Well-being and quality of life of Kenyan nurses, midwives and community health volunteers: Measurement properties and correlates of the BBQ and WHO-5

Healthcare workers' quality of life (QoL) and well-being is directly linked to the quality of services they deliver. However, there is a shortage of validated measures to assess QoL, well-being and their predictors among healthcare workers in Kenya, as in other LMICs. This study aimed to assess the reliability and validity of the Brunnsviken Brief Quality of Life Scale (BBQ) and WHO-5 well-being index (WHO-5) among nurses, midwives and community health volunteers (CHVs) in Kenya. The BBQ and WHO-5 were selected due to their established psychometric strengths, brevity, and prior use in healthcare settings. Additionally, the sociodemographic, psychological, and health system factors associated with QoL and well-being in this population were also examined. This was a national, cross-sectional study conducted among 1907 nurses/midwives and 2027 CHVs in Kenya. Data was collected from June to November 2021 through telephone interviews. Internal consistency of the BBQ and WHO-5 scales was evaluated using Cronbach's alpha and Macdonald's omega. The BBQ and WHO-5 scales' construct validity were evaluated using Confirmatory Factor Analysis (CFA). Correlation and invariance analysis were used to evaluate divergent validity and measurement invariance, respectively. Univariate and adjusted linear regression models were used to explore the sociodemographic, psychological, and health system factors associated with QoL and well-being among the healthcare workers. The BBQ and WHO-5 had adequate reliability (both alpha and omega >0.70). CFA supported unidimensional structures of both the BBQ and the WHO-5 with acceptable model fit indices. Divergent validity and measurement invariance across language of administration (English and Swahili) were also established. Our results also showed that multiple individual and work environment factors influence both well-being and QoL of Kenyan healthcare workers. Therefore, BBQ and WHO-5 are reliable and valid measures for use among Kenyan healthcare workers. Since workplace and personal factors influence QoL and well-being of healthcare workers, multi-pronged approaches and interventions could be useful in improving the well-being and QoL of healthcare workers in Kenya.