Construction and Validation of Four-Dimensional General Health Questionnaire based on Health-Oriented Approaches




Four-dimensional general health questionnaire, Health-oriented approach, Validation


Background: Health assessment has evolved recently with the evolution of perspectives and is now focused on a four-dimensional model. This study aimed at construction and validation of the Four-Dimensional General Health Questionnaire based on health-oriented approaches.

Methods: This research was conducted in two stages. In the first stage, to make a questionnaire, based on theoretical foundations, interviews with experts and review of existing questionnaires, the initial form of the questionnaire was made with 106 items and in a sample of 160 people (80 men and 80 women) Was conducted. The results were analyzed by principal component analysis with varimax rotation and confirmatory factor analysis and the final form of 60 questions was developed. In the second stage, this form was implemented in a sample of 1651 people (791 males and 860 females) and its validity was calculated by validity coefficients of the criterion (convergent and divergent validity). through correlation with Ryff Psychological Well-Being Scale (RSPWB) and Goldberg General Health Questionnaire (GHQ), respectively, and its reliability was calculated by Cronbach's alpha internal consistency and split-half methods.

Results: The results led to the extraction of 4 factors which were named as physical health, mental health, social health and spiritual health and confirmatory factor analysis also confirmed these factors. Also the results showed the high validity and reliability of this questionnaire.

Conclusions: This questionnaire can be used to assess health in physical, psychological, social, and spiritual dimensions. It can also be a basis for further research in the direction of developing questionnaires based on health-oriented approaches.

Keywords: Four-Dimensional General Health Questionnaire, Health-oriented approach, Validation.


