The multidimensionality of well-being: Theory, measurement and empirical investigations Submitted by Myles-Jay Linton to the University of Exeter as a thesis for the degree of Doctor of Philosophy in Medical Studies In August 2017 This thesis is available for Library use on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. I certify that all material in this thesis which is not my own work has been identified and that no material has previously been submitted and approved for the award of a degree by this or any other University. Signature: ………………………………………………………….. 1 ABSTRACT Background: Well-being within this thesis is defined as the multidimensional quality of a person’s life, which can be broken down into ‘subjective’ and ‘objective’ forms. Despite persistent study, researchers fail to agree on the meaning of well-being or how it should be studied. Aim: The first half of the thesis aims to examine the meaning, measurement and theory of well-being. The second half of the thesis aims to investigate the factors associated with subjective well-being (SWB), and the influence of attributes of well-being on preferences for the future. Methods: A systematic review was conducted to identify measures of well- being for use in adults (general population). The dimensions within these measures were organised into a framework using thematic analysis. Further, the theories underpinning these measures were identified and described. Fixed- effect regression models were used to study the factors important for SWB using data from a longitudinal (1996 – 2013) cohort of middle aged-older adults in the United States (n = 2049). Finally, preferences for life in the future were estimated in a sample of young ‘emergent adults’ (n =140) in the United Kingdom, using discrete choice experiments (DCEs). Results: The systematic review identified 99 measures of well-being, which included 196 distinct dimensions. These measures were influenced by a diverse range of theories (n = 98). Mental health, social integration and satisfaction with work had a significant impact on each of the SWB outcome variables (life satisfaction, positive affect and negative affect) in the fixed-effects analysis. The DCE indicated that stated preferences for life in the future among emergent 2 adults were particularly driven by the prospect of social support from family and an aversion to experiencing mental health difficulties. Conclusion: This thesis has investigated inconsistencies in how well-being is understood, measured and studied. In response to this, a framework has been developed which organises the many measures available around key themes. Following on from the fixed-effects analysis and the DCE, future empirical research should be undertaken to investigate the interdependence of well-being and mental health. 3 TABLE OF CONTENTS Abstract ............................................................................................................. 2 List of Tables .................................................................................................... 9 List of Figures ................................................................................................. 10 Acronyms ........................................................................................................ 11 Dissemination ................................................................................................. 12 Acknowledgements ........................................................................................ 13 1. CHAPTER 1: INTRODUCTION ................................................................. 13 1.1. Introduction ................................................................................................... 13 1.2. Background .................................................................................................. 14 1.2.1. Significance of the topic ......................................................................... 14 1.2.2. Challenges and knowledge gaps ........................................................... 16 1.3. The purpose of this thesis ............................................................................. 17 1.4. Research aims .............................................................................................. 18 1.4.1. Disciplinary, theoretical and methodological approach ........................... 20 1.5. Thesis overview ............................................................................................ 21 2. CHAPTER 2: WHAT DOES ‘WELL-BEING’ MEAN? ............................... 24 2.1. Introduction ................................................................................................... 24 2.2. Well-being – Definitions within dictionaries ................................................... 24 2.3. Well-being - Definitions in the academic literature......................................... 28 2.3.1. Subjective and objective forms of well-being.......................................... 28 2.3.2. Synonyms of well-being ......................................................................... 29 2.4. This thesis’s operational definition of well-being ........................................... 34 2.5. Discussion .................................................................................................... 35 2.5.1. How should well-being be defined? ....................................................... 35 2.5.2. Difficulties defining well-being ................................................................ 36 2.5.3. Practical considerations ......................................................................... 37 2.5.4. Limitations ............................................................................................. 38 2.5.5. The use of terms within the thesis .......................................................... 39 2.5.6. Conclusion ............................................................................................. 39 3. CHAPTER 3: A REVIEW OF WELL-BEING MEASURES: DIMENSIONS, DEVELOPMENTS OVER TIME AND A THEMATIC FRAMEWORK .............. 41 3.1. Introduction ................................................................................................... 41 3.1.1. Measures of well-being .......................................................................... 41 3.1.2. Why is well-being measured? ................................................................ 42 3.1.3. Existing reviews on the measurement of well-being ............................... 43 4 3.1.4. Ongoing difficulties and challenges in the measurement of well-being ... 45 3.1.5. The current review ................................................................................. 46 3.1.6. Aims ...................................................................................................... 47 3.2. Methods ........................................................................................................ 47 3.2.1. Search strategy ..................................................................................... 47 3.2.2. Inclusion and exclusion criteria .............................................................. 48 3.2.3. Data extraction ...................................................................................... 48 3.2.4. Thematic analysis .................................................................................. 48 3.3. Results ......................................................................................................... 49 3.3.1. Identification of instruments ................................................................... 49 3.3.2. Instrument characteristics ...................................................................... 55 3.3.3. Dimensions of well-being ....................................................................... 58 3.3.4. Thematic framework .............................................................................. 59 3.4. Discussion .................................................................................................... 66 3.4.1. Main findings ......................................................................................... 66 3.4.2. Ongoing issues in the measurement of well-being ................................. 68 3.4.3. Limitations ............................................................................................. 71 3.4.4. Further research .................................................................................... 72 3.4.5. Conclusion ............................................................................................. 74 4. CHAPTER 4: AN INVESTIGATION INTO THE THEORIES UNDERLYING MEASURES OF WELL-BEING ....................................................................... 75 4.1. Introduction ................................................................................................... 75 4.1.1. Theories of well-being ............................................................................ 75 4.1.2. Existing reviews into theories of well-being ............................................ 76 4.1.3. Existing challenges ................................................................................ 77 4.1.4. The current review ................................................................................. 78 4.1.5. Aims ...................................................................................................... 79 4.2. Methods .......................................................................................................