Introduction
Akey challenge in health research is the conceptualization and measurement of abstract constructs, like social health. Because these constructs are difficult to measure directly, researchers must rely on indirect assessment methods. Effective measurement requires answering fundamental questions: (i) What is the conceptual definition being measured? (ii) What dimensions or components are included in this concept? (iii) Is the scope of the definition broad or narrow? These challenges have led to varied interpretations of social health in the literature [1, 2].
The concept of social health has historically shared a common origin with the broader notion of health. Like health itself, social health is a dynamic and evolving concept [2]. The changing definitions of health—from the early views, such as the Humoral theory, to the biomedical model’s focus on health as the absence of disease, and finally to the World Health Organization’s (WHO) 1948 definition—highlight this ongoing evolution.
The WHO defined health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity» [3]. This broad definition presents both challenges and opportunities for researchers and policymakers. This definition promotes a holistic view, critiques and rejects a one-dimensional approach, emphasizing the importance of physical, mental, and social aspects, and highlights the positive dimension of complete well-being and the negative dimension of the absence of disease or infirmity. Despite this comprehensive definition, the concept of social well-being remains conceptually and measurably ambiguous [2]. Despite its increasing recognition in social sciences, social health remains underexplored in health research [4].
Social health is increasingly recognized as a crucial dimension of overall health. However, despite its recognized importance, there is no consensus on a clear and universally accepted definition or measurement framework for social health, which hinders both research and policy development [2, 4]. A clear conceptualization of social health can help policymakers and researchers develop targeted interventions to improve well-being at both individual and societal levels. Given the growing recognition of the social aspects of health, defining and measuring social health is necessary for developing comprehensive health policies [5].
Existing literature conceptualizes social health in three primary ways. Firstly, it is viewed as a social aspect of an individual’s overall health, complementing physical and mental well-being, and involves interacting with society. Secondly, it refers to a healthy society characterized by pro-health social conditions. Lastly, social health is understood as achieving a better social status, which varies in meaning and manifestation depending on the specific societal context [6]. Cho et al. further categorize social health into micro- and macro-level components, identifying physical and mental health as individual determinants, while social structures, norms, institutions, and culture function as broader determinants [7]. Despite these conceptualizations, research has increasingly focused on individual-level social health, highlighting the need for further empirical validation research [2].
To address these gaps, this scoping review aimed to consolidate existing definitions and measurement tools for individual social health, identify research gaps, and propose a refined, evidence-based definition. By mapping key conceptualizations and measurement tools, this study provides a foundation for developing standardized assessment tools for individual-level social health.

Methods
Due to the broad nature of the research question, a scoping review was selected as the study type to identify and map relevant literature. The goal was to summarize and disseminate the findings, specifically addressing the research question: What are the definitions and measurement tools related to the concept of individual social health? A comprehensive approach was adopted.
The search was conducted on April 13, 2023, in three databases—ISI Web of Science, Scopus, and PubMed—following the PRISMA-ScR guidelines for scoping reviews [8]. The search method included a structured combination of keywords related to social health and its measurement. The databases were searched using the following strategy and without any time constraints:
“Social health OR community health OR healthy society OR health social dimension OR social wellbeing AND questionnaire OR measure OR scale OR indicator”
The inclusion and exclusion criteria for study selection were as follows: 

Inclusion criteria
Studies focusing on the conceptualization and measurement of social health, all study types related to defining or measuring social health, peer-reviewed journal articles, no geographical restrictions, no time limitation, publications in English.

Exclusion criteria
Opinion pieces, discussions, and letters, Studies that mention social health without providing a clear conceptualization or measurement approach, Non-peer-reviewed articles.
Before the selection process, the research team developed a list of key topics by consensus, based on the scope of the review and the research question. The list included: i) The concept of social health (explaining a concept or definition related to social health, or what such a concept or definition should include), ii) Dimensions and indicators of social health, iii) Measurement tools for social health (tools designed to measure the concept of social health). 
To ensure a systematic selection process, the screening and article selection method was as follows:
After removing duplicate and irrelevant articles, two authors independently screened the titles and abstracts of all retrieved articles. Articles that appeared potentially eligible were obtained for full-text review (Table 1). Any discrepancies in article selection were resolved through discussion and consensus.
To extract and synthesize the data, we conducted a thematic analysis to identify patterns within the literature. A standardized data extraction form was developed to capture key details, including title, author names, year, country, study design, definitions and indicators of social health, measurement approaches, findings, discussion points, and conclusions. Given the diversity of study designs and conceptualizations, a narrative synthesis was employed to systematically summarize and integrate the main findings.

