Volume 10, Issue 6 (Nov & Dec 2020)                   J Research Health 2020, 10(6): 411-420 | Back to browse issues page

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Mirzaei S, Najarpourian S, Na’imi E, Samavi S A. Development and Validation of a Well-being Scale Based on Nahj al-Balagha. J Research Health. 2020; 10 (6) :411-420
URL: http://jrh.gmu.ac.ir/article-1-1718-en.html
1- Department of Counseling, Faculty of Humanities, University of Hormozgan, Bandar Abbas, Iran.
2- Department of Counseling, Faculty of Humanities, University of Hormozgan, Bandar Abbas, Iran. , najarpourian@hormozgan.ac
3- Department of Counseling, Faculty of Psychology, Allameh Tabatabaei University, Tehran, Iran.
4- Department of Educational Sciences, Faculty of Humanities, University of Hormozgan, Bandar Abbas, Iran.
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1. Introduction
ealth is a comprehensive state of physical, psychological, and social well-being not just the absence of symptoms [1]. In the history of madness and mental illness, mental health is defined in two common ways: the absence of mental illness and a well-being state. Psychological well-being is one of the subcategories of positive psychology. Despite the DSM system, Martin Seligman, as the founder of positive psychology, proposes character strengths and virtues, which include six virtues: wisdom, love, transcendence, moderation, justice, and courage [2]. 
Psychological well-being is a general concept that includes a pleasant emotional experience, low levels of negative mood, and high life satisfaction [3]. To date, some models of well-being are being developed, such as the Jahoda model, the Diner mental/psychological well-being model, the Ryff six-factor psychological well-being model, and the theory of self-determination by Deci and Ryan. Jahoda acknowledged that mental health is beyond a disorder. His explanation also includes mental health features, such as self-respect (self-respect, self-esteem, and self-interest), self-actualization, integrity (resistance to stress), independence, the perception of reality, and compatibility. Besides, in terms of the Ryff model, the psychological well-being components include self-acceptance, autonomy, environmental mastery, personal growth, positive relationships with others, and life purpose. However, the model of Ryan and Deci consists of three components: autonomy, competence, and connectivity. Finally, the mental/psychological well-being model of Diner is a general concept derived from a person’s cognitive and emotional perception throughout life and has two cognitive and emotional components [4]. Therefore, none of the previous well-being theories have focused on spirituality and religion, while research literature has shown that religiosity is linked to positive health outcomes [5]. Also, studies confirm the positive relationship between religious practices and mental health [6]. On the other hand, most religions that have lasted for thousands of years in the world provide comprehensive and reliable theories and notions [7]. 
With this knowledge, Nahj al-Balagha is one of the main and most important sources of Islam, and consistent with nature, intellect, consciousness, and human emotions [8]. Nahj al-Balagha contains mental health messages and recommendations that fully meet well-known criteria in this field [3]. For example, Rahimian has shown that the training guidelines from Nahj al-Balagha can effectively improve individual mental health [9]. After reviewing the Nahj al-Balagha’s wisdom pearls, Mirzai et al. identified 10 psychological well-being components, including thanksgiving, hope, satisfaction in life, skill, patience, courage, freedom, trust, certainty, and knowledge [10]. These components are briefly explained as follows:
1. According to the words of Imam Ali (as), one of the characteristics of a healthy man is “thanksgiving” (Wisdom, 333) [11].
2. Another feature of a healthy person is “hope”, which increases the effort to achieve the goals, as well as resistance to major challenges (Wisdom, 386, 156) [11].
3. Another characteristic of a healthy person is life satisfaction. A person who is happy with his life and does not feel sorry for what he has lost in the past (Wisdom, 439, 228) [11].
4.In the light of God’s obedience, the healthy people acquire their “sense of competence” and try to acquire knowledge and awareness (Wisdom, 81, 94) and perform valuable work (Wisdom, 94), and can control themselves well (Wisdom, 449) [11].
5. “Patience” is one of the main features of healthy people. This feature enhances the people’s patience to cope with hardships and problems (Wisdom, 211), and evacuates their grudge and jealousy by forgiveness. Thus, people show appropriate responses to inappropriate actions (Wisdom, 178, 218) [11].
6. A healthy person is brave and does not withdraw when he does a hard and valuable job (Wisdom, 175) [11].
7. Healthy people are not greedy because of “freedom” from the constraints of the world (Wisdom, 228). Therefore, they do not lose their sense of satisfaction because of life limitations (Wisdom, 429) [11].
8. A healthy person is patient and hopeful with “confidence in the promises of God” (Wisdom, 135). Confidence in God will distract the person from greed (Wisdom 267, 300, 356, 359) [11].
9. Certainty is another feature of a healthy person (Wisdom, 147), and results in contentment (Wisdom, 349), which makes peace and life satisfaction (Wisdom, 371) [11].
10. The last component of psychological well-being is the “knowledge of the creator” (Sermon, 165), which is along with a transcending sense of humility to God (Wisdom, 333) [11].
Concerning the previous discussion, Islam’s teaching seems to have provided its followers with the means and the right way of life and explained everything necessary for human perfection [12]. However, there is no psychological well-being scale based on religious sources and especially Nahj al-Balagha. Also, Iranian culture is linked to Islamic culture, and the research review shows that the issue of mental health is highly emphasized in Nahj al-Balagha. Thus, it seems necessary to develop an appropriate scale to assess psychological well-being from the perspective of Nahj al-Balagha. Therefore, the present study aimed to develop and validate a psychological well-being questionnaire based on the approaches of Nahj al-Balagha.
2. Methods
Study design

