due to the multidimensionality and heterogeneity of the items.
The total variance explained by the factors was 77.443% and a total of 11 components were evidenced (Tab. III).
Component analysis thanks to Varimax rotation revealed 11 sub-dimensions with component loadings ≥ 0.40 on each component (Tab. IV). Dimensions were named:
- Mental well-being
- Healthy Eating Thought
- Healthy Responsibility
- Anti-stress activity
- Environmental
- Free Addiction Behavior
- Spiritual
- Mental/Nutrition
- Physical/Weight
- Healthy Daily Living
- Life Equilibrium
The internal consistency and stability of the IHWA_V2_2022 were assessed and found to be satisfactory (Tab. V). The α-coefficient indicated good internal consistency, and the intraclass correlation coefficients (ICC) were statistically significant (**p < 0.001 and *p < 0.05), demonstrating good stability of the scale over time.
None significant difference was recorded in the IHWA_V2_2022 administration according to sex (Tab. VI).
By considering age sub groups (Tab. VII), significant differences were reported in the ninth sub dimension “Physical/Weight”: the oldest participants recorded higher levels in maintaining their ideal weights (p = 0.039).
Discussion
The present study aimed to validate the Italian version of the IHWA short form, since in Italy, there was not any validated instrument to assess Integrative Health and Wellness. Additionally, the present work also explored any differences in integrative health and wellness according to sex and age.
Evidence suggested several sub dimensions in well-being composition, such as: autonomy, self-acceptance, positive relationships, environmental mastery, personal growth, and purpose in life (Ryff, 1989). In our study, a large sample was reached among individuals who answered the questionnaire. Dimensions highlighted from our component analysis were: mental well-being, healthy eating thought, healthy responsibility, anti-stress activity, environmental, free addiction behavior, spiritual, mental and nutrition, physical and weight, healthy daily living and life equilibrium. The internal consistency and stability of the IHWA_V2_2022 were satisfactory and the α-coefficient indicated good internal consistency with significant intraclass correlation coefficients (**p < 0.001 and *p < 0.05).
The factor analysis revealed a detailed and multifaceted structure of wellness dimensions. In fact, the identification of 11 components supported the idea that wellness was composed of multiple interrelated areas - many of which were amenable to self-care, coaching, and lifestyle interventions.
This aligned well with the IHWA’s holistic nature. However, some component labels, like “Mental Nutrition” and “Healthy Eating Thought” appeared potentially overlapping. In this sense, Gheonea et al.45 emphasized the interconnectedness between nutrition, emotional regulation, and mental well-being. In fact, well-being appeared to be strictly connected to nutrition, sleep quality, physical activity, abuse of various toxic substances, especially highlighting lower levels in quality of food and quality of sleep and exercise45.
By considering age sub groups, significant differences were reported in the ninth sub dimension “Physical/Weight”, since the oldest participants recorded higher levels in maintaining their ideal weights (p = 0.039). For all the other aspects there were no differences both according to sex and age.
Particularly, the lack of significant sex-related differences could also be referred to potential universality of wellness perceptions or instrument insensitivity to gender-specific factors. Given the IHWA included domains like spirituality and emotional expression, this result could suggest that these dimensions are experienced similarly across sexes in the Italian population. In this regard, data were partially in agreement with a previous review which supported that gender made a significant difference only in the outcomes of nurse coaching interventions46.
Despite the literature showing a substantial number of quantitative subjective well-being instruments47-49, there was a lack of tools in Italy assessing an individual’s integrative health and well-being representing a whole person approach Among these, Prilleltensky et al.50 assessed the Overall, Interpersonal, Community, Occupation, Physical, Psychological, and Economic well-being (I COPPE) in which well-being was represented as “a positive condition of happenings, carried out by the concurrent and fair satisfaction of different objective and subjective requirements of individuals, relationships, partnerships and communities”50. Evidence suggested a multilevel and multidimensional construct of well-being, since it highlighted a systemic attitude beyond the individual to include several levels of examination with different dimensions of people’s experiences, which were all important to explain their condition of well-being51. The I COPPE scale was made up of a total of 21 items and 7 sub dimensions, namely: Overall Well-being, Interpersonal Well-being, Community Well-being, Occupational Well-being, Physical Well-being, Psychological Well-being, Economic Well-being. All these sub dimensions were integrated among them in a time perspective. However, the dimensions’ scores were strongly dependent to the subjective experience of well-being52 by balancing time skills and related circumstances52,53. Therefore, well-being was perceived by individuals in different aspects of life50 and could be explained as a function of social and environmental circumstances as much as individual peculiarities54,55. Additionally, spiritual aspects have been often omitted from clinical assessment tools, while in the IHWA a specific component has been addressed supporting the meaningful assessment in the Italian clinical or community context.