Results
In the initial search, 1,892 articles were retrieved, and 1,236 were retained after removing duplicates and irrelevant papers. After screening the titles and abstracts, 68 articles were assessed for eligibility. Of the studies selected for full-text review, 43 were excluded for various reasons (Figure 1): 
17 articles did not focus on the concept of individual social health; 15 articles that connected social health with another topic; 11 articles used terms related to social health as outcome measures rather than as a primary concept. Ultimately, data from 25 articles that met the inclusion criteria were included in the review (Table 1).

Concept of social health
The results of this review indicate that the existing literature on individual social health can be categorized into two main areas:
Conceptual definitions that describe social health at the individual level. Measurement tools that assess individual social health, often including implicit conceptualizations based on the indicators used. The review highlights that no universally accepted definition of individual social health exists, as definitions vary depending on the research context, geographic region, and target population. However, key components consistently associated with individual social health include social support (SS), social relationships, social functioning, and social activities, with SS being the most frequently cited factor (Figure 2).

Social health from an individual perspective
A significant number of studies conceptualize social health as an aspect of individual well-being, alongside physical and mental health. For example, Keyes defines social health as an individual’s perception of how well they function within society and the quality of their relationships with others [9]. The predominant themes extracted from these studies include social relationships [10, 11], SS [5, 12-18], social cohesion and trust [9, 16, 19, 20], participation and membership in voluntary organizations [14, 21-23], social functioning [5, 10, 11, 23-26], altruistic social activities [10, 27], feelings of happiness and life satisfaction [18, 19, 26, 28, 29], social responsibility [22], the need for meaning in social life [5, 20], social belonging [12], independence, a sense of control over one’s environment [30, 31], self-acceptance [31], social progress [12, 19], and altruism [12]. This review confirms that individual social health is not merely the absence of social problems but rather an active state of social well-being, where individuals engage in meaningful interactions, receive and provide support, and experience a sense of belonging in their social environments.

Measuring social health
Various measurement tools have been developed to assess individual social health, each capturing different aspects of the concept. Below are the key tools identified in the reviewed studies:

Social health scale for individuals (2014)
This scale measures social health in the Iranian population using three dimensions: family, community, and friends and relatives. It categorizes the indicators into two main groups: 1) Social functioning, which includes financial assistance to others, emotional support, participation in social groups, involvement in community activities, social decision-making, spending time with family and friends, caregiving, participation in household chores, environmental protection, adherence to social norms, community involvement, and trust in others, and 2) SS, which includes expressions of love, legal security, moral and spiritual enhancement, appreciation, sense of community, quality of marriage, resolution of emotional issues, problem-solving in daily life, earning money, education, protection against violence, finding suitable employment, coping with the death of a family member or friend, support during illness, support during disability, being valued, and access to recreational facilities [5].
The social health scale for the elderly-short version (SHSE-S) is a reliable psychometric tool that was developed in 2020. It consists of three dimensions and 14 items: SS, social Adjustment, and perceived environmental resources (PER). Items 1-4 of the scale 1) Support in major decision-making; 2) Emotional care; 3) Providing comfort; 4) Assistance with daily tasks during illness) pertain to the SS dimension. Items 5-8. 5) Participation in group recreational activities; 6) Interaction with children; 7) Interaction with friends; 8) Interests and hobbies) are associated with the social adaptation (SA) dimension. Items 9-14 9) Built environment; 10) Public transportation facilities; 11) Fitness/recreational facilities; 12) Medical institutions; 13) Activity organization; 14) Free public services) fall under the PER dimension [14].
The life screen pictorial (TLS-P) is a standardized and innovative assessment tool administered electronically. It includes 11 items designed to assess both general social health needs and specific social needs of university students, utilizing the Life Screen Social Health Screening Tool developed by Johnson (2020). For university student populations, it is recommended to use all 11 items. For non-student populations, it is advised to use only the first seven items, which address general social health questions. The 11 items evaluating general social health needs are food insecurity, unstable housing/homelessness, hazardous living conditions, intimate partner violence (IPV) from family or parents, violence from significant others, financial concerns, stress, difficulties with socialization at university, feelings of safety on campus, engagement in risky sexual behaviors, and concerns about student loans [32].
The social health reflective behaviors questionnaire, developed in 2018, evaluates how individual and social assets contribute to life satisfaction as an indicator of social health. Individual assets include educational attainment, social skills, self-control, and the achievement of life goals. Social assets encompass family support, peer support, parental supervision, and school connections [29].

