Validity evidence for the Indonesian version of the Flourishing Index among individuals with chronic disease
DOI:
https://doi.org/10.21580/pjpp.v11i1.29089Keywords:
chronic disease, confirmatory factor analysis, flourishing, IndonesiaAbstract
Flourishing is a multidimensional indicator of positive functioning that may be particularly relevant for individuals living with chronic conditions, whose well-being is shaped by psychological, physical, social, and material demands. This study evaluates the validity evidence supporting the interpretation of scores from the Indonesian version of the Flourishing Index (FI) in this population. A total of 272 adults with chronic conditions participated in the field study. Following the Standards for Educational and Psychological Testing, evidence was gathered from three sources: test content, response processes and internal structure. Content evidence was examined based on the judgment of three experts, with all items obtaining an I-CVI of 1.00. Response-process evidence was examined through cognitive interviews (N = 5). The original 0-10 response format was modified to a 1-5 one to align the response options with the needs and context of our study, while retaining the original item content. Internal-structure evidence was examined using confirmatory factor analysis of the six-domain model in jamovi version 2.4 with maximum likelihood estimation. All 12 items showed standardized loadings above .50. Model fit was generally acceptable, at χ²(39) = 74.10, p < .001, RMSEA = .057, CFI = .977, TLI = .961, and SRMR = .034, while McDonald’s omega for the total scale was .866. Composite reliability was acceptable for five domains, but the character and virtue domain showed weaker reliability and convergent evidence. Taken together, the findings support interpretation of the Indonesian FI scores for research and supportive well-being assessment among adults with chronic conditions, with further replication warranted.
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References
AERA, APA, & NCME. (2014). Standards for educational and psychological testing. American Educational Research Association (AERA), American Psychological Association (APA), National Council on Measurement in Education (NCME).
Afiatin, T., Subandi, M. A., & Reginasari, A. (2023). The dynamics of flourishing Indonesian Muslim families: An interpretative phenomenological analysis. Psikohumaniora: Jurnal Penelitian Psikologi, 8(1), 1–18. https://doi.org/10.21580/pjpp.v8i1.14382
Bourdeau, C., Lippé, S., Robaey, P., Rondeau, É., Krajinovic, M., Sinnett, D., Laverdière, C., & Sultan, S. (2024). Contributing factors to well-being in a sample of long-term survivors of childhood acute lymphoblastic leukemia: The role of social support in emotional regulation. Health Psychology and Behavioral Medicine, 12(1). https://doi.org/10.1080/21642850.2023.2301550
Centers for Disease Control and Prevention. (2026, May 14). About Chronic Diseases. https://www.cdc.gov/chronic-disease/about/index.html
Chen, Y., Weziak-Bialowolska, D., Lee, M. T., Bialowolski, P., McNeely, E., & VanderWeele, T. J. (2022). Longitudinal associations between domains of flourishing. Scientific Reports, 12(1), 2740. https://doi.org/10.1038/s41598-022-06626-5
Cohen, S., Janicki-Deverts, D., Doyle, W. J., Miller, G. E., Frank, E., Rabin, B. S., & Turner, R. B. (2012). Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proceedings of the National Academy of Sciences, 109(16), 5995–5999. https://doi.org/10.1073/pnas.1118355109
Cyranowski, J. M., Zill, N., Bode, R., Butt, Z., Kelly, M. A. R., Pilkonis, P. A., Salsman, J. M., & Cella, D. (2013). Assessing social support, companionship, and distress: National Institute of Health (NIH) Toolbox Adult Social Relationship Scales. Health Psychology, 32(3), 293–301. https://doi.org/10.1037/a0028586
Diener, E., Biswas-Diener, R., Wirtz, D., Tov, W., Kim-Prieto, C., Oishi, S., & Choi, D. (2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2), 143–156. https://doi.org/10.1007/s11205-009-9493-y
