. 2018 Sep-Oct;15(09-10):14–23.

TABLE 1.

Characteristics of the reviewed wellness studies

STUDY (YEAR)	STUDY DESIGN	MEASURES	POPULATION	MAIN FINDINGS
T. Adams et al (1997)²⁹	Cross-sectional	LAP, LOT, SC scale, PWS	N=112, undergraduate students (107 completed the study)	LAP measures spiritual wellness, LOT and SC scale measure psychological wellness, and PWS measures overall wellness. Optimistic outlook (r=0.55, p<0.05) and sense of coherence (r=0.60, p<0.05) was demonstrated to directly impact overall wellness.
Degges-White (2006)²⁵	Cross-sectional	WMTS, 5F-Wel, SWLS	N=224, midlife women	There is lack of a significant relationship between timeliness and expectedness of transitions and life satisfaction and wellness (p=0.051) with this scale. This suggests that life satisfaction and wellness might not be negatively affected by midlife transitions. Mitigating factors, such as financial, support network, and life experience, could contribute to these findings. Household income did significantly contribute to differences in wellness and life satisfaction (p=0.001).
Schafer (2012)²⁸	Cross-sectional	OLP, PWS, WEL	N=768, military cadets	OLP and PWS were evaluated for internal validity, both of which were consistent with previous wellness studies in an outpatient setting. Both provided reliable and valid measurement with stringent criteria (PWS Internal Consistency for Emotional Reliability: α=0.78; Intellectual Reliability: α=0.66; Physical Reliability: α=0.69; Social Reliability: α=0.87; Spiritual Reliability: α=0.73); (OLP Internal Consistency for Emotional Reliability: α=0.81; Intellectual Reliability: α=0.72; Physical Reliability: α=0.70; Social Reliability: α=0.92; Spiritual Reliability: α=0.75). OLP and PWS were differentiated by theoretical basis, naming of wellness variables, number of questions, and scoring. Both the OLP and PWS appear suitable for measuring wellness in cadet soldiers.
Brissette et al (2013)⁴⁰	Cross-sectional	WellSAT	N=23, public health practitioners	Study results support that WellSAT is a practical and valid tool for health and school agencies to collect wellness program information in a standard format. Correlation between independent rater assessment of strength (r=0.88) and comprehensiveness (r=0.77) of programs was strong.
Hattie et al (2004)²⁶	Cross-sectional	103-item WEL	N=3,043	The reliability estimates of this WEL version, when correlated with related instruments, were high enough to meaningfully interpret their scores (p<0.01). This suggests usefulness of WEL score assessment. Factor analysis of WEL confirmed original 17 dimensions (third order) and 5 high-order dimension (second order: creative self, coping self, social self, essential self, and physical self). It defined wellness (first order) as “way of life oriented towards optimal health and well-being in which mind, body, and spirit are integrated by the individual to live life more fully within the human and natural community.” Clinically, the WEL is practical and comprehensive. It has reported internal consistency reliability scores (α=0.61–0.89).
Nagykaldi et al (2013)⁹	Longitudinal	HRA tool (web-based)	N=200	This comprehensive web-based health risk appraisal tool can improve preventive services, patient care, behavioral health outcomes, and wellness indicators in primary care settings. Wellness score improved from 67.6 to 69.9 in an intervention group (p=0.03) compared with no change in the control group.
Hermon and Hazler (1999)²³	Cross-sectional	WEL, MUNSH	N=155, undergraduate students	WEL gave more equal assessment recognition to each dimension of the wellness model. Findings show adherence to holistic wellness model. Wellness goes beyond physiology. Psychological constructs might hold equal or greater significance to our understanding of the wellness of the whole person. Predictor variables on quality of life and component of psychological well-being demonstrated a significant relationship (p<0.001).
Thompson et al (2011)³⁴	Longitudinal	Katz instrument of ADLs, Lawton IADLs, CDC QOL self-report, vital signs, N-CPC, MSPSS, SPS	N=27, aged 78–94 years	This scale measured wellness in older adults residing in community-dwelling, and examined functional/ physiological, cognitive/mental, social and spiritual domains. Parameters were highly correlated across multiple domains of wellness. Clusters were noted, especially across cognitive and physiological domains. Increased number of chronic diseases were negatively correlated with planning (p=0.016). Evidences need for integrated approach to assessment of wellness.