Iranian social health questionnaire (IrSHQ) (2017)
This scale measures individual social health with 29 items across 7 dimensions, which include the following subscales: Social interaction, social responsibility, conscientiousness, attitude to society, empathy, family relationship, and social participation [22]. 

Iranian social health scale (ISHS) (2018)
This tool assesses social health based on four indicators: life satisfaction, happiness, quality of life, and self-perceived health [33].

Patient-reported outcomes measurement information system (PROMIS) (2010)
This scale was developed to measure social health. This tool evaluates two main subdomains: social functioning (which generally addresses the difference between ability and satisfaction) and social relationships (which encompasses the concept of SS). These subdomains were explored within four contexts: family, friends, work, and leisure [10].

Social health assessment for chronic illness patients (2014)
This scale is a psychometrically validated tool developed to measure social health, considering cultural and linguistic factors through a comprehensive conceptual model. This tool is designed for assessing social health in individuals with chronic illnesses. It evaluates two main concepts: Social functioning and social relationships. Social functioning includes indicators of the ability to engage in social roles and activities and satisfaction with these roles and activities. Social relationships encompass indicators of social companionship, emotional, informational, and instrumental support, as well as social isolation [11].

LIfescreen-c (TLS-C) (2020)
This is a screening tool designed to enhance colleges’ ability to identify students at risk of prevalent social health issues. This concise dual-purpose tool evaluates both general social health needs, as identified by the WHO (e.g. food insecurity), and specific social health needs of college students, identified through literature review and existing practices (e.g. campus dating). Additionally, it identifies social health-promoting factors, such as spirituality, based on the same sources. The tool encompasses three domains: i) General social health needs, including indicators, such as housing and food insecurity; ii) Social health-promoting factors, which cover indicators, like spirituality, SS, and social engagement; iii) Specific student social health needs, addressing issues, such as dating, campus safety, internet use, alcohol and drug use, sexual behavior, suicidal thoughts, financial concerns, loans, and stress [32].

Social health scale validation study (2011)
This scale evaluates how social health scales align with mental health assessment tools, demonstrating that validated measures of social functioning and relationships correlate strongly with broader health indicators [24].

Discussion
This scoping review explored the definitions and measurement approaches of individual-level social health. The findings indicate that the literature on social health can be categorized into two broad domains: conceptual definitions and measurement tools. Despite the extensive body of research, many studies lack a clear or explicit conceptualization of social health to justify their selection of measures. Furthermore, there is no consensus on a standardized definition, highlighting the variability in how social health is conceptualized and measured across studies [2].
Most studies adopt an individualistic perspective, commonly defining social health through key concepts, such as ‘social relationships’ and ‘social activities. The literature reveals a set of widely recognized components including: social relationships [10, 11], SS [5, 12-18], social cohesion and trust [9, 16, 19, 20], participation and membership in voluntary organizations [14, 21-23], social functioning [5, 10, 11, 23-26], altruistic social activities [10, 27], feelings of happiness and life satisfaction [18, 19, 26, 28, 29], social responsibility [22], the need for meaning in social life [5, 20], social belonging [12], independence, a sense of control over one’s environment [30], self-acceptance [31], social progress [12, 19], and altruism [12]. These elements provide a comprehensive understanding of social health and serve as important building blocks for further research and applications. 
The review also highlights the existence of multiple measurement tools, each designed to reflect a unique definition and approach. The increasing development and publication of social health measurement instruments suggest a growing interest in assessing social health at the individual level [2]. This trend may be attributed to the relative simplicity of measuring individual social health compared to the complexity of macro-level social health indicators.

Variability in definitions and measurement approaches
An important finding of this review is that different measurement tools employ unique items based on their underlying definition of social health. For instance, the social health measurement tool designed in Iran in 2014 assesses social health at the family, community, and friends/relatives levels [6], whereas the social health status exam for the elderly (SHSE-S) emphasizes SS, social adjustment, and environmental resources, underscoring the importance of age-specific factors [30]. Such diversity in measurement tools presents a significant challenge in comparing and synthesizing findings across studies. This finding aligns with the results of other studies that have examined the measurement of social indicators, such as social isolation. For example, a study in Canada examining diverse definitions of social isolation found substantial inconsistencies due to varying definitions and indicators. Similar to the present review, that study highlighted the need for standardized measures to ensure comparability across studies and contexts [34].