The present study included some limitations. First of all, the demographic concentration of the sample, specifically youngers and females among participants, which suggested the need for future studies in more clinical or diverse populations. Secondly, the present study aimed to validate the IHWA questionnaire in a general context, thus, additional research in applied healthcare settings would be valuable to confirm its practical utility. Thirdly, the questionnaire was spread on-line. In this regard, we acknowledged participants, however this data collection method showed demographic imbalances. Additionally, the use of PCA rather than EFA could be considered a further limitation in terms of construct validity.
Conclusion
The present study aimed to quantify wellness in general population and validate the IHWA into Italian. Our findings suggested higher reliability scores, identifying it as a tool’s potential use in health and wellness assessment in Italian-speaking contexts.
Additionally, our findings suggested significant age-related difference in the “Physical/Weight” sub dimension which was particularly valuable in light of studies such as Teraž et al.56, who found that physical health perceptions and lifestyle behaviors differ significantly with age, especially among older adults. However, further studies will be performed, also considering specific groups of population to further process with nursing coaching interventions.
Acknowledgements
Authors acknowledge the “INTEGRATIVE NURSE COACH ® ACADEMY” for giving permission for the use of HIWA-SV-2022.
Informed Consent for publication
Consent was collected to all the participants.
Availability of data and materials
Data are available at the first author.
Conflict of interest statement
None
Funding
None
Auhtors contribution
Conceptualization: E.V.
Methodology: E.V., K.A.
Investigation: R.M.
Writing—original draft preparation and editing: E.V.
All authors have read and agreed to the published version of the manuscript.
Figures and tables
| Items | Mean ± s.d. | Item-to-total correlation r** (p-value) | α-Cronbach if item deleted |
|---|---|---|---|
| Item no.1 | 119.14±14.98 | 0.340** | 0.828 |
| Item no.2 | 120.04±15.01 | 0.241** | 0.832 |
| Item no.3 | 118.95±14.86 | 0.434** | 0.825 |
| Item no.4 | 119.21±14.70 | 0.591** | 0.821 |
| Item no.5 | 118.91±14.87 | 0.585** | 0.823 |
| Item no.6 | 118.99±14.30 | 0.719** | 0.813 |
| Item no.7 | 119.09±14.76 | 0.456** | 0.824 |
| Item no.8 | 119.28±14.81 | 0.428** | 0.825 |
| Item no.9 | 120.01±14.59 | 0.524** | 0.822 |
| Item no.10 | 119.13±14.80 | 0.552** | 0.822 |
| Item no.11 | 118.67±14.83 | 0.519** | 0.823 |
| Item no.12 | 118.91±14.69 | 0.527** | 0.822 |
| Item no.13 | 119.45±14.98 | 0.354** | 0.827 |
| Item no.14 | 119.33±14.85 | 0.417** | 0.826 |