Diržytė, A., & Perminas, A. (2021). Self-reported health-related experiences, psychological capital, and psychological wellbeing in Lithuanian adults sample. Health Psychology Open, 8(1). https://doi.org/10.1177/2055102921996164
Edgar, A., & Pattison, S. (2016). Flourishing in health care. Health Care Analysis, 24(2), 161–173. https://doi.org/10.1007/s10728-016-0315-5
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
Fathinah, A., Istiningtyas, L., & Situmorang, D. D. B. (2023). Languishing and flourishing experiences in schizophrenic patients during hospitalization. Psikohumaniora: Jurnal Penelitian Psikologi, 8(1), 103–118. https://doi.org/10.21580/pjpp.v8i1.15536
Faul, A. C., D’Ambrosio, J. G., Yankeelov, P. A., Cotton, S. G., Furman, C. D., Hall-Faul, M., Gordon, B., & Wright, R. B. (2019). Human flourishing and integrated care models: The development of the Flourish Index. The Gerontologist, 59(6), e653–e663. https://doi.org/10.1093/geront/gny114
Fuller-Thomson, E., Agbeyaka, S., LaFond, D. M., & Bern-Klug, M. (2016). Flourishing after depression: Factors associated with achieving complete mental health among those with a history of depression. Psychiatry Research, 242, 111–120. https://doi.org/10.1016/j.psychres.2016.04.041
Garrido, S., Méndez, I., & Abellán, J.-M. (2013). Analysing the simultaneous relationship between life satisfaction and health-related quality of life. Journal of Happiness Studies, 14(6), 1813–1838. https://doi.org/10.1007/s10902-012-9411-x
George, D., & Mallery, P. (2010). SPSS for Windows step by step: A simple guide and reference, 17.0 update. Allyn & Bacon.
Grenville-Cleave, B., Guðmundsdóttir, D., Huppert, F., King, V., Roffey, D., Roffey, S., & Vries, M. de. (2021). Creating the world we want to live in: How positive psychology can build a brighter future. Routledge.
Ha, J., Weziak-Bialowolska, D., Choi, Y. Y., Jang, S., Hwang, J., & Cho, S. (2026). Validating the Korean versions of the Flourish Index and the Secure Flourish Index: A comprehensive psychometric approach. Frontiers in Psychology, 17, 1694272. https://doi.org/10.3389/fpsyg.2026.1694272
Hair, Joe F., Howard, M. C., & Nitzl, C. (2020). Assessing measurement model quality in PLS-SEM using confirmatory composite analysis. Journal of Business Research, 109, 101–110. https://doi.org/10.1016/j.jbusres.2019.11.069
Hair, Joe F., Ringle, C. M., & Sarstedt, M. (2011). PLS-SEM: Indeed a silver bullet. Journal of Marketing Theory and Practice, 19(2), 139–152. https://doi.org/10.2753/MTP1069-6679190202
Hair, Joseph F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
Ho, S., Cook, K. V., Chen, Z. J., Kurniati, N. M. T., Suwartono, C., Widyarini, N., Wong, P. T. P., & Cowden, R. G. (2022). Suffering, psychological distress, and well‐being in Indonesia: A prospective cohort study. Stress and Health, 38(5), 879–890. https://doi.org/10.1002/smi.3139
Hone, L. C., Jarden, A., Schofield, G. M., & Duncan, S. (2014). Measuring flourishing: The impact of operational definitions on the prevalence of high levels of wellbeing. International Journal of Wellbeing, 4(1), 62–90. https://doi.org/10.5502/ijw.v4i1.4
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Huangfu, Z. (2020). Life course changes provoked by chronic disease: A study on everyday life for patients with systemic lupus erythematosus. International Journal of Nursing Sciences, 7, S31–S37. https://doi.org/10.1016/j.ijnss.2020.05.006
Huppert, F. A., & So, T. T. C. (2013). Flourishing across Europe: Application of a new conceptual framework for defining well-being. Social Indicators Research, 110(3), 837–861. https://doi.org/10.1007/s11205-011-9966-7
Kelly-Hedrick, M., Rodriguez, M. M., Ruble, A. E., Wright, S. M., & Chisolm, M. S. (2020). Measuring flourishing among internal medicine and psychiatry residents. Journal of Graduate Medical Education, 12(3), 312–319. https://doi.org/10.4300/JGME-D-19-00793.1
Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548. https://doi.org/10.1037/0022-006X.73.3.539
Kline, R. (2013). Exploratory and confirmatory factor analysis. In Applied quantitative analysis in education and the social sciences (pp. 171–207). Routledge.
