Translation, cultural adaptation, and psychometric validation of the WHO-5 well-being index for Arabic-speaking university students

Abstract

University life is a formative period characterized by increased autonomy, evolving social roles, and sustained academic demands, placing students at heightened risk of psychological distress. Reliable assessment of subjective well-being is essential for early identification, prevention, and the promotion of adaptive functioning. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Arabic version of the World Health Organization-Five Well-Being Index (WHO-5) among university students in the United Arab Emirates (UAE). A cross-sectional psychometric validation study was conducted between February 2024 and March 2025 using an online survey of 568 university students in the UAE. The translation and cultural adaptation followed a standardized seven-step process, including forward translation, reconciliation, backward translation, comparison with the original instrument, pilot testing, and psychometric evaluation. Construct validity was assessed using confirmatory factor analysis with robust maximum likelihood estimation. Model fit was evaluated using McDonald's fit index (MFI), comparative fit index (CFI), incremental fit index (IFI), normed fit index (NFI), non-normed fit index (NNFI), and root mean square error of approximation (RMSEA). Convergent validity, internal consistency reliability, and measurement invariance across gender were also examined. The original one-factor model demonstrated suboptimal fit. After specifying two theoretically justifiable residual correlations between WHO_1 and WHO_4 and between WHO_2 and WHO_5, the modified one-factor model showed good fit under the robust solution (CFI = 0.993, NFI = 0.990, NNFI = 0.976, RMSEA = 0.068; 90% CI: 0.027 -0.113). Standardized factor loadings ranged from 0.508 to 0.805. Convergent validity was supported by an average variance extracted of 0.533, while internal consistency was demonstrated by a Cronbach's α of 0.833 and composite reliability of 0.848. Multi-group confirmatory factor analysis provided preliminary evidence of configural, metric, and scalar invariance across gender. However, the elevated absolute RMSEA values observed in the gender-specific and multi-group models indicate that these invariance findings should be interpreted with caution. The Arabic WHO-5 demonstrated satisfactory preliminary evidence of construct validity, convergent validity, internal consistency, and measurement invariance among university students in the UAE. These findings support its use as a brief measure of subjective well-being in this population. Nevertheless, the results represent an initial validation rather than definitive evidence for widespread research or clinical application. Future multicenter and longitudinal studies should evaluate test -retest reliability, relationships with established mental health measures, diagnostic performance, clinical utility, and measurement invariance across broader Arabic-speaking populations.