| Item no.15 | 118.55±14.94 | 0.404** | 0.826 |
| Item no.16 | 119.36±14.74 | 0.536** | 0.822 |
| Item no.17 | 120.21±14.53 | 0.559** | 0.820 |
| Item no.18 | 120.57±15.02 | 0.236** | 0.832 |
| Item no.19 | 120.48±14.69 | 0.487** | 0.823 |
| Item no.20 | 119.78±15.08 | 0.186** | 0.834 |
| Item no.21 | 118.46±14.87 | 0.354** | 0.828 |
| Item no.22 | 119.31±14.87 | 0.399* | 0.826 |
| Item no.23 | 118.89±15.00 | 0.247** | 0.832 |
| Item no.24 | 118.98±14.93 | 0.336** | 0.828 |
| Item no.25 | 118.63±15.03 | 0.260** | 0.803 |
| Item no.26 | 119.15±15.08 | 0.220** | 0.831 |
| Item no.27 | 118.30±15.16 | 0.179** | 0.831 |
| Item no.28 | 118.79±14.93 | 0.275** | 0.832 |
| Item no.29 | 118.25±15.07 | 0.264** | 0.829 |
| Item no.30 | 118.63±15.30 | 0.244* | 0.845 |
| Item no.31 | 118.51±14.94 | 0.385** | 0.826 |
| Item no.32 | 119.18±14.91 | 0.342** | 0.828 |
| Item no.33 | 118.80±14.95 | 0.290** | 0.830 |
| Item no.34 | 118.21±14.95 | 0.460** | 0.825 |
| Item no.35 | 118.89±14.77 | 0.525** | 0.823 |
| Item no.36 | 118.25±14.81 | 0.555** | 0.822 |
| **p < 0.001; *p < 0.05. | |||
| KMO measure of sampling adequacy | 0.561 | |
|---|---|---|
| Bartlett’s test of sphericity | Approx. chi-square | 28334.961 |
| Df | 630 | |
| p | 0.000 | |
| Total variance explained | ||||||
|---|---|---|---|---|---|---|
| Items | Initial Eigenvalue | Extraction Sums of squared Loadings | ||||
| Total | % of variance | % cumulative | Total | % of variance | % cumulative | |
| Item no.1 | 7.023 | 19.509 | 19.509 | 4.445 | 12.346 | 12.346 |
| Item no.2 | 3.416 | 9.489 | 28.998 | 2.847 | 7.909 | 20.255 |
| Item no.3 | 3.169 | 8.803 | 37.801 | 2.710 | 7.528 | 27.783 |
| Item no.4 | 2.844 | 7.901 | 45.702 | 2.628 | 7.301 | 35.084 |
| Item no.5 | 2.673 | 7.426 | 53.128 | 2.497 | 6.937 | 42.021 |
| Item no.6 | 1.989 | 5.525 | 58.653 | 2.490 | 6.917 | 48.938 |
| Item no.7 | 1.620 | 4.500 | 63.153 | 2.448 | 6.800 | 55.738 |
| Item no.8 | 1.498 | 4.161 | 67.315 | 2.126 | 5.906 | 61.644 |
| Item no.9 | 1.346 | 3.740 | 71.054 | 2.044 | 5.678 | 67.322 |
| Item no.10 | 1.209 | 3.357 | 74.412 | 1.972 | 5.479 | 72.800 |
| Item no.11 | 1.091 | 3.031 | 77.443 | 1.671 | 4.642 | 77.443 |
| Item no.12 | 0.923 | 2.564 | 80.007 | |||
| Item no.13 | 0.840 | 2.333 | 82.340 | |||
| Item no.14 | 0.717 | 1.993 | 84.332 | |||
| Item no.15 | 0.687 | 1.909 | 86.242 | |||
| Item no.16 | 0.623 | 1.731 | 87.972 | |||
| Item no.17 | 0.555 | 1.542 | 89.514 | |||
| Item no.18 | 0.497 | 1.381 | 90.895 | |||
| Item no.19 | 0.444 | 1.234 | 92.128 | |||
| Item no.20 | 0.404 | 1.121 | 93.250 | |||
| Item no.21 | 0.341 | 0.946 | 94.196 | |||
| Item no.22 | 0.295 | 0.820 | 95.016 | |||
| Item no.23 | 0.249 | 0.691 | 95.707 | |||
| Item no.24 | 0.235 | 0.652 | 96.360 | |||
| Item no.25 | 0.208 | 0.578 | 96.937 | |||
| Item no.26 | 0.201 | 0.557 | 97.495 | |||