1. Vailant GE, Mental health. The American Journal of Psychiatry 2003;160:1373-84.
2. World Health Organisation. Mental health: concepts, emerging evidence, practice. Geneva: University of Melbourne; 2021.
3. DiClemente RJ, Crosby RA, Kegler MC. Emerging theories in health promotion practice and research: Strategies for improving public health. San Francisco: JOSSEY-BASS; 2020.
4. Schultz D. Growth psychology: models of the healthy personality. Tehran: Peikan Publish; 2021.
5. Ruggeri k, Garcia-Garzon E, Maguire A, Matz S, Huppert FA. Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries. Health and Quality of Life Outcomes 2020;18:176-92.
6. Wright TA, Walton AP. Affect, psychological well-being and creativity: Results of a field study. Journal of Business and Management 2013;9:55-73.
7. Keyes, CLM. Promoting and protecting mental health as flourishing. American Psychological 2007;622:95-108.
8. Farokhnezhad Afshar P, Pirooz F, Ajri-Khamesiou M. Explaining social well-being in the perspective of retired men of the armed forces: A qualitative content analysis. Annals of Medical & Health Sciences Research 2018;8:209-14.
9. Peters D, Calvo RA, Ryan RM. Designing for motivation, engagement and well-being in digital experience. Frontiers in Psychology 2018;9:797.
10. Holt-Lunstad J. The major health implications of social connection. Association for Psychological Science 2021;30:251-59.
11. Asadi M, Ghasemzadeh N, Nazarifar M, Niroumand Sarvandani M. The effectiveness of emotional-focused couple therapy on marital satisfaction and positive feelings towards the spouse. International Journal of Health Studies 2020;6:36-40.
12. Dimatteo MR. The psychology of health. Tehran: Samt; 2020.
13. Sadock BJ, Sadock VA, Ruiz P. Synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Tehran: Arjmand; 2021.
14. Hagiwara AF. Identifying and comparing daily stress experience, physical and psychological health and coping strategies among Asian and American graduate students. PhD thesis, Physical Activities and Educational Services. United States: Ohio State University; 2002.
15. Kube T, Rozenkerantz L, Rief W, Barsky A. Understanding persistent physical symptoms: Conceptual integration of psychological expectation models and predictive processing accounts. Clinical Psychology Review 2020;76:101829.
16. Hoseini A, Razaghi N, KhosroPanah AH. Aconcept analysis of spiritual health. Journal of Religion and Health 2019;58:1025-46.
17. Bufford RK, Paloutzian RF, Ellison CW. The spiritual Well-being scale. Journal of Psychology and Theology 2012; 19:56-70.
18. Ellison C. Spiritual well-being conceptualization and measurement. Journal of Psychology and Theology 1983;11:330-40.
19. Park CL. Meaning, spirituality, and health: Abrief introduction. Revista Pistis & Praxis: Teologia e Pastoral 2014;6:17-31.
20. Goldberg DP, Hillier VF. A scale version of general health questionnaire. Psychological Medicine 1979;9:131-45.
21. Sereda Y, Dembitskyi S. Validity assessment of the symptom checklist SCL-90-R and shortened versions for the general population in Ukraine. BMC Psychiatry 2016;16:300.
22. Ware J. SF-36 health survey update. Spine 2000;25,3130-39.
23. Hagiwara AF. Identifying and comparing daily stress experience, physical and psychological health and coping straiegies among Asian and American graduate students. PhD thesis, Physical Activities and Educational Services. United States: Ohio State University; 1992.
24. Margolis S, Schwitzgebel E, Ozer DJ, Lyubomirsky S. A new measure of life satisfaction: The riverside life satisfaction scale. Journal of Personality Assessment 2018;101:323-30.
25. Ryff C, Keyes C. The structure of psychological well-being revisited. Journal of Personality and Social Psychology 1995;69:719–27.
26. Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): Development and UK validation. Health and Quality of Life Outcomes 2007;5.
27. Molavi H, Torkan H, Soltani I, Palahang H. Normative evaluation and validity and reliability of the subjective well-Being Questionnaire. Iranian Journal of Psychiatry and Clinical Psychology 2010;16:231-38.
28. Keyes C. Social Well-Being. Social Psychology Quarterly 1998;61:121-40.
29. Gomez R, Fisher JW. Domains of spiritual well-being and development and validation of the Spiritual Well-Being Questionnaire. Personality and Individual Differences 2003;35:1975-91.
30. Zhou L, Parmanto B. Development and validation of a comprehensive Well-Being Scale for people in the University Environment (PITT Wellness Scale) using a Crowdsourcing approach: cross-sectional study. Journal of Medical Internet Research 2020;22:222-30.
31. Joshanloo M, Rostami R, Nosratabadi M. Examining the factor structure of the Keyes Comprehensive Scale of Well-being. Journal of Developmental Psychology: Iranian Psychologists 2007;3:35-51.
32. Leung CH, Pong HK. Cross-sectional study of the relationship between the spiritual wellbeing and psychological health among university students. Plos ONE 2021;16.
33. Bozek A, Nowak PF, Blukacz M. The relationship between spirituality, health-related behavior, and psychological well-being. Frontiers in Psychology 2020;11:1997.
34. VanderWeele TJ, Kubzansky LD. Current recommendations on the selection of measures for well-being. Preventive Medicine 2020;1:106004.
35. Nazifi M, Mokarami HR, Akbaritabar A K, Faraji Kujerdi M, Tabrizi R, Rahi A. Reliability, validity and factor structure of the Persian translation of General Health Questionnire (GHQ-28) in hospitals of Kerman university of medical sciences. Journal of Advanced Biomedical Sciences 2018;3:336-42.
36. Calderon R, Kim G, Ratsameemonthon Ch, Pupanead S. Assessing the adaptation of a Thai version of the Ryff Scales of Psychological Well-Being: A PLS-SEM approach. Scientific Research An Academic Publisher 2020;11.
37. Aghababaei N, Farahani H. The role of appreciation in predicting psychological and actual well-being. Journal of Developmental Psychology: Iranian Psychologists 2011;8(29):75-85.
38. Ghanbari R, Mohammadimehr M. Identification of dimensions and indicators of spiritual health: A qualitative study. Journal of







How to Cite

Construction and Validation of Four-Dimensional General Health Questionnaire based on Health-Oriented Approaches. (2022). International Journal of Health Studies, 9(1), 22-30.