Based on the number of latent variables, the minimum sample size was determined for the confirmatory factor analysis (CFA) and the structural equation modeling. According to a rule (20 cases per factor/latent variable), the study sample size was estimated as 200, because the researcher-made questionnaire was constructed based on the predesigned psychological well-being of 10 factors. The study samples were selected using the convenience sampling method from all male and female adults aged 20 and 50 years, in Tehran. Then, the researcher-made questionnaire was electronically provided to individuals. The questionnaire was answered by about 200 people. 
The questionnaire items were developed and then confirmed by three psychologists, in the development and validation phase of the questionnaire. The psychologists confirmed the items based on the Mirzaie et al. model of psychological well-being [10], which included 10 components, such as thanksgiving, hopefulness, life satisfaction, skill, patience, courage, freedom, trust, certainty, and knowledge. Also, the questionnaire was administered along with the Ryff psychological well-being questionnaire in 100 cases and then in 200 cases to evaluate the questionnaire’s criterion validity. Calculating the internal consistency, the Cronbach alpha coefficient was used to investigate the questionnaire’s reliability. Moreover, the questionnaire’s validity was assessed using both the criterion and the validity of the construct. The correlation between the overall scale and subscale scores and the Ryff scale and its subscales was examined in the criterion validity. Next, CFA was used to determine the validity of the questionnaire and confirm the proposed factor structure. The CFA was used because this method provides a predesigned model based on the theory and previous studies. So that the number of factors in the model was previously predicted by the researcher. 
Confirmatory methods (hypothesis testing) determine whether data are consistent with a certain factor structure given in the hypothesis. However, factors are discovered rather than predefined in the exploratory factor analysis [13]. Since the factors of the psychological well-being model have already been identified in this research, CFA was used to examine the proposed factor structure. The items were scored on a 6-point Likert scale to analyze the obtained data. So, the questionnaire data were entered into SPSS v. 21 and the results were prepared as statistical tables. Then, CFA was used to confirm the factors, in Amos software v. 16.
The researcher-made psychological well-being questionnaire is a scale based on Nahj al-Balagha’s approaches. This questionnaire includes 74 items scored on a 6-point Likert scale (completely agree, agree, no comment, disagree, and completely disagree). Also, the items 12, 13, 14, 15, 18, 19, 24, 25, 35, 39, 67, and 69 are scored reversely. The questionnaire consists of 10 subscales of competence (questions 1-8), hopefulness (9-11), freedom (12-20), the satisfaction of life (21-24), trust (25-41), courage (42-48), patience (49-53), thanksgiving (54-61), knowledge (62-65), and certainty (66-74).
The Ryff psychological well-being questionnaire contains 84 items and 6 subscales, including self-acceptance, autonomy, the mastery of the environment, personal growth, positive relationships with others, and life purpose. This questionnaire is scored on a 6-point Likert scale (totally agree, agree, somewhat agree, somewhat disagree, disagree, totally disagree). Initially, Ryff developed the questionnaire’s first version with 120 items, in 1995. Then, a shorter version was made in the following years, based on some studies. But Ryff believes that the 84-item version has a greater ability than other versions to determine individuals’ psychological well-being. In the 84-items version, the measurement of each factor requires 14 items. Various studies have examined this questionnaire’s psychometric properties [14]. Bayani et al. examined the validity and reliability of the 84-item version, in a sample of 145 people, in Iran. The results of the test-retest method showed the reliability coefficients of 0.82, 0.71, 0.78, 0.77, 0.78, 0.77, and 0.77 for the total scale, self-acceptance, autonomy, environmental mastery, personal growth, positive relationships with others, and purpose in life subscales, respectively [15]. Moreover, we calculated the correlations between the score of the scale and the scores of the life satisfaction scale, the Oxford happiness questionnaire, and the self-esteem scale of Rosenberg to assess the validity; the obtained correlation coefficients were 0.47, 0.58, and 0.46, respectively. Consequently, the questionnaire on the psychological well-being of the Ryff had the appropriate validity. 
3. Results
A total number of 200 people took part in this study; 16.3% and 82.8% of participants were men and women, respectively. Out of the total participants, 18.7% had a diploma or lesser education, 41.4% had undergraduate education, 32.5% had an MSc, and 5.9% had a PhD degree. Also, 41.9%, 36.9%, 15.8%, and 4.4% of participants were in the age range of 20 to 30 years, 30 to 40 years, 40 to 50 years, and over 50 years, respectively. Furthermore, 65.5% and 33.5% of the participants were married and single, respectively. Table 1 provides the descriptive statistics of the scores of variables, including mean, standard deviation, maximum, and minimum. 