Evolution of social health measurement tools
This review underscores the dynamic nature of social health measurement tools, which continue to evolve in response to changing societal needs. The development of tools, such as TLS-P and TLS-C, tailored for specific populations, like students, reflects a broader trend of adapting measurement instruments to different demographic groups [11]. This aligns with prior research advocating for the continuous refinement of health assessment tools to accommodate lifestyle changes, technological advancements, and cultural shifts [27]. 

Cultural sensitivity in social health measurement
The findings further underscore the significance of cultural considerations in the development of social health measurement tools. For instance, the 2018 tool, specifically designed for the Iranian population, highlights the necessity of integrating cultural awareness into social health assessments to improve the validity and reliability of measurements [28]. Cross-cultural variations in social norms, behaviors, and values can substantially impact how social health is perceived and measured. Previous studies have warned that neglecting cultural nuances may result in measurement bias and misinterpretation of findings [22]. Thus, the development of culturally sensitive instruments is essential for ensuring more accurate and meaningful assessments across diverse populations.
Conceptual ambiguity and the need for standardization: The findings of this review reinforce that social health remains an under-specified and contested concept, with no universally accepted definition or standardized measurement tools. While there is broad consensus on the importance of social health as a key component of overall well-being, variations in definitions and measurement approaches persist. Most studies emphasize the individual dimension of social health [20], often treating it as an independent aspect alongside mental and physical health, with a strong focus on individual status and behaviors. This aligns with the increasing recognition of social determinants in shaping health outcomes, but also highlights a gap in integrating societal-level indicators into measurement frameworks.

Implications for research, policy, and practice
There is an urgent need for a clearer conceptual framework to enhance the application of social health in research, interventions, and policymaking. Given its critical role in shaping individual and community well-being, further exploration and refinement of its definitions and measurement tools are necessary. A standardized yet adaptable framework could enhance comparability across studies while allowing flexibility to accommodate specific social and cultural contexts.

Conclusion
This study highlights the persistent gaps in defining and measuring individual social health. The absence of a clear, standardized definition has contributed to conceptual ambiguity and methodological inconsistencies in social health research. Providing precise theoretical and operational definitions across various levels can enhance our understanding of social health, clarify its distinctions from related concepts, and facilitate the development of targeted interventions. To address these gaps, future research should prioritize refining the definition of social health and its operationalization, ensuring it reflects emerging societal needs and cross-cultural variations. Further exploration of the determinants of social health at individual, community, and societal levels will be crucial in complementing existing research. Despite the increasing body of literature, the broad and evolving nature of social health has hindered consensus on its conceptualization and measurement.Based on our review and research experiences, we propose the following definition of individual social health: Is a characteristic of individuals that stands alongside their physical and mental health and pertains to the well-being of their social life—defined as the quality and quantity of their social relationships and social activities. It represents the social dimension of their mental health and relates to their healthy participation in social interactions, both interpersonal and institutional. In this sense, it serves as the social dimension of mental health, reflecting an individual’s capacity for healthy social participation. Furthermore, our research team is currently developing a validated questionnaire to facilitate the empirical assessment of this construct in future studies.

Strengths and limitations
To the best of our knowledge, this study is among the first to comprehensively review both the conceptualization and measurement of individual social health using a broad and systematic search strategy. A key strength of this review is the consultation process with experts in social health, ensuring a well-informed synthesis of findings. However, several limitations must be acknowledged. The study was restricted to English-language publications within a specific time frame, which may have excluded relevant studies in other languages or outside the search period. Additionally, the review focused on selected databases, potentially omitting relevant research from other sources. Moreover, many studies mentioning social health in their titles or texts did not explicitly define the concept or utilize specific measurement tools, limiting the ability to draw definitive conclusions. Despite these limitations, this study provides valuable insights into the current landscape of social health research. By identifying key conceptual trends and measurement approaches, it lays the groundwork for future studies to refine definitions and develop more precise measurement tools. Policymakers and public health professionals can also leverage these findings to design targeted interventions aimed at improving social health outcomes in diverse populations.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (Code: IR.USWR.REC.1402.068).

Funding
This work is part of the national project which is supported by the Iranian Ministry of Health in collaboration with the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Authors' contributions
Conceptualization, writing of the original draft, critical review, and supervision: Fardin Alipour and Hassan Rafiey; Review, and editing: Meroe Vameghi; Literature review and data analysis: Mostafa Mardani and Minire Balochi; Writing, review, and editing: All authors.

Conflict of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors would like to express their sincere gratitude to all the researchers and experts in the field of social health whose work has contributed to the foundation of this study.




References