| Item no.27 | 0.182 | 0.504 | 97.999 | |||
| Item no.28 | 0.157 | 0.435 | 98.434 | |||
| Item no.29 | 0.118 | 0.328 | 98.762 | |||
| Item no.30 | 0.099 | 0.274 | 99.036 | |||
| Item no.31 | 0.084 | 0.233 | 99.270 | |||
| Item no.32 | 0.080 | 0.222 | 99.492 | |||
| Item no.33 | 0.066 | 0.183 | 99.675 | |||
| Item no.34 | 0.056 | 0.155 | 99.830 | |||
| Item no.35 | 0.040 | 0.112 | 99.942 | |||
| Item no.36 | 0.021 | 0.058 | 100.000 | |||
| Extraction method: Principal component analysis. | ||||||
| Items | Components | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Mental Well-Being | 2. Healthy Eating Thought | 3. Health Responsibility | 4. Anti-stress activity | 5. Environ mental | 6. Free to Addiction Behavior | 7. Spiritual | 8. Mental Nutrition | 9. Physical/ Weight | 10. Healthy Daily Living | 11. Life Equilibrium | |
| Item no.3 | 0.688 | -0.074 | 0.183 | -0.208 | 0.192 | -0.030 | 0.270 | -0.105 | -0.152 | -0.160 | 0.229 |
| Item no.4 | 0.558 | -0.086 | 0.146 | 0.078 | 0.192 | 0.143 | 0.429 | 0.049 | -0.345 | 0.192 | 0.185 |
| Item no.5 | 0.840 | 0.151 | 0.001 | 0.140 | -0.007 | -0.048 | 0.031 | 0.028 | 0.070 | 0.120 | 0.052 |
| Item no.6 | 0.646 | 0.183 | 0.404 | -0.062 | 0.095 | 0.346 | 0.257 | -0.078 | -0.038 | 0.027 | -0.008 |
| Item no.10 | 0.528 | -0.022 | 0.328 | 0.322 | -0.110 | -0.322 | 0.215 | 0.320 | 0.234 | -0.153 | -0.148 |
| Item no.11 | 0.759 | -0.175 | 0.091 | 0.152 | 0.164 | -0.189 | -0.002 | 0.294 | 0.075 | -0.045 | 0.230 |
| Item no.12 | 0.559 | 0.018 | 0.489 | 0.034 | -0.052 | 0.005 | -0.041 | 0.182 | -0.175 | -0.094 | 0.334 |
| Item no.16 | 0.689 | -0.070 | 0.176 | 0.162 | -0.270 | 0.003 | 0.063 | 0.168 | 0.259 | 0.079 | -0.041 |
| Item no.15 | 0.393 | 0.584 | -0.096 | -0.152 | -0.298 | 0.006 | 0.084 | 0.139 | 0.303 | 0.271 | -0.006 |
| Item no.20 | -0.114 | 0.580 | -0.037 | -0.050 | -0.006 | 0.161 | -0.078 | 0.172 | 0.297 | 0.021 | -0.331 |
| Item no.22 | 0.014 | 0.776 | 0.194 | 0.108 | 0.134 | -0.122 | 0.062 | 0.088 | 0.139 | -0.180 | 0.057 |
| Item no.33 | -0.016 | 0.849 | 0.011 | 0.023 | 0.091 | -0.038 | 0.083 | -0.099 | -0.120 | 0.160 | 0.016 |
| Item no.31 | 0.186 | 0.080 | 0.693 | 0.075 | 0.219 | -0.106 | -0.018 | -0.202 | 0.018 | 0.055 | -0.203 |
| Item no.34 | 0.105 | 0.169 | 0.593 | -0.155 | 0.426 | -0.009 | 0.051 | 0.167 | -0.055 | 0.099 | 0.273 |
| Item no.35 | 0.034 | 0.006 | 0.736 | 0.175 | -0.193 | 0.350 | 0.183 | 0.144 | 0.120 | -0.068 | 0.082 |
| Item no.36 | 0.306 | 0.030 | 0.658 | 0.200 | 0.006 | 0.024 | -0.132 | 0.134 | 0.092 | 0.237 | 0.000 |
| Item no.2 | 0.285 | -0.416 | -0.104 | 0.602 | -0.111 | -0.136 | 0.148 | 0.115 | -0.033 | 0.120 | -0.059 |
| Item no.17 | 0.252 | 0.232 | 0.164 | 0.752 | -0.003 | -0.051 | 0.272 | -0.061 | -0.108 | 0.001 | -0.175 |