According to Table 1, the total Mean±SD is 343.37±86.45, the maximum score is 439 and the minimum score is 206. 
The Cronbach alpha coefficient was used to assess the reliability of the questionnaire by calculating internal consistency (Table 2). 

According to the result, the coefficients obtained for all components except the competency are above 0.70, which represents a suitable reliability coefficient. The total scale has the highest coefficient, and then, the components of trust, certainty, courage, patience, thanksgiving, freedom, life satisfaction, hopefulness, and competence have the correct reliability, in the respective descending order. The correlation was also calculated between the total and the subscales scores of the developed questionnaire and the Ryff questionnaire to examine the convergent validity of the questionnaire; Table 3 presents the results. 

Concerning Table 3 data, and taking into account the value of the validity coefficient and the meaning level of 0.01, there was a significant correlation between the Ryff questionnaire scores and the psychological well-being questionnaire scores (r=0.54). Also, there was a significant correlation between the scores of the components of the Ryff and researcher-made questionnaires, including life satisfaction (r=0.57), hopefulness (r=0.50), courage (r=0.46), freedom (r=0.41), confidence (r=0.41), certainty (r=0.36), knowledge (r=0.33), and thanksgiving (r=0.27) (P=0.001). However, the correlation values were insignificant for patience and competence. Among all the subscales, life satisfaction, hopefulness, courage, confidence, freedom, and certainty had the highest validity coefficients with the subscale of environmental mastery (0.57, 0.55, 0.50, 0.46, 0.46, and 0.44, respectively). Besides, the knowledge subscale had the highest value of the validity coefficient with the personal growth subscale (r=0.43). Also, the self-acceptance component had the highest validity coefficients with the subscales of patience (r=0.38) and thanksgiving (r=0.35).
The CFA was used to determine the questionnaire’s factor structure. Tables 4 and 5 present the results of the model fitting and the factor loading of items on each component. 

