Factorial validity of the Twi versions of five measures of mental health and well-being in Ghana

Richard Appiah*, Lusilda Schutte, Angelina Wilson Fadiji, Marié P. Wissing, Amanda Cromhout

*Corresponding author for this work

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Mental health is considered an integral part of human health. Reliable and valid measurement instruments are needed to assess various facets of mental health in the native language of the people involved. This paper reports on five studies examining evidence for the factorial validity of the Twi versions of five mental health and well-being measurement instruments: Affectometer-2 (AFM-2); Automatic Thought Questionnaire–Positive (ATQ-P); Generalized Self-Efficacy Scale (GSEs); Patient Health Questionnaire-9 (PHQ-9); and Satisfaction with Life Scale (SWLS) in a rural Ghanaian adult sample.


Measures were translated and evaluated using a research-committee approach, pilot-tested, and administered to adults (N = 444) randomly selected from four rural poor communities in Ghana. We applied confirmatory factor analysis (CFA), bifactor CFA, exploratory structural equation modeling (ESEM), and bifactor ESEM to the AFM-2, ATQ-P, and the PHQ-9, and CFA to the GSEs and the SWLS. The omega coefficient of composite reliability was computed for each measure.


A two-factor bifactor ESEM model displayed superior model fit for the AFM-2. The total scale and the Negative Affect subscale, but not the Positive Affect subscale, attained sufficient reliability. Two models (a four-factor 22-item bifactor ESEM model and a 5-factor 22-item ESEM model) fitted the data best for the ATQ-P. The bifactor ESEM model displayed a high reliability value for the total scale and satisfactory reliability values for three of its four subscales. For the GSEs, a one-factor CFA model (residuals of items 4 and 5 correlated) demonstrated superior model fit with a high reliability score for the total scale. A two-factor ESEM model outperformed all other models fitted for the PHQ-9, with moderate and satisfactory reliability scores for the subscales. A one-factor CFA model (residuals of item 4 and 5 correlated) demonstrated superior model fit for the SWLS, with a satisfactory reliability value for the total scale.


Findings established evidence for the factorial validity of the Twi versions of all five measures, with the global scores, but not all subscale scores, demonstrating satisfactory reliability. These validated measurement instruments can be used to assess mental health and well-being in the research and practice contexts of the current sample.

Original languageEnglish
Article numbere0236707
Number of pages22
JournalPLoS One
Issue number8
Publication statusPublished - 11 Aug 2020
Externally publishedYes

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