(Renger, 2000)¹³	Cross-sectional	OLP	N=102	The theoretical framework and validity of OLP were examined. OLP was administered before (test) and after (retest) LEP. Four of 6 scales had test-retest stability above r=0.8.
(Chang, 2003)⁴⁵	Cross-sectional	WEL	N=6, Korean American adolescents	Only 4 of 19 subscales of WEL had large effect size (d value>0.8) between the English and Korean version. There is a need for adaptation of personality measures across cultures. Adaptations could uncover important differences in underlying factors that contribute to wellness between different cultures.
(Rachele et al, 2014)²⁷	Cross-sectional	5F-Wel, IPAQ-A	N=493, 12–15 years old	Demonstrated a significant relationship between self-reported physical activity and various elements of wellness. Friendship (p=.001), self-worth (p=.002), gender identity (p=.026), love (p=.022), self-care (p=.001), spirituality (p=.014), cultural identity (p=.0333), and exercise (p=.001) were all associated with meeting the physical activity guidelines. If causal links of these relationships are determined, this will establish implications for physical activity promotion interventions.
Duncan et al (2011)³⁷	Cross-sectional	Survey evaluating overall experience and impact	2,756 surveys; 1 survey per wellness clinic visit	Evidence suggests a hospital-based wellness clinic based on complementary and alternative medicine (CAM) is feasible, well-used, and perceived by most to have positive health benefits related to decreased work stress, improved mood/sleep, and improved lifestyle. Overall, 97% of participants reported they would recommend the wellness clinic to a friend or co-worker.
Parks & Steelman (2008)³⁸	Meta-analysis	4 databases: Info Trac, ProQuest, PsycINFO, and Dissertation Abstracts International; reference sections of retrieved studies; organizational publications and websites	17 of 200 studies that met inclusion criteria and were analyzed	Participation in organizational wellness program was associated with lower absenteeism (Q=16.94, p<0.05) and higher job satisfaction (Q=16.52, p<0.01). There is evidence to support continued use of wellness programs in organizations.
Adams et al (1998)³⁰	Cross-sectional	PWS	N=1,077	In all but 3 of the analyses, the highest and lowest perceived wellness groups were significantly different (p<.05); therefore, construct validity of PWS was strongly supported. PWS fills a void in perceived health research and demonstrates utility as research tool.
Myers et al (2004)⁴¹	Longitudinal	5F-Wel, WEL	N=3,993	5F-Wel was revised to provide useful and reliable (RMSEA=0.10 and NNFI=0.89) measure of wellness with only 56 items. This new measure, called 4F-Wel, can provide reliable scores for 4 distinct aspects of wellness: cognitive-emotional, relational, physical, and spiritual. This scale still needs more comparison to 5F-Wel.
Lebensohn et al (2013)³³	Cross-sectional	PSS, CES-D, MBI, SWLS, Wellness behavior survey	N=168, first-year family medicine residents	This scale evaluated the well-being of FM residents, looking at measures of various dimensions of wellness. Restful sleep was significant predictor in all 5 models for well-being measures (p<.001). Physical activity was associated with more positive well-being in 4 of the 5 well-being measures (p<.05).
Naydeck et al (2008)³¹	Longitudinal	HRA administered by Highmark Wellness Program, Highmark Wellness Program intervention	N=9,666	A study suggests a comprehensive health promotion program (Highmark Wellness Program) can lower healthcare costs and produce a positive ROI ($1.65 for every dollar spent on the program). The most significant difference was between participants and nonparticipants for inpatient expenditures, which averaged $181.78 savings per person per year (p<0.0001).
Mareno, 2010)³²	Cross-sectional	BMS-WBCI	N=106, undergraduate students	The BMS-WBCI has 44 items and 3 subscales that measure physical, emotional, intellectual, occupational, social, and spiritual wellness dimensions. The data provided normal distribution (normal curve within 3 SD and p<0.05) and strong internal consistency (α=0.91). Researchers support the use of this instrument among the college population.
DeStefano and Richardson (1992)¹⁸	Cross-sectional	LAQ	N=214, incoming college freshman	This scale has little support for external validity of specific LAQ scales as specific indicators of current health. LAQ scales are related more highly to individuals’ perceptions of their general physical and mental health than with the objective indicators (p<0.01). Most LAQ scales are correlated more highly with perceptions of one’s own mental health than with perceptions of one’s own physical health (p<0.01). Objective/perception differences are mainly among high/higher levels of health vs. healthy/unhealthy responses.