Before carrying out the CFA, we examined the assumptions for using this method, including missing data, outliers, normality, and multiple linear analyzes, which were approved for all assumptions.
The fitness indices’ values showed a modest fit for this model (Table 4). The CFA resulted in the values of 0.07, 0.91, 0.88, 0.87, 0.83, 0.90, and 0.89 for the indices of RMSEA, CFI, GFI, AGFI, NFI, IFI, and TLI, respectively. Therefore, the model benefits from moderate fitness.
The majority of the items were loaded with a standard factor of greater than 0.30 (Table 5), when carrying out the CFA for the Nahj al-Balagha mental health questionnaire. In other words, the grade points were significantly related to their factors (P<0.001), also, items with a factor loading of below 0.30 were excluded from the questionnaire. The excluded items included items 5 and 6 from the value component, item 16 from the freedom component, item 24 from the life satisfaction component, items 35 and 39 from the feeling of assurance component, and items 67 and 69 from the component of the certainty. Overall, the questionnaire factor analysis revealed that the questionnaire items account for about 59% of the total psychological well-being variance.
4. Discussion 
According to the results, the researcher-made questionnaire is suitable for evaluating psychological well-being. Furthermore, CFA results show that this model is well fitted and most items have a high load. Most standard coefficients were above 0.30 and items below 0.30 were removed from the questionnaire. Overall, the questionnaire’s factor structure analysis revealed that the questionnaire items explained about 59% of the total psychological well-being variance. Also, the observed factor structure was classified into 10 categories: thanksgiving, hope, life satisfaction, competence, patience, courage, freedom, trust, certainty, and knowledge. This factor structure has significant conceptual similarity with positive psychology and the theories of psychological well-being. So that the subscale of “life satisfaction” in this structure is in line with the Diner theory and the concept of “hopefulness” is concurrent to the concept of “hope” in the Snyder theory. Also, the subscales of “courage”, “freedom”, the “knowledge of the creator”, and “thanksgiving” correspond to the concepts of “courage” (struggle, perseverance, and hard work), moreover, “moderation” (self-control), “transcendence”, and “appreciation” are similar in Seligman’s theory. On the other hand, positive features, such as patience, forgiveness, hope, and freedom, which are considered by other positivist theorists like Seligman, have a positive relationship with the subscale of “confidence”. The other subscale in this structure is “certainty”, meaning belief in the world, afterward, a major belief affects minor beliefs, such as belief in a just and unjust world. The more powerful this belief is, the weaker the level of mental health threats, such as anxiety, worry, depression, suicidal thoughts, and anger will be caused by ill-treatment and injustices brought to human beings by others [16]. Patience is another factor that includes subcategories, such as forgiveness and the lack of envy, and is consistent with the Seligman theory of forgiveness and the meaning of jealousy in psychology. Finally, the subscales of competence that include subcategories, such as “acquire knowledge and science”, “having great goals”, “self-control”, “worship”, and “doing great and worthy work” are consistent with the “concepts of self-control”, “sense of purposefulness”, and the “love of learning” in the Seligman theory.
5. Conclusion
Given the need for an objective tool to assess psychological well-being, the current questionnaire focusing on Nahj al-Balagha can be a useful tool for assessing adult mental health status and psychological well-being. This questionnaire is not only suitable for evaluating psychological well-being, but also an effective measure of psychological well-being and mental health for research. Also, this questionnaire can be used in clinical and research situations at a practical level. However, along with the results, some limitations have accompanied the present study and the sampling method. The most important limitations include the implementation of research on a sample of Tehran citizens and the use of self-report questionnaires. Accordingly, it is recommended to use this questionnaire in different populations. Besides, it is suggested to repeat the validity assessment of this questionnaire with other related questionnaires to increase the reliability and validity of this questionnaire. The use of the other methods of information collection, especially in a qualitative manner, including interviews, can partially resolve the shortcomings in the self-report questionnaire.
Ethical Considerations
Compliance with ethical guidelines

The research plan was approved by the Ethics Committee of the University of Hormozgan (Code: 9832, on May 22, 2017).
This research is extracted from a PhD. dissertation of first author, Department of Counseling, Faculty of Humanities, University of Hormozgan, Bandar Abbas.
Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflicts of interest.
The authors appreciate the collaboration of all Nahj al-Balagha and psychology professors and experts, as well as all others who participated in this research in the development and validation phases of the psychological well-being questionnaire for Nahj al-Balagha. 

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Type of Study: Orginal Article | Subject: Health Promotion
Received: 2019/01/17 | Accepted: 2019/05/20 | Published: 2020/11/1

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