| Item no.18 | -0.131 | -0.046 | 0.154 | 0.841 | -0.015 | 0.120 | -0.054 | -0.009 | 0.112 | -0.199 | 0.109 |
| Item no.19 | 0.205 | 0.129 | 0.075 | 0.560 | 0.360 | 0.075 | -0.025 | -0.028 | 0.370 | 0.069 | 0.176 |
| Item no.25 | 0.013 | -0.004 | 0.120 | 0.053 | 0.734 | 0.157 | -0.101 | -0.069 | 0.329 | 0.093 | 0.015 |
| Item no.26 | 0.097 | 0.245 | -0.071 | 0.160 | 0.643 | 0.210 | -0.141 | -0.112 | -0.335 | 0.123 | -0.123 |
| Item no.27 | -0.037 | 0.041 | 0.070 | -0.116 | 0.745 | -0.026 | 0.170 | 0.257 | -0.032 | -0.296 | 0.024 |
| Item no.8 | 0.037 | 0.017 | -0.002 | 0.295 | 0.153 | 0.533 | 0.461 | -0.011 | 0.251 | 0.033 | -0.314 |
| Item no.28 | 0.040 | -0.128 | 0.083 | 0.060 | 0.047 | 0.891 | -0.015 | 0.029 | -0.075 | 0.022 | 0.083 |
| Item no.30 | -0.156 | 0.088 | 0.029 | -0.105 | 0.149 | 0.815 | -0.036 | -0.256 | -0.169 | -0.123 | -0.132 |
| Item no.7 | 0.183 | 0.110 | 0.025 | 0.000 | 0.040 | 0.005 | 0.857 | -0.073 | -0.043 | 0.124 | 0.266 |
| Item no.9 | 0.296 | 0.085 | -0.013 | 0.294 | -0.288 | -0.070 | 0.692 | 0.194 | 0.123 | 0.170 | -0.171 |
| Item no.13 | 0.162 | 0.012 | -0.014 | 0.071 | 0.018 | -0.154 | 0.063 | 0.793 | 0.072 | 0.157 | 0.218 |
| Item no.21 | 0.048 | 0.434 | 0.153 | 0.009 | 0.153 | -0.049 | 0.106 | 0.516 | -0.030 | -0.267 | -0.027 |
| Item no.23 | 0.257 | 0.037 | 0.170 | -0.215 | -0.010 | 0.005 | -0.376 | 0.610 | 0.056 | 0.306 | -0.252 |
| Item no.24 | 0.104 | 0.162 | 0.117 | 0.120 | 0.078 | -0.179 | 0.036 | 0.094 | 0.842 | 0.202 | -0.033 |
| Item no.14 | 0.017 | 0.356 | 0.021 | -0.034 | -0.326 | 0.295 | 0.325 | 0.332 | -0.113 | 0.412 | 0.236 |
| Item no.29 | 0.010 | 0.045 | 0.093 | -0.053 | -0.008 | -0.127 | 0.131 | 0.050 | 0.293 | 0.830 | 0.035 |
| Item no.32 | 0.052 | -0.088 | 0.275 | -0.126 | 0.000 | 0.102 | 0.324 | 0.261 | -0.427 | 0.570 | 0.025 |
| Item no.1 | 0.343 | -0.045 | 0.011 | 0.020 | 0.005 | -0.043 | 0.152 | 0.118 | 0.017 | 0.069 | 0.819 |
| Extraction method: principal components analysis. Rotation method: Varimax with Kaiser normalization. a The rotation reached the convergence criteria in 23 iterations. | |||||||||||
| Internal consistency (α-Cronbach) | Relative stability ICC C.I. 95% | Absolute stability μ±s.d. | |
|---|---|---|---|
| IHWA-Total | 0.848 | 0.831**0.815-0.846 | 3.40±0.365 |
| 1. Mental Well-Being | 0.881 | 0.871**0.858-0.883 | 3.477±0.045 |
| 2. Healthy Eating Thought | 0.739 | 0.735**0.706-0.761 | 3.385±0.300 |
| 3. Health Responsibility | 0.706 | 0.701**0.669-0.731 | 4.031±0.098 |
| 4. Anti-stress activity | 0.720 | 0.722**0.692-0.750 | 2.170±0.059 |
| 5. Environmental | 0.661 | 0.646**0.605-0.683 | 3.803±0.185 |
| 6. Free of Addiction Behavior | 0.732 | 0.734**0.704-0.762 | 3.591±0.116 |
| 7. Spiritual | 0.758 | 0.753**0.719-0.782 | 2.945±0.422 |
| 8. Mental Nutrition | 0.582 | 0.554**0.503-0.601 | 3.559±0.246 |
| 9. Physical/Weight | --- | --- | 3.516±1.230 |
