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Research Article: Psychometric validation of the Chinese Warwick–Edinburgh mental well-being scale in patients with heart failure or myocardial infarction: evidence from classical test theory and item response theory

Date Published: 2026-07-15

Abstract:
Positive mental well-being is increasingly recognized as an important component of cardiovascular care, particularly among patients with heart failure or myocardial infarction. However, validated Chinese-language instruments for assessing positive mental well-being in this population remain limited. This study evaluated the psychometric properties of the Chinese-language 14-item Warwick–Edinburgh Mental Well-Being Scale (WEMWBS) in patients with heart failure or myocardial infarction. In this cross-sectional validation study, 392 patients with heart failure or myocardial infarction completed the Chinese-language WEMWBS. Construct validity was examined using exploratory and confirmatory factor analyses. Convergent validity was assessed using factor loadings, composite reliability (CR), and average variance extracted (AVE), and criterion-related validity was evaluated using the 5-item World Health Organization Well-Being Index (WHO-5) as an external criterion. Internal consistency was estimated using Cronbach’s ?. Item-level performance was examined using item response theory under the graded response model. The Chinese-language WEMWBS showed excellent internal consistency, with Cronbach’s ? = 0.961. The modified one-factor confirmatory factor model showed acceptable fit on most indices, with ?²/df = 2.68, CFI = 0.955, TLI = 0.944, RMSEA = 0.091, and SRMR = 0.038. Criterion-related validity was supported by a strong positive correlation with the WHO-5 (r = 0.746). Item response theory analyses indicated generally satisfactory item discrimination and ordered threshold parameters. The Chinese-language WEMWBS demonstrated satisfactory psychometric properties in patients with heart failure or myocardial infarction. These findings support its potential use as a patient-reported outcome measure for assessing positive mental well-being in this population. Longitudinal and intervention studies are needed to evaluate its responsiveness, predictive validity, and clinical utility in cardiovascular care.

Introduction:
Positive mental well-being is increasingly recognized as an important component of cardiovascular care, particularly among patients with heart failure or myocardial infarction. However, validated Chinese-language instruments for assessing positive mental well-being in this population remain limited.

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