Hey et al (2006)¹⁹	Cross-sectional	BMS-WBCI, TestWell, Wellness Inventory, NIH EATS, Self-report physical activity question	N=141, college undergraduates	The BMS-WBCI was developed in Study 1 to measure wellness in a college population. This population had distinct risk factors. In Study 2, the reliability and validity of BMS-WBCI was further evaluated. The split-half reliability and alpha coefficients were fair to excellent for each dimension (α=0.75 (Mind), 0.87 (Body), 0.92 (Spirit)). It has high internal consistencies (range, α=0.81–0.91). Additionally, the between-scale correlations ranged from r=0.277–0.526. These results demonstrate that the BMS-WBCI is a valid and reliable assessment of wellness for college students.
Jones & Frazier (1994)²⁰	Cross-sectional	TestWell, Wellness Inventory	N=90, wellness professionals	The TestWell Wellness Inventory has 100 questions and is scored on a 5-point Lickert scale. It has 10 subscales: physical fitness, nutrition, self-care and safety, emotional wellness, social awareness, emotional awareness and sexuality, emotional management, intellectual wellness, occupational wellness, and spirituality and values. A study demonstrated reliability coefficients Cronbach’s α of 0.84 among wellness professionals assessed with TestWell.
Palombi (1992)²¹	Cross-sectional	WI, LAQ, LCI	N=114, full-time undergraduate students aged 18–50 years old	This scale has strong internal consistency (Cronbach’s coefficient α=0.93). Coefficient α>0.74 was obtained on 8 of 12 subscale scores (eating, moving, feeling, thinking, playing and working, communicating, finding meaning, and transcending). It has strong internal consistency of LAQ (α=0.93). Cronbach’s coefficient was α>0.74 on 8 of 10 subscale scores (nutrition, drugs and driving, emotional awareness, emotional control, intellectual, occupational, social, and spiritual). It has strong internal consistency of LCI (Cronbach’s coefficient α=0.93). Cronbach’s coefficient was α>0.74 on most of the 7 subscale scores (nutrition, physical care, cognitive and emotional actions, environmental actions, coping style, and social support).
Ryff and Keyes (1995)³⁵	Cross-sectional	Ryff’s psychological well-being scales	N=1,108, non-institutionalized, English-speaking adults, aged 25 years or older	The scale measures 6 dimensions of wellness: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Each dimension was operationalized to be 20 items, which is 120 items in total. The response scale was a 6-point continuum, ranging from completely disagree to completely agree. Concerning the 120-item scale, it shows convergent and discriminant validity with other measures. In the 18-item scale, the 18 items continue to meet psychometric criteria, with each item correlating strongly and positively with only its own scale. Comparison of the theory-based indicators of well-being with other frequently used measures indicated moderate-to-strong associations between 2 scales (Self-Acceptance and Environmental Mastery) and single- and multi-item scales of happiness, life satisfaction, and depression. However, the remaining 4 dimensions of well-being (Positive Relations With Others, Purpose in Life, Personal Growth, Autonomy) showed mixed or weak relationships with these prior indicators.

5F-Wel: Five Factor Wellness Inventory; ADLs: activities of daily living; BMS-WBCI: Body-Mind-Spirit Wellness Behavior and Characteristic Inventory; CDC: Center for Disease Control; CES-D: Center for Epidemiologic Studies—Depression Scale; HRA: Health Risk Assessment; IADLs: instrumental activities of daily living; IAPQ-A: International Physical Activity Questionnaire for Adolescents; LAP: Life Attitude Profile; LAQ: Lifestyle Assessment Questionnaire; LCI: Lifestyle Coping Inventory; LEP: Life Enhancement Program; LOT: Life Orientation Test; MBI: Maslach Burnout Inventory; MUNSH: Memorial University of Newfoundland Scale of Happiness; MSPSS: Multidimensional Scale of Perceived Social Support; N-CPC: Neuropsychological—CogniFit Personal Coach; NIH EATS: National Institute of Eating at America’s Table Study; NNFI: non-normed fit index; OLP: Optimal Living Profile; PSS: Perceived Stress Scale; PWS: Perceived Wellness Survey; QOL: Quality of Life; RMSEA: root-mean-square error; SC: Sense of Coherence; SPS: Spiritual Perspective Scale; SWLS: Satisfaction With Life Survey; WEL: Wellness Evaluation of Lifestyle; WellSAT: Wellness School Assessment Tool; WI: Wellnes Inventory; WMTS: Women’s Midlife Transition Survey