Levin, J. (2020). Human flourishing and population health: Meaning, measurement, and implications. Perspectives in Biology and Medicine, 63(3), 401–419. https://doi.org/10.1353/pbm.2020.0029
Lomas, T., Koga, H., Padgett, R., Pawelski, J., Kim, E., Makridis, C., Gundersen, C., Bradshaw, M., Pertel, N. Le, Shiba, K., Johnson, B., & VanderWeele, T. (2024). Childhood and demographic predictors of life evaluation, life satisfaction, and happiness: A cross-national analysis of the Global Flourishing Study. https://doi.org/10.21203/rs.3.rs-4783710/v1
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382–386. https://doi.org/10.1097/00006199-198611000-00017
Lyubomirsky, S., & Lepper, H. S. (1999). A Social Indicators measure of subjective happiness: Preliminary reliability and construct validation. Social Indicators Research, 46(2), 137–155. https://doi.org/10.1023/A:1006824100041
MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149. https://doi.org/10.1037/1082-989X.1.2.130
Megawati, P., Lestari, S., & Lestari, R. (2019). Gratitude training to improve subjective well-being among adolescents living in orphanages. Humanitas: Indonesian Psychological Journal, 16(1), 13. https://doi.org/10.26555/humanitas.v16i1.9196
Nurcahyo, F. A., & Valentina, T. D. (2024). The Indonesian version of the flourishing scale: Is it reliable and valid for Indonesian people? Evaluation & the Health Professions, 47(1), 32–40. https://doi.org/10.1177/01632787231215316
Pieper, J. (1990). The four cardinal virtues: Human agency, intellectual traditions, and responsible knowledge. University of Notre Dame Press.
Piotrowski, N. A. (2010). Salem health: Psychology and mental health. Salem Press.
Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what’s being reported? critique and recommendations. Research in Nursing & Health, 29(5), 489–497. https://doi.org/10.1002/nur.20147
Ramírez-Maestre, C., Esteve, R., López-Martínez, A. E., Serrano-Ibáñez, E. R., Ruiz-Párraga, G. T., & Peters, M. (2019). Goal adjustment and well-being: The role of optimism in patients with chronic pain. Annals of Behavioral Medicine, 53(7), 597–607. https://doi.org/10.1093/abm/kay070
Rina, A. P., Surjaningrum, E. R., & Dewi, T. K. (2024). Biological, psychological, and social factors of flourishing in chronic diseases: A systematic review of research. Health Psychology Research, 12(1), 1. https://doi.org/10.52965/001c.126453
Rina, A. P., Surjaningrum, E. R., & Syaharani, S. R. K. (2024). Profil kesejahteraan autoimun: Studi deskriptif mengenai flourishing pasien autoimun di Komodai Tulus. Prosiding SEMNAPSI - Peran Psikologi Dalam Pemberdayaan Masyarakat Untuk Meningkatkan Kesejahteraan Masyarakat Indonesia - Fakultas Psikologi Universitas Mercu Buana Yogyakarta, 513–518. https://ejurnal.mercubuana-yogya.ac.id/index.php/SEMNAPSI/article/view/4171
Rossi, M., & Tappolet, C. (2016). Virtue, happiness, and well-being. The Monist, 99(2), 112–127. https://doi.org/10.1093/monist/onv038
Rule, A., Abbey, C., Wang, H., Rozelle, S., & Singh, M. K. (2024). Measurement of flourishing: A scoping review. Frontiers in Psychology, 15, 1293943. https://doi.org/10.3389/fpsyg.2024.1293943
Rusyda, A. L. (2025). Exploring the non-communicable disease burden in Indonesia – Findings from the 2023 Health Survey. Indonesia Journal of Public Health Nutrition, 5(2). https://doi.org/10.7454/ijphn.v5i2.1064
Sattler, S., Wilkinson, R., & Lee, M. T. (2023). A brief measure of complete subjective well-being in Germany: A population-based validation of a German version of the Flourish Index (FI) and the Secure Flourish Index (SFI). PLoS ONE, 18(11), e0284892. https://doi.org/10.1371/journal.pone.0284892
Schmidt-Sane, M., Cele, L., Bosire, E. N., Tsai, A. C., & Mendenhall, E. (2023). Flourishing with chronic illness(es) and everyday stress: Experiences from Soweto, South Africa. Wellbeing, Space and Society, 4, 100144. https://doi.org/10.1016/j.wss.2023.100144
Schotanus-Dijkstra, M., Pieterse, M. E., Drossaert, C. H. C., Westerhof, G. J., de Graaf, R., ten Have, M., Walburg, J. A., & Bohlmeijer, E. T. (2016). What factors are associated with flourishing? Results from a large representative national sample. Journal of Happiness Studies, 17(4), 1351–1370. https://doi.org/10.1007/s10902-015-9647-3
Seligman, M. (2011). Flourish. Penguin Random House.