| 10. Healthy Daily Living | 0.652 | 0.643**0.602-0.681 | 3.574±0.344 |
| 11.Life Satisfaction | --- | --- | 3.352±0.918 |
| **p < 0.001; *p < 0.05. C.I.: Interval confidence; ICC = intraclass correlation coefficient. | |||
| IHWA_V2_2022sub dimensions | Mean | s.d. | C.I. 95% | F | p-value | ||
|---|---|---|---|---|---|---|---|
| Min. | Max | ||||||
| 1. Mental Well-Being | Female | 27.7698 | 5.98234 | 27.3242 | 28.2153 | 0.131 | 0.718 |
| Male | 27.9245 | 5.78939 | 27.2243 | 28.6248 | |||
| 2. Healthy Eating Thought | Female | 13.6000 | 3.37237 | 13.3488 | 13.8512 | 0.782 | 0.377 |
| Male | 13.3849 | 3.35791 | 12.9788 | 13.7911 | |||
| 3. Health Responsibility | Female | 16.0863 | 2.55623 | 15.8960 | 16.2767 | 0.585 | 0.445 |
| Male | 16.2264 | 2.48817 | 15.9255 | 16.5274 | |||
| 4. Anti-stress activity | Female | 8.6302 | 3.87409 | 8.3417 | 8.9187 | 0.399 | 0.528 |
| Male | 8.8075 | 3.92022 | 8.3334 | 9.2817 | |||
| 5. Environmental | Female | 11.4446 | 2.07414 | 11.2901 | 11.5991 | 0.707 | 0.401 |
| Male | 11.3170 | 2.17368 | 11.0541 | 11.5799 | |||
| 6. Free to Addiction Behavior | Female | 10.7453 | 3.56858 | 10.4796 | 11.0111 | 0.166 | 0.684 |
| Male | 10.8491 | 3.41119 | 10.4365 | 11.2617 | |||
| 7. Spiritual | Female | 5.9108 | 2.33025 | 5.7372 | 6.0843 | 0.209 | 0.648 |
| Male | 5.8340 | 2.32794 | 5.5524 | 6.1155 | |||
| 8. Mental Nutrition | Female | 10.6374 | 2.49571 | 10.4515 | 10.8233 | 0.605 | 0.437 |
| Male | 10.7774 | 2.48317 | 10.4770 | 11.0777 | |||
| 9. Physical/Weight | Female | 3.5108 | 1.09338 | 3.4294 | 3.5922 | 0.048 | 0.827 |
| Male | 3.5283 | 1.15148 | 3.3890 | 3.6676 | |||
| 10. Healthy Daily Living | Female | 10.7295 | 2.37152 | 10.5529 | 10.9061 | 0.034 | 0.854 |
| Male | 10.6981 | 2.32073 | 10.4174 | 10.9788 | |||
| 11. Life Satisfaction | Female | 3.3698 | .91887 | 3.3014 | 3.4382 | 0.935 | 0.334 |
| Male | 3.3057 | .91751 | 3.1947 | 3.4166 | |||
| s.d.: standard deviation; C.I.: Interval Confidence; F: Anova test. *p < 0.05 is statistical significant. | |||||||
| IHWA_V2_2022sub dimensions | Mean | s.d. | C.I. 95% | F | p-value | ||
|---|---|---|---|---|---|---|---|
| Min. | Max | ||||||
| 1. Mental Well-Being | > 30y | 27.6626 | 6.00176 | 27.0086 | 28.3165 | 0.952 | 0.433 |
| 31-40y | 27.6731 | 6.03238 | 26.9979 | 28.3484 | |||
| 41-50y | 28.4660 | 5.85686 | 27.6300 | 29.3019 | |||
| 51-60y | 27.6960 | 5.62572 | 26.7001 | 28.6919 | |||
| < 61y | 25.7778 | 4.99444 | 21.9387 | 29.6168 | |||
| 2. Healthy Eating Thought | > 30y | 13.3436 | 3.36659 | 12.9767 | 13.7104 | 1.124 | 0.344 |
| 31-40y | 13.7896 | 3.33679 | 13.4161 | 14.1632 | |||
| 41-50y | 13.3037 | 3.47501 | 12.8077 | 13.7996 | |||
| 51-60y | 13.8000 | 3.30688 | 13.2146 | 14.3854 | |||
| < 61y | 13.5556 | 2.83333 | 11.3777 | 15.7334 | |||