Strine, T. W., Chapman, D. P., Balluz, L. S., Moriarty, D. G., & Mokdad, A. H. (2008). The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U.S. community-dwelling adults. Journal of Community Health, 33(1), 40–50. https://doi.org/10.1007/s10900-007-9066-4
Stripp, T. A., Cowden, R. G., Wehberg, S., Ahrenfeldt, L. J., Hvidt, N. C., & Lee, M. T. (2024). Salutogenic health measures: Psychometric properties of the Danish versions of the Flourish Index and the Secure Flourish Index. Scandinavian Journal of Psychology, 65(4), 645–655. https://doi.org/10.1111/sjop.13011
Sulaiman, W. S. W., Shariff, M. I. A. Bin, & Khairudin, R. (2023). The role of psychological capital in flourishing among job seekers: Grit as a mediator. Psikohumaniora: Jurnal Penelitian Psikologi, 8(1), 119–136. https://doi.org/10.21580/pjpp.v8i1.14939
Tani, Y., Matsuyama, Y., Yamaoka, Y., Matsukura, H., Kawahara, T., & Fujiwara, T. (2023). Change of human flourishing during the COVID-19 pandemic in Japan: Results from population-based U-CORONA study. SSM - Population Health, 23, 101430. https://doi.org/10.1016/j.ssmph.2023.101430
Taylor, E. S. (2006). Health psychology (6th ed.). McGraw-Hill.
Torres, Z., Oliver, A., Tomás, J. M., & Kondo, N. (2024). Exploring social network typologies and their impact on health and mental well-being in older adults: Evidence from JAGES. Social Science & Medicine, 348, 116792. https://doi.org/10.1016/j.socscimed.2024.116792
VanderWeele, T. J. (2017). On the promotion of human flourishing. Proceedings of the National Academy of Sciences, 114(31), 8148–8156. https://doi.org/10.1073/pnas.1702996114
VanderWeele, T. J., & Lomas, T. (2023). Terminology and the well-being literature. Affective Science, 4(1), 36–40. https://doi.org/10.1007/s42761-022-00153-2
Wȩziak-Bialowolska, D., McNeely, E., & VanderWeele, T. J. (2019a). Flourish Index and Secure Flourish Index – Validation in workplace settings. Cogent Psychology, 6(1), 1598926. https://doi.org/10.1080/23311908.2019.1598926
Wȩziak-Bialowolska, D., McNeely, E., & VanderWeele, T. J. (2019b). Human flourishing in cross cultural settings. Evidence from the United States, China, Sri Lanka, Cambodia, and Mexico. Frontiers in Psychology, 10, 1269. https://doi.org/10.3389/fpsyg.2019.01269
WHO. (2018, August 31). Noncommunicable diseases Indonesia 2018 country profile. World Health Organization. https://www.who.int/publications/m/item/noncommunicable-diseases-idn-country-profile-2018
Yaghmaei, F. (2003). Content validity and its estimation. Journal of Medical Education for Future Demands, 3(1), e105015. https://brieflands.com/journals/jme/articles/105015
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