| 3. Health Responsibility | > 30y | 16.0798 | 2.53342 | 15.8037 | 16.3558 | 0.673 | 0.611 |
| 31-40y | 16.3010 | 2.51425 | 16.0195 | 16.5824 | |||
| 41-50y | 16.0733 | 2.60260 | 15.7018 | 16.4448 | |||
| 51-60y | 15.9040 | 2.49006 | 15.4632 | 16.3448 | |||
| < 61y | 15.8889 | 2.89156 | 13.6662 | 18.1115 | |||
| 4. Anti-stress activity | > 30y | 8.9847 | 3.85304 | 8.5648 | 9.4045 | 1.457 | 0.213 |
| 31-40y | 8.6052 | 4.00399 | 8.1570 | 9.0534 | |||
| 41-50y | 8.5759 | 3.93409 | 8.0144 | 9.1374 | |||
| 51-60y | 8.1280 | 3.56048 | 7.4977 | 8.7583 | |||
| < 61y | 10.0000 | 3.80789 | 7.0730 | 12.9270 | |||
| 5. Environmental | > 30y | 11.2822 | 2.05317 | 11.0585 | 11.5059 | 1.077 | 0.367 |
| 31-40y | 11.4175 | 2.12525 | 11.1796 | 11.6554 | |||
| 41-50y | 11.5812 | 2.14291 | 11.2753 | 11.8870 | |||
| 51-60y | 11.5200 | 2.11218 | 11.1461 | 11.8939 | |||
| < 61y | 10.5556 | 1.94365 | 9.0615 | 12.0496 | |||
| 6. Free of Addiction Behavior | > 30y | 10.6258 | 3.62315 | 10.2310 | 11.0205 | 0.454 | 0.769 |
| 31-40y | 10.7314 | 3.45599 | 10.3445 | 11.1182 | |||
| 41-50y | 10.9529 | 3.44626 | 10.4610 | 11.4448 | |||
| 51-60y | 10.9360 | 3.60050 | 10.2986 | 11.5734 | |||
| < 61y | 11.5556 | 3.16667 | 9.1214 | 13.9897 | |||
| 7. Spiritual | > 30y | 5.9080 | 2.29999 | 5.6574 | 6.1586 | 0.506 | 0.731 |
| 31-40y | 5.8867 | 2.36522 | 5.6220 | 6.1515 | |||
| 41-50y | 5.9634 | 2.38277 | 5.6233 | 6.3034 | |||
| 51-60y | 5.8080 | 2.28846 | 5.4029 | 6.2131 | |||
| < 61y | 4.8889 | 1.53659 | 3.7078 | 6.0700 | |||
| 8. Mental Nutrition | > 30y | 10.5337 | 2.48635 | 10.2628 | 10.8047 | 1.090 | 0.360 |
| 31-40y | 10.7702 | 2.51146 | 10.4891 | 11.0514 | |||
| 41-50y | 10.6073 | 2.58085 | 10.2390 | 10.9757 | |||
| 51-60y | 10.9760 | 2.28058 | 10.5723 | 11.3797 | |||
| < 61y | 9.8889 | 2.84800 | 7.6997 | 12.0781 | |||
| 9. Physical/Weight | > 30y | 3.5644 | 1.11789 | 3.4426 | 3.6862 | 2.529 | 0.039* |
| 31-40y | 3.6084 | 1.10726 | 3.4845 | 3.7324 | |||
| 41-50y | 3.3351 | 1.04769 | 3.1855 | 3.4846 | |||
| 51-60y | 3.4080 | 1.15770 | 3.2031 | 3.6129 | |||
| < 61y | 3.8889 | 1.05409 | 3.0786 | 4.6991 | |||
| 10. Healthy Daily Living | > 30y | 10.7638 | 2.30238 | 10.5129 | 11.0147 | 0.438 | 0.781 |
| 31-40y | 10.6796 | 2.43572 | 10.4070 | 10.9523 | |||
| 41-50y | 10.5812 | 2.43925 | 10.2330 | 10.9293 | |||
| 51-60y | 10.9040 | 2.21587 | 10.5117 | 11.2963 | |||
| < 61y | 11.0000 | 1.80278 | 9.6143 | 12.3857 | |||
| 11. Life Satisfactionm | > 30y | 3.3497 | .93502 | 3.2478 | 3.4516 | 0.055 | 0.994 |
| 31-40y | 3.3625 | .91418 | 3.2601 | 3.4648 | |||
| 41-50y | 3.3508 | .95559 | 3.2144 | 3.4872 | |||
| 51-60y | 3.3280 | .85926 | 3.1759 | 3.4801 | |||
| < 61y | 3.4444 | .52705 | 3.0393 | 3.8496 | |||
| s.d.: standard deviation; C.I.: Interval Confidence; F: ANOVA test. *p < 0.05 is statistical significant. | |||||||
